Gastro Flashcards
Interpret this serology
HBsAg neg
anti-HBc neg
anti-HBs neg
Susceptible
Interpret serology
HBsAg neg
anti-HBc pos
anti-HBs pos
Resolved infection
Interpret
HBsAg neg
anti-HBc neg
anti-HBs pos
Vaccinated
HBsAg pos
Anti-HBc pos
IgM anti HBc (high titre) pos
anti HBs neg
Acute HBV infection
HBsAg pos
Anti HBc pos
IgM anti HBc neg
Anti HBs neg
Chronic infection
HBsAg neg
Anti HBc pos
Anti HBs neg
False pos or
Recovering acute infection or
Distant past infection anti HBs too low for detection
Occult (variant) chronic infection
What are the clinical features/manifestations of coeliac disease? (10)
IBS-type symptoms (bloating, flatulence, diarrhoea, constipation)
Fatigue
Fe-deficiency anaemia
Depression
Osteoporosis
Abnormal LFTs
Folate deficiency
Neurological symptoms (e.g. cerebellar ataxia, peripheral neuropathy)
Infertility
Dermatitis herpetiformis (itchy purplish rash, usually on flexures)
Diagnosis of coeliac disease
- Serology - tissue transglutaminase (tTG) Ab and deamidated gliadin peptide (DGP) Ab (need to be consuming adequate gluten)
- total IgA (IgA deficiency affects 2-5% of coeliac pt’s)
- Genetic testing (HLA-DQ8 and HLA-DQ2) - not diagnostic, useful in pt’s who refuse to reexpose to gluten, test of exclusion
- Small bowel biopsy - gold standard
What are the Rome III (2006) criteria for diagnosis of IBS?
Recurrent abdo pain or discomfort with 2+ of:
- improvement with defecation
- onset assoc. with change in frequency of stool
- onset assoc. with change in stool form
Duration of at least 6 months with symptoms present at least 3 days/month for the preceding 3 months
What are the Rome III (2006) criteria for diagnosis of IBS?
Recurrent abdo pain or discomfort with 2+ of:
- improvement with defecation
- onset assoc. with change in frequency of stool
- onset assoc. with change in stool form
Duration of at least 6 months with symptoms present at least 3 days/month for the preceding 3 months
What are the extra-articular manifestations of IBD?
Systemic: FTT in infants, tiredness, malaise, weight loss, fevers
Arthritis: (seroneg spondylo) typically asymmetrical affecting large joints +/- sacroiliac +/- enthesitis
Eye: iritis, episcleritis, uveitis
Liver: primary sclerosing cholangitis, autoimmune hepatitis (UC), gallstones (Crohn’s)
Skin: erythema nodosum, pyoderma gangrenosum
What is a simple screening test for alcoholism?
CAGE
C: Have you ever felt the need to Cut down?
A: Have you felt Annoyed at the suggestion that you might have a problem?
G: Have you ever felt Guilty about excessive drinking?
E: Do you need an Eye opener in the morning?
What are the main clinical manifestations (spectrum of disease) of alcoholic liver disease?
Fatty liver (asymptomatic) Alcoholic hepatitis (acute inflam changes, usually symptomatic with abdo pain - fever - jaundice - coma) Cirrhosis (replacement of hepatocytes by fibrosis)
What is the metabolic syndrome?
Insulin resistance + abdominal obesity + hypertriglyceridaemia + low HDL + HTN
What are the peripheral stigmata of chronic liver disease?
Spider naevi Bruising Leukonychia (horizontal white bands on nails caused by hypoalbuminaemia) Clubbing Palmar erythema Gynaecomastia Testicular atrophy Dupuytren's contracture Parotid enlargement Paucity of axillary and pubic hair
