Gastrointestinal System Flashcards
Lethargy and pruritus + elevated ALP and γGT
Lab findings?
Primary biliary cholangitis - the M rule
* IgM
* anti-Mitochondrial antibodies, M2 subtype
* Middle aged females
C. difficile does not respond to first-line vancomycin.
Next line?
Oral fidaxomicin
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First episode of C. difficile infection
* first-line therapy is oral vancomycin for 10 days
* second-line therapy: oral fidaxomicin
* third-line therapy: oral vancomycin +/- IV metronidazole
Recurrent episode
* < 12 weeks of symptom resolution: oral fidaxomicin
* > 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
Life-threatening C. difficile infection
* oral vancomycin AND IV metronidazole
* specialist advice - surgery may be considered
Site of disease involvement in
Primary Sclerosing Cholangitis vs Primary Biliary Cholangitis
PSC - intra and extra-hepatic biliary ducts
PBS - only intrahepatic biliary ducts
Palpable gallbladder in the presence of painless jaundice
Most likely diagnosis?
Cholangiocarcinoma
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* Courvoisier’s sign - a palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones
- Cholangiocarcinoma is a cancer of ductal cells in the biliary tree. This can be painless and obstruct the bile ducts, causing jaundice with an obstructive picture (raised ALP, conjugated bilirubin in the urine).
Tumor marker associated with cholangiocarcinoma?
CA19-9
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* Often used for detecting cholangiocarcinoma in patients with primary sclerosing cholangitis
A triad of abdominal pain, hepatomegaly and ascites that is of sudden onset is a classical presentation of ( ____ )?
Budd-Chiari syndrome
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* acute onset is the key
Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.
Causes:
* polycythaemia rubra vera
* thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
* pregnancy
* combined oral contraceptive pill: accounts for around 20% of cases
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with _____?
Oral fidaxomicin
_________________________
*If > 12 weeks: oral fidaxomicin or vancomycin
Inheritance pattern of haemachromatosis?
Autosomal recessive
First-line for H. pylori re-testing after eradication treatment completion?
Urea breath test
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* Hydrogen breath test: used to diagnose small bowel bacterial overgrowth syndrome
* Stool antigen test: NICE guideliness found insufficient evidence to recommend the stool antigen test or serological testing.
Initial management of ascites secondary to cirrhosis is the administration of ( what )?
spironolactone (an aldosterone antagonist)
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* If the ascites is tense, therapeutic paracentesis may provide symptomatic relief.
(What) reduces the risk of recurrence of C. diff infection in patients undergoing antibacterial treatment.
Bezlotoxumab is a monoclonal antibody which targets C. difficile toxin B
* NICE do not currently support its use to prevent recurrences as it is not cost-effective
What kind of GI condition does omeprazole increase your risk of?
Severe diarrhoea (Clostridium difficile infections)
Advanced dementia + not tolerating orally.
Next step?
- ‘Artificial nutrition and hydration is rarely appropriate in advanced dementia’ (Royal College of Physicians of Edinburgh, 2014).
- Insertion of PEG tubes in dementia patients has shown no significant increase in short term or long term mortality, and does not improve re-hospitalisation rates.
GI bleeding secondary to dabigatran.
Next step?
- Idarucizumab is a recently developed monoclonal antibody fragment which binds dabigatran with an affinity that is 350 times as high as with thrombin.
Feeding regime to prevent refeeding syndrome in starved patients?
Refeeding syndrome is characterized by rapid shifts in electrolytes, particularly phosphate, potassium, and magnesium, which can lead to cardiac and neurological complications.
Preferred diagnostic test for chronic pancreatitis?
Flushing, diarrhoea, abdominal pain and weight loss, with a systolic murmur over left sternal edge and hepatomegaly
Most likely diagnosis and initial test?
Carcinoid tumors
Best initial test: Urinary 5-hydroxyindoleacetic acid (5-HIAA)
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* Flushing - caused by histamine and bradykinin
* Systolic murmur over left sternal edge - due to pulmonary stenosis & tricuspid regurgitation 2/2 fibrosis caused by serotonin
* SOB - d/t bronchoconstriction 2/2 serotonin
* associated with niacin deficiency as tryptophan is used to make serotonin
When do symptoms of carcinoid syndrome manifest?
The liver dysfunction will reduce metabolism of serotonin, releasing serotonin into the systemic circulation
