Gastroenterology Flashcards
Gastrin secretion inhibitors
VIP, glucagon, somatostatin, Calcitonin
Gastrin secretion stimulator
epinephrine, calcium, gastric distension, vagal stimulation, acetylcholine, L-amino acids
cell that secretes gastrin? cell upon which gastrin acts?
Secreted by G cells in stomach/duodenum, acts on parietal cell of stomach
Earliest phenotypic manifestation of haemochromatosis
Transferrin saturation Increase
Findings of following in SIBO (high or low): MCV, folate, B12
high, high, low (Luminal bacteria consume cobalamin but produce folate)
Commonest worldwide cause of non-cirrhotic portal hypertension?
Schistosomiasis
Drug causes of non-cirrhotic portal hypertension
Azathioprine, chemos
Vascular causes of non-cirrhotic portal hypertension
Budd Chiari, sinusoidal osbtructive syndrome
Infiltrative causes of non-cirrhotic portal HTN
sarcoid, mastocytosis
What factors are assoc. w. rapid progression of Hep B?
longer duration of infection, Hep B genotype C, core promoter mutation, co-infection with Hep C, Male
Drug with highest resistance in Hep B
Lamivudine
ETOH time frame for withdrawal seizures
12-48 hours
ETOH time frame for DTs
48-96 hours
Toxic effect of ETOH is due to
acetaldehyde
ETOH hepatitis histopath hallmark
neutrophilic infiltrate
When to use acamprosate?
withdrawal sx >1/52
4 causes of AST:ALT >2
ETOH, NAFLD, Wilson’s, Hep C
Abnormally low ALP with other elevated liver eynzymes
Wilson’s
Who progresses to chronic Hep B
babies/ kids
Define chronic Hep B
sAg +ve for >6/12
When to Rx Hep B
eAg+, HBV VL>20K and ALT >2x ULN
eAg-, HBL VL >2K and ALT >2x ULN
MOA entecavir and tenofovir
HBV DNA Pol inhibitors
Which Hep B drug is safe in pregnancy
Tenofovir DF
Demographics at highest risk of HCC from Hep B
Africans >20, Asians >40
How to manage pregnancy with elevated HBV VL
Tenofovir 3rd trimester, baby get IgG and vax
Mgmt of Hep D
Peg-IFN
Hep C genotype in Australia
3
Hep C assoc. GN
MPGN
What % of Hep C infections progress to chronic
75%
Why are Egyptian’s at higher risk of Hep C
Schistosomiasis vaccine
Side effects of Ribavarin
Rash and haemolytic anaemia
SVR in Hep C
-ve PCR at 3/12
Mutation assoc. w. Hep C resistance
Y93H
Diagnostic criteria for eosinophilic oesophagitis
> 15eo/HPF on biopsy (not just distal as GORD could cause that distally) and symptoms of oesophageal dysfunction
6 foods in elimination diet for eosino eo
egg, milk, wheat, soy, nuts, seafood
most sensitive test for achalasia
manometry
Most important type of metaplasia in Barrett’s
Intestinal
Barrett’s increases risk of adeno ca by how much?
40-100x
MELD score for liver Tx in chronic cirrhosis
> 15
SAAG consistent w. portal HTn
> 11
HVPG consistent with cirrhosis
> 10
HVPG assoc. w. varices
> 12
When to start rifaxamin and what is the benefit?
after 1st epi encephalopathy, reduce recurrence of further
Which varices are best Mx with glue?
gastric
What is the R factor in LFTs?
(ALT/ULN) / (ALP/ULN)
Top causes of R factor >5
Paracetamol, sulfonamides, statins, tetracyclines
Drugs causing R factor <2
Penicillins, cephalosporins, terbinafine, OCP
How do non-selective BBs reduce risk of variceal bleed?
Reduced CO, and splanchnic vasoconstriction via alpha receptors
What factors make varices high risk?
Size, red wale sign, CP stage
Surveillance scope frequency
No varices = 2 years
Small or worse = annual
Definition of HRS-AKI
Creat 2-3x with bland UA and no other cause, diuretics withheld and 48h albumin given
Management of HRS-AKI
Terli and albumin 1g/kg/d
Define HRS-CKD
eGFR <60 for 3/12, no other cause
HCC - Barcelona liver clinic stage 0 definition and Rx
Single lesion <2cm
Resect or ablate
HCC - Barcelona liver clinic stage A definition and Rx
Single lesion or 3 lesions <3cm
Transplant
HCC - Barcelona liver clinic stage B definition and Rx
Multi-nodular
TACE
HCC - Barcelona liver clinic stage C definition and Rx
Portal invasion/distant mets
TKIs (sorafenib, lenvatinib)
HCC - Barcelona liver clinic stage D definition and Rx
CPC cirrhosis, ECOG >/=2
Palliate
Two most common mutations on haemachromatosis
1 - C282Y
2 - H63D
Penetrance for homozygotes of haemachromatosis mutations
10-30%
Ferritin level predictive of end-organ damage in haemachromatosis
> 1000
Indications for venesection haemachromatosis
Ferritin 100-400, organ dysfuncion (EF, ALT/AST), evidence of excess iron on MRI/biopsy