Gastro Flashcards
What are the different type of Hepatitis?
A, B, C, D, E
Which ones are spread through faecal-oral and which are spread through bodily fluids/sexual transmission?
Faecal Oral: A & E
Bodily fluids: B, C & D
Most common type of Hepatitis worldwide?
and probable answer if nil PMH/ prior IV Hx or unprotected sexual Hx
Hep A
Which Hep’s have vaccinations offered?
A, B & D
What is NAFLD?
Non alcohol fatty liver disease
Diagnosis of exclusion where patient presents with liver symptoms but no history of alcohol excess and tests for hepatitis & immune related liver disease are all normal.
Typical Px - obese patients with CVD risk factors
What is autoimmune hepatitis?
Key markers of it?
Rare autoimmune condition - causes chronic hepatitis linked to over activation of T cells.
Two types: Type 1 (adults) and Type 2 (teens/early 20s)
Type 1 - women in their late 40/50s, around or after the menopause. Px: fatigue + features of liver disease on examination. ANA antibodies high
Management for Autoimmune hepatitis?
Prenisolone & Azathioprine
How does Aspirin damage gastric mucosa?
Reduces mucus secretion which provides a barrier layer to the mucosa and thus protection from gastric acids.
How does IBS present?
Around ages of 20-40 Women more commonly affected than men Recurrent abdominal pain and discomfort With: - New onset of change in bowel habit or - Improvement of pain/discomfort after defecation - new onset of change in stool formation
How long do you have to have symptoms f IBS before you can diagnose?
Must be present for 1 day per week for the last 3 months
Management of IBS?
If excessive diarrhoea - Loperamide
If just abdominal pain/discomfort - Mebeverine
Can give both to target the different symptoms
What is Wilsons disease?
An inherited autosomal recessive condition of impaired copper metabolism. Faulty gene in on chromosome 13.
Results in excessive accumulation or deposition of copper throughout the body.
Wilsons disease presents as…
Hepatic, neurological & psychiatric symptoms
Presents in children with jaundice and liver failure, kayser fleischer rings (golden ring around the iris), dysarthria and dystonia.
Later presentations are more advanced with Parkinson like Neuro presentation (although asymmetrical unlike true Parkinson’s)
Treatment for Wilson’s disease?
Penicillamine
What is coeliac disease?
An autoimmune condition which reacts to gluten in the diet. Exposure to gluten triggers inflammation in the small bowel.
What antibodies are seen in coeliac disease?
Anti-tissue transglutaminase (Anti-TTG) most important
and
Anti-endomysial (anti-EMA)
What is coeliac disease?
An autoimmune condition which reacts to gluten in the diet. Exposure to gluten triggers inflammation in the small bowel.
Presents as: failure to thrive in young children Diarrhoea (non-bloody) Fatigue Weight loss Mouth ulcers Dermatitis Herpetiformis
Diagnostic results seen….
Treatment for Wilson’s disease?
Low ceruloplasmin + high urinary copper
Definitive diagnosis liver biopsy
Penicillamine
Is coeliac linked to other conditions?
Yes - other autoimmune conditions such as: T1DM Thyroid disease Autoimmune hepatitis PBC/PSC
Management for Coeliac?
No cure - gluten free diet life long
Which hormone inhibits gastrin secretion?
Somatostatin
Think Zollinger Ellison Syndrome
Liver cancer has two main types….
Hepatocellular carcinoma (HCC) and cholangiocarcinoma
Main risk factors for
- Hepatocellular carcinoma (HCC)
- Cholangiocarinoma
HCC
- Viral Hep B & C,
- Alcohol use
- NAFLD
- Chronic liver disease
Cholangiocarcinoma
- PSC
What does a high alphafetoprotein suggest?
HCC
What does a high Ca19-9 suggest?
Cholangiocarcinoma
Management of HCC and Cholangiocarcinoma?
Both have a very poor prognosis
Liver transplant can be curative if patient healthy enough to undergo procedure
Medical Mx of HCC - kindse inhibitors (end in ‘nib’) Lenvatinib
45 year old male, history of alcohol excess, 3 month history of intermittent, severe abdominal pain + diarrhoea with pale, bulky, foul smelling stools that are hard to flush…
Chronic pancreatitis
Alcohol excess + reduced pancreatic enzyme production - pale, foul smelling stools
What do the combination of: - post prandial abdo pain (pain after eating) - weight loss due to reduced intake - concurrent CVD PMH (angina, PVD etc) and - unremarkable examination
suggest?
Mesenteric ischaemia
How do you test for H Pylori?
Urea breath test
What is the management for H pylori?
Amox + Clarithromycin + Omeprazole (PPI)
Patient who suffers from dysphagia to both solids and liquids and no other PMH.
A birds beak deformity is seen on barium swallow…
Achalasia
How do you treat Achalasia?
Dilatation of lower oesophageal sphincter using Botox or balloon dilatation
Definitive diagnostic test for Achalasia?
How do you treat Achalasia?
Oesophageal pH monitoring
Dilatation of lower oesophageal sphincter using Botox or balloon dilatation
What can octreotide be used for?
Octreotide - a synthetic somatostatin
Somatostatin inhibits gastrin secretion so useful in Gastrinoma
Oesophageal varices….
Occur in patients with alcoholic history
Presents as patient with liver disease (hepatomegaly/splenomegaly), spider naevi, deranged LFTs
Management of Oesophageal varices?
Resuscitation, PPI and urgent endoscopy
Patient presents with generalised pruritus, jaundice, deranged LFTS, ALP being highest & elevated AMA levels….
Diagnosis?
Definitive diagnostic test?
Management?
Primary Biliary Cirrhosis (PBC)
Definitive - Liver biopsy
Management - Ursodeoxycholic acid
Risk factors for Gastric cancer:
H. Pylori Pernicious anaemia Smoking Blood group A Diet (high in nitrate & salt)
