Gastro enzymes

Question 1

Where is ALT and when is it raised

Answer 1

LIVER enzyme

Raised in: LIVER DYSFUNCTION, ACUTE PHASE REACTON

Question 2

Where is ALP found

Answer 2

liver
biliary duct
bone
placenta (very non specific)

Question 3

What ratio of ALP: ALT suggests post-hepatic causes

Answer 3

ALP&raquo_space;> ALT (because it tells you that both are damaged but BILIARY TRACT especially damaged)

Question 4

what other enzyme can you get that is LIVER SPECIFIC

Answer 4

GGT

Question 5

Where s AST found and what does it indicateb

Answer 5

LIVER enzyme; liver INJURY

Question 6

what causes raised AST:ALT = 2:1

Answer 6

alcohol

Question 7

sx haemochromatosis

Answer 7

fatigue
erectile dysfunction
arthralgia
arthritis
bronze skin
diabetes
heart failure

Question 8

what stain can you do for haemochromatosis

Answer 8

Pearl stain

Question 9

mx haemochromatosis

Answer 9

1. venesection
2. desferroxamine

Question 10

sx of chronic panceatitis

Answer 10

pain 15-30 mins after meals
staetorrhoea, diabetes mellitus (a long time after sx begin)

Question 11

ix for chronic pancreatitis

Answer 11

Bloods: faecal elastase (measures expcrine function), HbA1c, glucose levels (for DM)
USS (exclude gallstones)
CT with contrast

Question 12

what is GORD

Answer 12

reflux of gastric acid and bile causing oesophagitis

Question 13

RF for GORD

Answer 13

raised intra abdo pressure (obesity/pregnancy)
oesophageal sphincter hypotension (drugs, achalasia, hiatus hernia)
acid hypersecretion (smoking, Zollinger Ellison)

Question 14

what investigations cana you get for suspected GORD

Answer 14

OGD, CXR
consider barium swallow, 24h oesophageal monitoring

Question 15

How do you treat GORD

Answer 15

conservative: WL; stop smoking, ssmall regular meals, avoid large meals. avoiod alcohol and spices

medical:
(OTC - antacid (gaviscon))
- PPI (omeprazole)
- H2 antagonist (ranitidine)

surgical: nissen fundoplication

Question 16

DANGEROUS associations of H pylori

Answer 16

• peptic ulcer diisease (both duodenal and gastric)
• MALToma (eradicating H puylori causes regression)
• atrophic gastrtis

Question 17

how long do you need to give therapy for H pyloi

Answer 17

7 days

Question 18

when should you instruct people to take a PPI

Answer 18

half hour before meals

Question 19

cx of PPI

Answer 19

osteoporosis
low phosphaate

Question 20

what occurs in Budd Chiari

Answer 20

blockage of the hepatic vein:
T1: thrombosis
T2: tumour

Question 21

sx budd chiari

Answer 21

sudden onset abdo pain

ascites

tender hepatomeg

Question 22

what is carcinoid syndome usually due to

Answer 22

liver mets