Gastroenterology Flashcards
Treatment of Barrett’s with a reduction in adenocarcinoma
High dose PPI and aspirin
Barrett’s surveillance
No dysplasia - surveillance
Low grade at 2 endos 6 months apart- RFA
High grade dysplasia - oesophagectomy vs low endo resection followed by RFA
Post RFA - 5 years
Portal HTN pressure
> 5mmHg
Primary prophylaxis if nil bleed
Non selective b blocker or ligation
Prevention of hepatorenal syndrome in SBP
IV albumen at diagnosis and day 3
High ALP and GGT and antimitochondrial antibodies
PBC
PBC treatment
Ursodeoxycholic acid
Liver transplant referral
Kings college criteria (not paracetamol)
PT >100 OR 3 of
Age over 40
Jaundice for 7 days
PT over 50
Bili over 180
Non A or Non B hepatitis, Wilson’s or drugs
Type 1 AIH
Anti Smooth muscle antibodies and ANA
Type 2 AIH
Anti LKM1
Target antigen: Cyp450 2D6
Haemachromatosis gene mutation
HFE gene mutation (C282Y or H63D)
Test for Pancreatic insufficiency with chronic pancreatitis
Faecal elastase
FAP gene
APC gene chromosome 5
Tumour suppressor gene
Autosomal dominant
MYH associated polyposis
MutY gene
HNPCC gene mutations
MSH2 (60%) and MLH1 (30%)
Mismatch repair genes causing micro satellite instability
Right sided tumour
> 10 adenomas
3 cases, 2 generations, 1 age <50
5-AZA SE
Hepatotoxicity Myelosuppressions Allergy/pancreatitis NHL Non melanomatous skin cancer
No effect in pregnancy
Risk of progression from high grade dysplasia to adenocarcinoma
10%
The benefit of IV PPI pre endoscopy
Reduces endoscopy therapy does not reduce mortality, rebleed or death
Treatment of acute bleeding UGIB
Adrenaline + diathermy/clip has mortality/rebleed benefit
Post endoscopy PPI IV for 72 hours (oral similarly efficacious)
Restart aspirin at 3 days
Restart warfarin/DOAC 2 weeks
High gradient ascites
Serum albumin: ascites alumen >11g/L
Portal HTN
Low gradient ascites
<11g/L ‘Leaky capillaries (infection) or cancer
Treatment of SBP
WCC >250
Cefotaxime 2g TDS
Cease beta blockers (mortality risk)
Bactrim prophylaxis
Histology of alcoholic liver disease
Mallory-Denk hyalines surrounded by neutrophils (termed Mallory-Denk bodies)
macrovesicular steatosis
Histology of NASH
fat droplets in the hepatocytes in association with ballooning degeneration and lobular inflammation.
DNA stool test for CRC
KRAS mutation NDRG4 BMP3 methylation Beta actin Haemoglobin immunoassay
When to refer cirrhosis for transplant
Evidence of hepatic dysfunction (child’s Pugh 7 or meld >10) or first complication (ascites varicella bleed or hepatic encephalopathy)
Child Pugh score
Albumin Bilirubin Coagulation (pt inr) Drain the ascites Encephalopathy
Ferroportin
Stimulates iron release from entericyte into blood stream at basolateral surface
Hepcidin
Inhibits iron release from enterocyte ast basolateral membrane
Genetic variant of crowns disease which could lead to early initial surgery due to structures
NOD2/CARD15
Positive pANCA negative ASCA
UC
Negative pANCA pos ASCA
Crohns
Drug for Crohn’s with anti-IL12/23 action
Ustekinumab
Hormones that stimulate appetite
Ghrelin
Neuropeptide
Agouty related peptide
IBD drugs to avoid in pregnancy
MTX contraindicated
Infliximab (anti-TNF) should be avoided in third trimester
Indication for elective total colectomy in UC patients
Risk of cancer
Unable to wean steroids
Steriod side effects
UC/Crohn’s surveillance
Colonoscopy 8 years from disgnosis every 1-3 years
Diarrhoea associated with resection of terminal ileum
Bile malabsorption related
Serology coeliac
1) Tissue transglutaminase Ab (IgA-tTG)(most accurate) or Endomysial Ab (IgA-EMA).
2) Anti-gliadin Ab (less sensitive/specific)
HLA-DQ2 DQ8 - rule out test
When to treat with Abx in acute pancreatitis
If necrosis is present
Corckskrew oesophagus
Oesophageal spasm
Most commonly in seting of uncontrolled GERD
Most common cause of viral gastro
norovirus
therpaeutic effect of lactulose
lowers faeces pH
Interferon treatment of HCV
Interferon alfa-2b (5 million U) of subcutaneously daily for 4 weeks and then three times per week for 20 weeks
MELD score
Creatinine
Bilirubin
INR
autoimmune pancreatitis serological test?
IgG4
Diagnosis of wilsons disease
Low serum copper and ceruloplasmin levels
High 24 urine copper
Rx: trientine and zinc
HCC finding on quad phase imaging
Enhance on arterial imaging rapidly
Wash out in arterial phase
Serum albumin gradient > 1.1 and ascites protein <2.5
Cirrhosis
Budd Chiari
Liver mets
Barrett’s oesophagus histology
Intestinal metaplasia characterized with goblet cells.
Most specific autoimmune hepatitis
Anti-SLA/LP (Soluble Liver Antigen/Liver–Pancreas Antigen)
Medication for post-ERCP pancreatitis
NSAIDS i.e. indomethacin pre ERCP
