Gastroenterology Flashcards
What are the causes of hepatitis? (6)
Hereditary - Wilson's, haemochromatosis, alpha anti-1-deficiency Viral hepatitis Autoimmune hepatitis NAFLD Drug-induced e.g. paracetamol overdose Alcoholic hepatitis
Which of the viral hepatitis’ can cause cholestasis?
Hepatitis A
Which Ig indicates a recent or current infection of hepatitis B?
IgM
Which two blood tests are initially used to diagnose hepatitis B?
HBsAg and anti-HBc
Both of these suggest a current infection
Which antibody indicates immunity to hepatitis B?
anti-HBsAg
Which marker indicates hepatitis B is highly infective?
HBeAg
What do these results suggest?
———HBsAg + – – + +
——Anti-HBs – + + – –
——–HBeAg + – – +/– –
——Anti-HBe – +/– – +/– +
——Anti-HBc + + – + +
IgM anti-HBc + – – – –
—–HBV DNA + – – + + (low)
————-ALT H N N H N
- Acute infection
- Previous infection and immunity
- Vaccination
- Chronic infection - active
- Chronic infeciton - not active
Which hepatitis marker suggest high risk of chronicity and hepatocellular carcinoma?
HBV DNA
What type of medication is used to treat hepatitic C?
Direct acting antivirals
What are the 3 most common causes of cirrhosis in the UK?
Alcohol
Chronic hepatitis B and C
NAFLD
In which scenario can ELF be used to screen for cirrhosis?
NAFLD
What test is used first-line to detect hepatocellular carcinoma in those with cirrhosis?
How often should the test be done?
USS
Every 6 months
What is the MELD score?
How often do NICE recommend doing it?
What is in the MELD score? (5)
3 month mortality for those with compensated cirrhosis
Every 6 months
Bilirubin, INR, (i.e. liver) creatinine, sodium, whether they are on dialysis (i.e. kidney)
What are the complications of cirrhosis? (6)
Malnutrition Portal hypertension and variceal bleeding Ascites and SBP Hepatic encephalopathy Hepato-renal syndrome Hepatocellularcarcinoma
What medication is used for stable varices?
Propranolol
What options are there for varices via endoscope?
Elastic band ligation
Injecting sclerosant
What is the treatment for bleeding varices? (4)
Terlipressin
Correct coagulation e.g. vitamin K, FFP
Prophylactic antibiotics
Urgent endoscopy
What is the management for ascites? (4)
Ascitic tap and drainage
Prophylactic antibiotics (e.g. ciprofloxacin)
Aldosterone antagonist
Low sodium diet
What is the antibiotic of choice for spontaneous bacterial peritonitis?
IV cephalosporin e.g. cefotaxime
Why does hepato-renal syndrome occur?
Reduction in circulating blood volume due to portal hypertension means blood flow to kidneys reduced
RAAS activated which vauses vasoconstriction of renal blood vessels
How do you manage hepatic encephalopathy? (3)
Lactulose - helps to remove ammonia
Antibiotics e.g. rifaximin
Nutritional support
Which value of SAAG suggests a transudate and exudate?
> 11g/L - transudate i.e. portal hypertension
<11g/l - exudate i.e. malignancy, nephrotic syndrome, infection
What occurs at these times after withdrawing from alcohol? 6-12h: 12-24h: 24-48h: 24-72h:
- Nausea, sweating, tremors
- Hallucinations
- Seizures
- Delirium tremens
Which medication is commonly used to combat the effects of alcohol withdrawal?
Chlordiazepoxide (Librium)
What are the complications of alcohol abuse? (6)
Alcoholic liver disease Cirrhosis Alcohol dependence and withdrawal Wernicke-Korsakoff syndrome Alcohol cardiomyopathy Pancreatitis
In what scenario is coeliac disease tested for, even if there are no symptoms?
New diagnosis fo type 1 diabetes
What signs and symptoms would you expect in someone with coeliac disease?
Diarrhoea, weight loss, fatigue, anaemia (e.g. iron, B12, folate), mouth ulcers
What special rash do people with coeliac get and where does it tend to present?
Dermatitis herpetiformis
Typically occurs on abdomen
What are the rare neurological signs of coeliac? (3)
Peripheral neuropathy
Cerebellar ataxia
Epilepsy
What are the complications of untreated coeliac disease? (6)
Nutritional deficiencies Anaemia Hypospenism Osteoporosis Malignancy (e.g. lymphoma) Refractory disease
What are the red flags for dyspepsia?
Anorexia Loss of weight Anaemia Recent onset/progressive Melaena or other GI bleed Swallowing difficulty
Which scoring system can you use if you suspect an upper GI bleed?
What score indicates high risk?
Glasgow-Blatchford - a score of more than 0 is high risk
Which score can you use to assess the risk of re-bleeding after treating an upper GI bleed?
Rockall score
What is the management for an upper GI bleed?
ABCDE assessment
Bloods
Access i.e. 2 large bore cannulas
Transfuse
Endoscopy - urgent if unstable, otherwise within 24h
Drugs - stop any NSAIDs or anticoagulants
What bloods should you order in an upper GI bleed? (6)
FBC, U&Es (urea), LFTs, coagulation screen, INR, crossmatch
What special tests should you order in suspected dyspepsia or ulcer disease? (2)
H pylori
FIT
What type of bacteria is H pylori?
Gram negative bacilli
What is triple therapy for H pylori?
PPI, amoxicillin and either clarithromycin or metronidazole
What test is used to screen for Zollinger-Ellison disease?
Fasting serum gastrin
What imaging is available to investigate dysphagia? (4)
Endoscopy
Barium swallow
Videofluroscopy (difficulty swallowing vs food sticking)
Oesophageal motility
Which medications may precipitate GORD?
CCBs Bisphosphoates NSAIDs Anticholinergics TCAs
What lifestyle advice can you give for GORD? (7)
Smaller, more frequent meals Avoid caffeinated drinks Weight loss Raise bed using blocks Stay upright after meals Avoid large meals before bedtime Avoid smoking
What are the features of ulcerative colitis?
Continuous inflammation Limited to colon and rectum Only superficial mucosa Smoking is protective Use aminosalicylates first line Primary sclerosing cholangitis
What are the features of Crohn’s disease?
No blood or mucus Entire GI tract Skip lesions Transmural Smoking worsens symptoms
What systemic features are used in the scoring of severity for UC? (4)
Raised ESR (>30)
Heart rate (>90)
Anaemia
Fever
How many stools per day are in the following severity categories for UC?
Mild
Moderate
Severe
- <4
- 4-6
- > 6
What are the 3 options for inducing remission in UC?
Aminosalicylates
Steroids
Calcineurin inhibitors e.g. tacrolimus
What are the 3 options for maintaining remission in UC?
Aminosalicylates
Immunosuppressants e.g. azathioprine
BIologics
What are the 3 options for inducing remission in Crohn’s?
Steroids
Immunosupperssants
Biologics
What are the 3 options for maintaining remission in Crohn’s?
Azathioprine or mercaptopurine
Methotrexate
Biologics
What lifestyle changes can help the following symptoms in IBS?
- Bloating
- Diarrhoea
- Constipation
- Oats and linseeds, avoid beans and pulses
- Reduce alcohol and fizzy drinks and sorbitol
- Limit high fibre foods
What pharmacological options are there for IBS?
Bloating
Diarrhoea
Constipation - what can be used second line?
Other
Bloating - buscopan, colpermin
Diarrhoea - loperamide
Constipation - laxatives (apart from lactulose); linaclotide can be used second line
Amitryptiline, SSRIs
