Gastroenterology Flashcards
1
Q
how is bilirubin produced in liver?
A
conjugated
2
Q
clinical signs of conjugated hyperbilirubinaemia
A
jaundice
dark urine
pale stool
itch
3
Q
what causes conjugated hyperbilirubinaemia
A
post-hepatic obstruction
4
Q
causes of obstructive jaundice (5)
A
common: gallstones (biliary colic and cholecystitis/chalngitis), carcinoma of head of pancreas
uncommon: sclerosing cholangitis, cholangiocarcinoma, chronic pancreatitis
5
Q
causes of hepatocellular jaundice
A
common: alcoholic hepatitis or cirrhosis, viral hepatitis, drug induced, NASH
uncommon: autoimmune liver disease, haemochromatosis, Wilson’s Disease
6
Q
most likely diagnosis if rise in ALT, AST»_space; rise in alkaline phosphatase (ALP)
A
hepatocelullar damage
7
Q
most likely diagnosis if rise in ALT, AST «_space;rise in alkaline phosphatase (ALP)
A
obstructive cause
8
Q
organs of production of AST
A
liver (mitochondrial enzyme), heart, muscle, kidney and brain
9
Q
ALT:AST ratio in disease
A
- viral hepatitis: ALT>AST
- viral hepatitis + cirrhosis: AST>ALT and ratio >1
- alcoholic liver disease and steastohepatitis: AST>ALT
- liver disease w/out cirrhosis (alcohol and obesity most common cause): AST>ALT
10
Q
organs of production of alkaline phosphatase (ALP)
A
hepatic canalicular and sinusoidal membranes
bone
intestine
placenta
11
Q
serum levels of ALP in intracellular and extracellular cholestatic disease
A
increased
if GGT abnormal, ALP presumed to come from liver
12
Q
gamma-glumayl transpeptidase activation and serum levels
A
increased activity with drugs (phenytoin, warfarin and rifampicin) and alcohol
13
Q
levels of alpha- fetoproteins in liver disease
A
raised in hepatocellular carcinoma
increased in pregnancy and regenerative liver tissue with hepatitis, chronic liver disease and teratomas
14
Q
what is an alcohol unit?
A
10ml or 8g of pure alcohol
15
Q
acute confusional state from alcohol withdrawal
A
delirium tremens: untreated can result in seizures and death
16
Q
heme breakdown
A
heme –> (heme oxygenase)
biliverdin –> (biliverdin reductase)
bilirubin
by phagocytosis
17
Q
what is CAGE
A
- have you ever attempted to CUT down on drinking
- do you ever get ANNOYED when people complain about your drinking
- do you ever feel GUILTY about things you have done while drinking
- do you ever need a drink to get going in the morning (EYE OPENER)
18
Q
bilirubin excretion
A
conjugated bilirubin –> (bacteria) urobilinogen (unconjugated and colourless) –> stercobilin (brown) or urobilin (yellow)
19
Q
increase unconjugated bilirubin cause
A
increase breakdown of RBC, Gilbert’s syndrome, haemolysis
20
Q
causes of jaundice?
A
- prehepatic: haemolysis (i.e. sick cell) (unconjugated)
- hepatic: liver failure
- post hepatic: obstructive (pale stools, dark nine, itch)
21
Q
def hepatitis
A
liver inflammation
22
Q
def cirrhosis
A
fibrosis of the liver
nodule formation
23
Q
symptoms of acute hepatitis
A
unwell
jaundice
RUQ pain
confusion
coagulopathy (bruising)
24
Q
symptoms of chronic hepatitis
A
often none
fatigue
low grade fever
25
def fulminant hepatitis
ACUTE hepatitis with liver failure
| dvlpt of encephalopathy within 28 days of jaundice
26
blood test results in acute hepatitis
raised ALT/AST (>1000)
high bilirubin
(in severe cases):
coagulopathy
renal impairment
27
complications of cirrhosis
-loss of function:
jaundice (heme breakdown)
coagulopathy (clotting)
decreased drug metabolism (sedatives: benzos and opiates)
decreased hormone metabolism (increased levels of oestrogen)
increased sepsis (decreased immune)
```
-portal hypertension:
varices (oesophageal, caput medusa, piles)
ascites
encephalopathy (ammonia)
hepatorenal syndrome
```
28
normal venous portal pressure and portal pressure in portal hypertension
normal: 5-8 mmHg
| in portal hypertension: 10-12 mmHg
29
symptoms present with decreased hormone metabolism (increased oestrogen)
```
erythema
spider nevi
gynocomastia
loss of secondary body hair
shrinking external genitalia
```
30
causes of cirrhosis
```
hazardous alcohol
chronic hep B and C
autoimmune liver disease
haemachromatosis
Wilson's disease
chronic obstruction
```
31
why do you get leuconychia with liver disease
pale nails due to decreased albumin
32
alcoholic hepatitis symptoms and signs
jaundice
large tender liver
vomitting (feeling ill: not eating or drinking)
33
what must be the plasma concentration of bilirubin for jaundice to be clinically apparent
50 microM/L
34
how is bile released and how much is released in a day from liver?
CCK
vagal
--> response to food
500-1000 ml/day
35
composition of bile
- 98% water
- HCO3
- bilirubin
- bile salts/acids (derived from cholesterol)
- metabolites of hormones and drugs
- heavy metal ions
36
conjugation of bilirubin
in hepatocyte:
- protein bound and conjugated with glucuronic acid (by glucuronyl transferase enzyme)
- -> glucuronyl transferase renders it water soluble
37
causes of haemolytic jaundice (prehepatic)
- RBC abnormality (ie sickle cell)
- incompatible blood transfusion
- drug reaction
- hypersplenism
38
biochemistry in haemolytic jaundice
- liver function normal
- glucuronyl transferase saturated
- increase conjugated bilirubin output
- increase unconjugated bilirubin in plasma
39
hepatocellular jaundice causes
- congenital (neonatal)
- infection (viral hep)
- cirrhosis (alcohol or NASH (steatohepatitis))
- damage due to toxins or drugs
40
biochemistry in hepatocellular jaundice
- increase unconjugated and conjugated bilirubin
- may be decrease of conjugated bilirubin in gut (due to hepatocellular fibrosis)
- elevated ALT
- mild raised ALP
41
def kernicterus
build-up of bilirubin in the brain (especially in neonates): bile pigment deposition in basal ganglia: permanent brain damage
42
Qs to ask with jaundice for symptoms
- pain
- duration
- itching
- colour of stools and urine
43
obstructive jaundice causes
- obstruction of bile duct by stone
- obstruction of bile duct by tumour (i.e. head of the pancreas)
- intra-hepatic cholestasis
44
biochemistry of obstructive jaundice
- normal liver function
- raised plasma bilirubin and conjugated bilirubin
- raised ALP
45
Qs to ask in jaundice in social history
- drug and alcohol
- cigarette use (pancreatic cancer)
- foreign travel
- sexual history (hep B)
46
jaundice and examination
- sclera and skin
- scratches (pruritus)
- evidence of weight loss (thenar wasting)
- troisier's node (malignancy)
47
Prognosis of hep A
99% recovery
| 1% Fulminant hepatitis: transplant or death
48
Epidemiology of hep A
| Spread, countries, duration, incubation
Faecal-oral spreadable
Dvlping countries
12/52 duration
4-6 weeks incubation
49
Hep B
| spread, endemic, complications
Blood, sex, vertical (mother to child)
Africa and Asia
Liver cancer
50
Factors determining progression of acute hepatitis B to chronic infection
-age:
<1yo: 90% chronic
1-5 yo: 30% chronic
>5 yo: 1-% chronic
- immunosuppression (ie HIV)
- route of infection
- genotype
51
Hep B cirrhosis prognosis
Determined by:
- Rate of fibrosis progression (stage and grade)
- Viral load
52
What is Wilson’s disease + symptoms
Autosomal recessive condition characterised by toxic accumulation of copper in liver and brain
Symptoms: neurological: tremor, dementia, dyskinesia, dysarthria
Liver: cirrhosis, hepatitis
Kayser-Fleischer rings (eyes)
Renal tubular acidosis
Haemolysis
Blue nails
53
What is Rovsing’s sign?
Pushing the colon in a anti peristalsis direction in the left iliac fossa to illicit pain in the right iliac fossa
Sign of appendicitis
54
Diagnosis of Wilson’s disease
Reduced serum caeruloplasmin
Reduced serum copper
Increased 24h urinary copper excretion
55
What is Wernicke-Korsakoff syndrome( cause and symptoms)
Wernicke’s encephalopathy: triad of mental confusion, ataxia and ophthalmoplegia
Korsakoff’s syndrome: late manifestation when Wernicke’s encephalopathy has not been treated
Thiamine deficiency (alcohol, chronic subdural haematoma, hype remedies gravidarium, thyrotoxiscosis, spread of cancers, log term dialysis, congestive heart failure
56
Def ophthalmoplegia
Paralysis/weakness of one or more occulomotor muscles
| Could be myotonic or neuropathic
57
Def hyperemesis gravidarium
Pregnancy complication: severe nausea, vomiting, fatigue, dehydration, weight loss
Goes beyond the 12th week of regnant (up to he 20th week)
58
def odynophagia
pain on swallowing
59
def halitosis
bad breath
60
what is delirium tremens
acute confusional state which results when sudden alcohol withdrawal in chronic alcohol intake
untreated: seizures and death
61
management of acute alcohol withdrawal
- benzodiazepine or carbamazepine
- clomethiazole (alternative to benzodiazepine or carbamazepine)
- info about local alcohol support services
-for delirium tremens: oral lorazepam (or parenteral lorazepam or haloperidol)
62
difference between acute and chronic hepatitis
inflammation persisting > 6 months
63
natural history of acute hepatitis
3 possibilities:
- recovery
- fulminant hepatitis (death or liver transplant)
- chronic hepatits --> increase fibrosis --> cirrhosis
64
def of steatohepatitis
inflammation in the liver in association with fatty infiltration
65
signs of decompensated liver disease
```
jaundice
ascites
encephalopathy
vatical bleeding
small liver
easily bruising
spontaneous bacterial peritonitis
collateral veins in the abdomen
+stigmata of liver disease
```
66
management of alcohol related liver disease
- liver transplant (if decompensated liver disease after best management and 3 months abstinence from alcohol)
- corticosteroids
- nutritional support
67
main causes of cirrhosis
alcohol abuse
hep B and C
NAFLD and NASH
68
types of neonatal jaundice
- unconjugated hyperbilirubinaemia: potentially toxic (penetration through blood brain barrier), may be pathological or physiological (glucuronyl transferase not at optimal level)
- conjugated hyperbilirubinaemia: non toxic, always pathological
69
treatment of neonatal jaundice
- unconjugated hyperbilirubinaemia: phototherapy or exchange transfusion
- conjugated: treat underlying obstructive condition
70
investigations in jaundice
- trans-abdominal US: duct dilation or normal ducts?
| - CT
71
obstructive jaundice clinical picture
jaundice
dark urine
pale stools
72
pre hepatic jaundice clinical picture
jaundice
no dark urine
no pale stools (may have dark stools)
73
infective causes of liver disease
hepatitis A, B or C
cytomegalovirus
Epstein Barr virus
74
lifestyle cause of liver disease
DM
obesity
alcohol excess
75
drug causes of liver disease
```
paracetamol overdose
anti epileptics
rifampicin
flucloxacillin
methotrexate
```
76
obstructive causes of liver disease
carcinoma of the pancreas
| gallstone
77
autoimmune causes of liver disease
autoimmune hepatits
primary billiard cholangitis
primary sclerosing cholangitis
78
hereditary causes of liver disease
hereditary haemochromatosis
Wilson's disease
alpa-1-antitrypsin deficiency
79
biliary tree path from liver to duodenum
- left and right hepatic ducts
- common hepatic duct
- cystic duct
- common bile duct
- ampulla of Vater/Sphincter of Oddi/ Major duodenal papillary
80
causes of acute pancreatitis
```
Idiopathic
Gallstones, genetic (CF)
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidemia/hypercholesteremia
ERCP
Drugs
```
81
management of acute pancreatitis
- IV fluids, O2 and pain relief
- antibiotics if associated infection
- early nutritional support
- lipase and amylase levels
- CT, MRI or ultrasound
- ERCP/cholecystectomy if caused by gallstones
82
what might precipitate decompensation of a previous stable liver cirrhosis
- infection
- alcohol binge
- GI bleed
- hypoglycaemia
83
causes of fresh blood in the stools
```
haemorrhoids
acute anal fissure
colorectal neoplasms
acute proctitis
IBD
```
84
def hemicolectomy
removal of half the colon
85
def ileostomy
stoma of SI
86
def colostomy
stoma of colon
87
def anterior resection
removal of part of the rectum (leaving rectal sphincter intact)
88
def abdomino-perineal resection
excision of lower rectum and anus with removal of the anal sphincter and placement of colostomy
89
what is the 2 week wait guideline for colorectal cancer
- >40 w/ unexplained weight loss and abdominal pain
- >50 w/ unexplained rectal bleeding
- >60 w/ iron deficiency anaemia OR changes in bowel habit >6weeks
- tests that show occult blood in their faeces
90
what is the screening for colorectal cancer?
from 50; every 2 years
- faecal immunochemical test
- faecal occult blood
- flexible sigmoidoscopy
91
what should you advise to reduce risk of bowel cancer?
- bowel screening
- healthy weight
- diet high in starchy veg, pulses and whole grains
- reduce consumption of red and processed meat
- avoid alcohol and smoking
- regular physical activity
92
most frequent sights for CRC
left side of colon, in sigmoid
caecum
rectum
93
risk factors for CRC
- age
- animal fat and red meat
- sugar consumption
- colorectal polyps
- FH
- chronic IBD
- obesity
- smoking
- acromegaly
- abdo radiotherapy
- uretosigmoidoscopy
94
what reduces the risk of CRC
- vegetables, garlic, milk, Ca consumption
- exercise
- aspin and NSAIDs
95
what are the different types of CRC
- adenocarcinomas (from polyps)
| - carcinoid tumours (from neuroendocrine cells)
96
CRC TNM staging
T1: tumour in inner layer of bowel
T2: tumour in muscle layer
T3: tumour grown into outer lining go bowel wall
T4: tumour has grown through outer layer of muscle wall
N0: no lymph nodes
N1: cancer cells in up to 3 nearby lymph nodes
N2: cancer cells in 4+ nearby lymph nodes
M0
M1: metastests (liver, lungs)
97
CRC number staging
- Stage 1: T1/T2, N0, M0 (cancer hasn't spread outside the bowel wall)
- Stage 2: T3/T4, N0, M0 (cancer has grown into or through the outer layer of the bowel wall)
- Stage 3: any T, N1/N2, M0 (the cancer has spread to nearby lymph nodes)
- Stage 4: Any T, Any N, M1 (the cancer has spread to other parts of the body)
98
CRC Dukes' staging
Dukes' A: TNM stage 1
Dukes' B: TNM stage 2
Dukes' C: TNM stage 3
Dukes' D: TNM stage 4
99
what is Lynch syndrome?
- mutation
- inheritance
- cancers
- diagnosis
HNPCC: mismatch repair gene mutation (microsatelite instability)
inheritance: autosomal dominance
- cancer: colon, stomach, SI, bladder, skin, brain, hepatobiliary system, endometrial/ovarian
- diagnosis: Amsterdam criteria, Bethesda guidelines
100
diagnostic methods of CRC
barium enema
colonoscopy
CT/MR
101
what are the different mutations in CRC
apc (FAP)
Kras
P53
MLH1/MSH2 (HNPCC°
102
what is the Amsterdam criteria?
- >3 relatives, spanning 2 generations (1 must be first degree relative)
- age of onset <50 in at least 1 relative
- FAP excluded
103
treatment of CRC
surgery
| chemo
104
what is diverticular disease
out pouching of colonic mucosa and submucosa through inherent weakness in outer muscle layers
105
where is the commonest site for diverticular disease?
sigmoid colon (due to chronic constipation and/or accumulation of faecal matter)
106
risk factors of diverticular disease
age
high meat and red meat intake
FH
chronic constipation
107
complications of diverticular disease
- infection (diverticulitis)
- bleeding (occult/overt)
- perforation
- abscess formation
- fistula formation (with bladder or vagina)
- obstruction
108
clinical features of diverticular disease
- asymptomatic
- intermittent LIF pain/discomfort
- erratic bowel habit
- severe pain and constipation (if narrowing)
109
presentation of acute diverticulitis
sever pain in LIF
fever
constipation
110
presentation of acute appendicitis?
- T° (37.7-38.3)
- loss of appetite
- nausea and vomiting (+Diarroea)
- dull pain in umbilical region that becomes sharp when moving towards RIF
- abdominal tenderness RIF
111
what is acute abdomen?
condition of severe abode pain, requiring emergency surgery, caused by acute disease of or injury to the internal organs
112
how do you know if it is acute abdomen?
if someone previously well and abode pain > 6h, w/ no symptoms of diarrhoea
113
causes of bowel obstruction
```
adhesions
hernia
stricture
cancer
gallstones ileus
```
114
acute abdomen: causes of RUQ pain
- Gallbaldder disease (cholecstitis, cholangitis etc)
- Duodenal ulcers
- Pancreatitis
- Medical disorders (ie referred pain from pneumonia)
- Hernias
115
acute abdomen: causes of LUQ pain
- Acute pancreatitis
- Spontaneous splenic rupture
- Medical disorders (ie pneumonia)
Hernias
116
acute abdomen: causes of RIF pain
- Acute appendicitis
- Perforated duodenal ulcer
- Crohn's disease
- Diverticulitis
- Constipation
- Renal colic
Obs and gynae (ectopic pregnancy, ruptured ovarian cyst, salphingitis)
117
acute abdomen: causes of LIF pain
- Diverticulitis
- Constipation
Obs and gynae (ectopic pregnancy, ruptured ovarian cyst, salphingitis)
118
acute abdomen: causes of epigastric pain
- peptic or duodenal ulcers
| - acute pancreatitis
119
acute abdomen: causes of central pain
- Early appendicitis
- Small bowel obstruction
- Acute pancreatits
Mesenteric thrombosis
120
acute abdomen: causes of suprapubic pain
- acute urinary retention
- UTI
Ectopic pregnancy
121
classic signs of acute abdomen?
- Fever (low grade)
- Tenderness
- Rigidity and guarding
- Rebound tenderness
- Bowel sounds (absent in peritinitis and increased in small bowel obstruction)
Abdominal distention (6Fs)
122
where is the deep inguinal ring located?
between the pubis tubercle and ASIS (midpoint of the inguinal ligament
123
where is the superficial inguinal ring located?
above and medial to pubis tubercle
124
predisposing factors to hernias
- weakness of abdominal wall/increase in abode pressure
- coughing
- straining
- obesity
- abdominal distension
- pregnancy
- heavy lifting
- age
- congenital
125
what are the different types of hernias?
```
epigastric
umbilical
incisional
direct inguinal
indirect inguinal
femoral
```
126
what is the difference between a direct and indirect inguinal hernia
indirect: pass through deep inguinal ring (IN the canal)
direct: weakness in the posterior wall of the abode canal
127
what can cause dysphagia
- muscular (muscular dystrophy, myasthenia gravis)
- neuro (stroke, PD, MS)
- weakened muscle or impaired coordination
- narrowing of the throat/oesophagus (throat/oesophageal cancer, GORD, sacs/rings in oesophagus)
- achalasia
128
what are the complications of dysphagia
choking
pulmonary aspiration
lack of nutrition
129
def odynophagia
dysphagia with pain
130
causes of odynophagia
ulcers
tumours
fungal infections
131
what must you ask when taking a UGIT disease history
- weight loss
- vomit and blood
- meleana? change in bowel habit
- pain
- symptoms of anaemia
- any previous investigations (i.e. endoscopy)
- meds linked i.e. omeprazole, NSAIDs
- any previous abode surgery
- relevant FH
- lifestyle
132
what cellular changes happens in Barretts oesophagus
epithelium change from squamous to columnar (metaplasia to dysplasia)
133
2 week referral for oesophageal cancer?
-dysphagia OR
->55 with weight loss AND 1 of following:
upper abdo pain
reflex
dyspepsia
134
risk factors for oesophageal cancer
- smoking
- alcohol
- diet lacking in veg/fruit/dairy/folate/vit A
- pickle consumption
- high BMI
- GORD
135
what investigations if oesophageal cancer?
```
OGD, bloods, ECG/Pulmonary Function Test/CXR
CT thorax/abd/pelvis
EUS
PET
laparoscopy
CPx (cardio pulmonary exercise test)
```
136
treatment of oesophageal cancer
surgery
chemo
radiotherapy
137
cause of peptic ulcer disese
H pylori
| NSAIDs
138
risk factors for peptic ulcer disease
-smoking
-alcohol
-FH of PUD
-physical stress
-hypersecretory syndromes (Zollinger Ellison syndrome)
medications
139
drugs that are linked to formation of peptic ulcers or GI bleeds
```
anticoags
corticosteroids
K+ channel activator
SSRIs
antiplatelets
NSAIDs
```
140
symptoms of peptic ulcer disease
```
epigastric pain
dyspepsia
appetite loss
vomiting/nausea
GORD
feeling full after a meal
(w/ duodenal ulcers, pain can get better w/eating)
```
141
treatment of H pylori?
7 day, twice daily course of
- PPI
- amoxicillin
- either clarithromyocin or metronidazole
(if allergic to penicillin: clarithromyocin and metronidazole)
142
treatment of peptic ulcer disease due to NSAIDs
stop NSAIDs
| 4-8 week course of full dose PPI
143
complications of peptic ulcer disease
- internal bleeding (anaemia, haematesis, meleana)
- perforation
- gastric outlet obstruction
- stomach cancer
144
what is the Glasgow blatchford score used for
stratifies upper GI bleeding patients who are at low risk and candidates for outpatient management
145
what is the Rockall score used for?
determines severity of upper GI bleeding (needs to have an endoscopy done)
146
what does coffee group blood suggest in emesis
bleeding has slowed or stopped
147
what is Mallory Weiss oesophageal tear
due to alcohol or bullimia (vomiting/retching)
| due to prolonged vomiting
148
what is the trauma lethal triad
hypothermia
coagulopathy
metabolic acidosis
149
what are abdominal red flag symptoms
```
rectal bleeding
anaemia
weight loss
FH of colorectal cancer
abdo/rectal mass
raised CRP/ESR or faecal calprotectin
for woman > 50 with persistent bloating: can be ovarian cancer
```
150
what are the 2 types of IBS
diarrhoea
| constipation
151
symptoms of IBS
colicky pain
bloating
altered bowel habit
(extra-intestinal manifestations: nausea, thigh pain, backache, lethargy, urinary symptoms, gynae symptoms)
152
diagnostic criteria of IBS
-abdominal pain/discomfort that is relieved by defecation OR associated with altered bowel frequency or stool form
+ at least 2 of the following
- altered stool passage
- abdominal bloating, distention, tension orr hardness
- symptoms made worse by eating
- passage of mucus
153
treatment of IBS
- diet
- exercise
- laxatives or loperamide, tricyclic antidepressants
- psychological help
- acupuncture
- probiotics?
- hypnotherapy?
154
what is Carnett's sign
abdo pain s unchanged or increased when muscles of abode wall are tensed
155
def diarrhoea
production of more that 2 unformed stools per day
156
difference between acute and chronic diarrhoea
acute: less than 4 weeks
chronic: more than 4 weeks
157
def dysentery
diarrhoea with visible blood in the stools
158
def tenesmus
ineffective and painful straining on stool or urination
159
social history of patient with diarrhoea?
```
travel
employment (food-handler, caregiver)
consumption of unsafe foods
swimming/drinking untreated fresh surface water
animal contact
receptive anal intercourse
contact with other ill persons
```
160
causes of diarrhoea
```
gastroenteritis
diverticulitis
antibiotic therapy
IBS
IBD
colorectal cancer
coeliac disease
appendicitis
```
161
causes of constipation
```
rectocele
IBS
drug induced
dysinergic defecation
enterocoele
slow transit
```
162
risk factors for IBD
- genetics
- smoking
- NSAIDs
- hygiene (decrease in it decreases risk for CD)
- stress/depression
- appendectomy (is protective)
163
histological difference between crohn's disease and ulcerative colitis
- inflammation: CD: deep (transmural), patchy/ UC: mucosal, continuous
- granulomas: CD: ++/ UC: rare
- goblet cells: CD: present/ UC: depleted
- crypt abscesses: CD: +/ UC: ++
164
clinical features of Crohn's disease
```
diarrhoea (sometimes w/ blood)
abdo pain
weight loss
malaise
lethargy
anorexia
nausea/vomiting
low grade fever
mouth ulcers
joint pain/back pain
uveitis/conjunctivitis
```
165
investigations in Crohn's disease
- bloods: CRP, FBC, etc
- faecal calprotectin
- stool sample for infective agent
- endoscopy
166
management of Crohn's disease
- glucocorticoid
- azathioprine or mercaptopurine
- infliximab and adalimumab (TNF-A inhibitors)
-surgery
167
clinical features of Ulcerative Colitis
- diarrhoea with blood and mucus
- lower abode discomfort
- malaise, lethargy, weight loss, anorexia
- aphthous ulcerations in the mouth may be seen
168
def proctitis
inflammation of the lining of the rectum
169
investigations of ulcerative colitis?
- bloods: CRP, FBC, etc
- faecal calprotectin
- stool sample for infective agent
- endoscopy
170
treatment of ulcerative colitis
- topical (or oral) aminosalicylate
- topical or oral corticosteroids
- tofacinib, vedolizumab
-surgery
171
causes of hypoalbuminia
reduced synthesis
loss (renal or bowel)
NOT MALNUTRITION
172
what is the MUST score
5 step screening tool to identify adults who are malnourished or at risk
