GI Flashcards
dysphagia - key questions for hx
how long being going on
solids or liquids
pain
weight loss
pmhx eg immunocompromised, systemic sclerolsis (affects motility of esophagus)
meds - anticholingergics (can affect motility)
smoking/ alcohol - malignancy risk
haemoglobin level for blood transfusion for gi bleed
below 70
haemoglobin level for blood transfusion for gi bleed
below 70 - but not always
drugs used to prevent future gi bleeding
ppi, h pylori abx, varicies prevention - bb, second look endoscopy - gastric ulcers
drugs used to prevent future gi bleeding
post endoscopy care
ppi, h pylori abx, varicies prevention - bb, second look endoscopy - gastric ulcers
definition of diarrhoea
3 or more loose stools a day
what is gluten
protein found in wheat
first line antibodies for coaeliacs
ttg and antibodies (bc of iga deficiency)
Metabolic ketoacidosis with normal or low glucose
Alcohol ketoacidosis
What is rosvings sign
when you press on left iliac fossa and elicit right iliac fossa pain
Positive means appendicitis
What is a hartmanns procedure
An emergency Hartmann’s procedure involves resection of their rectosigmoid colon. An end colostomy is formed and rectal stump sewn. It is indicated by perforation of the rectosigmoid bowel, and subsequent peritonitis. Causes of perforation include colon cancer, diverticulitis, and trauma. Colostomies are brought out on the left side of the abdomen, and sewn flush with the skin.
What advice should you give a pt who is having an upper GI endoscopy who is on a PPI
If a patient is taking a proton pump inhibitor or H2 receptor blocker then it should be stopped at least 2 weeks prior to the endoscopy as it could mask serious underlying pathology such as gastric cancer
What is the 2 ww criteria for upper gi scope
dysphagia
upper abdominal mass consistent with stomach cancer
Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia
signs of liver disease
Spider naevi Clubbing Jaundice Loss of secondary sexual hair Gynaecomastia Ascites Splenomegaly Peripheral oedema
what’s in the child pugh score
Bilirubin INR Albumin Ascites Hepatic encephalopathy
which antibiotic is associated with Hepatitis and cholestatic jaundice
flucloxacillin
what blood picture do statins cause to LFTs
Hepatic picture (raised AST/ ALT) Not cholestatic (raised ALP, normal AST/ ALT) Statins most commonly cause a mild transaminitis (a raise in ALT or AST). Elevations in these enzymes occur in approximately 2% of individuals taking statins. Despite this, you can safely prescribe statins in patients with mild liver dysfunction (e.g non-alcoholic fatty liver disease patients) as long as you monitor the LFTs.
How do nsaids affect the liver
Most commonly cholestatic picture
NSAIDs can cause a spectrum of liver disease ranging from dose-dependent hepatotoxicity to cholestatic hepatitis. Ibuprofen classically causes a cholestatic hepatitis.
how does co-amoxiclav affect liver
Cholestatic picture
Co-amoxiclav can cause cholestatic hepatitis. The onset is 1-6 weeks after completing a course and is more likely to occur with treatment courses exceeding 14 days. Nausea and jaundice are the main symptoms. The illness is usually mild but can be more severe in the elderly.
how much paracetamol is considered an overdose
> 150mg/kg/24 hrs
what is the effects of a cp450 inhibitor vs inducer
inhibitor - increases plasma drug concentrations - need to lower dose
inducer - decreases plasma drug concentrations - therapeutic effect of drug is lost
list some common cp450 inhibitors
macrolides - eg clarythromycin, erythromycin
amioderone
fluoxetine
cipro
list some common cp450 inducers
carbamazepine
rifampicin
alcohol
st johns wort
list some adverse consequences in liver disease, and that you should consider when prescribing for patients with liver disease
Encephalopathy (sedatives, antipsychotics, opioids)
Ascites (NSAIDs, sodium)
Varicies (NSAIDs, antiplatelets)
Bleeds/ coagulopathies (anticoagulants etc)
