Gastro enzymes Flashcards
(24 cards)
Where is ALT and when is it raised
LIVER enzyme
Raised in: LIVER DYSFUNCTION, ACUTE PHASE REACTON
Where is ALP found
liver
biliary duct
bone
placenta (very non specific)
What ratio of ALP: ALT suggests post-hepatic causes
ALP»_space;> ALT (because it tells you that both are damaged but BILIARY TRACT especially damaged)
what other enzyme can you get that is LIVER SPECIFIC
GGT
Where s AST found and what does it indicateb
LIVER enzyme; liver INJURY
what causes raised AST:ALT = 2:1
alcohol
sx haemochromatosis
fatigue erectile dysfunction arthralgia arthritis bronze skin diabetes heart failure
what stain can you do for haemochromatosis
Pearl stain
mx haemochromatosis
- venesection
2. desferroxamine
sx of chronic panceatitis
pain 15-30 mins after meals
staetorrhoea, diabetes mellitus (a long time after sx begin)
ix for chronic pancreatitis
Bloods: faecal elastase (measures expcrine function), HbA1c, glucose levels (for DM)
USS (exclude gallstones)
CT with contrast
DANGEROUS associations of H pylori
- peptic ulcer diisease (both duodenal and gastric)
- MALToma (eradicating H puylori causes regression)
- atrophic gastrtis
how long do you need to give therapy for H pyloi
7 days
when should you instruct people to take a PPI
half hour before meals
cx of PPI
osteoporosis
low phosphaate
what occurs in Budd Chiari
blockage of the hepatic vein:
T1: thrombosis
T2: tumour
sx budd chiari
sudden onset abdo pain
ascites
tender hepatomeg
what is carcinoid syndome usually due to
liver mets
what is a hiatus hernia
herniation of part of the stomach above the diaphragm
wha are the two types of hiatus hernia
- sliding (95%): the gastroesophageal junction moves above the diaphragm
- rolling (paraoesophageal): the gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus
risk factors for hiatus hernia
- obesity
- increased intraabdominal pressure (e.g. ascites, multiparity)
clinical features of hiatus hernia
most are asymptomatic
heartburn
dysphagia
regurgitation
chest pain
* GORD sx + lower dysphagia + painless regurgitation = hiatus hernia
investigations for hiatus hernia
- FBC (check for IDA)
- CXR (1st line): gastric air bubble may be seen above diaphragm, behind the heart
- barium swallow = confirms diagnosis
- OGD (gold standard)
management of hiatus hernia
- conservative management e.g. weight loss, low fat diet, smaller meals, stop smoking, less alcohol
- medical management: PPI
- surgical management: only for symptomatic paraesophageal hernias = Nissen Fundoplication
