Gastroenterology Flashcards
What are used in the management of severe alcoholic hepatitis?
Corticosteriods
What is a common diabetic drug which can cause cholestasis?
Gliclazide
What drugs can cause a liver injury?
Paracetomal
Sodium valproate, phenytoin
MAIOs
Anti-TB drugs (isonizaid, rifampicin, pyrazinamide)
Statins
Alcohol
Amiodarone
Methyldopa
Nitrofurantoin
Drugs that can cause liver cirrhosis
Methotrexate
Methyldopa
Amiodarone
Diagnostic test of choice for pancreatic ca
CT
Risk factors for pancreatic cancer
Older age
Smoking
Diabetes
Chronic pancreatitis
HNPCRC
Multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation
Presentation of pancreatic cancer
Painless jaundice
- Pale stools
- Dark urine
- itchy
Cholestatic LFTs
Anorexia
Epigastric pain
Loss of exocrine function (steatorrhoea)
Loss of endocrine function (DM)
Possible atypical back pain
What is courvoisiers law?
The prescence of painless obstructive jaundice and a palpable gallbladder is unlikely to be due to gallstones
Investigations of pancreatic cancer
USS
CT
What may imaging show classically in pancreatic cancer?
The “double duct” sign -> the presence of similtaneous dilatation of the common bile and pancreatic ducts
Treatment of pancreatic cancer
Whipples resection
Adjuvant chemotherapy
ERCP + stenting usually used for palliation
What is a whipples resection?
Pancreaticoduodenectomy
What genes are most strongly associated with coeliac disease?
HLA-DQ2 + HLA-DQ8
What is coeliac disease?
Autoimmune disease which causes a sensitivity to the protein gluten
Conditions that are associated with coeliac disease
Dermatitis herpatiformis (vesicular puritic skin eruption)
T1DM
Autoimmune hepatitis
IBS
Autoimmune thyroid disease
Signs/symptoms of coeliac disease
Chronic or intermittent diarrhoea
Failure to thrive or faltering growth in children
Persistent or unexplained GI symptoms including N+V
Prolonged fatigue
Recurrent abdo pain / cramping / distension
Sudden / unexpected weight loss
Unexplained IDA or other anaemia
Complications of coeliac disease
Anaemia
Hyposplenism
Osteoporosis
Osteomalacia
Lactose intolerance
Enteropathy-assosiated T cell lymphoma of the small intestine
Subfertility
Rarely oesophageal cancer or other malignancies
What electrolyte abnormalities are most commonly seen in refeeding syndrome
Hypophosphataemia
Hypomagnesia
Hypokalaemia
Where is the mutation if you have familial adenomatous polyposis?
A tumour supressor gene called adenomatous polyposis coli gene (APC)
What are the 3 types of colon cancers?
Sporadic (95%)
HNPCC (5%)
FAP (<1%)
Inheritance of HNPCC
Autosomal dominant
Another name for HNPCC
Lynch syndrome
Most common genes in HNPCC
MSH2
MLH1
What other cancer except CRC are patients with HNPCC at risk of?
Endometrial
What criteria is used to aid diagnosis of HNPCC?
Amsterdam criteria
Amsterdam criteria of HNPCC
At least 3 family members with colon cancer
The cases span at least 2 generations
At least one case diagnosed before 50 y/o
Patients with FAP, alongside CRC are also at risk of what?
Duodenal tumours
What test is recommended for post eradication H pylori treatment?
Urea breath test
HbsAg implies what?
Acute Hep B disease (1-6months)
Surface antigen first marker to be produced in infection
If HbsAg present > 6 months, what does this imply?
Chronic disease i.e. infective
What does anti-Hbs imply?
Immunity (exposure or immunisation)
It is negative in chronic disease
What does anti-HbC imply?
Previous or current infection
What is HbeAg a marker of?
HBV replication and infectivity
What may trigger an UC flare?
Stopping smoking
Stress
NSAIDs
Abx
What is classed as mild UC?
<4 stools per day +/- blood
Nil systemic disturbance
Normal ESR + CRP
What is classed as moderate UC?
4-6 stools per day
Minimal systemic disturbance
What is classed as severe UC?
> 6 Stools / day -> containing blood
Evidence of systemic disturbance e.g.
- fever
- tachycardia
- abdo pain / distension / reduced bowel sounds
- anaemia
- hypoalbuminaemia
What is the most common cause of HCC worldwide?
Chronic hep B
What is the most common cause of HCC in europe?
Chronic hep C
Main risk factor for HCC
Liver cirrhosis
Risk factors for HCC
Liver cirrhosis
- hepatitis
- alcohol
- haemachromatosis
- PBC
alpha-1-antitrypsin defieicny
hereditary tyrosinosis
glycogen storage disease
aflatoxin
OCP
Anabolic steriods
Male
Diabetes
Metabolic syndromes
When does HCC tend to present?
Late
Presentation of liver disease
Jaundice
Ascites
RUQ pain
Hepatomegaly
Itchy
Splenomegaly
What tumour marker is looked at in HCC?
AFP
What is the screening is used for HCC?
USS
Who often gets screening for HCC?
Patients with liver cirrhosis 2ndry to hep B, C or haemachromatosis
Men with liver cirrhosis secondary to alcohol
Treatment of HCC
Early disease; surgical resection
Liver transplant
Radiofrequency ablation
Transaterial chemoembolisation
Sorafenib
What is whipples disease caused by?
Tropheryma whippelii infection
Who is whipples disease more common in?
HLA-B27 positive
Middle aged men
Presentation of whipples disease
Malabsorption; diarrhoea, weight loss
Large joint arthralgia
Lymphadenopathy
Hyperpigmentation and photosensitvity
Pleurisy
Pericarditis
Neurological sx; rare
Investigatin of whipples disease
Jejunal biopsy
Finding of biopsy in whipples disease
Deposition of macrophages containing PAS granules