Gastroenterology Flashcards
Korsakoff’s
Due to chronic thiamine deficiency or thalamic damage (e.g. infarct, bleed)
Features:
- Anterograde amnesia
- Confabulation
- Blunted affect
- Apathy
- Lack of insight
- PMH alcoholism, starvation
Imaging:
- Bilateral atrophy of the mamillary bodies or medial thalamus
Management:
- Thiamine replacement
- Supportive care
Delirium tremens
An acute confusional state developing within a week of cessation/reduction from heavy alcohol intake
0-12hr
- Tremor
- Sweating
- Anxiety
- Palpitations
- Disorientations
12-24hr
- Hallucinations incl. visual, auditory, and tactile
24-48hr
- Seizures
Management:
- CIWA
- ALN support
- Chlordiazepoxide
Hereditary haemochromatosis
Inherited syndrome of dysregulated iron absorption/binding/storage leading to iron accumulation within the tissues
Most commonly mutations in HFE
Features:
- Liver cirrhosis
- Arthritis
- Diabetes
- Arrhythmias
- Skin discolouration
- Loss of libido, infertility
Diagnosis:
- High iron:transferrin ration
- High ferritin levels
- Genetic testing
Management:
- Venesection
- Iron chelation therapy
- Monitoring via ferritin levels
GLASGOW score
P - PaO2 < 7.9
A - Age > 55
N - Neutrophils - WCC > 15
C - Calcium < 2.0
R - Renal - urea > 16.0
E - Enzymes - LDH > 600
A - Albumin < 32
S - Sugars - glucose > 10
Functional bowel disorders
Incl. IBS, functional bloating, functional constipation, and functional diarrhoea
Symptoms should be present for >= 6 months and should occur at least 3 days/month for 3 months
Features:
- Abdominal pain either:
- relieved by defaecation
- associated with altered stool frequency
- associated with altered stool appearance
- associated with two of:
- bloating
- altered stool passage
- symptoms worsened by eating
- passage of mucus
Management:
- Diet:
- Diarrhoea/bloating - reduce insoluble fibre
- Constipation - fibre supplementation
- FODMAP diet
- Medications:
- Diarrhoea - loperamide
- Constipation - isphagula husk
- Spasm - mebeverine, peppermint oil
- Pain - amitriptyline and/or SSRI
Oesophageal variceal bleeding
Usually secondary to chronic liver disease with portal hypertension
Management:
- 1st line = Band ligation
- 90% success
- 2nd line = TIPSS
- 3rd line = surgical portocaval shunting
- 40% mortality, 95% success rate
- 4th line = oesophageal transection
- 10-20% operative mortality
Prognosis:
- 30% mortality from variceal haemorrhage
- 80% risk of rebleed following oesophageal transection
Hepatitis A
Nature - RNA virus
Spread - faeco-oral
Course - acute hepatitis, no chronic state
Diagnosis - positive IgM + IgG
Management - supportive
Hepatitis B
Nature
- dsDNA virus
Spread
- blood-born, venereal, vertical
Histology:
- Chronic - ground-glass hepatocytes
Course
- acute hepatitits + occasional chronicity
Management - pegylated interferon alpha-2a
Serology:
- HBsAg = current acute infection
- HBsAg + HBeAg + HBV - DNA = chronic infection
- HBcAg IgM = previous infection within 6/12
- HBcAg IgG = previous infection
- Anti-HBsAg without anti-HBcAg = immunisation
Hepatitis C
Nature - RNA
Spread - blood-born, venereal, vertical
Histology - increased in activation of sinusoidal lining cells, lymphoid aggregates
Course - mild acute phase, chronicity
Diagnosis - anti-HCV for exposure, HCV PCR for current infection
Management - 45% spontaneously clear, else antivirals
Hepatitis D
Nature - incomplete virus
Spread - blood-borne but requires pre-existing HBV
Histology - microvesicular steatosis
Course - severe acute hepatitis in the pregnant
Hepatitis E
Nature - RNA
Spread - faeco-oral, vertical
Histology - marked cholestasis
Course - acute hepatitis, small risk of chronicity
Management - supportive
Primary sclerosing cholangitis
Chronic inflammation and fibrosis of the intra- and extra-hepatic bile ducts
- 80% also have IBD
Features:
- Obstructive jaundice
- Pruritus
- Fatigue
- Liver cirrhosis
Investigations:
- Bloods:
- Positive pANCA, anti-SMA, ANA, anti-
cardiolipin
- High total IgM
- Cholestatic jaundice
- Imaging:
- MRCP
Management:
- Cholestyramine (for pruritus) +/- ursodeoxycholic acid
- Liver transplantation is curative
- Screening via bloods + US for cholangiocarcinoma/liver fibrosis
Budd-Chiari syndrome
A rare condition cause by obstruction of the portal venous blood flow
- Can be chronic or acute
- Causes include thrombosis and external
compression
Features:
- Hepatomegaly
- Splenomegaly
- Ascites
- Stigmata of chronic liver disease
Management:
- Anticoagulation
- Venous shunting
- Liver transplantation
VIPoma - aka Verner-Morrison syndrome, WDHA syndrome
A rare neuro-endocrine tumour secreting VIP
- Vasodilation, water/electrolyte secretion,
suppression of gastric acid
- Mainly sporadic, 5% associated with MEN 1
- >50% metastatic by time of diagnosis
Features:
- Profuse watery diarrhoea
- Secretory - persistent after 48hr fast
- Odourless, tea-coloured
- Mild abdominal pain
- Dehydration
Investigations:
- Stool monitoring:
- Diarrhoea > 3L/day
- Bloods
- Hypo- /achlorydia
- Hypokalaemia
- Raised VIP
- Imaging:
- CT
- Somatostatin receptor scintography
Management:
- IV fluids + electrolytes
- Octreotide
- Surgical excision
Superior mesenteric artery syndrome (SMAS)
A rare condition caused by compression of the duodenum between the SMA and the abdominal aorta
Pathophysiology:
- SMA is supported by adipose tissue
- With extreme weight loss this tissue is lost and the SMA sags against the duodenum causing compression
- Other causes include hyperextension due to prolonged bed rest, scoliosis surgery, or rapid growth spurts
Features:
- Chronic to acute features of total or partial small bowel obstruction
- Abdominal pain
- Vomiting
- Bloating
Management:
- Weight gain
