Gastroenterology Flashcards
Early dumping syndrome
- Rapid onset - 15 minutes
- Colicky abdominal pain, diarrhoea, nausea, tachycardia
- Sympathetic nervous response - due to rapid emptying of food into bowel causing fluid shifts
Late dumping syndrome
- Onset 2-3 hours post meal
- Dizziness, fatigue, diaphoresis, weakness
- Postprandial (reactive) hypoglycaemia - following insulin peak
Hepatitis B serology - Previous infection
HBsAg-
HBsAb+
HBcAb+
HBeAg-
Hepatitis B serology - Previous vaccination
HBsAg-
HBsAb+
HBcAb-
HBeAg-
Hepatitis B serology - Chronic infection
HBsAg+
HBsAb-
HBcAb+
HBeAg+
Hepatitis B serology - Acute infection
HBsAg+
HBsAb-
HBcAb+
HBeAg+
Hepatitis B serology - Precore mutant infection
HBsAg+
HBsAb-
HBcAb+
HBeAg-
Indications for infliximab and adalimumab in Crohn’s disease
- Refractory to steroids and AZA/MP/MTX
- Refractory fistulising Crohn’s disease
Indications for H. pylori eradication
MALT lymphoma
Active peptic ulcer disease
PHx of documented peptic ulcer
Common cause of portal hypertension
Cirrhosis - 90%
Portal vein thrombosis
Hepatic schistosomiasis
Portal hypertension - diagnosis
Hepatic venous pressure gradient (HVPG) = wedged hepatic venous pressure (WHVP) - free hepatic venous pressure (FHVP)
PHT = HVPG greater than 5
Clinically significant PHT = HVPH greater than 10
Cirrhosis - predictors of 3 month mortality
MELD score
- INR
- Creatinine
- Bilirubin
- Haemodialysis
Cirrhosis - predictors of 1-2 year mortality
Child-Pugh score
- Encephalopathy
- Ascites
- Bilirubin
- Albumin
- Prothrombin time / INR
Site of folic acid absorption
Proximal jejunum
Site of fat absorption
Duodenum
Site of bile salt absorption
Terminal ileum
Site of vitamin B12 (cobalamin) absorption
Terminal ileum
Alpha-1 antitrypsin deficiency (AAT) - liver pathophysiology
Toxic gain of function - accumulation in hepatocyte of unsecreted variant AAT protein
Site of vitamin C absorption
Proximal jejunum
Site of iron absorption
Duodenum
Site of calcium absorption
Proximal jejunum
Serology - primary biliary cirrhosis (PBC)
AMA +ve
ANA +ve
ALP elevated
Lipids elevated
Serology - primary sclerosing cholangitis
P-ANCA +ve
Serum IgM elevated
Hypergammaglobulinaemia
ALP elevated
Serology - autoimmune hepatitis type-1 (AIH-1)
Anti-SMA +ve
ANA +ve
P-ANCA +ve
Serology - autoimmune hepatitis type-2 (AIH-2)
Anti-LKM +ve
ANA +ve
Paracetamol poisoning - indications for N-acetyl cysteine (NAC)
- Concentration above treatment line in normogram at ≥4 hours
- Single ingestion more than 150mg/kg (or 7.5g total), if concentration unavailable
- Unknown time of ingestion and concetration more than 10mg/L
- Evidence of liver injury and past history of paracetamol ingestion
Eosinophilic oesophagitis - presentation
Oesophageal dysfunction / dysphagia Food bolus obstruction Corrugated iron rings, longitudinal furrows Young males History of atopy
Eosinophilic oesophagitis - treatment
PPI - sufficient up to 80%
Topical corticosteroid (eg. fluticasone)
Oesophageal dilatation
Barrett’s oesophagus - treatment
- Surveillance - until high grade dysplasia
- PPI - reduces progression
- Oesophagectomy - young patients
- Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) - preferred treatment
Achalasia - treatment
- Dilatation - treatment of choice, younger patients
- Botox - 70% success, elderly patients
- Myotomy - surgical division of LOS
- GTN / CCB - less effective
Most common pharmacological cause of gastric ulceration
Aspirin - 45% Ibuprofen - 25% Indomethacin - 25% Diclofenac - 15% Meloxicam - less ulcers, but not completely benign
H.pylori associated ulcers - treatment
Triple therapy
- Amoxycillin
- Clarithromycin
- PPI
Most likely Hepatitis C genotype to progress to cirrhosis / HCC
Genotype 3
- Associated with steatosis
- Increased progression to cirrhosis / HCC
- Lower response rates to treatment
Hepatitis C - treatment
Genotype: 1 – sofosbuvir, ledipasvir 2 – sofosbuvir, ribavirin 3 – sofosbuvir, daclatasvir 4, 5, 6 – sofosbuvir, peg-interferon, ribavirin (usually 12 weeks duration)
Hepatitis C direct acting antivirals (DAA) - mechanism of action
Sofosbuvir - nucleoside NS5B polymerase inhibitor
Ledipasvir - NS5a inhibitor
Daclatasvir - NS5a inhibitor
Chronic hepatitis B - treatment
Entecavir
OR Tenofovir
OR Pegylated interferon
(until 6 months after HBeAg seroconversion and undetectable HBV DNA; if HBeAg -ve chronic hepatitis, treat until HBsAg clearance)
Hepatocellular carcinoma (HCC) - treatment
Resection - very early stage, less than 2 cm
Transplantation - early stage, 3 nodules ≤3cm
Chemoembolisation (TACE) - larger tumours
Sorafenib - advanced stage, slows progression
Hepatocellular carcinoma (HCC) - surveillance
6-monthly liver US and AFP
Spontaneous bacterial peritonitis - treatment
IV Ceftriaxone
Prophylaxis - norfloxacin, Bactrim DS
Ulcerative colitis - treatment (induction)
Sulfasalazine or 5-aminosalicylate - in mild to moderate
Corticosteroids - in severe
Ulcerative colitis - treatment (maintenance)
Sulfasalazine
5-aminosalicylate
Crohn’s disease - treatment (induction)
Corticosteroids - eg. budesonide
Crohn’s disease - treatment (maintenance)
Thiopurine - eg. azathioprine
Infliximab - in refractory or fistulising disease
