2.0 Flashcards
what can cause spider naevi
liver disease
pregnancy
COCP
sqaumous cell carcinoma RF
smoking
immunosuppression
actinic keratoses
bowen’s disease
diagnostic ABPI scores
normal 0.9 - 1.3
<0.9 - peripheral arterial disease
<0.5 - severe disease
<0.3 - critical limb ischaemia
> 1.3 - arterial calcification / peripheral artery disease
toxic epidermial necroslyis causing drugs
penicillins
allopurinol
phenyoin
sulfonylureas
pellagra
nacin deficiency
dementia
diarrhoea
dermatitis
possible consquence of isonazid therapy
psoriasis Mx
1 - topical steroid + vit D analogue ]
2 - vit D x2 dosage
Bullous pemphigoid
autoimmune subepidermal blistering
pruritus
vesicle eruptions
onychomycosis
fungal nail infection
Mx Oral terbafine
Impetigo
topical fusidic acid
polymorphic eruption of pregnancy
steroid + emollient
define erythroderma
complications
used to describe when 90% of BSA is affected
dehydration
infection
heart failure - SOB
lichen planus
purple
papules
polygonal
rashes on felxor surfaces
mucous involvement - 50% white lace on buccal mucosa
what causes hirsitism
PCOS
cushing
congential adrenal hyperplasia
Mx:
- weight loss
- COCP
what causes hypertichosis
anorexia nervosa
ciclosporin
types of autoimmune hepatitis
type 1
- ANA
- Anti-smooth muscle antibodies
- affects adults and chidlren
type 2
- anti-liver / kidney
microsomal type 1 antibodies
- affects children only
type 3
- soluble liver kidney antigen
- affects middle age
red flags for gastric cancer
- new onset dyspepsia > 55 yrs
- unexplained weight loss
- unexplained persistent vomiting
- progressive worsening dysphagia
- odynophagia
what is sister mary joseph node?
metastatic umbilical lesion
signifies advanced malginancy
what is the peabody’s sign?
found in DVT patients
calf muscle spasm occurring on elevation and foot extension of the affected leg - positive test
what investigation is best for looking at mural invasion for malignant oesophageal stricture?
endoscopic USS
better than CT/MRI
- USS can display all the layers of the wall of the oesophagus
features of mesenteric ischaemia
affects small bowel
emboli pathology –> more severe than ischaemic colitis –> significany occlusion to arteries
abdo pain
Increased WCC due to increased lactate
features of ischaemic colitis
affects large bowel (splenic flexure most common)
less severe than mesenteric ichaemic –> transient occlusion
bloody diarrhoea
thumb printing - muscoal oedema/haem
why do coeliac patients have regular immunisations?
- Chronic folate deficiency –> results in hyposplenism
- hence offered pneumococcal vaccine
- result of excessive loss of lymphocytes via the damaged GI tract
types of colon cancer
sporadic (95%)
hereditary non-polyposis coclrectal carcinoma
Crohns MX
Inducing
- IV glucocorticoids
- 5-ASA (mesalazine)
- Azathioprine
Maintaining
- Stop smoking
- Azathioprine / mercaptopruine
- Methotrexate
80% of patients will eventually have surgery
triad for budd-chari
Ix
abdo pain
ascites - portal HTN
tender hepatomegaly
USS - doppler flow
what kind of lymphoma does coeliacs increase the risk of?
enteropathy-associated T cell lymphoma
EATL
what pathogen is MALT lymphoma associated with>?
h pylori
UC Mx
Inducing
- proctitis = oral aminosalicylates
- proctosigmotis (+ colitis) = oral aminosalicylates + topical
- Systemic /Severe = IV hydrocortisone
Maintaining
- distal = oral / topical aminosalicyalte (mesalazine)
- extensive (oral aminosalicylate)
- refractory (2+ exacerbations in the past year) = thiopurine (azthiopurines)
criteria to classifiy severity of UC
truelove & witt - NICE recommended
how to differentiate between acute liver failure + chronic liver cirrhosis?
acute liver failure triad 1. encepthalopathy 2. coagulopathy 3. jaundice
not in CLC:
- raised PT
- raised bilirubin
- presence of encephalopathy
CLC
- Thrombocytopenia
- Significantly raised AST (x10)
Primary biliary cholangitis
- IgM
- Anti-mitochondrila
- antibodies
middle aged females
diagnostic features for spontaneous bacterial peritonitis
e.coli
paracentesis - neutrophil > 250
difference between peutz-jeghers syndrome + hereditary haemorrhagic telangiectasia?
PJS - benign hamartomatous polyps in the GI tract
- Dominant
HHT - mucous involved but without intestinal polyps
- iron-deficiency
RFs for developing c.diff
Mx: 1st / 2nd
- use of 2nd / 3rd gen cephalosporins
- PPIs
1 - metronidazole
2 - vancomycin
Severe - IV vanc + metron
coeliac diagnosis
immunology:
histology
- endomyseal IgA
- tran-tissueglutamase (TTG) antibodies IgA
villous atrophy
crypt hyperplasia
intraepithelial lymphocytes
how to classifsy pancreatic severity?
pao2 - <8 age >55 neutrophilia >15 calcium renal fucntion - urea enzymes LDH, AST albumin >32 sugar >10
what is gilbert’s
when the body doesn’t process bilirubin properly
- isolated bilirubin in response to physiological stress
No treatment required
what is hepatorenal syndrome?
- vasoactive mediators –> splanchnic vasodialation
- reduced systemic vascular resistance –> kidney hypoperfusion
- RAAS activated
- renal vasoconstriction
Mx of hepatorenal syndrome
- vasopressin analogues (terlipressisn) - vasoconstriction
- transjugular intrahepatic portsysyemic shunt
- volume expansion with 20% albumin
what diseases are associated with h.pylori
- duodenal ulcers (most common)
- gastric cancer
- MALT
- atrophic gastritis
what is triple Mx for h-pylori
confirmation test
PPI + amox + clarithromycin
PP + metron + clarithromycin
urea breath test
wilsons criteria
- reduced serum caeruloplasmin
- reduced serum copper
- increased 24hr urinary copper excretion
Wilson’s MX
penicillamine - chelates copper
types of hepatorenal syndrome
type 1
- rapid progression (2 weeks)
- upper GI bleed
- Significant AKI (creatinine raised +220)
- associated with impaired cardiac / liver / encephalopathy
type 2
- gradual decline
in liver cirrhosis what are the most specific markers of disease - blood tests?
- thrombocytopenia (low platelets) –> lack of thrombopoetin (TPO) syntheised in the liver
TPO –> stimulates platelet production
- AST - reliable + durable marker for degree of necroinflammation activity (raised x10)
difference between dysphagia + odynophagia
dysphagia - difficulty on swallowing
odynophagia - pain on swallowing
metoclopromide - action and uses
D2 receptor antagonist
pro-kinetic
useful to use in autonomic neuropathy in T2DM
don’t use in parkinson’s or bowel obstruction
what bloods would you see for autoimmune hepatitis
raised ALT / AST
low ALP
patient with hep C
investigation of choice for liver cirrhosis
transient elastography (fibro scan)
what is haematochezia
passage of fresh blood from the rectum
–> indicating a lower GI bleed
what is thiamine used for in the body?
sugar + aminoacid catabolism
conditions associate with thiamine deficiency?
wernicker’s –> korsakoff’s
dry beriberi - peripheral neuropathy
wet beriberi - dilated cardiopathy
what is ITP?
idiopathic thrombocytopenic purpuria
- low platelets following infection
- increased bleeding time
diagnosis of exclusion
Mx:
- dont give platelets
- give steroids
what is TTP?
thrombotic thrombocytopenic purpuria
terrible partners
- low platelets
- anaemia
- renal
- temp rise
- neuro
- ER
- schistocytes
what is HUS?
haemolytic uraemic syndrome
trigger due to E.coli
- kidney failure
- bloody diahorrea
- creatinine rise
schistocytes
what is DIC?
inappropriate activation of clotting cascade:
- consumption of platelets + clotting factors
Triggered by trauma / sepsis
low platelets
low fibrinogen
raised PT
raised D-dimer
how the you grade encephalopathy?
west-haven criteria
1 - changes in behaviour w/ minimal consciousness change
2 - Gross disorientation, drowsiness, asterixis
3 - Marked confusion, incohorent speech, sleeping most the time
4 - comatosed, unresponsive to pain
decorticate - stiff with both arms
decerebrate posturing - arms straight, toes pointed
what LFTs point towards alcoholic liver disease?
AST > ALT
GGT
what is autonomic dysreflexia?
only occurs above T6
due to triggers of facial impaction + urinary retention
- Unopposed sympathetic stimulation
- HTN
- Flushing
- Sweating (above the level of the lesion)
what are manometry studies?
evaluates the sphincter function / muscles of the oesophagus
determine a safe swallow
used before fundoplication
haemochromatosis bloods
- raised transferrin saturation
- raised ferritin
- low TIBC
excess iron accumalation
–> more iron to bind to tbe transferrin
describe what they do:
- ferritin
- transferritin
- total iron binding capcity
ferritin
- intracellular iron stores
transferritin
- binds to iron to trasnsport it
(saturation of transferritin increases in haemochromatosis)
TIBC - the measure of iron binding sites (reduced, as there is increased saturation of iron)
what tests are checked before giving azathiopurine therapy?
thiopurine methyltransferase (TMPT) activity
this enzyme metabolises thiopurines
which specific liver test demonstrates the ability of hepatoctes carrying out their synthetic function?
albumin
PT
what is the child pugh?
list them
estimates cirrohsis severity
ascites encephalopathy INR albumin bilirubin
clinical features of acute liver failure
jaundice
fetor hepaticus - breath of the death / seen in portal HTN
what antigens / antibodies signify chronic Hep B infection
chronic:
- anti-HBc IgG
- anti
IgM anti-HBc = implies current infection
when is prophylactic abx given to patients with ascites?
Mx
for risk of developing spontaneous bacterial peritonitis
- ascites
- low SAAG > 11
oral ciprofloxacin –> e.coli
Mx for haemochromatosis
regular venesection
symptoms of irritable bowel syndrome
- pain relieved by defecation
- altered bowel habit
- abdominal bloating
- passage of mucus
- symptoms made worse by eating / at night
in a picture of microcystic anaemia - how do you detemine between anaemia of chronic disease and iron def?
iron studies undergone:
High TIBC in IDA
low / normal TIBC = IDA
mechanism of action of loperimide
acts on u-opioid receptors
–> reducing gastric motility
Ix for NAFLD
enhanced liver fibrosis (ELF)
