26/5 Flashcards
Boerhaave’s syndrome vs Mallory Weiss tears
What is a common finding on CXR for boerhaave. How is it managed?
Oesphageal tears which both present with small haematesis (Boerhaave’s sometimes none) but
Boerhaave’s = full thickness - severe chest pain WORSE ON SWALLOWING
- pneumomediastinum on CXR
- manage like sepsis until surgical correction - high mortality rate
Mallory Weiss = small tears in the lower oesophagus
Pes cavus vs pes planus?
Cavus = high arch
Planus = low arch
What is Charcot-Marie-Tooth disease?
Most common herideratry cause of peripheral neuropathy
Mostly motor loss rather than sensory
No cure - just physio and OT
What can help to differentiate between oropharngeal and eosphageal causes of dyspesisa?
Can’t swallow, coughing, hoarseness? = oropharngeal
Oropharngeal = barium swallow
Esophageal
- solids and liquids = neuromuscular = manometry
- solids > liquids = structural
Viral Hep A VIVA
Prodromal viral illness
RUQ pain
Jaundice
Tender Hepatosplenomegaly
Pruritus
Bloods
= IgM = active infection
= IgG = previous infection/immunisation
Management
= supportive with basic analgesia
REPORT ALL VIRAL HEPS TO PUBLIC HEALTH
Relate stool and urine colour to site of liver pathology
Conjugated bilirubin is soluble so get dark urine
Pre-hepatic problem (heamolytic anaemia) = increase in UCB = normal urine and stool
Hepatocellular = increase in UCB and CB
= dark urine but normal stool
Post-hepatic = increase in CB = dark urine AND PALE stool
Pale stool because bililary obstruction is preventing CB from being released into duodenum = pale stool
What viral hepatitis is very dangerous in pregnancy?
Hep E
Management of chronic viral hepatitis?
Chronic = hep B and C
Conservative = RACES
Refer to GI/hepatology/ID
Alcohol - stop
Contact tracing
Education
Screen for complications and more viruses
Medical
- Antiviral meds can be used to slow the progress in HepB - Pegylated interferon alfa-2a
- HepC is now curable with direct-acting antivirals (DAAs) - tailored to the genotype (typically takes 8-12weeks)
Surgical
- liver transplant
Explain HepB antibodies and screening?
HbSAg - currently infected (S = Sick)
HbEAg - measure of how active the infection is, high = very infective
IgM = active infection
IgG = previous/chronic infection
HbSAb = immunisation or current/previous infection (SAB = used to have a SAB = previously there)
What HepB measurement is used to monitor repsonse to treatment?
HBV DNA
GORD Viva
GORD
- caused by defective LOS, reduced oesphageal motility or hiatus hernia
Sx
- chest/epigastric pain worse after eating and on lying down
- dysphagia
- acid reflux taste in mouth
Red flag sx
- progressive dysphagia
- anaemia
- weight loss and anorexia
- haematesis and vomiting in general
- melena
- odynophagia
- >55
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Invx
Bedside
- Stool test - test for H.pylori
- High dose PPI treatment afterward
Bloods
- if red flag sx
Imaging
- if cough, hoarseness of voice, halitosis? - yes = barium swallow
no = OGD
any red flag sx + >55 = 2 week OGD
Management
Conservative
Dietary advice, avoid eating before bed
Reduce alcohol and stop smoking
Lose weight
Medical
If H.pylori +ve start MAG for 7 days
If not PPI
Surgical
Anti-reflux surgery if not responding etc.
What should be given over FFP if it is avaliable in major bleeding with warfarin?
Prothrombin complex concentrate
What can you see in ABG of someone with COPD?
Raised CO2 - CO2 retainer
Fever on alternating days
Malaria
What adverse effects can be seen with PPIs
- Low Na, low Mg
- osteoporosis
- increased risk of C.diff
