27/5 Flashcards
What examination findings would you expect in bladder cancer?
PR AND ABDO !!
PR - smooth prostate - may feeel a pelvic mass if cancer has spread
Abdo exam - sometimes a palpable mass in suprapubic region
General exam - signs of anaemia, weight loss and cachexia
Lymphadenopathy - inguinal region
ATHLETICS for predinsolone longterm
Who can’t get methotrexate?
Side effects?
Pregnant women
Renal impairment
Liver disease (can cause hepatotoxicity - hence checking for LFTs)
ALWAYS split into common and rare
Common
- GI distrubance e.g. vomiting and diarrhoea
- Mouth sores
- Mild alopecia
Rare
- hepatotoxicity
- myelosuppression
- pulmonary toxicity
- TERATOGENICITY
What is a possible complication of EBV and what is told to pts as a result?
Splenic rupture
Hence no contact sports for at least 1 month
What electrolyte imbalance are you expecting to see in anorexia?
Most things low but G and C high (Girlies in GC - girls get anorexia)
Growth hormone, glucose, salivary Glands, Cortisol, Cholesterol, Carotinaemia
Causes of acute pancreatitis?
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Scorpion
Mumps
Autoimmune
Steroids
Hypercalcemia/hyperlipidemia/hypothermia (THINK OF GLASS OF COLD MILK)
ERCP
Drugs (diuretics etc.)
What stoma is spouted vs flat and why?
What type of stoma is more permanent?
What is a J-pouch?
What complications can occur with a stoma?
Ileostomy should be spouted as bowel contents are more irritating from there and this should keep contents away from skin
Colecostomy will be flat as not as irritating
End more permanent - loop is reversible
J-pouch is a fake rectum formed of ileum
Psycho-social impact
Skin irritation
Stenosis
Obstruction
Retraction
Among many
What kind of stoma is common after an anterior resection for a high rectal tumour (>8cm from the anal margain)?
What is done if lower than 8cm from anal margain?
Loop ileostomy - temporary (so that the anastomosis lower down has time to heal)
Abdomino-perineal resection
What is Hartmann’s procedure?
Complete resecton of the rectum and sigmoid colon = end colostomy (can be revised later as still have rectum)
This is preferred in emergencies as not performing anastomosis at the same time (perforations and obstructions)
IN EMERGENCIES ALL END STOMAS
Memory aid for IBD
Endoscopic findings on Crohn’s vs UC
CLOSE UP
Continous inflam
Limited to rectum and colon
Only superfical mucosa
Smoking is protective
Excrete blood and mucus
Use aminosalicylates (MESALAZINE)
PSC/pseudopolyps
NESTS
No blood
Entire GI tract
Skip lesions/strictures
Transmural inflam and terminal ileum
Smoking increases
UC = continous colonic inflam and ulcers and crypt abscesses
Crohns = COBBLEstone appearance and deep ulcers
Cobbledy crohns
Management of UC vs Crohns
UC =
Conservative
- potentially continue smoking (but don’t recommend)
Medical - flares
1. Topical ASA (mesalazine) (IF left sided disease or else not gonna reach is it)
2. Oral ASA
3. Oral prednisolone
4. Tacrolimus
If severe
1. IV steroids
2. If not improving in 72hrs - IV ciclosporin (DMARD)/consider surgery
Surgery
1. Panproctocolectomy with end ilesotomy
2. Other surgical options too with temporary end ileostomy
Crohns
Conservative
- stop smoking
Medical
- oral/IV steroids to induce remission
>2 flares in a year = 1. azathioprine 2. methotrexate 3. biologics
Surgical
- not required in same way as UC (mostly for anal sx instead)
What type of IBD is assoc. with colangiocarinoma?
UC
Give 3 causes of SOL in the brain
Abscess
Tumours
Haematoma
