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GP FELLOWSHIP RNZGP > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

HBsAg pos
Anti-HBc pos
IgM Anti-HBcore Negative
Anti-HBs Negative

What is this?

A

Chronic hepatitis B

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2
Q

HBsAg neg
Anti-HBc neg
Anti-HBs pos

What is this?

A

Vaccinated

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3
Q

HBsAg neg
Anti-HBc pos
Anti-HBs pos

What is this

A

Resolved HepB infection

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4
Q

HBsAg pos
Anti-HBc pos
IgM Anti-HBcore pos
Anti-HBs Negative

What is this?

A

Acute Hep B infection

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5
Q

Stages of Chronic Hepatitis B infection (just the stages)

A

Phase 1: Immune tolerance
Phase 2: Immune clearance
Phase 3: Immune control
Phase 4: Immune escape

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6
Q

Stages of Chronic Hepatitis B infection (Description of stages- tests)

A

Immune tolerance
- Viral load HIGH
- LFTs Normal
- HBeAg pos
–> monitor 6-12 monthly

Immune clearance
- Viral load HIGH
- LFTs deranged
- HBeAg pos
–> refer for treatment

Immune control
- Low viral load
- LFTs normal
- Anti- HBeAg
–> monitor 6-12 monthly

Immune escape
- Viral load HIGH
- LFTS deranged
- Anti- HBeAg
—> refer for treatment

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7
Q

HCC surveillance (indications, and what)

A
  • LIVER US +/- AFP

Chronic heb B PLUS
- Cirrhosis
- Without cirrhosis but:
African >20
ASTI >50
Asian men >40
Asian women >50
Family hx HCC

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8
Q

Chronic Hep B monitoring

A

Viral load

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9
Q

Iron supplementation counselling

A
  • Constipation
  • GI upset: nausea
  • 3 months then retest
  • Take on empty stomach
  • Dark stools
  • Take with vitamin C
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10
Q

Chronic Heb B management (on antivirals)

A
  • Quarterly viral load
  • annual HbsAg and Anti-Hbs (for seroconversion- therefore cessation of treatment)
  • HCC surveillance
  • Condoms with new partners
  • etOH
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11
Q

Aspirin advice for bowel cancer prevention

A

100mg daily for at least 2.5 years (from 50-70 years)

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12
Q

Immediate emergency management of haematemesis (shock symptoms)

A
  • Call ambulance for urgent transfer to tertiary centre
  • Insert 2x large bore IV cannulae in cubital fossa
  • Normal saline 0.9% bolus (500ml-1000ml)
  • IV pantoprazole 40-80mg stat ** don’t forget
  • Keep NBM
  • Monitor vitals
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13
Q

Clinical signs for haemachromatosis

A
  • Bronzed skin
  • Joint swelling/tenderness

Then think liver disease signs
- Hepatomegaly, spider naevi

Then think heart failure
- Peripheral pitting oedema, elevated JVP

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14
Q

General causes for LFT derrangement (young, without cancer risk factors)

A
  • Alcoholic hepatits/fatty liver diseae
  • Hepatic steatosis
  • Hepatitis A,B,C
  • Autoimmune hepatitis
  • Haemochromatosis
  • Rare: Wilson’s, alpha 1 anti-trypsin deficiency
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15
Q

Non alcoholic fatty liver disease- new name

A

MAFLD
Metabolic (dysfunction) associated fatty liver disease

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16
Q

Management of MALFD

A
  • Weight loss 7-10% (referral to AEP)
  • Mediterranean diet
  • Atorvastatin 10mg
  • No alchohol
  • arrange Fibroscan to assess for fibrosis
  • Discuss HepA&B vaccination
  • Aggressive management of CVD risk factors
17
Q

Screening for HCC in cirrhosis

A

AFP (alphafetoprotein) every 6 months
Liver US every 6 months

18
Q

Differentials for dyspepsia

A
  • GORD
  • H.pylori gastritis
  • PUD
  • Medication induced Gastritis
  • EtOH induced gastritis
  • Functional dyspepsia
  • Biliary colic
  • Gastric or oesophageal ca
  • pancreatitis
  • Gastroparesis
19
Q

PUD management
(Plus indications for prolonged acid suppression & repeat gastroscopy)

A
  • Pantoprazole 40mg**
  • Smoking cessation
  • Consider repeat gastroscopy 8-12 weeks to check resolution ***

**
Giant ulcer >2cm
Other issue needing ongoing NSAIDs (eg stroke prevention)
>2 in a year
Persistent on repeat endoscopy

Giant >2cm
persistent symptoms despite PPI
evidence of bleeding
features of malignancy

20
Q

LFTs: ALP >200 and ALP 3x ALT
- Cholestasis or HC damage

A

Cholestasis

21
Q

LFTs: ALT >200 and ALT 3x ALP
- Cholestasis or HC damage

A

HC Damage

22
Q

Causes of Cholestasis picture on bloods

A

1) Pregnancy
2) Biliary obstruction:
- Gallstone
- Head of pancreas carcinoma
- Cholangiocarcinoma
3) Drugs: erythromycin, oestrogen, flucloxcillin
4) Primary biliary cirrhosis
5) Primary sclerosing cholangitis

23
Q

> 60 & weight loss
PLUS and
- Diarrhoea
- Vomiting
- Abdominal pain
- Change in bowels,
- New onset diabetes

a) What are you concerned about?
b) what test

A

Pancreatic carcinoma

CT abdomen

24
Q

Traveller’s Diarrhoea Pharmacology management

A

Azithromycin 1g single dose

25
Q

Distal Oesophageal Spasm pharmacology

A
  • Trial PPI
  • GTN 400mcg spray
    or if disabling
  • Diltiazem MR 180mg daily
26
Q

Hepatitis B non responder (someone who received childhood vaccines but then titre <10)
Booster plan?

A

One today (=4th dose) then if titre in 4 weeks then if negative then for 2 further doses 1 month apart

27
Q

IBS non-pharmacological management

A
  • Use food diary to identify triggers to avoid
  • Refer to dietician for low FODMAP diet
  • Referral to psychologist for CBT
  • Advise on meal portion control
  • Regular meal times
28
Q

Anal fissure treatment (hint: topical)

A

GTN 0.2% ointment up to QID

29
Q

Anal fissure non-pharmacological management

A
  • High fibre diet to achieve soft bowel motions
  • Sitz bath or warm salt bath after opening bowels
30
Q

TRIPLE THERAPY for H Pylori

A

Esomeprazole 20mg BD 7-14 days

AMoxicillin 1g PO BD 7-14 dyas

Clarythromycin 500mg PO BD 7-14 days

31
Q

GORD treatment duration (inital)

A

4-8 weeks

32
Q

IBS differentials (vague bloating and pain)

A
  • SIBO
  • Coeliac
  • IBD
  • lactose/gluten/fructose intolerance
33
Q

SIgns of severity for diverticulitis

A

Signs of peritonitis
- severe pain
- rebound tenderness or guarding

Sepsis
- SBP <90
- Hypoxaemia

Bowel obstruciton
- distension
- obstipation

34
Q

Non-pharmacological bowel cancer prevention

A
  • Avoid smoking
  • <2 std /day etOH (1 for women)
  • Increased cereal fibre
  • Healthy BMI
  • 30-60 mins exercise per day
35
Q

Hepatitis C treatment medication contraindications

A
  • Statins
  • PPIs
36
Q

Test for screening for cirrhosis

A

Fibroscan

or

AST to platelet Ratio Index (APRI) - if fibroscan not available

Plus INR (sensitive)

37
Q

When to tests for success of HCV treatment?

A

12 weeks post test HCV RNA level

(Antibody will stay positive life long)

38
Q

Tests to consider at time of diagnosis of Coeliac disease

A
  • TSH
  • LFTs
  • B12, Folate, Vit D
  • BMD

Also
- Join coeliac australia

39
Q

Jaundice differentials (also with weight loss) (HINT cancer and non-cancerous causes)

A
  • Pancreatic carcinoma of the pancreas
  • Cholangiocarcinoma
  • Hepatocellular carcinoma
  • Liver metastases

NON CANCER:
- Alcoholic hepatitis
- Viral hepatitis eg HCV
- Choledocolithiasis
- Primary biliary cirrhosis

GP FELLOWSHIP RNZGP (20 decks)

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