Gastro 2 Flashcards
What criteria shows a severe flare of UC? (3 and name of criteria)
how is it treated?
1. first line =
2. If first-line is CI…
3. If no improvement in…then…
As per the Truelove and Witts criteria; >6 bowel motions a day with blood and fever.
- first line = Amit for IV corticosteroid
- If first-line is CI- intravenous ciclosporin
- If no improvement in 72hrs then adding intravenous ciclosporin to intravenous corticosteroids or consider surgery
Prolonged vomiting- what do you see on ABG?
Pathophysiology of why
- Low K+, Low Cl-, Metabolic Alkalosis
Physiology
- Loss of Cl-, H+ and water
- Fluid loss ,means RAAS activates (decreased renal perfusion)
- Increase in aldosterone which promotes the reabsorption of Na+ in exchange for H+ and K+ in the DCT
- Yes water will follow Na+ but more potassium and H+ are lost in urine, leading to hypokalaemic metabolic alkalosis
Management of severe alcoholic hepatitis
1.
what scale used see who will benefit?
- Corticosteroid- reduce pro-inflam TNFa and IL-10
Maddrey’s discriminant function (DF) - uses prothrombin time and bilirubin concentration
What cancer does coeliac disease increase you risk of?
enteropathy-associated T cell lymphoma
extremely rare
Barrets Oesophagus management
1.
2. Surveillance
- if metaplasia (but not dysplasia) =
- if dysplasia of any grade =
- High dose PPI
- endoscopic surveillance with biopsies
- if metaplasia = endoscope every 3-5 years
- if dysplasia of any grade = endoscopic intervention 2 options:
- radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
- endoscopic mucosal resection
post cholecystectomy- chronic diarrhoea/ steatorrhoea managment?
1 med
Bile-acid malabsorption may be treated with cholestyramine (it is a bile acid sequestrant)
genetic pattern of hereditary hemochromatosis
autosomal recessive
Management prophylaxis for hepatic encephalopathy
1.
2. second line
- lactulose
- second line - add rifamixin
antibiotics such as rifaximin
are thought to modulate the gut flora resulting in decreased ammonia production
other options include embolisation of portosystemic shunts and liver transplantation in selected patients
c diffe management
first episode
1. first line-
2.
3.
recurrent episode
- within 12 weeks of symp resolution give…
- after 12 weeks…
life threatening
1.
2.
- oral vancomycin 10 days
- second-line therapy: oral fidaxomicin
- Third-line therapy: oral vancomycin +/- IV metronidazole
recurrent
1. < 12 weeks oral flindoxmicin
2. > 12 weeks oral vanc or flindox
life threatening
1. IV metronidozole AND ORAL vanc
2. Specialist advice +/- surgery
Spontaneous bacterial peritonitis: most common organism
Management (1)
Prophylaxis
what drug is given?
What is the criteria to receive it?
E. coli
intravenous cefotaxime is usually given
Prophylaxis
oral ciprofloxacin or norfloxacin
criteria- have asctites
- previous SBP
- fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
management of mall intestine bacterial overgrowth syndrome (SIBO).
first-line Rifaximin
Diarrhoea, fatigue, osteomalacia
think ceoliac, its a malabsorption picture so think either crohns or coeliac
look at CRP if raised think Crohns if not think coeliac
Vit C deficiency what are we thinking? - scurvy (4 features)
- poor wound healing (capillary fragility and bleeding tendency)
- gingivitis, loose teeth
- bleeding from gums, haematuria, epistaxis
- general malaise
Pernicious anaemia predisposes which type of cancer?
pernicous anaemia common features (2)
gastric carcinoma
angular cheilitis
low vit B12
Peutz-Jeghers syndrome
big STEM giveaway
whats seen in GI?
genetic pattern?
responsible gene encodes (2)
STEM- pigmented freckles on the lips, face, palms and soles
GI- numerous hamartomatous polyps
autosomal dominant
responsible gene encodes serine threonine kinase LKB1 or STK11
