Gastro Flashcards
What is ferritin and when is it produced?
It is an acute phase protein and is produced in increased quantities when there is an inflammatory activity.
What are the two different causes of increased ferritin?
Without iron overload, (inflammation, alcohol, liver disease, CKD, malignancy)
With iron overload (10%): hereditary haemochromatosis
best way to to see if iron overload is present is through transferin saturation
What is the best marker for low iron overload?
Transferin saturation
When is there decreased ferritin levels?
Because iron binds to ferritin, in cases where there is iron deficiency anaemia;
Measurement of serum ferritin levels can be useful in determining whether an apparently low haemoglobin and microcytosis is truly caused by an iron deficiency state
What is the first line investigation for coeliac’s disease?
- tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
-
endomyseal antibody (IgA)
needed to look for selective IgA deficiency, which would give a false negative coeliac result
What is the gold standard investigation for coeliac’s diseae?
Endoscopic intestinal biopsy
young patient presents with the following:
1.bloody diarrhoea
2.urgency
3.tenesmus
4.abdominal pain, particularly in the left lower quadrant
Ulcerative Colitis
What is the most common extra-intestinal feature in both CD and UC
Arthritis
With what eye disease is CD associated with?
Episcliritis
young patient with
1.non-bloody diarrhoea
2.abdominal pain
3.weight loss
Crohn’s disease
What happens in Barret’s Oesophagus?
metaplasia of the lower oesophageal mucosa (squamous epithelium being replaced by columnar epithelium)
What is the strongest risk factor for Barret’s Oesophagus?
GORD
What is the management of barret’s oesophagus?
what happens if there dysplasia vs metaplasia
- high-dose proton pump inhibitor
- endoscopic surveillance with biopsies
for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years
if dysplasia of any grade is identified endoscopic intervention is offered. Options include:
radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
endoscopic mucosal resection
What drug for isolated peri-ana Crohn’s Disease?
metronidazole
What medication to induce emission of Crohn’s Disease?
- 1st line: glucocorticoids (oral, topical or intravenous)
-Enteral feeding with an elemental diet may be used in addition to or instead of other measures to induce remission, if there is concern regarding the side-effects of steroids (for example in young children)
2nd line: 5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective
azathioprine or mercaptopurine* may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine
What medication for refractory or fistulating Crohn’s ?
infliximab
What medication to maintain remission in Crohn’s?
as above, stopping smoking is a priority
azathioprine or mercaptopurine is used first-line to maintain remission
What is the management of stricturing terminal ileal disease
ân ileocaecal resection
What is the first line investigation and management for perianal fistulae
MRI
Oral metronidiazole
Which is associated with Abdominal mass palpable in the right iliac fossa?
Crohn’s
What is the cause of Melanosis coli?
laxative abuse
Which diabetic medication can cause cholestasis
Gliclazide
Sulphonylureas may cause cholestasis
Which parasite is resistant to chlorine?
giardia lamblia
What is the first line management of hepatic encephalopahty?
NICE recommend lactulose first-line, with the addition of rifaximin for the secondary prophylaxis of hepatic encephalopathy
-lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
What is the management of a variceal bleed ?
Telipressin (vasoactive agent)
Prophylactic antibiotics
endoscopy: endoscopic variceal band ligation
What can be given for prophylaxis of variceal bleed?
propranolol (non-cardioselective B-blocker (NSBB))
reduced rebleeding and mortality compared to placebo
endoscopic variceal band ligation (EVL)
