gastro Flashcards
prophylaxis of oesophageal varices?
propranolol -> non-selective B blocker
endoscopic variceal band ligation
tx for active variceal bleeding
A-E
correct clotting
terlipressin
prophylactic ABX -> reduces mortality
endoscopic band ligation
TIPSS if above fails
what is the best test to measure and monitor acute liver failure
prothrombin
as it has a shorter half life than albumin
ALT and AST arent great indicators of liver function in acute liver failure
after blood tests what scan/imaging can be used to determine the extent of alcoholic liver disease
transient elastography
-> also known as a fibroscan which looks at the extent of fibrosis by looking at the elasticity of the liver
how to distinguish between upper and lower GI bleed
high urea levels= upper GI as blood is digested into proteins which are metabolised into urea in the liver
alcohol units calculation?
total vol x ABV / 1000
iron studies for haemochromatosis
raised transferrin saturation,
raised ferritin
low TIBC
why does haematochromatosis cause hypogonadotrophic hypogonadism
due to iron deposition in pituitary gland causing impaired function
ix of choice for pharyngeal pouch
barium with fluoroscopy
radiology sign of pancreatic cancer
double duct
- dilation of pancreatic and cbd
derranged LFT with T2DM
NAFLD
what is gilberts syndrome
autosomal recessive* condition of defective bilirubin conjugation due to a deficiency of UDP glucuronosyltransferase
unconjugated hyperbilirubinaemia
jaundice seen only in times of stress
no TX, just reassure
what is melanosis coli
disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages.
It is associated with laxative abuse-> senna
what is a carcinoid tumour
produce vasoactive amines -> 5HT, bradykinin, adrenaline, prostaglandins
these are inactivated by the liver and cause mets there
flushing
diarrhoea
bronchospasm
hypoT
ix: urinary 5HIAA
Mx: ortreotide
cyproheptadine might help
ix for post eradication of h pylori
urea breath test
stool not an option !!
why would ALP be raised in coeliac
due to low calcium so bone is broken down to increased this
what is seen on paracentesis that confirms SBP
> 250 neutrophils
side effect with TIPSS
exacerbates hepatic encephalopathy
plummer vinson symptoms
Plummers DIE: Dysphagia, Iron deficiency anemia, Esophageal webs
blood test results for anaemia of chronic disease
low Hb
low MCV
proportional rise of urea and creatinine
early signs of haemochromatosis
fatigue
erectile dysfunction
arthralgia
ABG renal tubular acidosis?
hypercholraemic met acidosis with normal anion gap
type 1 renal tubular acidosis
cant generate acid urine
causes hypokalaemia
complications type 1 RTA
nephrocalcinosis and renal stones
causes type 1 RTA
idiopathic
rheumatoid arthritis, SLE
Sjogren’s, amphotericin B toxicity
analgesic nephropathy
type 2 RTA causes
decreased HCO3- reabsorption in proximal tubule
causes hypokalaemia
complications of type 2 RTA
osteomalacia
causes type 2 RTA
diopathic, as part of Fanconi syndrome, Wilson’s disease, cystinosis, outdated tetracyclines, carbonic anhydrase inhibitors (acetazolamide, topiramate
cause of type 3 RTA
carbonic anydrase 2 def
results in hypokalaemia
really rare
type 4 RTA
reduction in aldosterone causes reduction in ammonium excretion
causes hyperkalaemia
caused by
hypoaldosteroism
diabetes
2 1 4 low low more?
mnemonic for RTA
type 2 proximal CT
type 1 distal CT
type 4 CD
low low more
potassium !!
sodium rapidly high to low causes?
high to low, brain will blow
cerebral oedema
sodium rapidly low to high?
low to high -> brain will die
central pontine myelinolysis
how to rule out pseudohyponatremia
calculate osmolar gap = measured serum osmol - calculated serum osmol
if gap if <10 then its normal
how does acute pancreatitis cause reduced calcium
lipase causes liberation of free acids which bind to calcium and reduce its circulating concentration
vitamin def that can cause haemorrhagic disease of the newborn
vit k def
what is pellagra
niacin (b3) def
causes diarrhoa, dermatitis, dementia
ways to do rta qu
- Is urine pH > 5.3? => if Yes, it’s Type 1 RTA. => confirm w/ hypoK + kidney stones (‘stONE for type ONE’)
- If urine pH < 5.3, check K+ level.
=> if high, it’s Type 4 RTA (‘MORE k+ for type FOUR’)
=> if low, it’s Type 2 RTA - Know the typical underlying causes
- Type 1: Autoimmune = RA, Sjogren, SLE
- Type 2: Fanconi syndrome
- Type 4: DM nephropathy
iron def anaemia vs anaemia of chronic disease bloods
TIBC is high in iron def
tests needed before fundoplication surgery
Oesophageal ph
manometry studies
hepatorenal syndrome mx
vasopressin analogues -> increases splanchnic circulation
volume expansion with 20% albumin
TIPSS
what is the most sensitive marker of CLD -> cirrhosis
thrombocytopenia
ix and mx of SIBO
ix: hydrigen breath test
Mx: correct underlying disease
rifaximin trial
co-amox/metronidazole if this doesnt work
RF for SIBO
neonates with congential abdo issues
scleroderma
DM
pellagra symptoms
Dermatitis, diarrhoea, dementia/delusions, leading to death
how to maintain remission of UC in patient who has:
severe relapse or >2 exacerbations within one year
oral azathioprine
oral mercaptopurine
first line ix for acute mesenteric ischaemia
venous BG -> lactate
child pugh score includes?
A - albumin
B - bilirubin
C - clotting
D - distention (ascites)
E - encephalopathy
treatment of achalasia
- pneumatic (balloon) dilation is increasingly the preferred first-line option
less invasive and quicker recovery time than surgery
patients should be a low surgical risk as surgery may be required if complications occur - Heller cardiomyotomy should be considered if recurrent or persistent symptoms
- intra-sphincteric injection of botulinum toxin is sometimes used in patients who are a high surgical risk
- drug therapy (e.g. nitrates, calcium channel blockers) has a role but is limited by side-effects
ix for achalasia
oesophageal manometry
-> EXS tone on swallowing
barium swallow -> birds beak
chest xray
- wide mediastinum
what is achalasia
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus
who is achalasia more common in
middle aged men and women
px of achalasia
dysphagia to solids and liquids
heatburn
regurg of food
blood results of a patient with alcoholic hepatitis
raised GGT
macrocytic anaemia -> due to deficiencies
ratio AST/ALT x2
constipation mx
1st line: bulk forming e.g. Ispaghula Husk
2nd line hard stools: osmotic e.g. Macrogol
2nd line soft stools with tenesmus: stimulant e.g. Senna
Opioid induced: osmotic e.g. macrogol + stimulant e.g. Senna
Faecal impaction: high dose macrogol +/- disimpaction/enema/suppository
Note: Avoid stimulant in long term as causes electrolyte abnormalities
what is the anatomical landmark for an upper gi bleed
origin proximal to the ligament of Treitz
this is the suspensory muscle of duodenum ans marks boundary between first and second parts
