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
