Gastroenterology + hepatology Flashcards
Crohns disease Management
Conservative: stop smoking Medical: Inducing remission: 1. Steroids or budesonide +/- enteral feeding 2. 5-ASA 3. Azathioprine + mercaptopurine can be used as add on 4. Infliximab – refractory disease or fistulation 5. Metronidazole – peri-anal disease Maintaining remission: 1. Azathioprine or mercaptopurine 2. Methotrexate 3. 5-ASA if previous surgery Surgery: 80% require surgery
Non-alcoholic fatty liver disease
Caused by obesity and describes a disease range. Metabolic manifestation of metabolic syndrome
Features: asymptomatic, hepatomegaly, ALT raised greater than AST
Ix: LFT, Increased echogenicity on US
Associate: Obesity, hyperlipidaemia, T2DM, jejunoileal bypass, sudden weight loss/starvation
Mx: Lifestyle changes + monitoring.
?gastric banding and insulin sensitising drugs
Liver cirrhosis classification
Child-Pugh classification Incorporates: • Bilirubin • Albumin • Prothrombin time • Encephalopathy • Ascities
Clostridium difficile
G+ve rod, exotoxin production – pseudomembranous colitis
Association: clindamycin and cephalosporins
Features: diarrhoea, abdo pain raised WCC, Severe toxic megacolon
Ix: FBC, clostridium difficile toxin in stool sample
Mx: metronidazole for 10-14 days
Vancomycin oral if severe
Life threatening: oral vancomycin and IV metronidazole
Hepatocellular carcinoma
RF: cirrhosis (secondary to Hep B&C, alcohol, haemachromatosis, PBC), A1-AT def., Hereditary tyrosinosis, GSD, Aflatoxin, drugs (OCP, anabolic steroids), porphyria cutanea tarda, male, diabetes mellitus + metabolic syndrome
Features: late presentation, cirrhosis signs
Screening: Liver US +/- Alpha fetoprotein in high risk groups
Mx:
Early: resection
Late: transplantation,
Other: radiofrequency ablation, transarterial chemoembolisaion, sorafenib (multikinase inhibitor)
Oesophageal cancer
Adenocarcinoma (GORD), Squamous Cell carcinoma
RF: Smoking, alcohol, GORD, barrets oesophagus, achalasia, Plummer-Vinson syndrome, SSC- nitrosamines
Ix: Upper GI endoscopy, contrast swallow, CT (staging) +/- staging laparoscopy
Mx: surgery and adjuvant chemotherapy
Splenectomy
Causes: trauma, rupture, AIHA, ITP, HS, hypersplenism
Complications: Redistributive thrombocytosis (early VTE),
Gastric dilation, Left LL atelectasis, susception to infection (haemophilus, pneumo, menigo)
Mx: Immunisations (pnemococcal, HiB, Men C, Flu)
Daily Abx (Pen V or erythromycin)
Warning/alert card
Film: Howell-Jolly bodies, Pappenheimer bodies, target cells
Massive splenomegaly
>20 cm Causes: • CML • Myelofibrosis • Malaria • Leishmaniasis • Gauchers, (AR, glucocerebrosidase def)
Splenomegaly
Haematological • Haemolysis (hereditary spherocytosis) • Myeloproliferative disorders • Leukaemia, lymphoma Infection • EBV, CMV, hepatitis, HIV • TB, infective endocarditis • Malaria, leishmaniasis, hydatid disease Portal HTN – cirrhosis, Budd-Chiari Connective tissue: SLE, RA, Sjogrens Other: • Sarcoid • Amyloidosis • Gauchers • Primary antibody deficiency
