Gastroenterology Flashcards
(12 cards)
Hypokalaemic, hypochloraemic metabolic alkalosis + diarrhoea
Villous adenoma
Between 20 and 40% of patients also have blood loss and iron deficiency anaemia. Removal of any polyp at the same time as colonoscopy is the intervention of choice.
Hypertension, hypokalaemia +/- metabolic alkalosis
Conn’s syndrome
Ferritin and folate deficiency
Diarrhoea
Worsening with pregnancy
Coeliac disease
Abrupt onset of voluminous watery diarrhoea
Rapid descent into hypovolaemia, acidosis and death
Cholera (caused by strain of Vibrio cholerae)
Post-cholecystectomy
Diarrhoea + colicky lower abdominal pain
Bile acid diarrhoea
Diarrhoea, arthropathy
Positive PAS staining
Whipple’s disease
The causative organism is the Gram-positive bacillus Tropheryma whipplei. Diarrhoea and arthropathy are typical presenting features of the condition. The best test for the condition is a duodenal biopsy, with subtotal villous atrophy, PAS staining of macrophages and the presence of bacilli within macrophages confirming the diagnosis. Although Whipple’s disease most typically involves the gastrointestinal tract, involvement of the heart, brain and lungs is well recognised too. In Whipple’s disease, without central nervous system involvement, the initial therapy is either ceftriaxone or penicillin intravenously for at least two weeks. This is followed by TMP-SMX for one-year.
Cause of caput medusae?
Recanalisation of the paraumbilical veins (which normally close shortly after birth)
ONLY occurs when there is marked portal hypertension
Pain, fever, shock, weight loss
Several abscesses seen on US
Recent travel e.g. to India
Pyogenic abscess
Most common causes: enterococci, S.aureus and E.coli
Anti-LKM2 antibodies
Autoimmune hepatitis
Drug-induced hepatitis
Use of oral ketoconazole
Jaundice, hepatomegaly
Raised bilirubin, raised ALT (normal LFTs 1yr ago)
Anti-LKM2 antibioties
Drug-induced hepatitis
Unexplained jaundice repeatedly during episodes of starvation (fasting)
Gilbert syndrome
Gilbert syndrome is a mild unconjugated hyperbilirubinaemia; the cause of the condition is inheritance of a form of the enzyme glucuronyltransferase that has reduced activity for conjugation of bilirubin. Factors that are associated with a particular reduction in enzyme activity - and consequent elevation in serum bilirubin - include fasting, infection and haemolysis. The syndrome is not associated with any adverse effects. The male to female ratio is 7:2.
Gene mutations in haemochromatosis
Most common: C282Y, H63D
The mutations associated with haemocromatosis result in increased iron absorption despite the existence of excessive iron stores; this results in the accumulation of iron in different organs of the body, and particularly in the liver.
