Gastroenterology and Hepatology Flashcards
First line Tx in MALToma
H pylori eradication (induces remission in up to 70% of patients) and then biopsy every three months. If not works, can use imatinib and rituximab in combination
Antibiotics and presentation Entamoeba histolytica
Metronidazole. Up to 1 - 3 week of bloody diarrhoea
Antibiotics in campylobacter and salmonella
Quinolones or cephalosporins
Treatment of anal fissure
- Soften stool through fibre diet 2. GTN ointment 3. Lidocaine ointment 4. Oral amlodipine / Botox injections
Hep A effect on hepatocytes
Necrosis
How does alcohol cause a hypo?
Alcohol impacts pancreatic microcirculation and leads to release of insulin and over shoot of first phase insulin release
Pharmacological tx of varices
Interventional tx for varices
Interventions for consequences of portal hypertension
Whipple’s disease
Triad: chronic cough, weight loss with steatorrhoea and arthritis
Biopsy will show infiltration of lamina propria with PAS macrophages
Up to two years of antibiotics such as co-trimoxazole required
Infection with tropheryma whipplei
Tropical sprue presentation
diarrhoea, abdominal pain and weight loss but no chronic cough
Treatment UC vs CD
Ix and Tx for PSC
Progressive bile duct inflammation, stricutring and cholestasis, best visualised using MRCP
“rosebead appearance”
also antibodies: p-ANCA (but AMA in PBC is much more diagnostic)
60-70% in those with UC
Presentes with fatigue and pruritus, obstructive jaundice and cirrhosis. but can be asx.
tx: cholestyramine relieves pruritus, ursodeoxycholic acid, antibiotics for bacterial cholangitis
Difference creon and cholestyramine
Creon: Pancreatic insufficeincy diarrhoea
Cholestyramine: bile acid diarrhoea, which is seen due to malabsorption related to Crohn’s or small bowel resection
Modern Hep B and Hep C treatment
Hep B: nucleotide analogue e.g. tenofovir
Bacterial overgrowth sx, side effects and tx
Early satiety, bloating and intermittent diarrhoea, increase in flatulence.
Positive lactulose hydrogen breath test
B12 deficiency (and macroblastic anaemia) can be due to bacteria using B12 for their metabolism.
Tx: rifaximin - alternatives metronidazole and tetracyclines
Flare up of UC steroids fail within 72 hours
If not dialted to more than 6cm, then may attempt cyclosporin to induce remission
What are contraindications to trnascutaneous liver biopsy?
ascites, INR > 1.6, platelets <60,
well recognised complication of coeliac disease
splenic atrophy
Mechanism that prevents reflux
How do you recognise and manage serious paracetamol overdose?
INR
Bilirubin
Hepatic encepahlopathy
worsenins acidosis
worsening kidney disease
Kings college criteria
Carcinoid syndrome dx
24 hr HIAA urine
