Gastroenterology Flashcards
How do you induce remission in crohns disease?
- Steroids
(Enteral feeding may be used especially in children) - 5ASA drugs (mesalazine(
- Azathioprine or mercaptopurine. Methotrexate is an alternative one.
- Infliximab
Metronidazole for isolated perianal disease
How do you maintain remission in crohns disease?
Azathioprine or mercaptopurine.
What do you need to check before starting mercaptopurine or azathioprine?
TPMP
Treatment of carcinoid tumours
Octreotide
Test for haemachromatosis
Tranferrin saturaton
What is the treatment for a gastric MALT lymphoma?
Eradication of H Pylori (8-% respond to this)
What caused hydatid cysts?
Tapworm parasites echinococcus granulosus
What is the target haemaglobin pre scope for an upper GI bleed?
70 - 80
Whats the most common cause of liver abscess in adults?
E coli
What are the lab results in wilsons disease?
Reduced serum caerulopasmin
Reduced total serum copper
Increased free serum copper
Increased 24 hour urinary copper excretion
Whats the treatment for wilsons disease?
Penicillamine (chelates copper)
Trientine hydrochloride
Treatment of C Diff
1st line - Oral vancomycin
2nd line - Oral fidaxomicin
3rd line - Oral vancomycin and IV metronidazole
What does an SAAG of over 11 mean?
Portal hyprtension
What does an SAAG of less than 11 mean?
No portal hypertension
What causes ascities with a SAAG of over 11?
Liver disorders (cirrhosis, ALD, liver failure, liver mets)
Cardiac (right heart failure, pericarditis)
Budd chiari
Portal vein thrombosis
Veno occlusive disease
Myxodema
What causes ascites with a SAAG of less than 11?
Hypoalbuminaemia (nephrotic syndrome, severe malnutrition) Malignancy (peritoneal carcinoma) Infections (TB) Pancreatitis Bowel obstrcution Biliary ascites Post op lymphatic leak Serositis in connective tissue diseases
Treatment of ascites
Aldosterone antagonist
Loop diuretics
Drainage if tense ascites
Prophylactic antibiotics if at risk of SBP (oral ciprofloxacin)
Diagnosis of small bowel overgrowth
Hydrogen breath test
Management of small bowel overgrowth
Rifaximin
Co amoxiclav and metronidazole can also be used.
Antimitochondrial antibodies are associated with which condition?
Primary biliary cholangitis
Management of primary biliary cholangitis
Ursodeoxycholic acid
Cholestyramine
Fatt soluble vitamin supplments
Liver transplant
Treatment of hepatic encephalopathy
Treat precipitating cause
Lactulose
Rifaximin
Treatment for achalasia?
Pneumatic balloon dilatation
Heller cardiomyotomy
Intraspinteric injection of botox injections
Drugs - nitrates, calcium channel blockers
What is budd chiari syndrome?
Hepatic vein thrombosis
What is the definition of type 1 hepatorenal syndrome?
Rapidly progressive with doubling of the serum creatanine to over 221 or a halving of creataning clearance to less than 20ml/min over a period of less than 2 weeks.
Prophylactic antibiotic for SBP?
Ciprofloxacin
Treatment of mild to moderate ulcerative colitis (proctitis)
- Topical aminosalicylate
- If remission not achieved in 4 weeks then add an oral aminosalicylate
- If remission still not achieved then add a topical or oral corticosteroid
Treatment of mild to moderate ulcerative colitis (proctosigmoiditis and left sided UC)
- Topical aminosalicylate
- If remission not achieved in 4 weeks add a high dose oral aminosalicylate OR high dose oral aminosalicylate and a topical steroid.
- If still not achieved then stop topcal treatment and offer and aral aminosalicylate and an oral corticosteroid
Treatment of mild to moderate ulcerative colitis (extensive disease)
Topical and high dose oral aminosalicylate
Treatment for inducing remission in a severe flare of ulcerative colitis
IV hydrocortisone
IV ciclosporin if contraindicated or if no improvement after 72 hours.
Contraindications to liver biopsy
Deranged clotting (INR over 1.4) Low plateltes (less than 60) Anaemia Extrahepatic biliary obstruction Hydatid cysts HAemangioma Unccoperative patient Ascites
Antibodies in autoimmune hepatitis
Anti smooth muscle antibodies
Plummer vinson syndrome
Triad of dyphagia (secondary to oesophageal webs), glossitis, iron deficiency anaemia
What anti emetic is useful in incomplete bowel obstruction?
Metoclopramide
What treatment can be given for a metastatic bowel obstruction?
Dexamethasone
Test for bile acid malabsorption
SeHCAT (nuclear medicine test)
What is zollinger ellison syndrome?
Condition charactersed by excessive levels of gastrin usually from a gastrin secreting tumour of the duodenum or pancreas (can occur as part on MEN1)
What does the jejunal biopsy show in whipples disease?
Periodic acid-schiff (PAS) granules
What is the treatment for whipples disease?
Oral co-trimoxazole for 1 year. (sometimes IV penicillin is needed first)
What is the genetic problem in heriditary non polyposis colorectal cancer?
Mutation in the DNA mismatch repar gene. (MSH2 or MLH1)
What other cancer are people with hereditary non polyposis colorectal cancer at risk of?
Endometrial cancer
What is barretts oesophagus?
Metaplasia of the lower oesophageal mucose with the squamous epithelium being replaced by columnar epithelium.
How often do patients with barrets oesophagus get endoscopies?
Every 3 - 5 years if there is no dysplasia
What is the treatment if there is dysplasia of the barretts oesophagus?
Endoscopic muscosal resection and then radifrequency ablation
How often should adults with cirrhosis be screened for hepatocellular carcinoma?
Every 6 months - done with ultrasound with our withour AFP
What is haemobilia?
A condition where there is bleeding into the biliary tree following connection between the splanchnic circulation and the inrahepatic or extrahepatic biliary system.
RUQ pain, GI bleeding and jaundice
Criteria for an acute transplantation following a paracetamol overdose?
- Arterial pH less than 7.3
- INR greater than 6.5
- Creatanine over 300
- Grade 3 or Grade 4 hepatic encephalopathy
