Gastroenterology Flashcards
Histology changes in coeliac
Vilnius atrophy
Mononuclear infiltrate lamina propria
Crypt hyperplasia
90-95% coeliac HLA what
DQ2
Advice re coeliac and starting solids
Weaning onto a gluten containing diet 5-7 months with bf delays onset but doesn’t alter incidence
Risk factors for coeliac and percent
First degree relative 4-11% (normal risk 1-2%)
Downs (7-19%)
Turners
Williams
IgA def, DM1 10% and highest risk apart from relative and downs, JIA, thyroid
Metabolic causes of pancreatitis
Hyperlipid Increased calcium Glycogen storage Organic acidaemia Burn
Failure to inhibit activation in which enzyme most commonly leads to familial pancreatitis
Trypsinogen (75%)
How much gut req to live
15cm with ileocaecal valve and 40 without
Stool osmolality
(Na + k) x 2
Osmotic diarrhoea (gap >50) and secretory diarrhoea (gap <50) causes
Osmotic: infectious, disaccharide def, laxative abuse, impaired absorption
Secretory: toxic E. coli, cholera, tumour, enteropathy
Low alk phos causes
Wilson and zinc def
ALT and AST also raised in
Muscle necrosis (check CK)
Treatment for wilsons
Copper chelation (penicillamine and pyridoxine)
Absorption of Fe and amino acids
Duodenum
Folate absorbed in
Jejunum
Galactose and fructose transporters
Galactose SLGT1
Fructose GLUT 5
Sucrose if from
Fructose and glucose
Most sensitive and specific coeliac test
Anti TTG IgA
(hLADQ2/8 99% of CD)
Eosinophilia oesophagitis presentation
Impacted food (obstructive dysphagia)
Meckles scan
tc99 scan
Hirsprungs incidence
1/5000
More boys
Percent of UC With primary sclerosing cholangitis
5%
Pyoderma gangreosum also assoc
Gilbert’s percentage
5-10%
Sucrose isomaltase def
Presents at 6m when sucrose added
Mx: sucrose free diet, enzyme replacement
Melanesia coli occurs with
Laxative abuse
100ml breast milk contains ?kcal
67 (280kj)
Caloric value of glucose
3.4kcal/g
Fat and CHO and protein kcal
Cat 10kcal/g
CHO and protein 4kcal/g
Triangular cord sign on USS
Biliary atresia
Crohns treatment
Enteral therapy (Crohn’s) 5 asa’s Prednisone Azathioprine Methotrexate TNF monocloncal antibodies
Two familial issues with what in familial pancreatitis
SPINK1
Trypsinogen activation within the pancreas is inhibited
by pancreatic secretory inhibitor (PSTI or SPINK1)
PRSS1
Multiple isoforms of trypsinogen – missense mutation
lead to premature activation within pancreas
Short gut causes renal stones by
Calcium binds to malabsorbed fat, allows an increased absorption of oxalate
Pill induced oesophagitis commonly from…
Tetracycline, Doxycycline
NSAIDs, aspirin
Potassium