Gi revision session Flashcards
what is PEG feeding used for
long term
what is NG feeding for
short term
what is pabernex
a vitamin D complex given to those with a thiamine deficiency, but not caused by alcohol
what can be given to people in withdrawel of alcohol
benzodiazapam
buzz word for sigmoid volvulus
coffee bean sign on xray
what can small bowel obstruction be caused by
previous surgery, scar tissue
buzz word for pernicious anaemia
swollen, smooth red apple looking tongue
what is a polyp
A polyp is a protrusion above an epithelial surface. It is a tumour (a swelling)
pedunculated and sessile can be easily resected
adenoma is the most common type, you should remove it and send to lab
what is adenoma of the colon
Benign tumours, Not invasive, do not metastasise. But they may evolve into cancers (dysplastic). should ALL be removed
examples of inherited carcinomas
HNPCC (right sided tumours) FAP (throughout colon)
what is gastrin
Stimulates H+ (acid) secretion by parietal cells in the stomach
Trophic (growth) effects on the mucosa of the small intestine, colon, and stomach
Inhibits the actions of Secretin and GIP
Inhibited by H+
what is CCK
Contraction of the gallbladder with simultaneous relaxation of the sphincter of Oddi
Inhibits gastric emptying
Stimulates secretion of pancreatic enzymes: lipases, amylase, and proteases
Secretion of bicarbonate from the pancreas
Trophic effects on the exocrine pancreas and gallbladder
what is secretin
Inhibits gastrin, H+ secretion, and growth of stomach mucosa
Stimulates biliary secretion of bicarbonate and fluid
Secretion of bicarbonate from the pancreas
Trophic effect on the exocrine pancreas
what is GIP
Stimulation of insulin secretion
Induces satiety
In large doses, decreases gastric acid secretion
In large doses, decreases the motor activity of the stomach and therefore slows gastric emptying when the upper small intestine is already full of food products.
what is GLP-1
Decreases gastric emptying
Induces satiety
Increases sensitivity of pancreatic beta-cells to glucose.
what is motilin
Increases gastrointestinal motility by stimulating the “migrating motility” or “myoelectric complex” that moves through the fasting stomach and small intestines every 90 minutes. This cyclical release and action get inhibited by the ingestion of food.
types of viral hepatitis
A, B, C, E
Hep A
ACUTE.
Faecal-oral. associated w poor sanitation. rare in UK. most common in children/young adults.
High ALT/AST
resolves spontaneously
Hep B
ACUTE and CHRONIC. incubation 1-6 months. DNA virus
blood borne and sexually transmitted. can be passed on vertically. PWIDs, children of infected, gay men are at highest risk
95% will clear spontaneously. only small amount need treatment
Hep C
CHRONIC. blood borne. RNA virus
PWIDs, bad tattoos or surgeries can cause it. most patients are asymptomatic until they get liver disease. 20% develop cirrhosis within 20 years
treatment, 8-12 weeks combo treatment
Hep E
ACUTE. faecal-oral. incubation 15-60 days
self limiting disease. can rarely cause chronic in immunocompromised. only 5% symptomatic
Diagnosis of viral Hepatitis
HBsAg (surface antigen)
Screen for evidence of infection
HBeAg (e antigen)
Indicates high viral replication / infectivity
Anti-HBs (surface antibody)
In infection usually seen with loss of HBsAg (indicating clearance of infection)
In vaccinated patients shows immunity
Anti-HBe (e antibody)
Indicates clearance of eAg / reduced viral replication
Anti-HBc (core antibody)
Only seen in previously infected patients (not in vaccinated patients)
HBV DNA PCR
Used to assess level of viraemia
what does HBsAg (surface antigen) show
shows evidence of active infection
what does HBeAg (e antigen) show
shows the level of viral replication
what does Anti-HBs (surface antibody) show
In infection usually seen with loss of HBsAg (indicating clearance of infection)
In vaccinated patients shows immunity
what does Anti-HBe (e antibody) show
Indicates clearance of eAg / reduced viral replication
what does Anti-Hbc (core antibody) show
Only seen in previously infected patients (not in vaccinated patients)
presence of IgM vs IgG in Hep infection
is IgG is present then they have chronic infection. if IgM then acute infection
liver enzymes
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)
liver function tests
Bilirubin
Albumin
Prothrombin time (PT)
causes of elevated ALT
ALT 50-200
Likely causes: NAFLD, chronic viral hepatitis
Other possibilities: autoimmune hepatitis, hereditary haemochromatosis, Wilson’s disease, ⍺1 anti-trypsin deficiency
ALT in the 1000’s
Likely causes: viral hepatitis, shocked liver, paracetamol overdose, autoimmune hepatitis, Budd-Chiari
ALT > 3000
Likely drug/ischaemia (paracetamol)
important points about ALT and AST
ALT can be elevated in HCV and fatty liver when AST normal
AST:ALT in alcoholic liver disease 2:1
ALT rarely > 3x ULN in alcoholic hepatitis
ALT also increased in acute biliary obstruction and precedes ↑ALP
what is unconjugated bilirubin
a breakdown product of Rd blood cells. Rbcs spleen; bound to albumin for delivery to liver
conjugated bilirubin
Bilirubin conjugated in liver with glucuronic acid. Conjugated bilirubin is not absorbed but bile is deconjugated in small bowel and colon.
causes of increased conjugated bilirubin
biliary pathology, hepatitis, cirrhosis, drug toxin, TPN
causes of increased unconjugated bilirubin
haemolysis, gilberts syndrome (the stress one)
what is albumin
its synthesised in the liver. it transports insoluble bilirubin, hormones and fatty acids.
decreases in late stage liver disease. can also decrease with malnutrition, malabsorption
prothrombin time (PT)
increased PT is related to a decrease in clotting factors. which can be found in chronic liver disease, acute liver injury or hepatocellular necrosis (toxins or viral hep)
when is ALP increased
primary biliary cholangitis, pregnancy. bone disease.
what is GGT
excreted in bile. it increases in alcoholic liver disease but levels drop 2-5 weeks after not drinking. anticonvulsants can also increase GGT
should ALT or AST normally be higher
ALT is physiologically higher. in alcoholic liver disease the AST:ALT ratio can jump to 2:1
what liver enzymes increase with obstruction
ALP and gamma-GT
platelets and cirrhosis
platelet count usually drops with cirrhosis
