Gastroenterology (GI) Flashcards
What is Gilbert’s syndrome?
An autosomal recessive condition of defective bilirubin conjugation causing jaundice.
It is harmless, so no treatment is required
What serum markers/antibodies are seen in Autoimmune Hepatitis?
Anti-nuclear abs (ANA) +/or Anti-Smooth muscle (SMA) abs present.
IgG raised
Soluble liver-kidney antigen (LKMI) may also be seen
Budd-Chiari Syndrome presentation
Triad of:
1) Abdo pain
2) Ascites
3) Liver enlargement
(Caused by occlusion of hepatic veins that drain the liver)
How does pyloric stenosis present in children?
Projectile vomiting after feeds + an olive shaped mass in the epigastrium
What Ix do you use to look for mesenteric ischaemia?
Arterial CT
Rx: Resect the area
Note: New onset AF is associated with mesenteric ischaemia.
What are the 4 Ms used to identify Primary Biliary Cholangitis (PBC)
IgM
Anti-Mitochondrial abs
Middle aged female
Anti-Smooth Muscle abs
What is the treatment for Autoimmune hepatitis?
Azithioprine
Unless elderly, as is an immunosuppressant.
2nd line = Prednisolone
How long does someone have to have diarrhoea before it is considered chronic?
3 weeks
How do you treat microscopic colitis?
Steroids Eg Butizinide
How do you treat proctitis?
Mild-Moderate =Mesalazine
Severe = Anti-TNF
NOTE: Adenocarcinomas are a complication of colitis
What are the 3 cardinal symptoms of UC?
Blood in stools, Diarrhoea, Abdo pain
Also increased risk of cancer
Do you get more weight loss in UC or Crohn’s?
Crohn’s
What drugs can cause chronic diarrhoea?
PPIs, NSAIDs, laxatives, metformin, anti-malarials (Eg Quinine)
What does the Truelove and Witt’s score assess severity of?
UC
What is Fitz-Hugh-Curtis Syndrome?
A rare disorder that occurs when pelvic inflammatory dx causes tissue swelling around the liver.
Confirm diagnosis with a high vaginal swab (cervical excitation)
Treat with Doxycycline or Azithromycin
What is the treatment for Wilson’s disease?
Penicillamine
How do you treat PBC (primary biliary cholangitis)?
Ursodeoxycholic acid
What does a low faecal elastase (less than 200) indicate?
Pancreatic exocrine insufficiency
Usually suggests chronic pancreatitis
What does elevated calprotectin indicate?
IBD
What are the 3 cardinal symptoms of UC?
Blood in stools
Diarrhoea
Abdo pain
In which do you have a greater risk of developing cancer, UC or Crohns?
UC
But more weight loss in Crohns
What is the CIWA score used for?
Alcohol withdrawal - if score over 8 then give Benzodiazepines to control psychomotor agitation (Eg Diazepam, Lorazepam + Chlordiazepoxide).
What are some rare causes of chronic diarrhoea?
Graft-vs-Host dx (consider is recent bone marrow transplant)
Tropical Sprue (an acquired malabsorptive condition - consider if Hx of recent travel to S+SE Asia or Carribean.)
Addison’s dx (fatigue, weight loss, weakness,anorexia,skin hyperpigmentation, postural hypotension)
What is Plummer-Vinson Syndrome?
A rare condition characterised by the triad of:
- Dysphagia
- Iron deficiency anaemia
- Oesophageal web
What are the features of C.Diff?
Greenish diarrhoea, abdo pain, high WCC, toxic megacolon
What is the leading cause of C.Diff?
Cephalosporin treatment
PPIs also cause C.Diff.
1st line therapy for C.Diff?
Oral metronidazole
If severe, oral vancomycin and IV metronidazole.
What cells line the lier sinusoids?
Kuppfer cells - sample antigens passing from gut to livers are important for infection clearance.
Liver also has erythropoeitic potential.
Which liver enzymes are raised in specifically hepatic damage?
ALT and AST
Which LFT markers are raised a cholestatic picture?
ALP and GGT
What are the causes of raised ALT ?
Raised serum ALT indicates hepatocyte damage
Hepatic causes - hepatitis (viral,alcohol), NAFLD,Liver ischaemia, paracetamol, overdose.
Extra-hepatic causes - MI, pancreatitis, kidney dx (better biomarkers exist!)
What are the causes of raised serum AST?
Indicates hepatocyte damage.
AST:ALT ratio –>
-normally, the AST is slightly lower than ALT.
- if AST> x2 ALT then alcohol is the cause of the hepatitis. Doesn’t necessarily mean they have cirrhosis.
- if AST > x0.8 ALT or they are equal, there has been cirrhotic progression or hepatitis.
In this case, assess the need for a transplant