Mixed all 2nd year systems Flashcards
what are 3 general tests that are involved with coeliac disease serology?
- Gliadin
- tissue transglutaminase
- IgA levels
what may a urea breath test be used for diagnostically?
helicobacter pylori infection
Name 2 other breath tests that can be carried out in GI disease investigation
- Hydrogen breath test - bacterial overgrowth
2. lactose intolerance
Suggest 2 tests which are used to assess oesophageal motility
- manometry
- Barium swallow
- oesophageal pH test
- Upper GI endoscopy
Name 2 general complications of endoscopic investigation
- perforation
- hemorrhage
- aspiration
suggest a bowel preparation that is used prior to endoscopy
picolax
aspartate and alanine require a ratio greater than what to be considered in the diagnosis of alcoholic liver disease?
AST/ALT>2
for diagonsis of alcoholic liver disease you can also carry out an USS
alcoholic patients will also have a raised gamma GT, macrocytosis and thrombocytopenia
describe 3 exclusions you would like to make before you make a diagnosis of hepatic encephalopathy?
- infection
- intracranial bleed
- hypoglycaemia
this is known as the differential diagnoses of hepatic encephalopathy
describe the treatments which are used for hepatic encephalopathy
suggest 4 things
- enema
- lactulose
- antibiotics
- NG tube
- ITU
- airway support
- bowel clear out
what condition is more likely to present with malabsorption?
A - Crohns disease
B - Ulcerative colitis
the majority of absorption will occur inside the small intestine. UC will only affect the large colon with the exception of extra-intestinal manifestations. Crohns disease will affect the SI so is the most likely to cause malabsorption.
Name 5 inflammatory indices that will be found in inflammatory bowel disease or IBD
- CRP elevation
- ESR elevation
- low albumin
- low haemoglobin
- high platelets
- high white cell count
ulcerative colitis will not have which of the following?
a. erythema nodosum
2. uveitis
3. renal calculi
4. sclerosing cholangitis
although a common extra-intestinal manifestation of IBD, renal calculi are only found in Crohns disease (CD)
the rest of the listed conditions will be found in ulcerative colitis.
what is the standard dose of melasazine in first line treatment of IBD?
3g per day
bare in mind that there will be no significant improvement in remission rate or adverse side effects.
steroids are 2nd line treatment for outpatients with IBD. what are two steroids used?
prednisolone (40mg/day with tapering reduction over 4 weeks)
budesonide - less effective than prednisolone but there are less adverse side effects. budesonide can only be used in ileal and ascending colon disease also.
name 3 side effects of using the thioprine, azathioprine as immunosupression for IBD
- leukopenia
- hepatotoxicity (therefore will require blood monitoring weekly for 8 weeks then every 8 weeks)
- pancreatitis
- long term lymphoma risks
which cranial nerve will provide innervation to the middle ear? (maleus, stapes and incus)
Jacob’s nerve which is a branch of the glossopharyngeal nerve (CN IX)
- the tympanic branch of the glossoopharyngeal
what is Arnald’s nerve?
arnalds nerve is the auricular branch of the vagus nerve. it will innervate the posterior third of the external auditory canal.
what nerve will innervate the anterior external auditory canal?
the facial nerve CN VII
which aminotransferase is likely to be elevated in steatohepatitis?
alanine aminotransferase (ALT)
describe a method of definitive diagnosis of steatohepatits
liver biopsy
what is the treatment for steatohepatitis?
- weight loss
2. exercise
what are the two most important treatments in alcoholic hepatitis?
- steroids
2. thiamine
3 structural changes at neurons will occur during long term memory. describe them
- more neurotransmitter release sites
- neurotransmitter release vesicles stored and released
- increase in the number of pre-synaptic vesicles
describe the 4 classes of biliary atresia
I - common bile duct affected
II - common hepatic duct
III - common hepatic duct and the bile and cystic duct
IV - hepatic ducts, common hepatic duct, bile and cystic ducts