gastroenterology Flashcards
Mx of Dyspepsia
review meds
lifestyle
trail of PPI for 4 weeks OR test & treat approach for H.pylori
testing for H.pylori, what if they took PPI and came back and symptoms still not resolved?
carbon-13 urease breath test
there is no need to check for H.pylor eradication if symptoms have resolved
still not resolved?…..do UREA BREATH TEST
Ix & Mx of PUD
Ix & Mx of Celiacs
PUD
Ix–> upper OGD + boipsy, CLO if hpylori
Mx–> lifestyle, trial PPI for 4 weeks
celiacs
put them on a gluten diet for 6 weeks first…..
Ix–> IgA (serum and total count) , Anti TTG, Anti EDM, endoscopic intestinal biopsy
Mx–> gluten free diet, pneumococcal vaccine
Chrons Mx
UC Mx
IBS Mx
IBS
LOW FODMAP, limit high fibre, limit fresh fruit to 3x a day
bloating–> oats and linseeds 1 TBS a day
constipation–> isaphagula husk
pain–> mebeverine, buscupan
Diahrrea–> loperamide
Chrons
right sided–> bumetinide
azathioprine or mercaptopurine
if CI–> methotrexate
UC
mesalezine
severe–> IV hydrocortisone
Ix & Mx GORD (when would u do upper OGD)
Ix & Mx Achalasia
Ix & Mx barrets oesophagus
GORD
Ix–> upper OGD if (over 55, cancer symp, relapsing), if - then consider 24 hr esops. PH monitoring
Mx–> PPI for 4-8 weeks, offer H2 antagonist of not work, fundoplication
Achalasia
Ix–> oesophageal MANOMETRY, barium swallow (birds beak) CXR
Mx–> nifedipine while waiting Sx, Pneumatic balloon dilation, hellers cardiomyotomy, in can’t Sx–> botulinum toxin
barret’s oesophagus
Ix–> upper OGD (salmon pink)
Mx–>HIGH DOSE PPI
Ix & Mx Cirrhosis scoring? How to check for liver fibrosis? Ix & Mx Alcoholic liver disease Ix & Mx & complix PBC Ix & Mx & complix PSC
Ix
bedside: BM, urine dip
bloods: basic, bilirubin, clotting, lipid profile, PT high, albumin low, plate low
Autoimmune: ANA, AMA, SMA AFP: HCC Alpha 1 antitrypsin Ceaeruplasmin--> LOW in wilson Ferritin, TIBG, total iron--> haemachromoatosis
Imaging:
USS–> increased echogenecity
FIBROSCAN ( transient elastography) measure stiffness of liver
ENHANCED LIVER FIBROSIS TEST
check 3 molecules involved in liver metabolism ( TIMP, PIIMP etc)
SCORING–> child Pugh and MELD (guide referral for l. transplant)
Mx
if Ascites–> ascitic tap, fluid restrict, spironolactone, prophylactic oral ciprofloxacin if protein is 15 g/L or less
if have SBP give–> intravenous cefotaxime
if encephalopathy–> give laxatives, antibiotics rifaximin
Alcoholic liver disease
Ix–> GgT highhh, AST:ALT ^^2
Mx–> prednisone–> acute episodes of alcoholic hepatitis
PBC
Ix–> IgM, Antimitchondreal antibodies,
Mx–> urseodeoxyxholic acid , for itching, cholestramine
complx: heptocellular carcinoma
PSC (UC)
Ix–> ERCP/ MRCP
Mx–> itching: cholestramine, liver transplant is curative
complix: cholangiocarcinoma
Ix & Mx Wilsons 1st line and GOLD
Ix & Mx Haemochromatosis
Ix & Mx Alpha 1 Antitrypsin Deficiency
WILSONS
Ix–> low serum caeruloplasmin, reduced total serum copper (bc its deposited in the tissue), Liver biopsy is GOLD standard
Mx–> Penicillamine
Haemochromatosis
Ix–> transferrin high, high ferritin , low TIBC, Liver biopsy w/ Perl’s stain can be used to establish the iron concentration in the parenchymal cells used to be the gold standard
Mx–> Venesection is the first-line treatment,
desferrioxamine may be used second-line
Alpha 1 Antitrypsin Deficiency
Ix–> A1AT concentrations
spirometry: obstructive picture
Mx–> no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation
black liver vibes?
stressed teenager w/ jaundice?
does not survive through adulthood due to absolute deficiency?
dubin johnson
gillbert
Criggler najjaar
triad of sudden onset abdominal pain, ascites, and tender hepatomegaly?
triad of sudden onset of severe chest pain, vomiting, Subcuta emphysema
triad high serum ketone levels , low G
dysphagia, regurg, halitosis
dysphagia (2ndry to oesophageal webs), glossitis, iron-deficiency anaemia
Budd-Chiari syndrome mackler's triad--> Boerhaave's syndrome Alcoholic ketoacidosis Pharangeal pouch Plummer-Vinson syndrome
PPI
4 SE
interactions
hyponatraemia, hypomagnasaemia
Osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
Diharrea
Interaction
Clopidogrel–>. reduces it
Mx of Variceal haemorrhage
Prophylaxis of variceal haemorrhage
ABC correct clotting: FFP, vitamin K vasoactive agents: terlipressin prophylactic IV antibiotics Quinolones both terlipressin and antibiotics should be given before endoscopy in patients with suspected variceal haemorrhage
endoscopy: endoscopic variceal band ligation
Sengstaken-Blakemore tube if uncontrolled haemorrhage
TIPSS if above measures fail
Prophylaxis:
Propranolol: reduced rebleeding and mortality
endoscopic variceal band ligation (EVL)
Pernicious anaemia Mx
3 IM per week for 2 weeks –> followed by—> by 3 monthly treatment of vitamin B12 injections
