Gastroenterology Flashcards
Management of non-variceal bleeding:
Variceal bleeding:
No PPI prior to endoscopy -> given afterwards.
Management of variceal bleeding: Terlipressin and prophylactic antibiotics (prior to endsocopy)
Band ligation and injection
TIPS may be offered if bleeding from varices not controlled
Alcoholic liver disease
Investigation findings:
Management:
Gamma-GT classically elevated
AST (2X) : ALT (3X is suggestive of acute alcoholic hepatitis)
Prednisolone
Pentoxyphyline is sometimes used
Aminosalicylates important side effect:
Agranulocytosis -> Check FBC
ASCITES:
Main differentiator:
SAAG >11
SAAG <11
SAAG > 11 indicates portal hypertension
Liver disorders
Cardiac
Other: Budd Chiari syndrome, portal vein thrombosis, veno-occlusive disease, myxoedema
Hypoalbuminaemia
Malignancy
Infections
Other: Pancreatitis, bowel obstruction, biliary ascites
UC management:
Proctitis
Proctosigmoiditis
Extensive disease
SEVERE colitis:
Proctitis: rectal mesalazine
Proctosigmoiditis: Rectal mesalzaine
Extensive disease: Rectal mesalazine plus high-dose oral aminosalicylate
In general: if remission not achieved in 4 weeks, add oral aminosalicylate
If remission still not achieved, stop topical, oral aminosalicylate and add oral steroid
Should be treated in hospital: IV steroids usually given first line
IV ciclosporin may be used if steroids are contraindicated
UC management: Maintaining remission
Proctitis and proctosigmoiditis:
Left-sided and extensive UC:
Proctitis and proctosigmoiditis:
Topical (rectal) aminosalicylate or rectal AS with oral AS
(monotherapy with oral is not as effective)
Oral aminosalicylate
What is Budd-Chiari syndrome
Usually seen in:
Features:
Investigation of choice:
Hepatic vein thrombosis
Context of procoagulant conditions - polycythaemia, thrombophillia, pregnancy, COCP (20% cases)
Triad of: Abdominal pain // Ascites // Tender hepatomegaly
US with Doppler flow studies = very sensitive
Features of carinoid tumours:
investigation:
Metastases are present in the liver and release serotonin into the systemic circulation
Flushing
Diarrhoea
Bronchospasm
Hypotension
Urinary 5-IHAA
Plasma chromogranin
Management: Somatostatin analogues octreotide
C.difficile severity scale - based on:
Classed into:
Diagnosis
Management:
WCC
Mild: normal WCC
Moderate: WCC <15 3-5 loose stools/day
Severe: WCC > 15, AKI, temperature
Life-threatening: hypotension, partial or complete ileus, toxic megacolon
Made by detecting CDT C.dif toxin
First episode: oral vancomycin 10 days
second line: Fidaxomicin
Third-line oral vancomycin plus Iv metronidazole
Recurrent episode: Fidaxomicin
Life threatening: Oral vancomycin and IV metronidazole
Coeliac complications:
anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)
Hyposplenism
osteoporosis, osteomalacia
lactose intolerance
enteropathy-associated T-cell lymphoma of small intestine
subfertility, unfavourable pregnancy outcomes
rare: oesophageal cancer, other malignancies
Coeliac investigations:
Gold standard investigation:
tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
endomyseal antibody (IgA) - needed to look for selective IgA deficiency, which would give a false negative coeliac result
anti-gliadin antibody (IgA or IgG) tests are not recommended by NICE
anti-casein antibodies are also found in some patients
Gold standard: intestinal biopsy
Drugs causing hepatocellular injury:
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
Drugs causing cholestasis:
COCP
Flucloxacillin, co-amoxiclav, erythromycin
chlorperazinem prochlorperazine
Gliclazide
Fibrates
Drugs causing liver cirrhosis:
Methotrexate
Methyldopa
Amiodarone
GORD: gold standard diagnostic test:
If endoscopy is negative consider 24-hr oesophageal pH monitoring (the gold standard test for diagnosis
