Gastro Flashcards
What is Zollinger-Ellison syndrome?
Zollinger-Ellison syndrome is a condition characterised by excessive levels of gastrin secondary to a gastrin-secreting tumour.
Where are most of the tumors found in Zollinger-Ellison syndrome?
The majority of these tumours are found in the first part of the duodenum, with the second most common location being the pancreas.
What are the features of Zollinger-Ellison syndrome?
multiple gastroduodenal ulcers
diarrhoea
malabsorption
What are the most common glands affected in MEN1?
The most common glands affected are the parathyroids, pancreas, and pituitary.
What types of drugs cause drug-induced cholestasis?
oral contraceptive pill
Which drugs are known to cause a hepatocellular picture with a rise in alanine transaminase (ALT) to greater than two times the upper limit of normal?
Amiodarone
Methyldopa
Nitrofurantoin
Phenytoin
What is the management of First episode of C. difficile infection?
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
What is the management of recurrent infections of C. difficile infection?
recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode
within 12 weeks of symptom resolution: oral fidaxomicin
after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
What is the management of Life-threatening C. difficile infection?
oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered
What on LFTS suggests alcoholic liver disease?
the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis
What is the pathophysiology of pernicious anaemia?
antibodies to intrinsic factor +/- gastric parietal cells
intrinsic factor antibodies → bind to intrinsic factor blocking the vitamin B12 binding site
gastric parietal cell antibodies → reduced acid production and atrophic gastritis. Reduced intrinsic factor production → reduced vitamin B12 absorption
vitamin B12 is important in both the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy
What is perncious anaemia?
Pernicious anaemia is an autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency.
What are the causes of perncious anaemia?
Whilst pernicious anaemia is the most common cause of vitamin B12 deficiency, it’s not the only cause. Other causes include atrophic gastritis (e.g. secondary to H. pylori infection), gastrectomy, malnutrition (e.g. alcoholism).
What are the risk factors of pernicious anaemia?
more common in females (F:M = 1.6:1) and typically develops in middle to old age
associated with other autoimmune disorders: thyroid disease, type 1 diabetes mellitus, Addison’s, rheumatoid and vitiligo
more common if blood group A
What are the features of pernicious anaemia?
anaemia features
lethargy
pallor
dyspnoea
neurological features
peripheral neuropathy: ‘pins and needles’, numbness. Typically symmetrical and affects the legs more than the arms
subacute combined degeneration of the spinal cord: progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia
neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritabiltiy
other features
mild jaundice: combined with pallor results in a ‘lemon tinge’
atrophic glossitis → sore tongue
