Gastroenterology Flashcards
6 big laboratory screen test for malabsorption
- Iron studies
- Prolonged PT
- Low calcium (vitamin D deficiency)
- Low cholesterol
- Low carotene
- Positive Sudan stain of the stool for fat (good screening test for steatorrhoea)
What food needs to be excluded in gluten-free diet?
- Wheat
- Rye
- Barley
Symptoms usually improve in weeks and histology in months if coeliacs disease is present
Extracolonic manifestations of Crohn’s disease
- Liver disease (PSC less common than UC)
- Gallstone disease (due to decreased bile salt pool)
- Renal disease due to urate and calcium oxalate stones, amyloidosis
- Malabsorption due to SB involvement
- Osteomalacia
What histological features are suggestive of UC over Crohn’s disease?
Mucus depletion and prominent crypt abscess
Bowel cancer screening in UC/Crohns
1-2 yearly screening if pancolitis for >7 years or L sided colitis for 15 years
If high grade dysplasia is seen in setting of severe inflammation, assessment of dysplasia can be misleading and should be repeated once Pt is stable.
Assessment of severity of UC
Mild - <4 bowel motions/day, minimal bleeding, normal pulse rate and temperature
Acute severe - >6 BM/day, profuse bleeding, temperature >37.5, HR >90, abdominal tenderness
Fulminant - >10 BM/day, continuous bleeding, fever and tachycardia, abdominal tenderness and distension
Sulfasalazine - SE, minimal dose
Mostly reaction to sulfapyridine - allergic reaction such as skin rash and SJS, haemolytic anaemia, nausea, headache, folate deficiency, reversible male infertility)
If reaction to sulfasalazine, use mesalazine which is the active component of sulfasalazine.
Minimum dose is 4g/day
Used indefinitely in UC to decrease relapse rate
Side effect of azathioprine/6MP
- Pancreatitis in 3%
2. Reversible bone marrow suppression
Manifestations of UC which are not cured by colectomy
- Ankylosing spondylitis
- Liver disease
- Pyoderma gangrenosum
Management of Crohn’s disease
Sulfasalazine/mesalazine - for colonic disease
Budesonide for SB disease esp ileocolonic disease
AZA/MTX are used to reduce long term relapse rates
With extensive ileal disease with bile salt diarrhoea, use Cholestyramine for bile salt sequestration
Metronidazole or ciprofloxacin is modestly useful in severe perianal disease and fistulaes - but tends to recur when stopped
TNF alpha inhibitor for fistulising disease
Causes of ascites based on SAAG >11g/L and <11g/L
> 11g/L - secondary to portal hypertension
- Cirrhosis
- Alcoholic hepatitis
- Cardiac ascites
- Budd Chiari syndrome (hepatic vein thrombosis) or IVC obstruction
<11g/L - not related to portal hypertension
- Peritoneal TB
- Peritoneal carcinomatosis
- Pancreatitis
- Nephrotic syndrome
Factors which can exacerbate acute hepatic encephalopathy in cirrhosis
- GIB
- Alkalosis - increases ammonia crossing BBB
- Hypokalaemia - causes increased renal ammonia production
- Infection
- Constipation
6 extrahepatic manifestations of HCV
- Mixed cryoglobulinaemia
- Porphyria cutanea tarda
- MPGN
- Hashimoto’s thyroiditis
- B cell lymphoma
- Polyarthralgia/polyarthritis
5 factors in Child Pugh score
3 serological factors which assess synthetic function (Bilirubin, INR, albumin)
2 Clinical factors (ascites, hepatic encephalopathy)
Max score of 15, with 1 year survival being:
5-6 = class A 100% 7-9 = class B 80% 10-15 = class C 45%
Distinguishing features of a spleen compared with a kidney
- Spleen has no palpable upper border
- Spleen has a notch
- Spleen moves inferomedially on respiration
- No resonance over a splenic mass
- Spleen is not bimanually palpable (ie not ballotable)
