Gastroenterology Flashcards
What is the route of the oesophagus?
Fibromuscular tube transporting food from pharynx to stomach beginning at cricoid cartilage (C6) to cardiac sphincter/orifice (T11)
What are the layers of the oesophagus?
Mucosa
Submucosa
Muscle layer
Adventitia
What are the two oesophageal sphincters?
• Upper Oesophageal Sphincter (UOS @ T11): Anatomical sphincter consisting of striated muscle at pharyngoesophageal junction;
Resting tone contracted reduce air entry
• Lower Oesophageal Sphincter (LOS; cardiac sphincter @ L1): Physiological (functional) sphincter present at gastro-oesophageal junction with no muscle but 4 factors maintaining function (acute angle + compressed when positive IAP + Mucosal folds + R Crus of Diaphragm)
Resting tone constricted prevent reflux
What are the two oesophageal sphincters?
• Upper Oesophageal Sphincter (UOS @ T11): Anatomical sphincter consisting of striated muscle at pharyngoesophageal junction;
Resting tone contracted reduce air entry
• Lower Oesophageal Sphincter (LOS; cardiac sphincter @ L1): Physiological (functional) sphincter present at gastro-oesophageal junction with no muscle but 4 factors maintaining function (acute angle + compressed when positive IAP + Mucosal folds + R Crus of Diaphragm)
Resting tone constricted prevent reflux
State the 4 oesophageal constrictions.
Mnemonic: ABCD
- Arch of aorta
- Bronchus (L)
- Cricoid cartilage
- Diaphragmatic hiatus (T10)
Which arteries supply the oesophagus?
- Oesophageal branch of Inferior Thyroid Artery (Fr. Thyrocervical Trunk)
- Oesohageal arteries (Fr. Thoracic aorta): 4-5x from anterior abdominal aorta + anastomose with oesophageal branches of inferior thyroid arteries + below with ascending branches of L phrenic + L gastric
- Left Gastric artery: Branches to anterior and posterior branch to supply intramural and submucosal plexuses
Which veins drain the oesophagus?
- Oesophageal veins (From peri-oesophageal venous plexus): Drain submucosal plexus -> Inferior thyroid vein (cervical) OR Azygous Veins, Hemiazygos Veins, Intercostal and Bronchial veins (abdominal)
- Left gastric veins: Drain into portal vein
Give 5 conditions where you may get mouth ulcers.
- Idiopathic
- Anaemia
- IBD
- Coeliac
- Behcet’s Disease
- Reiter’s Disease
- SLE
- Pemphigus
- Pemphigoid
- Drug Reactions
- SCC
- HSV 1
- Coxsackie A
- HZV
Give 3 conditions in which you may get oral white patches?
- Candida
- SLE
- Trauma: Mechanical/Irritative
- Immunocompromised
- Leucoplakia (pre-malignant)
Give 3 causes of glossitis.
Allergy
Burns
B12 deficiency
Folate deficiency
Infection
Kawasaki disease
Scarlett fever
Give a cause of Filiform Papillae.
- Unknown
- Heavy smoking
- Antiseptic mouthwashes
Describe Geographic Tongue.
Idiopathic condition presenting with erythematous areas surrounded by well-defined, irregular margins which are usually painless
What are the two subtypes of GORD?
How are they determined?
- Erosive Reflux Disease (ERD): Erosions present on endoscopy
- Non-Erosive Reflux Disease (NERD): No erosions present on endoscopy
Determined on endoscopy
What are the clinical features of GORD?
- Heartburn (or dyspepsia)
- Acid regurgitation
- Water-brash (sialorrhea + bad taste)
- Halitosis
- Odynophagia
- Cough
- Dental erosion
- Globus pharyngeus (FOSIT)
How do you diagnose GORD?
- Clinical diagnosis
- PPI Trial: Sx improvement over 8-week trial
Consider
• H. pylori testing: Urea breath test (-> detection of Carbon dioxide)
• Serology: IgG Ab
How do you manage GORD?
• Supportive: Diet/Weight reduction/Smoking cessation/ NSAID cessation
+
• PPI: Omeprazole (20mg PO OD)/ Lansoprazole (15-30mg PO OD)/ Esomeprazole (20-40mg PO OD)
(H. pylori infection)
+
• H. pylori eradication therapy: PPI + Metronidazole/Amoxicillin + Macrolide for 7/7
A patient with GORD has a positive Urea breath test.
What is the management?
H. pylori eradication therapy: Amoxicillin + Erythromycin + PPI
+
Gaviscon
What are the over the counter options for dyspepsia?
Gaviscon (Alginates)
Antacids (MgOH2)
Simeticone (antifoaming agents)
Describe Barrett’s Oesophagus.
Change in the stratified squamous epithelium (SSE) of oesophagus to the simple columnar epithelium (SCE) in intestinal metaplasia thus displacement of the squamo-columnar junction of the oesophagus
How is Barrett’s Oesophagus diagnosed?
- Upper GI Endoscopy + Biopsy: Abnormal epithelium (violaceous near to GO junction); Z-line (SC junction) migration cephalad (boundary at oesophageal and gastric epithelium junction); Ulceration; Strictures; Nodularity
- Biopsy: histologically ∆ from SSE -> SCE
How do you manage Barrett’s Oesophagus?
Depending on if it there is evidence of Dysplasia.
Non-Dysplasia:
Annual surveillance
+ PPI
Dysplasia
• Intervention: Radiofrequency ablation ± Endoscopic mucosal resection
Describe Achalasia.
Oesophageal motor disorder of unknown aetiology characterised by oesophageal aperistalsis and insufficient lower oesophageal (cardiac) sphincter relaxation following swallowing
The co-occurrence of Achalasia, Alacrima and Adrenal insufficiency is termed?
Allgrove Syndrome (Triple A)
Allgrove Syndrome describes…
Adrenal Insufficiency
Achalasia
Alacrima
What are the core clinical features of Achalasia?
- Dysphagia: Difficulty swallowing liquids and solids
- Retrosternal pressure/pain
- Regurgitation
- Gradual weight loss
- Recurrent chest infections (2º to regurgitation)
- Globus pharyngeus
- Coughing/Choking whilst recumbent
What type of food is difficult to swallow in Achalasia?
Solids and liquids
What investigations would you order to positively identify Achalasia?
- Upper GI Endoscope: Retained frothy saliva, oesophageal dilation, sigmoid oesophagus (tortuous)
- Barium swallow: Loss of peristalsis; delayed oesophageal emptying; dilated oesophagus tapering to narrowing (beak-like narrowing)
- Oesophageal manometry: Incomplete relaxation of lower oesophageal sphincter; oesophageal aperistalsis
What is the gold-standard investigation to accurately rule-in Achalasia?
Barium swallow - a loss of peristalsis, beak-like narrowing is observed
A patient who has been struggling to swallow both solids and liquids, with regurgitation and retrosternal pain undergoes a barium swallow.
A beak-like narrowing is shown with dilated oesophagus present and tapering at area of narrowing.
He is 34 years old and otherwise healthy with an ASA classification of 1.
How would you manage this patient?
• Pneumatic dilatation (balloon to mechanically stretch lower oesophageal sphincter)
OR
• Laparoscopic cardiomyotomy (Heller Procedure = opens tight cardiac sphincter
A patient who has been struggling to swallow both solids and liquids, with regurgitation and retrosternal pain undergoes a barium swallow.
A beak-like narrowing is shown with dilated oesophagus present and tapering at area of narrowing.
He is 34 years old and has Diabetes Mellitus, Cystic Fibrosis and recurrent chest infections with an ASA classification of 4.
How would you manage this patient?
Poor Surgical Candidate
• CCBs: Nifedipine/Verapamil
2nd Line
• Botulinum toxin type A (Paralysis of cardiac sphincter)
What is the second line treatment for Achalasia in a non-surgical candidate?
• Botulinum toxin type A (Paralysis of cardiac sphincter)
Describe Systemic Sclerosis.
Condition in which smooth muscle layer is replaced by fibrous tissue and LOS pressure is reduced which results in secondary GORD
Outline the clinical features of Systemic Sclerosis.
CREST symptoms
Calcinosis cutis Raynaud's (o)Oesophageal dysmotility - GORD Sclerodactyly Telangiectasia
What antibodies are present in Systemic Sclerosis?
Anti-Scl70
Anti-Centromere
How do you manage the GI symptoms of Systemic Sclerosis?
- Oral corticosteroid: Prednisolone
- PPI
If gastroparesis
• Prokinetic agent: Erythromycin/Azithromycin
How can you manage the Raynaud’s Phenomenon in Systemic Sclerosis?
• Lifestyle: Cold exposure, hand exercises, smoking cessation
+
• CCB: Amlodipine
+ (Digital Ulceration)
• PDE-5 inhibitor: Sildenafil/Tadalafil
What is a Hiatus Hernia?
Protrusion of the IA contents through the oesophageal hiatus (T10) of the diaphragm characterised by heartburn, regurgitation, chest/abdominal pain and bowel sounds in chest.
How may Hiatus Hernias be classified?
Grade 1: GO junction into thorax
Grade 2: Fundus/ portion of stomach into thorax
Grade 3: Mixed (both)
Grade 4: IA contents into thorax
What are the clinical features of a Hiatus Hernia?
- Heartburn
- Regurgitation/Vomiting
- Chest pain
- SOB
- Cough
- Dysphagia
- Odynophagia
- Hematemesis
- Non-bilious vomiting
What would the gold-standard imaging be for a suspected Hiatus Hernia?
What would you expect to see?
• CXR: Retrocardiac air bubble
How do you manage a Hiatus Hernia?
• Surgical repair ± anti-reflux procedure: Laparoscopic transabdominal surgery OR Open transabdominal surgery
Following treatment of a hiatus hernia via laparoscopic transabdominal repair, Mr. Johnson, a 57 year old male, is vomiting blood. Additionally, he reports pain.
O/E he is hypotensive and tachycardic. AXR shows pneumoperitoneum.
What is your differential?
How would you manage this?
Iatrogenic Oesophagus Perforation
• Endoscopic Oesophageal stenting
±
• Confirmatory water-soluble contrast XR-A
Describe Boerhaave’s Syndrome.
Transmural tears of distal oesophagus induced by sudden intra-oesophageal pressure rise characterised by retching, vomiting and severe epigastric/retrosternal pain
What is the pathological difference between Boerhaave’s Syndrome and Mallory-Weiss Tears?
Boerhaave’s = transmural
Mallory-Weiss = partial tears
What is the name of the crunching sound of the heart heard on auscultation due to air in the thorax?
Hamman’s Sign
A 47 year old man presents with brisk haematemesis and severe abdominal pain following a large meal and a night on the beers. He is retching.
O/E his RR is 26, his HR is 130bpm, regular and S1+S2 appear to have a crunching sound.
What investigations would you order?
What is your differential?
What screening tool may you use to calculate the risk of a GI bleed?
How would you manage this patient?
- CXR: Mediastinal, peritoneal, prevertebral air; widened mediastinum
- Water-soluble contrast swallow: Localises lesion
- CT: Confirmatory findings = oesophageal wall oedema, peri-oesophageal fluid ± bubbles and widened mediastinum
Boerhaave’s Syndrome
Blatchford Score
• IV Fluid Resuscitation \+ • Broad-spectrum ABX ± • Surgery
Describe Mallory-Weiss Syndrome.
Non-transmural tear of tissue in lower oesophagus associated with violent coughing or vomiting
How would you manage a Mallory-Weiss Syndrome?
• Endoscopy (endoscopic hemostasis) ± Blood transfusion: Identify cause of bleeding, stop bleeding (adrenaline ± cautery/clips) ± Blood transfusion
Describe what Oesophageal Varices are.
Enlarged veins within the oesophagus due to obstructed blood flow in the portal system characterised by brisk haematemesis, melaena and pre-syncope/LOC.
Outline the pathophysiology of how Oesophageal varices may occur.
A hepatic pathology e.g. Cirrhosis occurs which results in increased intrahepatic resistance. The retrograde pressure of blood via the portal vein, results in distension of the L Gastric (coronary) vein. Blood is then shunted into the azygous veins and venous hypertension occurs in the peri-oesophageal plexus resulting in distension and varices.
What are the clinical features of oesophageal varices?
- Brisk hematemesis
- Melaena
- Pre-syncope/LOC
- Jaundice
- Ascites
- Hepatic encephalopathy
- Spider naevi
- Hair loss
- Leukonychia
- Anorexia
- Weight loss
- Hepatomegaly
Why does leukonychia occur in chronic liver disease?
Chronic hypoalbuminaemia
What is the eponymous term for Leukonychia striata?
Muerhcke’s Nails
How do you manage a patient with bleeding Oesophageal varices?
• Endoscopy (endoscopic hemostasis) ± Blood transfusion: Identify cause of bleeding, stop bleeding (adrenaline ± cautery/clips) ± Blood transfusion
+
• NSBBs: Propanolol/Carteolol
What is the order of treatment in an Oesophageal variceal bleed?
A-E
Terlipressin + Band ligation
If controlled, calculate Child-Pugh Score
If uncontrolled, repeat and try cautery/clips.
If continuous bleeding, try TIPS
Give 5 RFs for Oesophageal Varices
Hepatitis
Cirrhosis
Portal hypertension
Budd-Chiari Syndrome
Alcoholism
Drug use
PMHx Varices
Parasitic infection
Thrombotic disorders
A 37 y/o M patient presents with dysphagia 3/12, heartburn and nausea and vomiting. He reports some abdominal pain. He has previously undergone a PPI trial which helped a bit but he is still getting symptoms.
His PMHx is asthma and rhinitis. Both of which are well controlled.
What investigations would you order?
H. Pylori breath test
OGD + Biopsy
A 37 y/o M patient presents with dysphagia 3/12, heartburn and nausea and vomiting. He reports some abdominal pain. He has previously undergone a PPI trial which helped a bit but he is still getting symptoms.
His PMHx is asthma and rhinitis. Both of which are well controlled.
The OGD shows focal oesophageal strictures, narrowing and crepe paper mucosa. A biopsy shows a Eosinophilic count of 30 per microscopy field.
What is the threshhold of eosinophilic count for this condition in an oesophageal biopsy?
What is your differential?
How would you manage this condition?
> 15 per microscopy field
Eosinophilic Oesophagitis
• Oral corticosteroid: Budesonide/Fluticasone
(inhaler)
±
• Endoscopic oesophageal dilatation
Describe what an Oesophageal cancer is.
Neoplasm in the mucosa originating from epithelial cells lining oesophagus, presenting with dysphagia and odynophagia
What is the most common type of Oesophageal cancer?
Adenocarcinoma
State 5 RFs for Oesophageal cancer.
GORD Barrett's Oesophagus High BMI Smoking Alcohol HPV
What is the initial investigation for a patient with suspected Oesophageal cancer?
• Oesophagogastroduodenoscopy (OGD) + Biopsy: Mucosal lesion; Histology shows SCC or AC
Which tool can be used to assess the risk of an Upper GI bleed?
Blatchford Score
Rockall Score
Give the components of the Blatchford Score.
Active: syncope/melaena
Blood urea: >7mmol/L
Circulatory (mmHg): <100mmHg
Drop in Hb: 129; 119
Elevated pulse: >100bpm
Failure: heart or liver
What tool can be used to predict the risk of rebleeding and mortality following a GI endoscopy?
What are the components.
Rockall Score
Age Blood pressure Comorbidity Diagnosis Endoscopy findings
What assessment tool is used to assess the prognosis of chronic liver disease (e.g. cirrhosis) in patients?
Child-Pugh Score
What are the components of the Child-Pugh Score?
Albumin Bilirubin Coagulation (PT) Disability (ascitic fluid) Encephalopathy (hepatic)
What are your management options for Oesophageal cancer?
Stage 0 + 1A
• Endoscopic resection ± ablation (if <2cm, carcinoma in situ)
Surgical Candidate (Stages 1B-3)
• Oesophagectomy
± (Stage 2B-3)
• Chemoradiotherapy: Cisplatin + Fluorouracil + Radiotherapy (CFR)
Non-surgical candidate (Stages 1B-3)
• Chemoradiotherapy or radiotherapy alone: CFR or Radiotherapy
Stage 4 • Chemotherapy: Fluorouracil + Cisplatin ± • Radiotherapy: Radiotherapy ± • Endoscopic ablation ± Stenting
How do you manage Nausea in a patient?
Supportive: trigger avoidance; fizzy drinks
Medical: Hyoscine; Cyclizine; Metoclopramide; Ondansetron
What class of drug is Hyoscine?
Anti-M1
What class of drug is Cyclizine?
Anti-H1
What class of drug is Promethazine?
Anti-H1
What class of drug is Domperidone?
D2 antagonist
What class of drug is Metoclopramide?
D2 antagonist
What class of drug is Ondansetron?
5HT3 antagonist
Which anti-emetic is safe in Parkinson’s disease?
Domperidone
What are the side effects of Metoclopramide?
Extrapyramidal side effects
Prolactin release
What are the side effects of Promethazine?
Anticholinergic syndrome
What are the side effects of Cyclizine?
Anticholinergic syndrome
Angle closure glaucoma
Describe Peptic Ulcer Disease.
Breach in mucosal lining of stomach or duodenum (> 5mm in diameter) with penetration to the submucosa.
Caused by: • H. pylori • NSAIDs • Zollinger-Ellison Syndrome -> Passaro’s triangle (gallbladder-D2/D3-pancreas) • Vascular insufficiency • Sarcoidosis • Crohn’s Disease
What is the term for the site where most gastronomas occur?
Passaro’s Triangle
Gallbladder-D2/3-Pancreas
What test is suggestive of a H. pylori infection causing an ulcer?
- H. pylori urea breath test/stool antigen test: Positive if H. pylori present
- Upper GI endoscopy: Peptic ulcer
What hormone will be elevated in Zollinger-Ellison Syndrome?
• Serum gastrin level: Hypergastrinemia in Z-E Syndrome
What is the difference between an ulcer and an erosion?
Ulcer > 5mm (diameter)
Erosion < 5mm
How do you manage Peptic Ulcer disease?
Supportive: Take medication regularly; eat good meals; reduce spicy foods
Medical: PPI;
H. Pylori eradication: Amoxicillin + PPI + Clarithromycin
Surgical: Endoscopic haemostasis (adrenaline + clips/ banding)
–> If an active bleed
Describe Gastritis.
Gastric mucosal inflammation often caused by H. pylori/ NSAIDs/ alcohol use/bile reflux or infection which is characterised by nausea, vomiting, loss of appetite, severe emesis, acute abdominal pain and fever.
What are the causes of Gastritis?
- H. pylori
- NSAIDs
- Alcohol
- Bile reflux
- Stress-induced (critically-ill)
- Auto-immune (Abs to Parietal cells)
- Infection by S. aureus; Streptococci; E. coli; Enterobacter; C. welchii
How do you treat Gastritis?
PPI/H2A
Describe Atrophic Gastritis?
Condition of mucosal atrophy, gland loss and metaplastic changes caused by chronic inflammation either from autoimmune (AMAG) or environmental causes (EMAG) characterised by haematemesis, epigastric pain, abdominal paraesthesia, dyspepsia and anaemia.
What are the two types of Atrophic Gastritis?
- Autoimmune Metaplasic Atrophic Gastritis (AMAG)
* Environmental Metaplasic Atrophic Gastritis (EMAG)
What is the main difference between Atrophic Gastritis and Gastritis?
Mucosal atrophy and gland loss occurs due to chronic gastritis (in Atrophic Gastritis)
Describe Menetrier’s Disease.
Rare disease featuring mucosal cell (foveola) overgrowth in mucosal lining on a background of inflammation characterised by epigastric pain, nausea, vomiting, diarrhoea, weight loss or anorexia or may be asymptomatic
What is the gold standard investigation for diagnosing Menetrier’s Disease?
• Endoscopy: Variable – gastric erosions ± atrophy + Foveolar cell proliferation
How do you manage gastric cancer?
• Surgery: Resection
± (T2 or higher and any N)
• Chemotherapy (Peri vs Post): Peri (ECF) Epirubicin + Cisplatin + Flurouracil; Post (Radiotherapy + Fluorouracil)
Localised Non-Surgical Candidate
• Chemoradiation: Radiotherapy + Fluorouracil
Advanced
• Chemoradiation: Radiotherapy + Fluorouracil
What is a GIST?
Common type of stromal/mesenchymal tumour in the GI tract present commonly in the stomach and proximal SI which have malignant potential and are asymptomatic.
How are Gastrointestinal Stromal Tumours found?
• Endoscopic
Often an incidental find
How may GISTs be managed?
Surgical Candidate
• Resection
Non-Surgical Candidate
• Imatinib (TKI)
What is the most common cause of a Gastric Lymphoma?
• H. pylori infection (90% cases)
Describe Zollinger-Ellison Syndrome.
Gastrin-secreting tumour resulting in gastric acid (HCl) hypersecretion with secondary ulceration characterised by symptoms of epigastric pain and diarrhoea.
How may ZES be diagnosed?
- Upper GI endoscopy: Prominent gastric folds ± Ulcer
- Endoscopic US (EUS): Identification of tumours
- Fasting Serum Gastrin: Elevated
- Basal Acid Output (BAO): Elevated
How do you measure a Basal Acid Output?
Continuous suction at subatmospheric pressure of 30-50mmHg via syringe in 15 minute periods
A patient with known Zollinger-Ellis Syndrome is shown to have elevated BAO and endoscopy shows multiple tumours. CT-CAP shows hepatic metastasis.
How would you manage this patient?
PPI
+
SS analogue
What is the role of Octreotide in ZES?
Octreotide is a SS analogue thus inhibits the secretion of Gastrin from G-cells
Describe Coeliac disease.
Systemic autoimmune disease triggered by dietary gluten peptide (a-gliadin) which triggers an immune reaction causing villous atrophy, hypertrophy of crypts and lymphocyte infiltration characterised by symptoms of bloating, diarrhoea, abdominal pain/discomfort
What is the offending agent in Coeliac disease?
alpha Gliadin
What anti
What dermatological manifestation of Coeliac disease exists?
Where is this most commonly found?
• Dermatitis herpetiformis: Pruritic papulovesicular lesions on extensor surfaces of arms, legs, buttocks, trunk, neck and scalp.
Outline the key clinical features of Coeliac disease.
- Bloating
- Weight loss
- Fatigue/Malaise
- Diarrhoea
- Abdominal pain/discomfort
- Anaemia: Microcytic (Iron-deficiency anaemia)/ Macrocytic (Folate/Vit B12 deficiency)
• Dermatitis herpetiformis: Pruritic papulovesicular lesions on extensor surfaces of arms, legs, buttocks, trunk, neck and scalp.
What is the gold-standard investigation in the diagnosis of Coeliac disease?
EMA Abs
IgA-tTG
Why is IgA used as the marker in Coeliac disease, not IgG?
IgA is the predominant antibody in the lining of the respiratory and gastrointestinal mucosa cf IgG being the predominant antibody in bodily fluids
IgG may be used in IgA deficiency - shown by blood test
What is the management for Coeliac disease?
Supportive: Annual Review; Vitamin D; Vitamin B12; Folate; Iron
± Coeliac Crisis
Corticosteroids
± Hyposplenism
Pneumococcal vaccine
What is the management for Coeliac disease?
Supportive: Annual Review; Vitamin D; Vitamin B12; Folate; Iron
± Coeliac Crisis
Corticosteroids
± Hyposplenism
Pneumococcal vaccine
What is a Coeliac crisis?
Initial presentation of Coeliac disease with severe diarrhoea, dehydration, weight loss, hypoproteinaemia and metabolic/electrolyte disturbances
What pathogen causes Whipple’s Disease?
Tropheryma whipplei
What are the clinical features of Whipple’s disease?
- Fever
- Night sweats
- Diarrhoea
- Weight loss
- Abdominal pain
- Arthralgia
- Skin hyperpigmentation to sun exposed areas
- Lymphadenopathy
- Neurological Sx: Seizures; Confusion; Nystagmus; Brisk reflexes; Hypertonia; Ataxia
How would you manage Whipple’s disease?
• ABX: Ceftriaxone OR Benzylpenicillin sodium
Outline the clinical features of GI TB.
- Cough: 2-3 weeks; dry -> productive
- Fever (low-grade)*
- Anorexia*
- Weight loss*
- Malaise*
- Night sweats*
- Diarrhoea*
- Abdominal pain*
- Abdominal mass*
- Hepatomegaly*
- Ascites*
- Dyspnea
- Crackles
- Bronchial breathing
- Amphoric breath sounds (distant hollow breath sounds heard over cavities)
- Clubbing
- Erythema Nodosum
How do you test for TB using AFB smear?
3 specimens, 8 hours apart which must be positive
How do you treat TB?
RIPPE
Rifampicin Isoniazid Pyridoxine Pyrazinamide Ethambutol
How do you treat multi-drug resistant TB?
MKIPE
Moxifloxacin Kanamycin Isoniazid Pyridoxine Pyrazinamide Ethambutol
What are the side effects of Rifampicin?
Red coloured urine
Rash
Purpura
Abdominal Pain/ Nausea
What are the side effects of Ethambutol?
Reduced visual acuity
Optic Neuritis
What are the side effects of Pyrazinamide?
Hyperuricaemia (gout)
What are the side effects of Isoniazid?
Peripheral neuropathy
Sideroblastic anaemia
Hepatitis
Describe what a protein-losing enteropathy is?
Umbrella term for conditions causing loss of serum protein via GI tract causing hypoproteinaemia characterised by peripheral oedema, ascites and other GI Sx dependent on cause.
