Tutorials; Cases Flashcards
(48 cards)
IBD Mgmt Drugs Pyramid
- AMINOSALICYLATES: antiinflamm
>MESALAZINE = remission and maintenance in UC - CORTICOSTEROIDS = remission in both UC and CD, NOT MAINTENANCE
>pred.
> budesonide (better sfx profile)
!taper off
- IMM SUPPR. = THIOPRINE = azathioprine = reduces cell proliferation
CI in preg., hepatic impairment, elderlry
!bone marrow dysf., hepatic impairment, pancreatitis
- BIOLOGICS = monoclonal antibodies in IBD = block cytokine / white cell movement
* target immune mediators
CI = severe infection, prego and breast feeding, latent TB, MS, live vaccines
- Sx
Significance of corticosteroid use in IBD
Only to induce remission in both UC and CD but not for LT maintenance d/t sfx
Bile Acid Sequestrants
Bind to bile acid = bile acid and bile lost in stool
- for pruritis
- LDL lowering
> CHOLESTYRAMINE
Bile Acid Drugs
Managing cholesterol gall stones 1º Biliary Cirrhosis
= reduce cholesterol formation in liver; prevent cholesterol saturation
> URSODEOXYCHOLIC ACID
What secretes Pepsinogen
Pepsinogen is secreted from peptic (or chief) cells in the oxyntic gland.
What do parietal cells secrete
HCl
in response to eating a meal. Acid secretion is highly regulated, with paracrine (histamine), neural (acetylcholine), and hormonal (gastrin) factors acting in concert to regulate parietal cell function
T/F = Fructose is absorbed passively across the colonic eptihelium
FALSE
Fructose is absorbed passively (via GLUT - 5) across small intestinal villus epithelium
T/F = Vagal stimulation results in stimulation of a profuse watery salivary secretion.
FALSE
The vagus nerve does not innervate the head or neck. The facial and glossopharyngeal nerves stimulate secretion of watery saliva.
Bile Salt Reabs
Reabs at Distal ileum via HEPATIC PORTAL
T/F = Cholecystokinin causes the sphincter of Oddi to relax.
TRUE
CCK causes gallbladder contraction leading to bile expulsion. Co-ordinated relaxation of the sphincter of Oddi is required to permit bile entry into the duodenal mucosa
T/F = Stomach distension leads to inhibition of gastrin secretion
F
Stomach distension leads to stimulation of gastrin secretion
In which condition is villous atrophy a characteristic finding upon intestinal biopsy?
COELIAC DISEASE
Although some other conditions can cause villous atrophy, coeliac disease is the most commonly associated with this. Malabsorption occurs as a consequence of autoimmune destruction of villi in coeliac disease, which typically presents as diarrhoea, steatorrhea, weight loss, and vitamin deficiency.
How would you expect transferrin and ferritin levels to be effected by iron deficiency?
High transferrin, low ferritin
In Iron deficiency, the liver increases production of transferrin in order to increase iron uptake and maintain iron homeostasis. In contrast, ferritin acts as an iron store, so levels increase when there are high amount of iron in the blood, and decrease in iron deficiency. A low ferritin is the more sensitive marker of iron deficiency and is the more commonly used test.
Which of the following drugs commonly cause constipation as a side-effect?
Opioids
Hepatitis bloods
HBsAg = indicates a current infection.
Anti HBc = indicates a previous infection.
Vaccination = only Anti HBs
Current infection = HBsAg “mops up” any antibody to hepatitis B surface antigen, so the test for HBsAg will appear negative.
Acute hepatitis B infection, Anti HBc will be IgM,
Vs
Chronic infection = antibody to hepatitis B core will be IgG.
How is crohn’s disease definitively diagnosed?
ENDOSCOPE
- cobblestone
- mucosal inflamm
- skip lesions
What can be a side effect of use of proton pump inhibitors such as omeprazole?
Increased risk of C. Diff infection
Which auto antibodies are characteristic for primary biliary cholangitis?
antimitochondrial antibodies
Which of the following are signs of chronic liver disease?
spider naevi , palmar erythema , gynaecomastia, ascites
What concentration of neutrophils in an ascitic tap would indicate starting antibiotics for spontaneous bacterial peritonitis?
> 250 cells per mm3
Essential mgmt of hepatic encephelopathy
Supportive care , Reversal of precipitating factors , Lactulose
All patients with hepatic encephalopathy should receive lactulose to reduce the nitrogenous load from the gut (the exact mechanism is unclear).
What would you expect to see upon endoscopy in ulcerative colitis?
Loss of vascular marking
Crypt abscesses
continuous uniform involvement
Which conditions have an association with coeliac disease?
AuImm conditions such as: Dermatitis Herpetiformis Insulin dependent diabetes mellitus Autoimmune thyroiditis Primary biliary cholangitis
Coeliac Disease complications
Small bowel lymphoma
Oesophageal carcinoma
Small bowel adenocarcinoma
