Gastroenterology Flashcards
What is Rovsing’s sign and what does it indicate?
Palpation of LLQ increases pain in RLQ
Indicates appendicitis
How does Wilson’s disease usually present? (Age + 3 features)?
Excessive copper deposition
Presents age 10-25
(Autosomal recessive)
Hepatitis, speech/ behaviour problems, haemolysis, blue nails, asterixis (flapping tremour), chorea (kerky movements)
- Liver + neuro signs = think Wilsons
What triad of features are seen in acute liver failure?
Encephalopathy
Jaundice
Coagulopathy
What is an important complication of primary sclerosing cholangitis?
Cholangiocarcinoma (jaundice, weight loss and biliary symptoms) - 10% of all those with PSC
A 25-year-old female currently under investigation for secondary amenorrhoea presents with jaundiced sclera. On examination spider naevi are present along with tender hepatomegaly. Blood tests show: Hb 11.6 g/dl Plt 145 * 109/l WCC 6.4 * 109/l Albumin 33 g/l Bilirubin 78 µmol/l ALT 245 iu/l What is the most likely diagnosis?
Autoimmune hepatitis
The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest autoimmune hepatitis
What are the histological findings in coeliac disease?
Villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia
What is Gilberts syndrome?
Autosomal recessive
Unconjugated hyperbilirubinemia
Reduced glucuronyltransferase
What is Virchow’s node?
Swollen LN in left supraclavicular region
- Indicates gastric cancer
You suspect bowel obstruction, what investigations must be done as a minimum?
AXR
PR exam
What is primary sclerosing cholangitis?
Fibrosis of intra and extrahepatic ducts, possibly autoimmune
- Associated with UC (80%)
What investigations could be done for suspected PSC? (3)
US then MRCP
pANCA may be +ve
LFT’s (obstructive)
What triad is typically seen in mesenteric ischemia?
CVD - look for AF
Poorly localised abdo pain (worse than exam would suggest)
Vomiting or diarrhoea
(High lactate)
What advice is given to patients awaiting OGD regarding their PPI’s?
Stop 2 weeks before gastroscopy
What antibody is highly specific for primary billiary sclerosis?
anti-Mitochondrial antibody
M’s (mitochondrial ab, Middle aged women, IgM)
What are the two hepatitis A antibodies and what do they show?
Hep A IgM = Current infection
Hep A IgG = Past infection or vaccination
(think G=gone)
Which blood test can be used to look for current hepatitis B?
HBsAg
(HBs antigen = acute disease)
HBeAg is a marker of infectivity
Also anti-HBc MAY be +ve
What are the two main antibodies seen in hepatitis B, what do they each show?
Anti-HBs = Immunity (either infection or vaccine)
Anti-HBc = Previous or current infection
C is CORE so will only be infection, not vaccination
A healthcare professional has been vaccinated against Hep B but never had the disease, what will a hep B screen show?
Anti-HBs = +ve Anti-HBc= -ve (shows current/ past infection) HBsAg = -ve (shows current infection) HBeAg = -ve (shows current infectivity)
A patient has previous had Hep B and is now immune, what will their bloods show? (Assuming no current active disease)
Anti-HBs = +ve Anti-HBc = +ve HBsAg = -ve HBeAg = -ve
How do you manage Hep A?
rest, fluids, anti-emetics
Stop alcohol and paracetamol
Recovery 3-6months
How do you manage Hep B?
(as Hep A) +
- No intercouse til non-infective
- If HBeAg +ve then give peginterferon alpha for a year
Symptoms resolve in 4-8 weeks (10% become chronic)
How do you manage Hep C?
Supportive as A/B
+ Peginterfron alpha and ribavarin
85% become chronic
What serology can be checked for Hep C, what does each indicate?
Anti-HCV = Current or recovered infection
HCV RNA = Active infection (the ones to be treated)
Name 5 symptoms of hepatitis?
Malaise Weakness Pruritus Jaundice (dark urine + pale stools) Anorexia Hepatomegaly