Gastro Flashcards
Typical PMH and Hx for mesenteric ischaemia (usually small bowel)
Vascular pathology: dm, hypertension, diabetes, smoking.
Hx: acute severe pain that’s out of keeping with exam findings. Can have blood, diarrhoea, fever.
Inv and tx for mesenteric ischaemia
Raised lactate
CT
Tx: surgery
Scoring systems for cirrhosis
Child-Pugh score (bilirubin, albumin, PT, encephalopathy and ascites are worst prognostic indicators)
MELD score
How can ischaemic hepatitis occur?
Septic shock, acute hypoperfusion can cause an AKI from tubular necrosis and ischaemic hepatitis,
Investigation findings for ischaemic hepatitis
Marked rise in ALT
May have deranged Us and Es from AKI
Triad of Budd-Chiari syndrome
Acute severe abdo pain,
Ascites,
Hepatomegaly
Pathophysiology and causes of Budd-Chiari
Polycythaemia, Combined pill Pregnancy Thrombophilia Describes hepatic vein thrombosis. US.
Investigation findings for alcoholic liver disease
Raised GGT
AST markedly higher than ALT, ratio > 3 strongly suggests alcoholic hepatitis
Mx of alcoholic hepatitis
Use Maddrey’s discriminant function to determine who will benefit from tx, based on PT and bilirubin.
Glucocorticoids (pred.)
Mx of UC (mild-moderate/severe)
Grading system for flare ups
Try love and Witt’s criteria
Mild-moderate: topical (if proctitis)/oral aminosalicylate to treat flare up and maintain remission.
Severe: Steroids then AZA to maintain remission
How does spontaneous bacterial peritonitis present?
Abdo pain, fever, ascites
What investigations are required for spontaneous bacterial peritonitis?
Paracentesis shows high neutrophils
What organism is most commonly found in SBP?
E.coli
Mx of SBP
IV cefotaxime
Pathological process of Primary biliary cholangitis
Autoimmune. Chronic inflammation causes progressive cholestasis, potentially ending in cirrhosis.
Demographic and sx of Primary Biliary Cholangitis
Typically itching in middle aged women.
Often asymptomatic till late stages when they develop itching and fatigue. May have signs of liver failure.
Investigations for PBC
Anti-mitochondrial antibodies (AMA) M2 subtype
Raised serum IgM
Mx of PBC
Ursodeoxycholic acid slows progression
Cholestyramine relieves pruritus
Complications of PBC
Variceal haemorrhage from portal hypertension,
Increased risk of hepatocellular carcinoma,
Osteoperosis
Pathology of haemochromatosis
Autosomal recessive condition. Disorder of iron absoprtion/metabolism, so iron accumulates.
Presentation of heamochromatosis
Often asymptomatic in early disease.
First signs are often fatigue, arthralgia and erectile dysfunction due to hypogonadism from liver cirrhosis .
Bronzed skin.
Hepatic: cirrhosis, hepatomegaly.
Most common inherited colorectal cancer
What other cancer does it predispose to?
HNPCC
Endometrial cancer
What vaccine is recommended to coeliacs?
Pneumococcal vaccine every 5 year, due to functional hyposplenism.
Roles of spleen
Creates lymphocytes
Removes/recycles old/damaged rbcs
