Gastrointestinal Flashcards
Management of acute liver failure
30º tilt - to minimise ICP elevation Intubation NGT Urinary cathether/CVC Analgesia Sedation 10% dextrose - for hypoglycaemia Dialysis - for renal failure Treatment of underlying cause
Features of Korsakoff’s syndrome
Anterograde/retrograde amnesia
Aphasia, apraxia, agnosia
Confabulation
Lack of insight
Causes of cirrhosis
HANDWAVE:
- Haemochromatosis
- Autoimmune - autoimmune hepatitis, PBC, PSC
- Non-alcoholic steatohepatitis (NASH)
- Drugs - amoxicillin, flucloxacillin, amiodarone, methotrexate
- Wilson’s disease
- Alpha-1 antitrypsin disease
- Viral hepatitis - hepatitis B, hepatitis C
- Ethanol
Pathology of cirrhotic nodules
Fibrous bands subdivide liver parenchyma into regenerative nodules - micro/macro/mixed
Serum albumin ascites gradient (SAAG)
SAAG = serum albumin - ascitic fluid albumin
> 11 g/L - transudate
Causes of liver decompensation
DIGROCK:
- Dehydration
- Infection (SBP)
- GI bleeding
- Renal failure
- Opioids
- Constipation
- Killing liver by other means (benzodiazepines, hypoxia, surgery, hyponatraemia, hypokalaemia)
Management of ascites
Fluid/salt restriction
Paracentesis
Transjugular intrahepatic portosystemic shunt (TIPS)
Management of hepatic encephalopathy
Laculose
Rifaximin
Most common pathogens in SBP
Gram-negative bacteria (E. coli, Klebsiella)
Management of SBP
Ceftriaxone/cefotaxime (IV)
Management of hepatorenal syndrome
Albumin
Child-Pugh score
ABCDE:
- Albumin
- Total bilirubin
- Clotting time (PT)
- Distended abdomen (ascites)
- Hepatic encephalopathy
Extraintestinal features of coeliac disease
Anaemia Bleeding diathesis (vitamin K deficiency) Osteoporosis Neurological features (hypocalcaemia) Hormonal disorders
Pathological process in gastritis
Metaplasia
Management of Crohn’s disease
Induction:
- Prednisolone
- Anti-TNF (infliximab)
- Immunomodulatory agents (azathioprine, mercaptopurine, methotrexate)
Maintenance:
- Anti-TNF
- Immunomodulatory agents