Gastroenterology 2.0 Flashcards
What to do if the patient has suspected C.difficile infection?
Commence Oral metronidazole and isolate for 48hours
if that is ineffective then switch to oral vancomycin!
when do you most commonly see spontaneous bacterial peritonitis?
in patients with ascites secondary to liver cirrhosis
When should you give antibiotic prophylaxis to patients with ascites.
What AB do you use?
- If they have had a previous episode of SBP
- If their fluid is <15g/L protein or score >9 on child-pugh score
Ciprofloxacin or norfloxacin
Child-pugh score tests?
Cirrhosis mortality
- bilirubin
- albumin
- ascites
- INR
- encephalopathy
How do you get Gilbert’s Syndrome?
When you get defective bilirubin conjugation due to a UDP glucuronyl transferase deficiency
Autosomal Reccessive
What is the presentation and treatment of Gilberts Syndrome?
- unconjugated hyperbilinaemia (i.e. not in urine)
- jaundice may only be seen during an intercurrent illness
No treatment required
What is the M rule of Primary Billiary Cirrhosis
- IgM
- Anti-mitochondrial antibodies; M2 subtype
- Middle aged females
In Wilsons, an excess deposition of copper, what happens throuhgout the body?
- Liver: Cirrhosis + hepatitis
- Neurological: speech and behavioural issues, basal ganglia degeneration
- Kayser fleisher rings
- Renal Tubular Acidosis
- Haemolysis
- Blue Nails
How do you diagnose Wilsons Disease
- reduced serum caeruloplasmin
- reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
- increased 24hr urinary copper excretion
What is the first line treatment for Wilsons
penicillamine (chelates copper)
What is a Mallory Weiss Tear and who usually gets it?
Severe vomiting → painful mucosa tears at the gastroesophageal junction resulting in haematemesis.
Occurs in alcoholics
What can predispose Oesophageal candadisis and how what these patients present?
Present with pain on swallowing.
HIV or inhaled steroid use
I someone has epigastric pain when hungry which is relieved by eating, what should you be thinking of?
A duodenal ulcer
gastric is worse with food, duodenal is worse when hungry.
How do you remember the causes of pancreatitis?
GET SMASHED
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps (other viruses include Coxsackie B)
- Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
- Scorpion venom
- Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
- ERCP
- Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
When the doctor palpates the left iliac fossa, the boy feels pain in the right iliac fossa.
May indicate appendicitis. What is this sign called?
Rovsings Sign
What is the thinking behind the pathogenesis of hepatic encephalopathy?
Excess absorption of ammonia and glutamine from bacterial breakdown of proteins in the gut.
Can occur with any lliver damage
Features of Hepatic Encephalopathy
- confusion, altered GCS
- asterix: ‘liver flap’, arrhythmic negative myoclonus with a frequency of 3-5 Hz
- constructional apraxia: inability to draw a 5-pointed star
- triphasic slow waves on EEG
- raised ammonia level (not commonly measured anymore)
What is the first-line treatment for Hepatic encephalopathy and why?
Lactulose
It is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
High urea levels can indicate an ______GI bleed versus _____GI bleed.
Why?
High urea levels can indicate an upper GI bleed versus lower GI bleed
Upper GI bleeds increased urea level occurs due to the breakdown of red blood cells in the stomach.
What is an indicatvie triad of mesenteric ischaemia?
CVD, high lactate, soft and tender abdomen
Plummer-Vinson syndrome is what?
Dysphagia, glossitis and iron-deficiency anaemia
(some definitions additionally include cheilitis in the syndrome).
How can constipation cause liver decompensation (jaundice and confusion).?
In patients with chronic Heaptitis, constipation can lead to toxin buildup.
Consider treating with an enema to avoid this!
What do you test for with Hep C, and what antibodies will hte patient eventually develop?
HCV RNA is diagnostic
Patients will eventually develop anti-HCV antibodies, and these will persist even if the infection is spontaneously cleared
