Gastrointestinal Flashcards
When should UGIB get endoscopy?
If unstable/severe bleeding - as soon as resuscitated
Any other - within 24 hours of admission
Haemochromatosis
- management in pregnancy
- considerations
No intervention needed
- if liver and cardiac function is normal
Management of vomiting 2y to hypercalcaemia
Dopamine antagonist
e.g. haloperidol/levopromazine
Investigation for severity of cirrhosis
Transient elastography
= Fibroscan
Positive AMA
Normal LFTs
Not diagnostic of PBC
Monitor annually with blood tests - likely to develop
Are there polyps in Lynch syndrome?
Can get colonic polyps
Anti-platelets in colonoscopy
Can be continued if straightforward, caution if removing polyps etc
Lymphocytic infiltration on colon biopsy =
- causes
Microscopic colitis
Causes = SSRI/NSAID/PPI
High risk of colon cancer from FH
- criteria
- management
<50 years 1st degree relative colon cancer
Colonoscopy every 5 years 55-75 years of age
Management of small bowel overgrowth
= rifaxamin
Deciding on colonoscopy surveillance:
Decide whether low, intermediate or high risk
low = 5 years
intermediate = 3 years
high = 1 year
Gastric biopsy
= lymphoepithelial lesions in gastric biopsy
- diagnosis
- management
MALT lymphoma
Eradication therapy for H. pylori
Anti-saccharomsces
Crohn’s Disease
Haemolytic anaemia
Cholestatic jaundice
Hyperlipidaemia
Zieve’s syndrome
IBD + PSC
When do they need colonoscopy
Annually
Inclusion bodies
IBD
Neutopaenia
- diagnosis?
CMV colitis
Management of varices (non-acute)
Grade 1 = annual endoscopy
Grade 2/3 = non-selective BB
Management of resistant IBS
Linaclotide
- used to manage constipation, not for use in children
What can you see in dumping syndrome?
Hypoglycaemia
Management of autoimmune hepatitis
Prednisolone
- don’t use azathioprine until ALP under control
High B12 + signs of infection
Consider liver abscess (stored B12 released during process)
Low serum albumin gradient
Ascites not associated with portal hypertension
Investigations for patients with unknown primary
Bloods = FBC, U+E, LFT, calcium, LDH
Marker = AFP, hCG
Imaging = CXR, CTAP
Other = urinalysis
What can you use to test for bile acid absorption?
SeHCAT test
= test for bile acids using an analogue, first at baseline then 7 days later
Management of UC flare
- nil steroid response at 72 hours
IV ciclosporin
Management in IBD when cannot use azathioprine
Methotrexate
Management of Barrett’s
- metaplasia
- dysplasia
Metaplasia only = endoscopy surveillance every 3-5 years
Dysplasia = ablation
Inducing remission in IBD
Maintaining remission in IBD
- options
Induction = steroids, infliximab
Maintenance = MTX, azathioprine
What can haemolytic uraemic syndrome result in?
Microangiopathic haemolytic anaemia
Coombs negative
Management of Zieve’s syndrome
Abstinence from ETOH
Management of high output stoma
Can use octreotide
= slows down gut transit time, allowing greater absorption
How often should venesection be undertaken in haemochromatosis
Every 2 weeks
Indications for liver transplant (after 24 hours)
pH <7.3
OR ALL THREE OF
PT >100
Cr > 300
Grade III or IV encephalopathy
FH of colon cancer in relative >50
- what level of risk is that in someone with UC
Intermediate
3rd line management of c.difficile
PO vancomycin and IV metronidazole
What bone abnormality do you see in coeliac disease?
Osteomalacia
UGIB and IV PPI
NICE do not advocate for the use of PPI pre-endoscopy
Diagnosis of Zollinger-Ellison syndrome
Serum gastrin and secretin stimulation test
Management of ascending cholangitis
Resuscitation
ERCP
Increasing stool frequency
Urgency
Incontinence
Pouch anastamosis in situ
- management
Pouchitis
Trial of metronidazole or ciprofloxacin
