Gastroenterology Flashcards
Screening for haemachromatosis
For general population?
For family members?
Screening for haemachromatosis
General population –> Transferrin saturation
Family members –> HFE genetic testing
C diff treatment
If Moderate?
If Life threatening?
C diff infection
- Moderate –> PO Metronidazole
- Severe –> PO Vancomycin + IV Metronidazole
What hormones do these cells produce
D cells
S cells
G cells
I cells
D cells –> Somatostatin
S cells –> Secretin
G cells –> Gastrin
I cells –> CCK
Small bowel overgrowth syndrome - causes? Ix?
Small bowel overgrowth syndrome
Causes: Systemic sclerosis, Diabetes, Congenital
Ix: Hydrogen breath test
(hydrogen and methane correlate with amount of bacteria)
H. pylori is associated with
Duodenal ulcers
Chronic NSAID use is associated with
Gastric ulcers
Gut anterial supply
Intermittent dysphagia
Regurgitation
Bird’s beaking
Diagnosis? Ix? Tx?
Achalasia
[1] OGD
[2] Barium swallow (diagnostic)
Tx: CCBs + Surgical dilatation
Regurgitation
Coughing up food
Halitosis
Diagnosis? Ix?
Pharyngeal pouch (Zenkers diverticulum)
Ix: Barium swallow or OGD
Tx: none required
Iron deficieny anaemia + Dysphagia
OGD: Oesophageal webs
Diagnosis?
Plummer-Vinson syndrome
Ix for peptic ulcer disease
< 55 years old and no red flags –> H. pylori Urea breath test
> 55 years old or red flags –> OGD + Biopsy
H pylori eradication thearpy
Clarithromycin AND Amoxicillin AND Omeprazole
Clarithromycin AND Metronidazole AND Omeprazole
Tx of hepatic encephalopathy
Oral Lactulose + Phosphate enema
Autoimmune hepatitis
Antibodies
Type 1 –> Anti-smooth muscle antibody + ANA
Type 2 –> Anti-liver-kidney microsome Ab (ALKM-1)
Ig levels in autoimmune hepatitis
Raised IgG
RAH
RUQ abdo pain
Ascites
Tender hepatomegaly
Diagnosis? ix?
Budd-Chiari syndrome (hepatic vein outflow obstruction)
- Ix: USS Doppler Hepatic vein
- Tx: Thrombolysis (< 72hr) or ANticoagulation (>72hr)
- Angioplasty
Ascitic tap
↑ polymorphonuclear leucocytes (PMN) >250 mm3
==> Spontaneous Bacterial Peritonitis (SBP)
Signs of portal hypertension
SAVE
- Splenomegaly
- Ascites
-
Varices
- Oesophageal varices (90%)
- Caput medusa
- Haemorrhoids
- Encephalopathy
Signs of liver decompensation
JACE
- Jaundice
- Hypoalbuminaemia
- Oedema
- Ascites
- Coagulopathy → Bruising
- Encephalopathy
Haemochromatosis
Cause
Ix
Haemochromatosis
Autosomal recessive mutation in HFE (or multiple blood transfusions)
HIGH Transferrin saturation
Perl’s stain or Prussain Blue stain for Iron
Tx: Venesection +/- Desferrioxamine
Hydatid liver cyst
Cause/Risk factors
Ix
Tx
Hydatid liver cyst
- Echinococcus granulosus (Tapeworm) –> Sheep / Dogs on Farms
- Ix: Western blot
- Tx: Praziquantel
Ix for portal hypertension
1st line
Gold standard
USS: [1st line investigation]
Hepatic venous pressure gradient (HVPG) measurement: [Gold standard]
Wilson’s disease
Cause
Ix
Tx
Wilson’s disease
- Autosomal recessive –> mutation in ATP7B gene
- LOW Ceruloplasma
- HIGH Free Copper, HIGH urinary copper
-
Tx
- Zinc + Trientine
Hepatitis B serology
Antibodies in PBC
IgM Anti-mitochondrial antibodies (PBC)
Tx for PBC
Ursodeoxycholic acid
PSC
Associations
PSC + UC
pANCA
HLA DQ2 and DQ8
Coeliac disease
Ix for Coeliac disease
Coeliac disease
IgA anti-TTG
OGD + Duodenal biopsy
increase intraepithelial lymphocytes
Villous atrophy + Crypt hyperplasia
Mesenteric adenitis
Cause
Mesenteric adenitis –> Yersinia enterocolitica
Tx for C diff infection
C diff infection
(1) PO Metronidazole for 10-14 days
(2) PO Vancomycin for 10-14 days
If severe –> Oral Vancomycin + IV Metronidazole
Definition of toxic megacolon
bowel diameter >6cm
Barium enenma: Lead piping (loss of haustra)
