Gastroenterology & Hepatology — Flashcards

Flashcard 61: What are adverse effects of Nicorandil?

Answer: • GI ulceration (anywhere in the tract, notably oral and perianal) • Headache (most common) • Hypotension • Palpitations

Extra: Nicorandil is a potassium channel activator and a nitric oxide (NO) donor used in the management of angina. It carries a specific risk of causing deep, painful mucosal ulcers, particularly in the gastrointestinal tract, which can occur long after starting the medication. Management usually involves drug withdrawal.

Flashcard 62: What is used to determine severity in C.Diff infection?

Answer: • White cell count (WBC ≥ 15,000 cells/μL)\n• Serum creatinine (> 1.5 mg/dL)

Extra: IDSA/SHEA criteria for Severe C. diff:\n- WBC ≥ 15,000 cells/μL \n- Serum creatinine > 1.5 mg/dL\n\nFulminant (formerly "critically ill") C. diff is characterized by hypotension/shock, ileus, or toxic megacolon.

Flashcard 63: What score is used to determine the severity of a GI bleed, and whether or not the patient needs admitting?

Answer: • Blatchford score

Flashcard 64: What is the definitive management in variceal haemorrhage?

Answer: • Endoscopic variceal band ligation

Flashcard 65: What is the first-line medication for primary biliary cholangitis?

Answer: • Ursodeoxycholic acid

Flashcard 66: What is the first-line treatment in mild-moderate flare of distal ulcerative colitis?

Answer: • Rectal Aminosalicylates

Flashcard 67: What will you find on LFTs in alcoholic hepatitis?

Answer: • AST/ALT ratio = 2:1

Flashcard 68: • What should be administered to patients before variceal band ligation?

Answer: • Vasoactive drugs (e.g., Terlipressin, Octreotide, or Somatostatin) • Prophylactic antibiotics (e.g., Ceftriaxone)

Extra: In the management of acute variceal bleeding: 1. **Vasoactive drugs** (Terlipressin is preferred) should be started as soon as variceal bleed is suspected, before endoscopy. 2. **Prophylactic antibiotics** (usually IV Ceftriaxone) reduce the risk of spontaneous bacterial peritonitis and rebleeding, and improve survival. 3. **Endoscopic Variceal Ligation (EVL)** is the preferred endoscopic treatment once the patient is stabilized.

Flashcard 69: What type of acid-base disturbance does diarrhoea cause?

Answer: Normal anion gap metabolic acidosis

Flashcard 70: In extensive disease of UC where rectal aminosalicylates are not sufficient, what should be added?

Answer: • Oral Aminosalicylates