GI & Liver Flashcards
Best indication of liver function
Prothrombin time
Complications of liver failure
Ascites
Cerebral oedema
Bleeding
Encephalopathy
Hypoglycaemia
Medical management of liver failure complications
Ascites – diuretics (spironolactone) and restrict sodium.
Cerebral oedema - annitol, decreases ICP
Bleeding – Vitamin K (more factors made) or give FFP if active bleeding
Encephalopathy - lactulose (decreases ammonia), antibiotics and enemas – stops the flora making NH3
Hypoglycaemia - dextrose
Which part of the GI tract is usually affected worse in Crohn’s disease?
Terminal ileum - B12 deficiency
Management of Crohn’s disease
Acute -
1: Prednisolone
2: Thiopurines/methotrexate
Maintain remission -
1: Thiopurines e.g. azathioprine
2: Methotrexate
Correct deficiencies
Final resort: Resection of bowel.
Risk associated with thiopurines
Non-melanoma skin cancer
Goblet cells in Crohn’s vs UC
Crohn’s - increase
UC - decrease
Management of UC
Acute-
Steroids (oral for moderate, IV for severe)
Chronic-
ASA: sulfasalazine, mesalazine
Colectomy
UC associated antibody
pANCA
Liver cirrhosis clinical manifestations
Ascites
Portal HTN
Varices
Cause of ascites in cirrhosis
Hypoalbuminaemia - reduced plasma oncotic pressure.
Portal hypertension - increased hydrostatic pressure
Renal water retention (peripheral arterial vasodilation mediated by NO etc.)
Ascites management
1: Salt restriction
2: Diuretics e.g. furosemide
Causes of portal hypertension
Prehepatic - portal vein thrombosis
Intrahepatic - schistosomiasis, cirrhosis.
Posthepatic - right sided heart failure
Bleeding varices investigation
Upper GI endoscopy
Treatment of bleeding varices
Urgent gastroscopy/endoscopy
Fluid resuscitation, remember can be massive
Terlipressin (ADH analogue) or Octreotide
Balloon tamponade
Best: endoscopic therapy: bang ligation or
sclerotherapy
Secondary prophylaxis of bleeding varices
Propranolol / Isosorbide
Repeat variceal banding
TIPSS
Hepatitis A virus type, transmission + management
RNA
Faeco-oral: contaminated food
Supportive care. Vaccine is available.
Hepatitis B virus type, transmission + management
DNA
Blood products: IVDU, MSM, vertical transmission
Vaccine
Antiviral treatment
Hepatitis D virus type + transmission
RNA
Blood products
Requires Hep B to replicate
Hepatitis C virus type, transmission + management
RNA
Blood products: IVDU > sex
Treat with antivirals
Hepatitis E virus type, transmission + management
RNA
Faeco-oral: undercooked meats
Usually asymptomatic
Supportive management
Haemochromatosis mode of inheritance
Autosomal recessive
Wilson’s disease mode of inheritance
Autosomal recessive
Haemochromatosis gene mutation
HFE mutation
