Gastroenterology Flashcards
organisms commonly implicated in SBP
Escherichia coli, Klebsiella pneumoniae, and pneumococci.
Screening test for Zollinger- Eliizon syndrom
Fasting gastrin
maltase as a brush border enzyme produces what
glucose + glucose
sucrase: as a brush border enzyme produces what
glucose + fructose
lactase: as a brush border enzyme produces what
glucose + galactose
monoclonal antibody which targets C. difficile toxin B
Bezlotuxumab
Think B for C Diff toxin B
LFTs in alcoholic liver disease
A key feature of ALD is that AST levels often exceed ALT levels, typically in a ratio greater than 2:1.
gamma-GT is characteristically elevated
the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis
: The predominance of AST over ALT in ALD is attributed to the higher concentration of AST in the mitochondria, which are more affected by alcohol-induced injury. Ethanol metabolism generates reactive oxygen species and promotes mitochondrial damage, leading to increased release of AST.
Immunology findings in Primary Biliary Colangitis
-anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific
smooth muscle antibodies in 30% of patients
raised serum IgM
Biopsy findings is most suggestive of ulcerative colitis
Goblet cell depletion neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
initial investigation for heamachromatosis
ferrritin and transferrin saturations
Diarrhoea - biospy shows pigment laden macrophages
Laxative abuse
Purtscher) retinopathy
cotton wool spots seen on fundoscopy represents Purtscher retinopathy. This condition may be seen following head trauma and in conditions such as acute pancreatitis, fat embolisation, amniotic fluid embolisation, and vasculitic diseases
Whipples disease
Whipple’s disease is a rare multi-system disorder caused by Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.
Features
malabsorption: diarrhoea, weight loss
large-joint arthralgia
lymphadenopathy
skin: hyperpigmentation and photosensitivity
pleurisy, pericarditis
neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus
Investigation
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Management
guidelines vary: oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin
villous adenoma
secretory villous adenomas of the colon cause hyperchloremic metabolic acidosis with associated hypokalaemia because they produce large volumes of potassium, bicarbonate-rich fluid. The presence of adenomas, metabolic acidosis, and hypokalaemia favours this diagnosis.
Fat soluabke vitamiins implicated in malabsorbition
A, D, E, K malabsorption.
Oceotide is a synthetic version of what?
Somatostatin (secreted by D cells in the panceas and stomach
Whipples disease biopsy findings
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
most appropriate test for bile acid malabsoprtion
SeHCAT test
Plummer-Vinson syndrome
rare condition characterized by the triad of iron deficiency anaemia, dysphagia due to esophageal webs, and atrophic glossitis
Ig in coeliac?
IgA
familial adenomatous polyposis (FAP) genetics
APC gene on Chr 5 - autosomal dominant
HLA Related Diseases:
A3 = Hemochromatosis
B8 = Graves disease
B16 = MS
B18 = T1DM
B27* = Ankylosing Spond, Psoraitic Arth, IBDs, Reactive Arth
DQ2&8* = Celiac
DR1 = Myasthenia, RA, Schizophrenia
DR2 = MS, Hay Fever, SLE, Goodpasture
DR3 = Addisons, Myasthenia, SLA, Graves, T1DM
DR4* = T1DM, RA
DR5* = T1DM, Hashimotos, Pernicious Anemia, RA, Antiphospholipid Sx
SBP diagnosis in ascitic fluid
> 250 neutophils in ascitic fluid
Whipples disease histological finding
PAS the Whip
duodenal or jejunal biopsy, where macrophages are found to stain positive for Periodic acid-Schiff (PAS) granules.
Autoimmune hepatitis is most characteristically associated with elevated levels of
IgG, Anti SMA, LKM1
Duodenem is the primary site of absorbtion of what and therefore what needs supplementing in a patient with a gastric bypass?
Calcium & iron -> both need to be supplemented
most abosrption of common nutrients is in the jejuenum important execeptions
fe and Ca are duodenally absorbed
bile salts and b12 are absorbed in the terminal ileum
