GI Medicine 3 Flashcards
Helicobacter Pylori
- What can it cause?
- How should it be managed?
- ulcers (95% of duodenal and 75% of gastric)
- atrophic gastritis
- gastric cancer
- B cell lymphoma of MALT tissue
- PPI + amoxicillin + (clarithromycin OR metronidazole)
-> if penicillin allergic PPI + clarithromyin + metronidazole
Helicobacter pylori tests
- Urea breath test
a) What happens?
b) When should it not be done?
c) What can it be used to assess? - What will remain positive after eradication?
- a) patient consumes drink containing urea and breaths into a tube 30 mins later
b) within 4 weeks of antibiotic or within 2 weeks of antisecretory drug (e.g. PPI)
c) eradication of h. pylori - serum antibody
Hepatic Encephalopathy
- What clinical features are seen?
- How is it graded?
- What procedure can cause it?
- How is it managed?
- change in GCS (see grading)
- constructional apraxia (unable to draw 5 pointed star)
- liver flap (myoclonus)
- triphasic slow waves on EEG
- late sign: sweet smelling breath
2. Grade I - irritability Grade II - confusion, abnormal behaviour Grade III - incoherent, restless Grade IV - coma
- transjugular intrahepatic portosystemic shunt
- treat underlying cause (e.g. GI bleed, infection, drug toxicity etc)
- 1st line: lactulose
- prophylaxis: rifaximin (ABx)
NOTE: these are the treatments as pathophysiology of disease is thought to be excess absorption of ammonia and glutamine due to excess protein breakdown by bacteria in gut
Hepatitis B serology
What do the following mean:
- HBsAg
- HBeAg
- Anti-HBs
- Anti-HBc
- sA for surface antigen - first marker to appear implying current infection
- product of breakdown of core antigen from infected liver cells - again therefore implying current infection
- anti- for antibodies - implies immunity (exposure of immunised)
- anti- for antibodies -implies previous / current infection
mnemonic: c for caught virus
Hepatomegaly
What should you suspect if
- non-tender, firm liver
- hard, irregular liver edge
- firm, smooth, tender liver edge +/- pulsatile
- cirrhosis
- > remember this is earl disease, will decrease in size in late disease - malignancy (primary or mets)
- congestive liver failure - right heart failure
- pain as liver is stretched
How can hepatorenal syndrome be managed?
- vasopressin analogues e.g. terlipressin
- transjugular intrahepatic portosystemic shunt
What genetic causes of jaundice will cause
- unconjugated hyperbilirubinaemia
- conjugated hyperbilirubinaemia
- Gilbert’s syndrome (mild UDP-glucoronyl transferase deficiency, benign)
- Crigler-Najjar syndrome
(absolute UDP-glucoronyl transferase deficiency - do not survive to adulthood)
NOTE: type 2 is slightly less severe and may improve with phenobarbital
- Dubin-Johnson syndrome
(defective hepatic excretion of bilirubin, grossly black liver, benign)
- Dubin-Johnson syndrome
- Rotor syndrome (defective uptake and storage of bilirubin - benign)
- a) What is used to measure total iron binding capacity?
b) When would this be raised? - What will be seen in anaemia of chronic disease?
- a) transferrin
b)
- iron deficiency anaemia
- by oestrogen (incl. pregnancy) - normocytic anaemia
- low iron + transferrin
- high/normal ferritin
Irritable Bowel Syndrome
- How long should it have been going on for in order to consider a diagnosis?
- What symptoms should be present for a diagnosis to be made?
- How would you describe this to a patient?
- 6 months
- abdo pain
+ pain relieved by defecation
OR + altered bowel frequency / stool form
+ 2 of the following:
- passage of mucous
- altered stool passage (straining, urgency, feeling of incomplete evacuation)
- abdo bloating / distension
- symptoms made worse by eating
- an overactive bowel
Irritable Bowel Syndrome Management
- What pharmacological treatment is first line if predominant symptom is:
a) pain
b) constipation
c) diarrhoea - What is second line?
- What dietary advice should be given?
- a) antispasmodics - mibeverine
b) laxatives (but avoid lactulose)
- > linactide can be given if others don’t work and constipated >12 months
c) loperamide
2. tricyclic
- avoid long gaps between meals
- drink lots - at least 8 cups a day
- avoid as much as possible fizzy drinks, caffeine and alcohol
- for wind and bloating: consider oat breakfast + linseeds
Ischaemia to the GI tract
(both mesenteric ischaemia and ischaemic colitis)
- What clinical features are seen?
- What is the investigation of choice?
- abdominal pain
- rectal bleeding
- diarrhoea
- fever
- bloods: raised white cell count with lactic acidosis
- CT scan
Acute mesenteric ischaemia
- What is the typical pathophysiology?
- How is it managed?
- embolus blocks an artery supplying the small bowel
- > therefore sudden onset, severe abdominal pain - surgery asap
Ischaemic Colitis
- What is the typical pathophysiology?
- What is seen on AXR?
- How is it managed?
- acute but transient compromise in blood flow to large bowel leading to inflammation, ulceration + bleeding
- often at edges of vascular territory e.g. splenic flexure - thumbprinting - due to haemorrhage and oedema
- often supportive
Liver Cirrhosis
- What can cause it?
- a) What investigation is done?
b) Who is this offered to?
c) What further investigations should be done if this is positive?
- non-alcoholic fatty liver disease
- alcohol
- viral hepatitis (B+C)
mnemonic: NAV
- a) transient elastogrpahy - measure “stiffness” of the liver indicating fibrosis
b)
- hep C infection
- alcohol-related liver disease
- men drinking >50 units per week or women >35 for several months
c)
- endoscopy to check fro varicose at diagnosis
- liver US + AFP every 6 months to screen for hepatocellular carcinoma
- What is a MUST score used for?
2. If a patient is high risk, what should be done?
- to assess malnutrition
- involve dietician
- try food-first approach before prescribing supplements
- if supplements required aim for it to be between meals rather than meal replacement
