Gastroenterology COPY Flashcards
BBV transmission methods
Sharing needles
Blood transfusion/blood products
Vertical
Uprotected sexual intercourse
Sharing razors/toothbrushes
Bites/cuts/straws
Tattoos, body pericings, acupuncture
Medical/dental treatment
Who to test for BBV?
Past or current IVDU
Migrants from high endemic prevalance
Paitnets due to recieve chemo
Ever on chronic haemodialys
Persistently abnormal ALTS
Healthcare workers following needlestick
Household contacts/relatvies
Prisoners
What would be seen if past infection hepatitis B
No surface antigen for Hep B
Immune tolerance stage of chronic HBV?
High HBV DNA, Normal LFTs, HBeAG positive
Immune clearance stage of chronic HBV
High HBV DNA
Abnormal LFTS
HBeAG positive
At risk of progression to cirrhosis annd HCC therfore should be referred for consideration of treatment
Immune control stage of chronic HBV
Best stage to be in
Low HBV DNA, Normal LFTS, HBeAG neg, anti-HBe positive
Immune escape stage of chronic HBV
High HBV DNA, Abrnomal LFTS
Why is hepatoma surveillance done?
The goal of screening is to detect subclinical disease, and when screening is performed at regular intervals, it is called surveillance. Surveillance of at-risk patients with imaging results in detection of HCC at an earlier stage, which has a favorable effect on outcomes.
First line for chronic hep B?
Nuceloside analogues
If someone gets HCV antibody positive and HCV PCR negative?
Repeat test at 3-6 month to check if cleared
If someone tests HCV antibody positive and HCV PCR positive
Repeat genotype test and then start treatment
Complications of coeliac
Ulcerative jejunitis
Small bowel lymphoma
Osteoporosis
Functional hyposplenism
Vit D deficinecy
What antibodies to look at in gastroenterology?
t-TG antibodies
IgA levels
What is calprotectin?
Found in cytosol of neutorphils and macrophages
Released as part of the innate immune response
Diagnosis of pancreatic exocrine malabsorption
Gold standard for diagnosis is faecal fat quantification
Measurement of faecal elastases more acceptable
Management of pancreatic malabsorpionr
Dietary fat restriciton
Pancreatic enzyme supplements
Supplement fat soluble vitamins
Manage bone disease
first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis
Daily rectal +/- oral mesalazine
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
Features of giardia lamblia?
fat malabsorption, therefore greasy stool can occur. It is resistant to chlorination, hence risk of transfer in swimming pools.
Management of Barretts oesophagus?
high-dose proton pump inhibitor
endoscopic surveillance with biopsies
if dysplasia of any grade is identified endoscopic intervention is offered. Options include:
radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
endoscopic mucosal resection
What letter of the alphabet to antibiotics causing C diff usually begin with?
C
What is autoimmune hepatitis?
condition of unknown aetiology which is most commonly seen in young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3. Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present
When to offer prophylatic abx in ascities?
Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved’
Features of type 1 autoimmune hepatitis?
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
Features of type II autoimmune hepatitis?
Anti-liver/kidney microsomal type 1 antibodies (LKM1)
Features of type III autoimmune hepatitis?
Soluble liver-kidney antigen
Memory aid for heart defects in carcinoid synrome?
TIPS
tricuspid insufficiency and pulmonary stenosis.
Managing severe colitis?
should be treated in hospital
intravenous steroids are usually given first-line
intravenous ciclosporin may be used if steroid are contraindicated
if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery
Third line vancomycin?
oral vancomycin +/- IV metronidazole
Investigation of choice for suspected perianal fistulae in patients with crohns
MRI
