Gastroenterology/ Nutrition Flashcards
Hepatitis B Serology:
HBsAg for 1-6 months => Acute infection
HBsAg: >6 months => Chronic infection
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Anti - HBs => Immunity (previous exposure or immunisation)
Anti - HBc => Previous (or current infection)
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HBcAg: makrer of HBV infectivity and replication
Haemorrhoid management
CONSERVATIVE
1. Soften stools:↑Fluid and fibre
2. Prevent constipation and straining e.g. bulk-forming laxatives
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3. Topical local anaesthetics and steroids may be used to help symptoms (for short term only)
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NON-OPERATIVE:
Rubber band ligation (elastic bands are applied onto an internal hemorrhoid at least 1 cm above the pectinate line to cut off its blood supply)
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OPERATIVE:
Excisional haemorrhoidectomy (surgical removal of piles; usually curative)
OR
Stapled haemorrhoidopexy: procedure for prolapsing haemorrhoids
Anal fissue management
Acute (< 1 week):
1. ↑Fibre diet and fluids
2. Stool softeners (laxatives)
3. Lubricants e.g. petroleum jelly may be tried before defecation
4. Simple analgesia (paracetamol or ibuprofen) if there is prolonged burning pain following defecation
5. Short course (a few days) of a topical anaesthetic (1–2 mL lidocaine 5% ointment) for an adult with extreme pain on defecation,
6. Sitz bath (you sit in warm water to help relieve pain in your bottom or around your private parts)
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Chronic:
Above + topical GTN
If topical GTN not effective after 8 weeks then secondary care referral should be considered for surgery (sphinterectomy or botulinum toxin)
What investigations are done to screen for hereditary haemochromatosis?
- Iron studies:
↑Ferritin (iron overload leads to increased ferritin storage)
↑Iron (increased iron absorption from the gut)
↑Transferrin saturation (more iron is bound to transferrin)
↓Total iron binding capacity (TIBC - less unbound transferrin due to iron overload)
…. - LFTs (↑ALT/AST if liver damage present)
- Confirm with HFE Genetic Testing (C282Y mutation)
What investigations are done to monitor treatment in heriditary haemochromatosis?
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
