Gastroenterology and renal Flashcards
Serum ascites albumin ratio to diagnose cirrhosis
1.5
Bacteria causing D&V after eating pre-prepared food?
Listeria
Presence of Hepatitis B surface antigen (HBsAg)
it is the first serum marker to be detected following initial infection.
Presence of Anti-HBc IgM means?
The presence of anti-HBc IgM indicates recent infection within the last six months
Presence of antibodies against HBeAg means?
HBeAg seroconversion is the development of antibodies against HBeAg (anti-HBe); it marks a transition from active disease to an inactive ‘carrier’ state.5 Anti-HBe remains in serum for life and indicates acquired, natural immunity (i.e. immunity from a previous infection only).
Main source of listeria
Cold pre-prepared food
Mild c.diff infection
Mild infection: not associated with an increased white cell count (WCC). Typically associated with fewer than 3 episodes of loose stools per day.
Moderate c.diff infection
associated with an increased WCC (but less than 15 × 109 per litre). Typically associated with 3 to 5 loose stools per day.
Severe c.diff infection
associated with a WCC greater than 15 × 109 per litre, or an acutely increased serum creatinine concentration (greater than 50% increase above baseline), or a temperature higher than 38.5 degrees Celsius, or evidence of severe colitis (abdominal or radiological signs). The number of stools may be a less reliable indicator of severity.
Life threatening c.diff infection
symptoms and signs include hypotension, partial or complete ileus, toxic megacolon or CT evidence of severe disease.
Diagnose SBP on an ascitic tap
> 250 polymorphonuclear cells (neutrophils) per cubic millimetre
Incubation period for Hep A
28-30 days
Treatment for Hep A
Supportive
Key facts re Hep A infection
No chronic carrier state
Nil chronic infection
Life long immunity after contracting
Skin sign in UC
Erythema nodosum
Skin sign in coeliac disease
Dermatitis herpetiformis
What is most helpful in diagnosing HUS
Peripheral blood smear with schistocytes
When to use calcium chloride in hyperkalaemia
Any severity with ECG changes
Moderate hypokalaemia range
Treatment
2.5-2.9
Oral replacement
Layers affected in
UC
Crohns
Mucosa and sub mucosa (SUPERFICIAL)
Transmural (FULL THICKNESS)
Which antibiotics used in patients with travellers diarrhoea who are at risk of developing an invasive infection
Ciprofloxacin
Which type of E.coli does NOT cause bloody diarrhoea
Enterotoxigenic (non invasive)
Primary biliary cirrhosis, primary sclerosing cholangitis and chronic active hepatitis are recognised associations of…
UC
What type of bacteria is Clostridium difficile
Gram-positive, anaerobic, spore-forming bacteria
primary sclerosing cholangitis vs primary biliary cholangitis
One major difference is that primary biliary cholangitis (PBC) affects only your intrahepatic bile ducts, the bile ducts within your liver. Primary sclerosing cholangitis (PSC) affects all of your bile ducts, including your extrahepatic ducts.
1st line for typhoid fever
Cefotaxime
Ciprofloxacin is a suitable alternative if the microorganism is sensitive.
Ovarian mets most often come from
Gastric Ca
Pabrinex contains the following vitamins:
Thiamine (vitamin B1)
Riboflavin (vitamin B2)
Nicotinamide (Vitamin B3, niacin and nicotinic acid)
Pyridoxine (vitamin B6)
Ascorbic acid (vitamin C)
Which two drugs have UK marketing authorisation for the management of acute alcohol withdrawal symptoms.
diazepam and chlordiazepoxide
Which screening tool is recommended by NICE for the identification of alcohol misuse.
AUDIT
First two choices in rapid tranq according to NICE
IM Lorazepam
IM haloperidol + promethazine
Wernicke’s encephalopathy triad
Acute confusion
Ophthalmoplegia
Ataxia
When is IM haloperidol + promethazine contraindicated in rapid tranq
If there is evidence of cardiovascular disease, including a prolonged QT interval, or no electrocardiogram has been carried out, then intramuscular haloperidol combined with intramuscular promethazine should be avoided, and intramuscular lorazepam used instead.
Define AKI stage 1 (based on blood results / UO)
A rise in serum creatinine of 26 μmol/L or greater within 48 hours.
50% or greater increase in serum creatinine (1.5 fold from baseline) within the preceding seven days.
A fall in urine output to less than 0.5 mL/kg/hour for more than six hours.
NSAID impact on
Renal plasma flow
Filtration fraction
eGFR
Decreased renal plasma flow, no change in filtration fraction, decreased GFR
Define AKI stage 2 (based on blood results / UO)
Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),
or
Urine output <0.5 mL/kg/hour for more than 12 hours
Define AKI stage 3 (based on blood results / UO)
Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), or
Creatinine rise to 354 micromol/L or more with acute rise of 26 micromol/L or more within 48 hors or 50% or more rise within 7 days, or
Urine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours
At what eGFR should dialysis be started?
Patients generally begin dialysis when their GFR reaches 10 ml/min or 15 ml/minute if they are diabetic.
Most common cause of gastroenteritis in children?
Rotavirus
Most common cause of gastroenteritis in adults?
Norovirus
Most common cause of HUS
Enterohaemorrhagic E.coli
Primary biliary cirrhosis, antibody often identified
anti-mitochondrial antibody
Primary sclerosing cholangitis, antibody often identified
anti-nuclear cytoplasmic antibody
Fulminant Hepatic Failure triad
hepatocellular injury, coagulopathy, and altered mental status
Causes of bloody diarrhoea
Campylobacter spp.
Shigella spp.
Salmonella spp.
Clostridium difficile
Enterohaemorrhagic Escherichia coli
Yersinia spp.
Schistosomiasis
Amoebiasis (Entamoeba histolytica)
What type of bacteria is Clostridium difficile
Gram-positive, anaerobic, spore-forming bacteria.
The current gold standard for the diagnosis of Clostridium difficile colitis
Cytotoxin assay.
Most common cause of toxic megacolon
UC
Campylobacter jejuni colitis treatment
Clarithromycin
Salmonella enterica severe diarrhoea antibiotic
Ciprofloxacin
AST:ALT ratio in NASH
<1
AST:ALT ratio in ALD
> 2
How is Gilbert’s passed on genetically
Autosomal recessive
