Gastroenterology Long Case 2 Flashcards
1
Q
Extraintestinal manifestations of IBD
A
Extraintestinal manifestations of IBD that areassociated with active GI diseaseincludes: - Oral ulcers - Erythema nodosum - Large joint arthritis - Episcleritis. Extraintestinal manisfestations of IBD that areindependentof GI diseaseincludes: - Primary sclerosing cholangitis - Pyoderma gangrenosum - Ankylosing spondylitis - Uveitis - Kidney stones - Gallstones.
2
Q
How would you manage Babak’s IBD?
A
Assess symptoms, scope, faecal calprotectin
Aim is for remission, increase 5ASA, AZA/MCP, steroids
TNF inhibitors/ustekinumab/vedolizumab
Consider surgery if unable to wean off steroids, bad side effects, severe colitis
Cancer screening
Vaccinations
Nutrition
Bone Health
3
Q
Extrahepatic manifestations of Hep C
A
• Haematological ○ Mixed cryoglobulinaemia ○ Monoclonal gammopathy ○ Lymphoma • Autoimmune disorders: ○ Rheumatoid factor, cardiolipin, smooth muscle antibodies, anti-thyroid antibodies – present in 40 to 65% of patients ○ Autoimmune hepatitis ○ Sialadenitis ○ ITP • T2DM – 11 fold increase • Dermatological: ○ Porphyria cutanea tarda ○ Leukocytoclastic vasculitis ○ Lichen planus ○ Necrolytic acral erythema • Hepatic osteodystrophy Renal diseases – especially membranoproliferative GN
4
Q
Causes of LFT derangement
A
NAFLD Alcohol Medications Infection Autoimmune Malignancy Thrombosis A1AT Infilitrative - Haemachromatosis/wilson's
5
Q
How would you manage Babak’s CLD?
A
Assess - Fibroscan, US dopplar, PLTs, LFTs, INR Non-pharm - Alcohol avoidance - Weight loss if overweight - High protein, low salt diet Pharm for complications Ascites - Spiro +frusemide - SBP prophylaxis if prev episodes Varices - B-blocker or scope surveillance - TIPS if no encephalopathy Encephalopathy - Lactulose (BO 2-3/day) - Rifaximin HCC screening Transplant
6
Q
Causes of CLD decompensation
A
Infection Bleeding Alcohol/drugs Constipation Diarrhoea Hypokalaemia Alkalosis
