gastro Flashcards
Right-sided tenderness on PR exam, think
appendicitis
what type of FBC/CRP results do you get in appendicitis?
a neutrophil-predominant leucocytosis is seen in 80-90% in appendicitis
The diagnostic investigation for necrotising enterocolitis is
The diagnostic investigation for necrotising enterocolitis is an abdominal x-ray
Men who have sex with men should be offered immunisation against
Hep A
management of Crohn’s patients who develop a perianal fistula
Oral metronidazole is useful in the management of Crohn’s patients who develop a perianal fistula
most common symptom of Crohn’s disease in children?
abdo pain
first-line to maintain remission in patients with Crohn’s
Azathioprine or mercaptopurine is used first-line to maintain remission in patients with Crohn’s
Patients with hyposplenism should be vaccinated against
Patients with hyposplenism should be vaccinated against pneumococcal (5-yearly booster), Haemophilus type B and meningococcus type C
causes of megaloblastic and normoblastic
macrocytic anemia
Isolated rise in GGT in the context of a macrocytic anaemia suggests
Isolated rise in GGT in the context of a macrocytic anaemia suggests alcohol excess as the cause
Methotrexate therapy may result in
megaloblastic macrocytic anaemia secondary to folate deficiency
Patients….. should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis
which parameters are used to monitor treatment of haemochromatosis
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
DPP4 mode of action
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
The AST/ALT ratio in alcoholic hepatitis is
2:1
The characteristic clinical features of alcoholic hepatitis are
- jaundice, anorexia, fever, and tender hepatomegaly.
- AST:ALT ratio of 2 or greater
- may also present with right upper-quadrant/epigastric pain, hepatic encephalopathy, and signs of malnutrition.
- Patients often stop drinking as they become ill, so it is common for patients to have stopped drinking alcohol several weeks prior to presentation.
alcoholic liver disease investigations
- gamma-GT is characteristically elevated
- the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis
alcoholic liver disease management
- glucocorticoids (e.g. prednisolone) are often used during acute episodes of alcoholic hepatitis
- pentoxyphylline is also sometimes used
common causative agent for ascending cholangitis
E.coli
nail changes in anemia
Koilonychia, or spooning of nails, is a classic clinical sign of hypochromic anemia, especially iron-deficiency anemia.
Patients must eat gluten for at least…before they are tested
Patients must eat gluten for at least 6 weeks before they are tested
In life-threatening C. difficile infection treatment is with
In life-threatening C. difficile infection treatment is with ORAL vancomycin and IV metronidazole
People with coeliac disease receive the pneumococcal vaccine due to
People with coeliac disease receive the pneumococcal vaccine due to hyposplenism
Patients with ascites secondary to liver cirrhosis should be given
Patients with ascites secondary to liver cirrhosis should be given an aldosterone antagonist like spiranolactone
acute infection in hepatitis B will give which serology results
HBsAg positive, anti-HBs negative, IgM anti-HBc positive - acute infection
previous hepatitis B, now a carrier:
previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive
previous immunisation for hep B serology results:
previous immunisation: anti-HBs positive, all others negative
Severe hepatitis in a pregnant woman - think hepatitis…
Severe hepatitis in a pregnant woman - think hepatitis E
which antigen can be used to monitor patients with colorectal cancer
Carcinoembryonic antigen may be used to monitor for recurrence in patients post-operatively or to assess response to treatment in patients with metastatic disease
First line treatment for diarrhoea in IBS
Loperamide
Erratic blood glucose control, bloating and vomiting in diabetic despite taking meds think
Erratic blood glucose control, bloating and vomiting think gastroparesis
Liver transplantation criteria in paracetamol overdose:
pH < 7.3 more than 24 hours after ingestion
when do you start acetylcysteine in paracetamol overdose?
Paracetamol overdose: if presentation 8-24 hours after ingestion of an overdose of more than 150 mg/kg start acetylcysteine even if the plasma-paracetamol concentration is not yet available
Hep B previous (> 6 months ago) infection, not a carrier
HBsAg negative, anti-HBs positive, IgG anti-HBc positive - previous infection, not a carrier (> 6 months ago)
The appearance of ground-glass hepatocytes on light microscopy can point towards…
The appearance of ground-glass hepatocytes on light microscopy can point towards a diagnosis of chronic hepatitis B infection
Red flag symptoms for gastric cancer includes
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain
Staphylococcus aureus gastroenteritis is characterised by
Staphylococcus aureus gastroenteritis is characterised by a short incubation period and severe vomiting
You are reviewing a 31-year-old man in the liver clinic. He is currently on triple therapy for hepatitis C. What is the best way to assess his response to treatment?
viral load
what should be assessed before offering azathioprine or mercaptopurine therapy in Crohn’s disease
TPMT activity should be assessed before offering azathioprine or mercaptopurine therapy in Crohn’s disease
