GI Med Flashcards
how does hyperthyroidism affect the liver
presents with high transaminases and jaundice
definitive diagnosis for AI Hep
liver biopsy
management for AI hep
start high dose steroids
add azathioprine later
what does liver biopsy show in AI hep
interface hepatitis (inflammation spilling over the portal tract limiting membrane to hepatocytes)
plasma cells
duration of therapy in AI hep
at least 2 years after blood tests normalise
treatment for peptic stricture
ppi if underlying GORD
balloon dilatation
severe complication of balloon dilatation
oesophageal perforation
investigation for oesophageal dilatation
CT with oral contrast
initial treatment of severe acute ulcerative colitis
IV hydrocortisone
initial treatment for mild acute ulcerative colitis
oral or rectal mesalazine
clinical evidence of severe colitis
6 or more stools per day, bloody stools and pulse >90
if no response to initial treatment for acute UC, what should you add
infliximab or IV ciclosporin
contraindications to ciclosporin
hypertension
renal impairment
maintenance therapy for UC
oral +/- topical mesalazine
why send off blood glucose in chronic liver disease pt
blood glucose is an indicator of liver synthetic function
management for acute oesophageal varix
fluid resus
IV vasopressin (terlipressin)
IV antibiotics
refer to endoscopy service
band ligation/sclerotherapy
TIPSS
last resort for bleeding varices when endoscopy not available
Sengstaken-Blakemore tubes
long term management for varices
non-cardioselective beta blockers
if not tolerated regular endoscopy and band ligation
most common cause of portal hypertension
cirrhosis
5 causes of macrocytic anaemia
pregnancy alcohol folate deficiency b12 deficiency hypothyroidism
why does thiamine need to be given slowly
reduce incidence of anaphylaxis
why do you not give glucose before thiamine
glucose can precipitate Wernicke’s
NB give if critically hypoglycaemic
initial screening for AI hep
Autoantibodies
serum immunoglobulins
maximum tumor size for Whipple’s procedure
3cm
if whipple procedure contraindicated, what can you do?
percutaneous biliary stent insertion to relieve biliary obstruction
gastrojejunostomy for gastric outlet/duodenal obstruction
PBC symptoms
pruritis lethargy loss of appetite jaundice xanthelasma spider naevi splenomegaly
investigations for PBC
LFT - minor increase AST/GGT. high ALP USS abdo serum lipids Antibodies viral hep screen blood clotting
contraindications for USS liver biopsy
extensive ascites platelet <100 INR >1.3 HB<100 acute confusional state
complications of PBC
malabsorption osteoporosis HCC liver failure haematemesis hypothyroidism
initial treatment for PBC
cholestyramine for pruritis
UDCA
fat solube vitamns
Steroids if inflammatory/AI overlap
drug for Wilson’s disease
penicillamine
signs of chronic pancreaetitis
intermittent epigastric pain boring to back diarrhoea/malabsorption weight loss anaemia diabetes
investigations for chronic pancreatitis
abdo x ray (calcifications) fbc lft serum albumin amylase CT MRCP
complications of late stage chronic pancreatitis
carcinoma opiate addiction pseudocyst formation malabsorption diabetes
AI hep antibodies
Smooth muscle
Liver kidney
PBC antibodies
AMA
what antibiotic can cause cholestasis?
macrolide antibiotics
what would differentiated WCC show for macrolide induced cholestasis
increased eosinophils
what drugs can cause drug induced liver disease
statins
thiazolodinediones
beta lactams
symptoms of haemochromatosis
tiredness, arthralgia, hepatomegaly, slightly deranged LFTs, new diabetes, male
investigations for haemochromotosis
iron studies
high iron
high serum ferritin
low TIBC
investigation for haemochromotosis complications
echo - cardiomyopathy ECG - cardiomyopathy genotyping liver biopsy - cirrhosis radiograph of joints - chondrocalcinosis hypogonadism/pituitary dysfunction
Screening for chronic hepatitis related HCC
USS every 6 months +/- AFP
