Gastro Flashcards
Pattern of LFTs in non-alcoholic steatohepatitis
ALT > AST
NASH - US findings
Increased echogenicity
Pellagra features
4 Ds:
- dementia
- dermatitis
- diarrhoea
- death
Pellagra = deficiency of
Vitamin B3 (Niacin)
Small bowel bacterial overgrowth (SBBOS) - gold standard diagnostic investigation
Jejunal aspirate - showing >100,000 bacteria/ml
Hydatid cyst (tapeworm Echinococcus)- clinical features
Cyst in liver or lungs
Type 1 hypersensitivity reaction if leaks
Biliary rupture (colic, jaundice + urticaria)
Whipple’s disease - infective agent
Tropheryma whippelii
Whipple’s disease - features
Insidious: Malabsorption Arthralgia Lymphadenopathy Cognitive impairment
Whipple’s disease - diagnosis
Jejunal biopsy - shows macrophages containing Periodic acid-Schiff (PAS) granules
Patients with ascites, give antibiotic prophylaxis for SBP if:
Had an episode of SBP previously
or
Ascitic fluid protein <15g/l + Child-Pugh score >9 or hepatorenal syndrome
Antibiotic prophylaxis for SBP
PO ciprofloxacin / norfloxacin
Blatchford score - Urea 6.5 - 8
2
Blatchford score - Urea 8 - 10
3
Blatchford score - Urea 10 - 25
4
Blatchford score - Urea >25
6
Blatchford score - Hb 12 - 13 (Man)
1
Blatchford score - Hb 10 - 12 (Man)
3
Blatchford score - Hb < 10 (Man)
6
Blatchford score - Hb 10 - 12 (Woman)
1
Blatchford score - Hb < 10 (Woman)
6
Blatchford score - Systolic BP 100 - 109
1
Blatchford score - Systolic BP 90 - 99
2
Blatchford score - Systolic BP < 90
3
Blatchford score - other markers scoring 1
Pulse >= 100
Presents with malaena
Blatchford score - other markers scoring 2
Presents with syncope
Hepatic disease
Cardiac failure
Treatment of bile acid diarrhoea (BAD)
Bile acid sequestrants - cholestyramine
Diagnosis of bile acid malabsorption
SeHCAT (selenium homocholic acid taurine) scan shows <15% retention at 7 days
H. pylori eradication - no allergies
7 days of
PPI + amoxicillin + clarithromycin/metronidazole
H. pylori eradication - penicillin allergic
PPI + clarithromycin + metronidazole
H. pylori eradication - penicillin allergic and previous clarithromycin use
PPI + bismuth + metronidazole + tetracycline
Patient with cirrhosis - first scope shows no varices
Rescope 2-3 years
Patient with cirrhosis - scope shows Grade 1 varices
Rescope 1 year
Patient with cirrhosis - scope shows grade 2 or 3 varices, or signs of bleeding
Non-cardio selective beta blocker
Crohns management - what does combined immunomodulator + biological therapy increase risk for
Non-melanoma skin cancer
Hepatosplenic T-cell lymphoma
Causes of ascites with SAAG > 11g/L
Liver (failure, mets)
Cardiac
Budd-Chiari
Portal vein thrombosis
Causes of ascites with SAAG < 11g/L
non-portal HTN
Hypoalbuminemia (nephrotic syndrome, malnutrition)
Malignancy
TB
Pancreatitis, bowel obstruction
Wilsons disease - clinical features
Deranged LFTs
Movement disorder
Psychiatric disturbance
Definition SBP
Ascites neutrophil count > 250 cells / mm^3
UC patient with increased stool frequency, incontinence after ileal pouch-anal anastamosis
Pouchitis
1st line management of pouchitis
Metronidazole or ciprofloxacin
Colonoscopy shows normal appearance, but colonic biopsy shows lymphocytic infiltrate
Microscopic colitis (chronic inflammatory)
Risk factors for microscopic colitis
SSRIs
NSAIDs
PPIs
Smoking
IBS constipation, despite optimal laxatives - next step
Linaclotide (guanylate cyclase-C receptor agonist)
C.diff 1st line treatment
PO Metronidazole 10 - 14 days
C.diff - 2nd line or severe
PO Vancomycin
C.diff - not responding to 1st or 2nd line treatment
Fidaxomicin
C.diff - life-threatening
PO Vancomycin + IV Metronidazole
Gardner’s syndrome (variant of familial adenomatous polyposis) presents with
Osteomas of the skull/jaw
Features of Alkaptonuria (ochronosis) AR disorder
Pigmented sclera
Urine turns black in air
Renal stones
Intervertebral disc calcification
Significance of HbsAg (Hepatitis B surface antigen)
Implies acute disease (usually present 1-6m)
If present >6m implies chronic disease