Gastro Flashcards
What does the presence of the Hep B surface antigen (HbsAg) show?
Active infection
What does the presence of the Hep B E antigen (HbeAg) show?
Acute phase of the infection
What does the presence of the Hep B surface Antibody (HbsAb) show?
Vaccinated or current infection
What does the presence of IgM and IgG Hep B core antigen (HbcAb) show?
IgM = Acute infection IgG = past infection if surface antigen is negative, chronic infection if surface antigen is positive
If someone’s Hep B serology was:
HbsAg = +ve
HbcAb IgM = +ve
HbsAb = -ve
what does this show?
An acute hepatitis B infection
If someone’s Hep B serology was:
HbsAg = +ve
HbcAb IgM = -ve
HbsAb = -ve
what does this show?
A chronic hepatitis B infection
If someone’s Hep B serology was:
HbsAg = -ve
HbcAb = +ve
HbsAb = +ve
what does this show?
Immunity due to previous infection
If someone's Hep B serology was: HbsAg = -ve HbsAb = +ve HbcAb= -ve HbsAb = -ve
what does this show?
vaccinated?
Which hepatitis viruses are vaccines available for?
A and B
What are the risk factors for transmission of Hepatitis B?
IVDU
Sexual contact
Blood products*
Healthcare workers*
- more rare
What are the risk factors for transmission of Hepatitis C?
IVDU
Sexual contact
Blood products*
- more rare
What is the natural history of Hep B infection?
Incubation period of 1-6 months
then get generalised symptoms e.g. fever, arthralgia, urticaria
Jaundice, hepatosplenomegaly and adenopathy are later signs
What is the presentation of a Hep C infection?
early/mild is asymptomatic
then often a silent chronic infection
~25% get cirrhosis
self limiting?
When are ALT and AST raised?
liver disease, including that secondary to congestive cardiac failure after a myocardial infarction.
ALT is more liver specific than AST and rises more than AST in early hepatocellular injury. AST is raised more in chronic injury.
When are ALP and GGT raised and why?
biliary outflow obstruction
anchored to the biliary canaliculus
How does mesenteric ischaemia present?
Sudden onset, severe abdominal pain that seems out of proportion to clinical findings e.g. abdomen SNT
Lots of vascular risk factors
Raised lactate
What are the Rockall and Glasgow-Blatchford scores used for?
Rockall = pre-endoscopic and post-endoscopic scores are added together to predict the risk of re-bleeding and death after intervention
Glasgow-Blatchford = Pre-endoscopic score to identify patients at low risk of requiring intervention
What is the Glasgow score used for?
JUST GLASGOW WHY ARE THERE TWO
Predicts severity of pancreatitis
What is the management for acute excess alcohol withdrawal and why?
1) Chlordiazepoxide (/benzo) to prevent seizures
2) Pabrinex/B1/Thiamine Replacement to prevent Wernicke’s Encephalopathy
What is Wernicke’s encephalopathy? What is the clinical presentation?
Disease of the brain parenchyma due to thiamine (B1) deficiency as a result of chronic alcohol use
Nystagmus, ataxia and confusion + short term memory loss
If left untreated, what can Wernicke’s encephalopathy progress to? How does this present?
Korsakoff’s Dementia/Syndrome
Confabulation, inability to create new memories, apathy, lack of insight
What is the management of H. Pylori infection?
Triple Therapy
Amoxicillin
Clarithromycin
Omeprazole
for 7 days
What is the King’s College Criteria?
A predictor of poor outcome in acute liver failure
An indication of patients that should be considered for urgent liver transplantation
usually due to paracetamol toxicity?
What are the first line blood tests for coeliac disease?
Total IgA and IgA-TTG
Describe budd-chiari syndrome
Hepatic vein obstruction
primary = hypercoaguable state or haematological disease e.g. polycythemia rubra vera or factor v leiden secondary = extrinsic compression
get a triad of: severe abdo pain, ascites and tender hepatomegaly
What are the signs of portal hypertension
SAVE
splenomegaly
ascites
varices
encephalopathy
How might ulcerative colitis present?
increasing diarrhoea that is probably bloody
tenesmus
LIF pain - crampy
rectal pain that is relieved by pooing
What are the extra-intestinal presentations of UC?
Skin - pyoderma gangrenosum, psoriasis, erythema nodosum
Eyes - scleritis, anterior uveitis
MSK - back pain (ank spond), reactive arthritis
Respiratory - upper lobe ILD
What are the bedside tests that could be done to investigate UC?
Baseline obs
Stool sample and culture - rule out infective cause
Faecal calprotectin - detects GI inflammation
What is the best imaging to identify UC? what would it show?
acute = Flexi sigmoscopy + biopsy
after a flare = colonoscopy
shows continuous inflammation that does not extend beyond the musclaris propria
Give 4 complications of UC
Toxic megacolon - non-obstructive dilation of the bowel secondary to an infection?
increased risk of VTE
increased risk of colon cancer due to chronic inflammation
obstruction/perforation
What is the name of the severity index for UC?
Truelove-Witt
What is the acute medical management of UC?
mild - mod = rectal mesalazine. can add in oral mesalazine if doesn’t resolve within 4 weeks
mod = PO prednisolone
severe = IV hydrocortisone + admission for supportive care. ?surgery
What is the long term medical management of UC?
Mesalazine 1st line Azathioprine 2nd line
Biologics? Ciclosporin? Surgery?
How does crohn’s present?
RIF pain
Apthous ulcers (white) can be on mouth or anus
B12 deficiency, weight loss, other nutritional deficiencies
same extra-intestinal effects as UC
diarrhoea but not bloody
What are the macroscopic and microscopic findings of Crohn’s?
macroscopic = cobblestone appearance, skip lesions, strictures, fistulae
microscopic = transmural inflammation, crypt abscesses, granulomas
What is the management of crohn’s?
steroids to induce remission
then azathioprine
NOT mesalazine
surgery for symptom relief
how may oesophageal cancer present?
Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use
how may achalasia present
Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
