Gastroenterology Flashcards
How does Wilson’s disease present?
liver: hepatitis, cirrhosis
neurological:
basal ganglia degeneration: in the brain, most copper is deposited in the basal ganglia, particularly in the putamen and globus pallidus
speech, behavioural and psychiatric problems are often the first manifestations
also: asterixis, chorea, dementia, parkinsonism
Kayser-Fleischer rings
green-brown rings in the periphery of the iris
due to copper accumulation in Descemet membrane
present in around 50% of patients with isolated hepatic Wilson’s disease and 90% who have neurological involvement
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails
How do we treat Wilson’s disease?
Penicillamine
How do we treat ascites secondary to liver cirrhosis?
Patients with ascites secondary to liver cirrhosis should be given an aldosterone antagonist. In ascites, aldosterone antagonists (such as spironolactone) are the preferred diuretic as they combat sodium retention. Due to this, patients should also be commenced on a low-salt diet.
Furosemide is a useful diuretic in combination with spironolactone, however, it is ineffective at blocking aldosterone (and its sodium retaining effects in the distal tubule and collecting duct).
What is the M rule in primary biliary cholangitis?
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
How do we induce remission in mild-moderate UC?
Topical (rectal) aminosalicylate
Name the most common anti-emetic that can cause EPSEs
Metoclopramide can cause extrapyramidal side effects, most commonly acute dystonia causing oculogyric crises, as is described in the history above. (eyes trapped in strange position, unable to move)
What is the first line management of NAFLD?
Weight loss
How do we manage ? variceal bleeding?
Terlipressin and prophylactic antibiotics is correct. This woman has a history of alcoholic liver cirrhosis, making variceal bleeding the most likely cause of the haematemesis. NICE recommends giving both terlipressin and prophylactic antibiotics before endoscopy. Bacterial infections occur in about 20% of patients with cirrhosis with upper gastrointestinal bleeding within 48 hours of admission which increases the mortality rate. Thus, it is important to prescribe prophylactic antibiotics. Terlipressin reduces portal blood flow, portal systemic collateral blood flow, and variceal pressure which reduces the risk of rebleeding.
Primary sclerosing cholangitis is most associated with…
UC
What test is recommended after H pylori eradication therapy?
Urea breath test
What is a severe flare of UC?
Stools 6+ a day + features of systemic upset
When do we omit PPIs prior to endoscopy?
2/52
Which vitamin is teratogenic in high doses?
Vitamin A
When is the Blatchford score used?
The Blatchford score is used to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy.
What is the AST/ALT ratio in alcoholic hepatitis?
The AST/ALT ratio in alcoholic hepatitis is 2:1
Salt (AST) before Lime (ALT) in your Tequila shot (alcohol)
How does pharyngeal pouch present?
A pharyngeal pouch, also known as Zenker’s diverticulum, is a condition where a small sac forms in the throat just above the oesophagus. This man’s symptoms of intermittent dysphagia (difficulty swallowing), halitosis (bad breath), and nocturnal coughing are characteristic of this condition. The coughing may be due to aspiration of food trapped in the pouch, while halitosis results from bacterial breakdown of retained food.
Where would you see Murphy’s sign?
Acute cholecystitis, not biliary colic
How do we interpret antibodies in hepatitis?
Anti-HBc = cirrhosis (previous or current infection)
Anti-HBs = safe (you are safe because of your immunisations)
HBsAg = AAAA s*** oh no you have new disease
