Gastroenterology by Dr Cintia Flashcards
Diseases of the Small and Large Intestines
Crohn Dx CLINICAL FEATURES
- Pain is more common, affects all colon except for rectum, skip lesions, transmural inflammation, causes fistulas, fissures, noncaseating granulomas, perianal disease.
Crohn Dx FIRST INVESTIGATION
-Stool sample faecal calprotectin (Neutrophil derived biomarker)
-CXR, AXR to see complications of peritonitis or toxic megacolon.
Crohn Dx BEST INVESTIGATION
- Biopsy (Cobblestone sign)
- MRI for perianal dx in Crohn.
Crohn Dx TREATMENT
1.Mild Crohn: Budesonide enteric- coated.
2.Diffuse Crohn: Oral Prednisolone.
3.Methotrexate
4.Azathioprine - Infliximab good for Crohn w/ perianal fistula
Ulcerative Colitis CLINICAL FEATURES
- Bleeding is more common, only affects the mucosa, but all the colon with rectal involvement, loss of haustra, crypt abscesses and ulcers, can cause toxic megacolon, perforation, Assoc w Primary sclerosing cholangitis
Ulcerative Colitis BEST INVESTIGATION
- Biopsy
Ulcerative Colitis TREATMENT
- Mesalazine/Sulfasalazine (Rectal+Oral preparation)
- Add Steroids (Budesonide, hydrocortisone, prednisolone rectally.
- Add Steroids orally (Prednisolone) Methotrexate and sulfasalazine cause oligospermia. But sulfasalazine is safe
to use in pregnancy and methotrexate not
syndrome diaphragmatic hernias
diaphragmatic hernia: Acquired
Congenital Malabsorption
Coeliac disease
Lactose intolerance
Diseases of the liver
Liver Function Test
Jaundice
drug-induced liver injury: Khat herbal leaves
Fatty liver (hepatic steatosis) Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Alcoholic hepatitis CLINICAL FEATURES
- Marked neutrophilia, fever, hepatic pain, tenderness, encephalopathy
Alcoholic hepatitis FIRST INVESTIGATION
- Inc AST>ALT, GGT
Alcoholic hepatitis TREATMENT
If encephalopathy->Prednisolone.
If CI (untreated inf)-> Oxpentifylline (CI in allergy to caffeine or theophylline)
alcoholic liver disease
Autoimmune hepatitis CLINICAL FEATURES
- Cx by infliximab, nitrofurantoin, minocycline
Autoimmune hepatitis BEST INVESTIGATION
Abs:
- ANA (cheaper)
- SMA (Smooth muscle ab) - anti-LKM1 (anti liver kidney microsomes)-assoc w/poor response to tx
Autoimmune hepatitis TREATMENT
Prednisolone + Azathioprine
Haemochromatosis CLINICAL FEATURES
AR. Multiple symptoms.
Accumulate in pituitary (Libido, impotence with low FSH and LH), skin (dark skin), joint
(Polyarthritis), Pancreas (DM), Liver (Chronic hepatitis).
- MC Heart manifestation: CHF
- MCC death: Cirrhosis
Haemochromatosis FIRST INVESTIGATION
- Ion studies- Transferrin saturation>70% (Check transferrin and ferritin e/2y)
Haemochromatosis BEST INVESTIGATION
- HFE gene (C282Y gene- 80-90% pts in Oz are homozygous for this mutation). If Hets pts will not develop symptoms.
Haemochromatosis TREATMENT
- Serial venesection until ferritin is <50ugs. Maintenance venesection 3x/year to keep ferritin<100
Primary Biliary Cirrhosis FIRST INVESTIGATION
-AMA Abs (Antimitochondrial)
Primary Biliary Cirrhosis BEST INVESTIGATION
Biopsy. - Transient elastography to stage severity of dx
Primary Biliary Cirrhosis TREATMENT
Ursodeoxycholic acid for pruritus, LFTs and survival.
Wilson’s Dx CLINICAL FEATURES
AR. Confusion, dysarthria, wide based gate, acute change of personality + cirrhosis - Kayser Fleischer rings
Primary Sclerosing Cholangitis CLINICAL FEATURES
-Assoc w CU.
- stricturing in intra and extrahepatic bile ducts
Wilson’s Dx FIRST INVESTIGATION
- Serum Ceruloplasmin (low) and high 24 hour urinary copper excretion 2. Slip lamp examination (Kayser Fleisher rings)
Hepatitis B CLINICAL FEATURES
-30% likely to pass it if needle injury. Compared to 3% in HCV and 0.03% in HIV.
- Sex is MCC of transmission.
- If HBsAg>6 months: Chronic Hep B
Hepatitis B FIRST INVESTIGATION
-HBsAg: aCute, Chronic, Carrier.
-Anti-HbsAb: cleAred, vAccination.
-Anti-HBcIgM: Acute hep
-Anti-HBcIgG: Chronic, Carrier, Cleared
-HBeAg. Acute&Chronic
Hepatitis B TREATMENT
Chronic:
-Interferon weekly injs for 48w. Not in decompensated liver dx-Do Child Pugh Score)
-Entacavir, tenofovir: Once daily lifelong tx.
Hepatitis C CLINICAL FEATURES
-#1 cx: needle sharing.
-No vaccine available.
-Chronic (>6m).
-10-30% of pts develop Cirrhosis in 20yrs. Compared to HepB that goes to cirrhosis faster
Primary Sclerosing Cholangitis FIRST INVESTIGATION
- US/P-ANCA
Primary Sclerosing Cholangitis TREATMENT
Ursodeoxycholic acid also reduce risk of CRC.
Hepatitis C BEST INVESTIGATION
Liver biopsy looking for cirrhosis
Primary Sclerosing Cholangitis BEST INVESTIGATION
MRCP
Hepatitis A TREATMENT
- Ig useful if immunocompromised and <12months babies. - Vaccine
Primary Biliary Cirrhosis CLINICAL FEATURES
- Pruritus, fatigue, cholestasis in biochemistry
Hepatitis A CLINICAL FEATURES
-Not chronic, travel Hx, endemic in Queensland and NT.
-Exclusion for 7 days after appearance of jaundice OR until resolution of symptoms
-NOTIFIABLE Dx
Hepatitis C TREATMENT
-Sofospuvir/Ledipasvir
-Peginterferon but causes BM supression (Do FBC monthly), depression (give it with low dose
SSRI)
-Do SVR12 (means cure).
Undetectable HCV RNA by PCR 12 weeks after end of tx
Hepatitis D CLINICAL FEATURES
Uncommon in Oz. From migrants If infectious is at the same time with HBV: Fulminant hepatitis. If superinifection-> Chronic hepatitis
Hepatitis D TREATMENT
Peginterferon for at least 48 weeks
Hepatitis C FIRST INVESTIGATION
-Anti HCV
-HCV RNA
-Serial ALT (3x in 6m) to see progression
Hepatitis E CLINICAL FEATURES
Dangerous in prEgnancy, oldEr pts, and preExisting liver dx-> acute liver failure
Hepatitis E TREATMENT
Ribavirin
Liver Tumors Simple
Liver cysts Benign: Hepatic Adenoma CLINICAL FEATURES
Young pts with benign tumour linked to OCPs or fertile women. - Pain, spontaneous rupture and haemorrhage are complications (esp in pregnancy).
Liver cysts Benign: Hepatic Adenoma TREATMENT
Resection before pregnancy should be indicated.
Liver cysts Benign: Hemangioma
Malignant - HEPATOMA or hepatocellular carcinoma HCC CLINICAL FEATURES
- Cx: Chronic alcoholism, Hep B C D infection, obesity, DM, smoking
Malignant - HEPATOMA or hepatocellular carcinoma HCC FIRST INVESTIGATION
Surveillance:
-Nodule<10mm: US e/3m
-Nodule>10mm: Contrast CT/MRI.
-Tumour marker: AFP
Malignant - HEPATOMA or hepatocellular carcinoma HCC BEST INVESTIGATION
Biopsy
Malignant - HEPATOMA or hepatocellular carcinoma HCC TREATMENT
Qx resection is not advised
- Sorafenib can prolong survival
Secondary liver cancer (Metastatisis)
Cirrhosis CLINICAL FEATURES
- Low albumin is best indicator of cirrhosis
Cirrhosis FIRST INVESTIGATION
- LFTs, FBE: Thrombocytopaenia, altered IRN, low albumin
- US.
- CT/MRI
Cirrhosis BEST INVESTIGATION
Liver Biopsy
Portal hypertension
Gastro-oesophageal Varices
Ascites