Gastro

• Investigations for alcoholic hepatitis:Gamma-GT (GGT)LFTs Gamma-GT tested via blood test and will be elevated in Alcoholic HepatitisAST:ALT  >3 suggests Alcoholic Hepatitis (Normally >2)
• What diagnostic test should be done for suspected alcoholic liver cirrhosis?Transient elastography "Transient elastography (FibroScan) is a non-invasive method proposed for the assessment of hepatic fibrosis in patients with chronic liver disease by measuring liver stiffnessHow is the test performed? With the patient lying supine, an ultrasound-like probe is placed on the skin over the liver area, typically in the right mid-axillary line. The patient feels a gentle 'flick' each time a vibration wave is generated by the pro...
• "Managment of acute alcoholic hepatitis:Glucocorticoids (e.g. prednisolone)" Pentoxyphylline is sometimes used but has not been shown to be more effective than prednisolone !SprankiClinical::Gastroenterology::Hepatitis::AlcoholicHepatitis
• "Maddrey's Discriminant Function (DF) is used to determine is patients with alcoholic hepatitis would benefit from steroid (glucocorticoid) administration" !SprankiClinical::Gastroenterology::Hepatitis::AlcoholicHepatitis
• An alcoholic with acute onset of abdominal pain, nausea, jaundice is most likely suffering from what condition?Alcoholic hepatits Symptoms must be acute-onset for suspicion of alcoholic hepatitisOther symptoms:Abdominal tenderness or pain over the liver.Nausea.Vomiting blood or material that looks like coffee grounds.Poor appetite.Yellowing of the skin and eyes (jaundice)Weight loss.Tiredness and weakness.Fever !SprankiClinical::Gastroenterolog...
• "Coeliac disease is an autoimmune disorder characterised by hypersensitivity to dietary {{c2::gluten</s...
• "The prevalence rate of coeliac disease in the UK is 1%, but only 36% of people with the condition are currently clinically diagnosed" "[CoeliacUK - Document: Coeliac disease fact sheet 2023. <span style=""color: rgb(17, 85, 204); font-we...
• "What is the likely diagnosis in a patient who has symptoms of malabsorption with villous atrophy on duodenal biopsy?Coeliac disease" !SprankiClinical::Gastroenterology::CoeliacDisease
• Gluten exposure in coeliac disease leads to villous atrophy which causes malabsorption !SprankiClinical::Gastroenterology::CoeliacDisease
• "Coeliac disease is associated with dermatitis herpetiformis, type 1 diabetes & autoimmune hepatitis" !SprankiClinical::Gastroenterology::CoeliacDisease
• Coeliac disease may present with many signs & symptoms:- Diarrhoea- Steatorrhoea- Abdominal pain - Bloating - Irritable bowel syndrome- Faltering growth- Prolonged fatigue- Mouth ulcers- Deficiencies- Dermatitis herpetiformis !SprankiClinical::Gastroenterology::CoeliacDisease
• Coeliac disease can be complicated with osteoporosis because of malabsorption of vitamin D !SprankiClinical::Gastroenterology::CoeliacDisease
• Coeliac disease can be complicated with anaemia because of folate deficiency or vitamin B12 or iron deficiency, but folate is more common !SprankiClinical::Gastroenterology::CoeliacDisease
• "What is the intial investigation for coeliac disease?Serology of anti-tissue transglutaminase (TTG) antibodies (IgA)" Reintroduce gluten at least 6 weeks prior to testinganti-endomysial antibodies are also present "[© NICE [02 September 2015] Coeliac disease: recognition, assessment and management [NG20]. Available from <span style=""color:...
• Gluten should be introduced in the diet at least 6 weeks before celiac disease serology tests & endoscopy anti-tissue transglutaminase "[© NICE [02 September 2015] Coeliac disease: recognition, assessment and management [NG20]. Available from https://www.nice.org.uk/guidance/ng20/chapter/Recommendations All rights reserved. Subj...
• What investigation is done if coeliac serology testing suggest a possible diagnosis?Endoscopic intestinal (duodenal) biopsy Vilous atrophy... "[© NICE [02 September 2015] Coeliac disease: recognition, assessment and management [NG20]. Available from https://www.nice.org.uk/guidance/ng20/chapter/Recommendations<span style=""font-weight: 400;""...
• What is the diagnostic/gold-standard investigation for coeliac disease?Endoscopic intestinal (duodenal) biopsy Serology for anti-tissue transglutaminase is done first !SprankiClinical::Gastroenterology::CoeliacDisease
• What is the management for coeliac disease?Gluten-free diet Educate them.Wheat (pasta, bread, pastry), barley (beer), rye, oats (some may tolerate) = glutenRice, maize, soya potatoes, sugar = gluten-free "[© NICE [02 September 2015] Coeliac disease: recognition, assessment and management [NG20]. Available from https://www.nice.org.uk/guidance/ng2...
• Anti-tissue transglutaminase antibodies can be used to monitor gluten-free diet compliace for coeliac disease !SprankiClinical::Gastroenterology::CoeliacDisease
• Patients with coeliac disease are offered pneumococcal vaccination every 5 years Especially for patients with hyposplenism Other vaccines could include influenza & meningococcal !SprankiClinical::Gastroenterology::CoeliacDisease
• Children with coeliac disease usually present around 6 months to 2 years old First taste of gluten in their diet !SprankiClinical::Gastroenterology::CoeliacDisease
• What malabsorption disorder is associated with HLA-DQ2 and HLA-DQ8?Coeliac disease This genotyping may help diagnosis if doubt persists after serology + intestinal biopsy !SprankiClinical::Gastroenterology::CoeliacDisease
• Coeliac disease peaks in childhood & 50-60yrs !SprankiClinical::Gastroenterology::CoeliacDisease
• Coeliac disease can present with anaemiaHb: ↓Vit B12: ↓Ferritin: ↓ anaemia with iron, B12, or folate deficiency !SprankiClinical::Gastroenterology::CoeliacDisease
• "Diverticulosis describes the presence of diverticula without causing symptoms" Found incidentally or presents with painless rectal bleeding !SprankiClinical::Gastroenterology::DiverticularDisease
• "Diverticular disease describes the presence of diverticula that causes symptoms" "Diverticulitis specifically causes inflammation & infectionSymptoms: - Lower intermittent abdominal pain<span style=""fo...
• "Diverticulitis describes the presence of diverticula that are inflamed/infected" "Symptoms: - (Left) lower abdominal pain- Low-grade fever- Change in bowel habit...
• "Diverticulum formation is caused by a low-fibre diet" "Decreased mobility contributes to this" !SprankiClinical::Gastroenterology::DiverticularDisease
• Diverticular disease is primarily a disease of the elderly Age-related weakening of the colonic wall, increased intraluminal pressure, and lifestyle factors e.g. reduced fibre intake. More common in > 60 years !SprankiClinical::Gastroenterology::DiverticularDisease
• Diverticula most commonly forms in the sigmoid colon thus presenting with lower abdominal (mostly left-sided) pain !SprankiClinical::Gastroenterology::DiverticularDisease
• "Diverticular disease can present with lower abdominal pain, altered bowel habit, & bloating" update 01/12/24 to include bloating !SprankiClinical::Gastroenterology::DiverticularDisease
• 20% of patients with Diverticular disease will experience acute diverticulitis at some stage !SprankiClinical::Gastroenterology::DiverticularDisease
• What is the suspected pathophysiology of diverticula?Lack of fibre means muscles in the colon have to work harder thus causing increased pressure which can result in out-pouchings "[Credit: almostadoctor - Diverticulitis by Dr Tom Leach Dec 2020. Click link here]" !SprankiClinical::Gastroenterology::DiverticularDisease
• "How can diverticular disease be diagnosed?Colonoscopy, CT abdomen (IV contrast), or barium enema " Avoid colonoscopy & barium enema in acute diverticulitis as it can cause perforation !SprankiClinical::Gastroenterology::DiverticularDisease
• Diverticula disease is notorious for concealing colon carcinoma !SprankiClinical::Gastroenterology::DiverticularDisease
• What classification criteria is used for acute diverticulitis?Hinchey "" !SprankiClinical::Gastroenterology::DiverticularDisease
• What is the asymptomatic management of diverticular disease?Increase fibre in diet !SprankiClinical::Gastroenterology::DiverticularDisease
• What is the symptomatic management of diverticular disease?Analgesia (paracetamol), & bulk-forming laxatives Avoid NSAIDs & Opioids because of ↑ risk of perforation !SprankiClinical::Gastroenterology::DiverticularDisease
• NSAIDs & opioids should be avoided in diverticular disease because of increased risk of rupture Use paracetamol !SprankiClinical::Gastroenterology::DiverticularDisease
• Patients with diverticulitis typically present with acute-onset of severe left lower quadrant pain, nausea & vomiting, change in bowel habit, fever Constipation (50%) > diarrhoea (25%) Can also present with PR bleeding, a palpable mass, abdominal distension, perforation, large bowel obstruction, fistula to bladder/SI !SprankiClinical::Gastroenterology::Diverticulitis