Gastroenterology Flashcards
(115 cards)
Alpha 1 antitrypsin deficiency causes liver damage by what mechansism?
Accumulation of unsecreted intracellular mutant AAT proteins leading to hepatocyte death.
What is the most likely type of glomerulonephritis to occur in patients with cirrhosis from any cause?
IgA nephropathy. This is likely due to the reduced clearance of IgA immune complexes by Kupffer cells in the liver.
What are the main recognised risk factors for gord?
Obesity, alcohol, hiatus hernia, smoking, drugs (e.g. bisphosphonates)
What other diseases are associated with GORD?
High acid production - Zollinger Ellison syndrome. Poor acid clearance- scleroderma, other connective tissue disease, gastroparesis.
Is helicobacter pylori associated with GORD?
No
What conservative management strategy for GORD is most effective?
Avoiding food at least 2hrs before sleep
What’s the incidence of Barrets amongst pts with chronic GORD?
10-15%
Which factors influence risk of progression to malignancy in Barrets oesophagus?
Segment length (>3cm worse), dysplasia grade (nil vs low grade vs high grade).
What treatment options are available for low (recetly treating more aggressively) and high grade dysplasia in Barrets oesophagus?
Endoscopic mucosa resection (effective for shallow disease), endoscopic mucosa dissection (for submucosal invasion). Surgery. If none of the above can be tolerated due to anaesthetic risk associated with longer procedure length, radiofrequency ablation can be performed quickly.
What is the first line treatment for eosinophilic oesophagitis?
PPIs. Then topical dispersible budesonide. Elimination diets sometimes work, but in adults the cause is often a swallowed aerosol (cf in kids where it is usually a dietary cause). Oral steroids or steroid agents can be used if topical steroids don’t work. Dupilmumab (targegs IL-4 and IL-13) is highly effective, but is only PBS funded for eczema (atypical dermatitis) at present, but can be paid for for off label use.
What is the demographic of pts with eosinophillic oesophagitis?
Young men with previous allergies.
Achalasia can be managed by a per oral endoscopic myotomy (POEM)- what pt demographic is this important for and what medication is required to start with it?
Young people. Is a long procedure, so need to have limited comorbidities to make it work from anaesthetic risk pov. Provides 80-90% cure with low complication rate. Can be associated with reflux after- treated with 8 weeks of PPI following procedure. Require a scope at 5 years to evaluate oesophagus.
Achalasia can be managed with pneumatic dilatation of the lower oesophageal sphincter (LOS). Who is this procedure good for and why?
Older patients who can still tolerate an endoscopy. The procedure is inflating a balloon in the LOS until the LOS ruptures. It’s quick, 80-90% curative, however it does carry a 3% perforation rate. Much faster than POEM, thus better for more comorbid pts.
How should you manage achalasia in patients who will only tolerate a brief endoscopy?
Botox injections to the lower oesophageal sphincter - provide 60-70% response, but need re-doing every 6 months. Pharmacotherapy can be used if endoscopy is contraindicated - nitrates and peripheral calcium channel blockers.
What percentage of cirrhosis patients will develop varicies?
50-60%
What percentage of cirrhosis patients diagnoses with varicies will bleed within 2 years of diagnosis?
30%
How much blood do you need to produce from the upper GI tract to produce malena?
150mls. Frank blood follow through from the upper GI tract suggests >500mls of blood loss.
What is the mortality risk associated with a first variceal bleed?
> 30%
In patients with oesophageal varicies, what treatment options are available to reduce the risk of having a first bleed?
Managing underlying portal hypertension with non-cardioselective beta blockade - carvedilol > propanolol - cam decrease risk by 50%. Target HR reduction of 25%.
Endoscopic banding of large varices may have additional benefit.
What are the interventions known to provide a mortality benefit in patients suspected of having an upper GI variceal bleed?
IV antibiotics (greatest impact on mortality, up to 50% reduction), terlipressin, octreotide, early endoscopy and banding.
What treatment options are available for variceal bleeding that is unable to be controlled initially with endoscopic banding?
Sengstaken-Blakemore or Linton tube - NGT that inflates in the lower third of the oesophagus to form a tamponade- can only be left in place for 12-24hrs. Danis stent - endoscopically inserted stent that tamponades the oesophagus- can be left for 7 days. Transjugular intrahepatic porto-systemic shunt (TIPSS) - rapidly addresses portal hypertension- carries risk of hepatic encephalopathy, especially in elderly pts and/or those with child’s B/C cirrhosis. Also can’t be done until bleeding tamponaded by one of the above methods.
After a variceal bleed is controlled, what options are available for secondary bleeding prophylaxis?
Beta blockers + band ligation is provided to all patients. In select patients, a transjugular intrahepatic porto-systemic shunt can be used. However a TIPSS procedure is usually a bridge procedure to get the patient to the most effective treatment- a liver transplant.
Is alcohol associated with an increased risk of peptic ulcer disease?
No. H. Pylori, smoking, NSAIDs and aspirin are.
Which drug is most greatly associated with peptic ulcer disease?
Aspirin. An alternative if pts are getting peptic ulcer disease might by clopidogrel for their cardiovascular disease.