key concepts

• Intrinsic factor antibodies are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies
• Prolonged vomiting may cause metabolic alkalosis due to the loss of H+ ions from in the vomitus. Similarly, as Cl-ions are lost in vomitus, prolonged vomiting can cause hypochloraemia.
• Vomiting / aspiration - metabolic alkalosis
• People with raised platelet count as well as nausea require a non-urgent referral for dypepsia
• If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then oral corticosteroids are added
• Bile-acid malabsorption may be treated with cholestyramine
• IV proton pump inhibitors should not be administered as part of the acute management of upper GI bleeding prior to endoscopy - they should be given after, if there is evidence of recent non-variceal haemorrhage
• In life-threatening C. difficile infection treatment is with ORAL vancomycin and IV metronidazole
• Treatment for Wilson's disease is currently penicillamine
• Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
• Acute hypoperfusion (e.g. low BP secondary to blood loss) may result in ischaemic hepatitis
• Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension
• Vomiting → severe chest pain, shock - Boerhaave syndrome
• Transient elastography may be useful for diagnosing and monitoring the severity of liver cirrhosis
• Terlipressin is used in the management of variceal haemorrhage
• Intrinsic factor antibodies are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies
• The oral contraceptive pill is associated with drug-induced cholestasis
• Budd-Chiari syndrome - ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation
• Coeliac disease is associated with iron, folate and vitamin B12 deficiency
• Octreotide is a somatostatin analogue used to treat the symptoms of carcinoid syndrome
• Primary biliary cholangitis - the M rule

  • IgM
  • anti-Mitochondrial antibodies, M2 subtype
  • Middle aged females
• Endoscopic intestinal biopsy is the gold standard for diagnosis of coeliac disease and should be performed in all patients if the diagnosis is suspected following serology
• Dysplasia on biopsy in Barrett's oesophagus requires an endoscopic intervention
• Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
• First-line pharmacological management of acute constipation is a bulk-forming laxative such as isphagula husk
• High-resolution CT scanning is the diagnostic investigation of choice for pancreatic cancer
• In an acute upper GI bleed, the Blatchford score can identify low risk patients who may be discharged
• All patients with suspected upper GI bleed require an endoscopy within 24 hours of admission
• Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure
• Ulcerative colitis - the rectum is the most common site affected
• Liver enzymes are a poor way to look at liver function - they are usually low in end-stage cirrhosis whereas coagulation and albumin are better measures
• Co-amoxiclav is a well recognised cause of cholestasis
• When treating dyspepsia, if either a PPI or 'test and treat' approach has failed then the other approach, H pylori testing and treatment, should be tried next
• The splenic flexure is the most likely area to be affected by ischaemic colitis
• Patients who have had an episode of SBP require antibiotic prophylaxis
• Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels are characteristic of autoimmune hepatitis
• High urea levels can indicate an upper GI bleed versus lower GI bleed
• Dysphagia, aspiration pneumonia, halitosis → ?pharyngeal pouch
• Ursodeoxycholic acid is the first-line medication for primary biliary cholangitis
• Ammonia crossing the blood-brain barrier contributes to hepatic encephalopathy