Gastroenterology Flashcards
What dx should you consider with a signficantly elevated serum ferritin
After exclusion of hereditary haemochromatosis
* infection or inflammation
* alcohol consumption
* metabolic syndrome
* obesity
* diabetes
* liver or renal disease
* thyrotoxicosis
* malignancy
How is HHC inherited
AR gene inheritence
>90% is from homozygous C282Y-HFE gene
heterozygot is nil risk, 1/10 people are this
What are HHC symptoms
- Fatigue
- deression/anxiety
- joint pain, escpecially in the fngers
- bronze/grey skin
- erectile dysfuction
- Ammennorhhea or oligomennorrhea
- brain fog
Treatment of HHC
- Primaily venesections
- Chelating therapy (deferairox) can be used in severe cases or those who cannot tolerate venesections
- no cahnge to iron required
alcoholic liver disease, the AST:ALT ratio is often
2:1
Smoking and IBD
Protective against UC
Risk factor for chrohns and associated w more severe disease
Symptoms /signs of hepatic encephalopathy
- confusion, altered GCS (see below)
- asterixis: ‘liver flap’
- constructional apraxia: inability to draw a 5-pointed star
- raised ammonia level (not commonly measured anymore)
Treatment of hepatic encephalopathy
treat any underlying precipitating cause
lactulose first-line ? excretes ammonia
antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
Treament of a Mild-moderate (<4 or 4-6 stools/day) UC flare
For proctitis +/- left sided disease
- Topical (rectal) aminosalicylate
- if remission is not achieved within 4 weeks, add an oral aminosalicylate
- if remission still not achieved add topical or oral corticosteroid
For patients with extensive disease
- topical + high-dose oral aminosalicylate, +/- oral corticosteroid
Severe flares should be treated in hospital
Causes of acute liver failure
paracetamol overdose
alcohol
viral hepatitis (usually A or B)
acute fatty liver of pregnancy
Features of acute liver failure
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy - sweet breath
renal failure is common (‘hepatorenal syndrome’)
Management of ascites
- Reducing diet sodium
- Fluid restriction
- ALdosterone antagonists (spironalactone)
- drainagae if tense
- Prophylactic ABc - SBP (ciprofloxacin)
Haemachormatosis recieving weekly venesections, what tests should be done to monitor treatment
FBC
Tranfserrin saturation
serum ferritin
TRanfserrin - first marker to rise in haemochromatosis , showing amount
The main risk factor for developing HCC
Chronic Hep B
Liver cirrhosis (etoh, hepatitis, haemachormatosis and PBC)
Features of HCC
- Raised AFP
- Features of cirrhosis (jaundice, RUQ pain, ascites, organomegaly, pruitus, splenomegaly)
Risk factors for Gastric cancer
- H.Pylori
- Smoking
- pernicious anemia
- japan/chinese ethnicity
- Blood group A
What is pernicious anaemia
macrocytic anaemia due to B12 deficiency/malabsorbtion
autoimmune condition against parietal cells that make intrinsic factor. Intrinsic factor is needed for your body to absorb vitamin B12 from the food you eat.
What antibodies are related to pernicious anaemia
Parietal cell antibody (PCA)
intrinsic factor antibody (IFA)
Extra intestinal features of IBD
- Arthritis - polyarticular, symmetric
- Uveitis (UC more common)
- Epscleritis (chrohns)
- Mouth ulcers
- Skin tags
- Pyoderma gangrenosum
- Primary sclerosing cholangitis (UC)
- clubbing
- erythema nodosum
- osteoporisis
Bloods related to IBD
- Anaemia
- Low B12 and Vit D
- Raised CRP + ESR
raised faecal calprotectin
What part of the gut is biopsied when confirming coeliac disease
duodenum and jejunum
What is Sjogrens syndrome
Autoimmune disease against exocrine glands (salivary and tears)
anti-SSA (Ro) and Anti-SSB (La)
what is primary sjogrens syndrome called
Sicca Syndrome
What conditions are associated with secondary sjogrens
SLE
RA
What symptoms are associated with sjogrens
Dry burning eyes
swollen/painful parotid glands and lymphnodes
xerostomia
cracked mouth
crusted nose
Dry vagina
Increased risk of infections
Tests for sjogrens
Anti SSA and SSB
sialometry
Lip biopsy
Cancer associated w Sjogren
B-call hodgkin lymphoma
