25/02 Flashcards
How is coeliac disease investigated?
TTG IgA with total IgA
If selective IgA deficiency then this can give a false negative result hence total IgA should be completed
Endoscopic intestinal biopsy is gold standard to confirm diagnosis
- villous atrophy
- crypt hyperplasia
- increase in intraepithelial lymphocytes
- lamina propria infiltration with lymphocytes
What test should be completed before starting azathioprine or mercaptopurine therapy in Crohn’s?
TPMT activity
Low levels can indicate poor metabolism and higher risk of serious SE
What is a key feature of ischaemic hepatitis?
Massively raised ALT (in thousands)
What is a marker for autoimmune hepatitis?
Massively raised ALT and AST compared to ALP
Raised ALP indicates problems with biliary tract
What is first line therapy of H.pylori?
PPI + amoxicillin +clarithromycin
OR
PPI +clarithromycin + metronidazole
For 7 days
What are causes of drug induced liver disease that affect the bile ducts?
COCP Co-amoxiclav/flucloxacillin Anabolic steroids Sulphonylureas Chlorpromazine
What are causes of drug induced liver disease that affects the hepatocytes?
Paracetamol Sodium valproate/phenytoin Statins Alcohol Methyldopa Nitrofurantoin
What are the key features of oesophageal rupture (boerhaave syndrome)?
Vomiting/retching
Severe retrosternal chest pain- radiates to back
Subcutaneous emphysema
-suprasternal crepitus on palpation
When should medication for maintaining remission be commenced in UC?
If severe exacerbation or >2 exacerbations in past year
What is the first line management in alcoholic hepatitis?
Glucocorticoids e.g. prednisolone
What are key features of ischaemic colitis?
Sudden onset severe abdo pain post meal
Pain out of proportion to clinical findings
What are the AST and ALT findings of alcoholic hepatitis?
Both <300
AST:ALT >2 is seen
