gastro Flashcards
what test can be used to check for enhanced liver fibrosis in patients with non-alcoholic fatty liver disease?
NICE recommends the use of the enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis
the ELF blood test is a combination of hyaluronic acid + procollagen III + tissue inhibitor of metalloproteinase
what tests can be used instead of ELF blood test to monitor NAFLD?
- Non-invasive tests may be used to assess the severity of fibrosis
- These include the FIB4 score or NALFD fibrosis score
- These scores may be used in combination with a FibroScan (liver stiffness measurement assessed with transient elastography)
- This combination has been shown to have excellent accuracy in predicting fibrosis
what are the features of severe pancreatitis?
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
what is the most common cause of biliary disease in patients with HIV?
sclerosing cholangitis secondary to CMV, cryptosprodium and microsporidia
what is the most common cause of pancreatitis in the context of HIV infections?
secondary to anti-retroviral treatment (especially didanosine) or by opportunistic infections e.g. CMV
what are the drugs that induce a cholestasis?
- combined oral contraceptive pill
- antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
- anabolic steroids, testosterones
- phenothiazines: chlorpromazine, prochlorperazine
- sulphonylureas
- fibrates
- rare reported causes: nifedipine
MNEMONIC: PASS FOR
phenothiazines
antibiotics
anabolic steroids
sulphonylureas
FOR-
FIBRATES
OCPS
RARE- NIFEDIPINES.
what is the paracentesis results required to diagnose SBP?
paracentesis: neutrophil count > 250 cells/ul
what is the management of choice in SBP?
intravenous cefotaxime is usually given
who should be considered for antibiotic prophylaxis for SBP?
- patients who have had an episode of SBP
- patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
- NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’
how can you prevent refeeding syndrome?
NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.
what are the watershed areas most affected by ischaemic colitis?
The two most common ‘watershed’ areas in the large bowel are at the splenic flexure and the rectosigmoid junction.
what are the key features of whipple’s disease?
- malabsorption: diarrhoea, weight loss
- large-joint arthralgia
- lymphadenopathy
- skin: hyperpigmentation and photosensitivity
- pleurisy, pericarditis
- neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus
what is the cause of whipple’s disease?
tropheryma whippelli
what is the treatment for whipple’s disease?
Oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin
what are the features of villous adenoma?
- non-specific lower gastrointestinal symptoms
- secretory diarrhoea may occur
- microcytic anaemia
- hypokalaemia
what are the features of whipple’s disease on blood tests?
The blood tests demonstrate anaemia, raised CRP and often hypoalbuminaemia.
who would qualify for surgical resection of hepatocellular carcinoma?
Patients with Child-Pugh A cirrhosis without signs of portal hypertension who have single lesions <2cm in size should be treated with surgical resection.
what are the components of the Child-Pugh criteria?
A - Albumin
B - Bilirubin
C - Clotting (PT)
D - Distension (Ascites)
E - Encephalopathy
‘Pour Another Beer At Eleven’ for PT, Ascites, Bilirubin, Albumin, Encephalopathy. (Child Pugh)
what exocrine marker can be used to assess chronic pancreatitis?
Faecal elastase can be measured both in the serum and stool and assesses for exocrine insufficiency seen in chronic pancreatitis.
Faecal elastase is an exocrine product of the pancreas and is not broken down by gastrointestinal enzymes; therefore, its level can be detected and measured. These levels are decreased when the exocrine-producing tissue of the pancreas is damaged and therefore correlates with reduced function.
what is the most important screening test for haemachormatosis in general population?
transferrin saturations + ferritin
what is the threadworm that can cause peri-anal itching?
Enterobius vermicularis
what medication is used in the prophylaxis of variceal haemorrhage?
propranolol
reduced rebleeding and mortality compared to placebo
what condition is PBC associated with?
Sjogren’s syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease
what drugs cause liver disease?
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
what are some of the common causes of decompensation in acute liver failure?
Constipation
Other common causes include infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.
what is used to monitor haemachromatosis treatment?
transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
Genetic tests confirm a diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) due to a defect in the MSH2 gene. What is the function of this gene
genes involved in DNA mismatch repair leading to microsatellite instability. The most common genes involved are:
MSH2 (60% of cases)
MLH1 (30%)
which blood group makes you more susceptible to gastric cancer?
blood group A: gAstric cAncer
what is caused by laxative overuse?
Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages
associated with laxative abuse, especially anthraquinone compounds such as senna
what condition is angiodysplasia associated with?
aortic stenosis
what is the imaging modality used to monitor the severity of cirrhosis?
transient elastography (fibroscan)
what are the features of budd-chiari syndrome?
hepatic vein thrombosis -
abdominal pain - sudden onset, severe
ascites - abdominal distension
tender hepatomegaly
what are some of the retinal features seen on fundoscopy in acute pancreatitis?
ischaemic (Purtscher) retinopathy - may cause temporary or permanent blindness
