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
