Gastro - Pass med Flashcards
Haemachromatosis
-genetic pattern
- Autosomal recessive iron accumulation
- lethargy, arthralgia, bronze skin, DM,
Mesenteric ischaemia vs Ischaemic colitis
Both - abdo pain, diahrohea, rectal bleeding, fever, bloods - elevated white blood cell and lactic acidosis
Diagnosis - CT scan
M - embolism occulsion of artery supplying small bowel. Hx Afib.
- Pain is severe, sudden onset, out of keeping with physical exam
- Urgent surgery,
I - acute compromise of blood flow to large bowel, leads to inflammation, ulceration and haemorhage.
- Thumbprintign may be seen on abdo xray due to oedema/haemorahge
- supportive management, surgery if conservative mesarues fail
how long before gastroscopy do you stop proton pump inhibitor?
2 weeks (as can mask serious pathology)
Urgent endoscopy - suspicion of gastric cancer
Non-urgent
- all patients with dysphagia or upper abdo mass consistent w stomach cancer
- > 55 w weight loss and one of (upper abdo pain, reflux, dyspepsia)
Non-urgent - patients with haematemeiss
-patient ?55 - treatement resistant dyspesis, upper abdo pain low hb levels, raised platelet count w other gastro signs. .
What anti-emtic should you avoid in bowel obstruction?
metoclopramide
Pernicious anaemia
- SOB, fatigue, lethargy
- lemon tinge skin
- vibration sensation loss - due tot he low B12 levels (loss of reflex or weakness)
gilberts syndrome
autosomal recessive of defective bilirubin conjugation due to UDP glucuronly transferase -
- hyperbillirubinaemia
- jaundice
Spontaneous bacterial peritonitis - what do you give long term treatment
-If patinets have had SBP with fluid protein less than 15 ,then get antibiotic prolyaxis of ciprofloxacin
Carcionoid syndrome
carcinoid tumours - occur when metastases are present in the liver and release serotonin into systemic circulation.
- diarrhoea, palpitations, flushing , bronchospasm, hypotension
- nueroendocrine tumour
- serotonin secretions causes this
- only occurs once tumour has metastasised to liver as this is where seritonin undergoes first pass metabolims.
inv - urinary 5-Hiaa
-plasma chromogranin
H.pylori - eradication therapy
-urea breath test
Malnutrtion score
MUST
0BMI <18.5
Unintentional weight loss great than 10% in last 3-6 monhts
BMI - <20 and unintentioanl weight loss great hern 5% within 3-6monhts
-MUST - can reduec risk of pressure sores
What anti-emetic medication is too be avoided ein parkinsons
-metoclopramide
When to give antibiotics for SBP in ascities?
patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’
Marker for hepatocellular carcinoma
Alpha feropotein (afp)
type 1 vs type 2 hepatorenal failure
type 1 - within 2 weeks
type 2- gradual decline