General Gastro & hep

Question 1

Somatostatin
What is the source
what is FX

Answer 1

statin= decrease
except for mucus

D cells in the pancreas & stomach

-Decreases acid and pepsin secretion,
-Decreases gastrin secretion
- Decreases pancreatic enzyme secretion,
-Decreases insulin & glucagon secretion
- inhibits trophic effects of gastrin,
stimulates gastric mucous production

Question 2

VIP
What is the source
what is FX

Answer 2

Small intestine, pancreas

Stim secretion by pancreas & intestines,
inhibits acid secretion

Question 3

Secretin
What is the source
what is FX

Answer 3

S cells in upper small intestine
Increases secretion of bicarbonate-rich fluid from pancreas & hepatic duct cells,

decreases gastric acid secretion, trophic effect on pancreatic acinar cells

Smothers h+

Question 4

CCK
What is the source
what is FX

Answer 4

– I (small intestine ) kick the gallbladder & make you feel full
I cells in upper small intestine

pancreas : Increases secretion of enzyme-rich fluid
gallbladder : contraction*8
sphincter of Oddi**- relaxation = decreases gastric emptying,
induces satiety
Increase intestinal motility

Question 5

Gastrin
What is the source
what is FX

Answer 5

G cells in antrum of the stomach

Increases acid secretion by gastric parietal cells, pepsinogen and IF secretion.

parietal cell maturation

Question 7

Rx remission in Crohn’s
isolated peri-anal disease

Answer 7

metronidazole is often used for isolated peri-anal disease

Question 8

Rx remission in Crohn’s

Answer 8

*1ST ln: **glucocorticoids (oral, topical or IV) **. Budesonide is an alternative in a subgroup of pts

• Enteral feeding
• 2nd line: 5-ASA drugs (e.g. mesalazine)

3RD Azathioprine/mercaptopurine
* Methotrexate is an alternative to azathioprine

refractory disease & fistulating Crohn’s: infliximab Pts typically continue on azathioprine/ methotrexate

*

Question 9

Severe colitis

Answer 9

• Admit
• IV steroids if contraindicated ciclosporin
• if after 72 hours =no improvement, IV ciclosporin to IV corticosteroids or consider surgery

Question 10

Inducing remission
Extensive disease

Answer 10

topical (rectal) aminosalicylate + high-dose oral aminosalicylate

No remission w/in 4

STOP topical treatments and offer a

high-dose oral aminosalicylate +  oral corticosteroid

Question 11

Inducing remission
proctosigmoiditis and left-sided UC

Answer 11

1. topical (rectal) aminosalicylate
2. No remission w/in 4 wks, add a **high-dose oral
3. aminosalicylate** OR switch to a high-dose oral aminosalicylate + topical corticosteroid
4. Still No remission still STOP topicals give oral aminosalicylate + oral corticosteroid

Question 12

Describe Severe UC

Answer 12

severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 13

Describe Mild- mod UC

Answer 13

mild: < 4 stools/day, only a small amount of blood

moderate: 4-6 stools/day, varying amounts of blood,

no systemic upset

Question 14

Rx mild-moderate flare of Inducing remission
proctitis

Answer 14

Rectal aminosalicylate (Mesalazine)

-if remission is not achieved within 4 weeks, + oral aminosalicylate

-if remission still not achieved add topical/ oral corticosteroid

Question 15

Drugs that cause liver injury

Answer 15

Isonizide
Paracetamol
Rifampicin
Ethanol
phenytoin
Allopurinol
I prep A

Question 16

Drugs that cause Cholestatic liver injury

Answer 16

Chlorpromazine
Azathioprine
ciprofloxacin, ofloxacin, cimetidine, phenytoin, naproxen, captopril, erythromycin, azithromycin, and dicloxacillin.