Abdominal Flashcards
Refeeding syndrome definition:
- Potentially fatal shift in fluids and electrolytes from rapid artificial feeding in malnourished patients
How does refeeding syndrome work?: (3)
- I S
T U
M R
- Increased insulin secretion drive K+, Mg2+ into cells, reducing them intravascularly
- Increases thiamine utilisation
- Increases metabolic rate which increases strains on CVS and resp.system.
Prevention of refeeding syndrome:
- Monitoring of the patients K, Ca, PO4, Mg
Short bowel syndrome:
- A condition where the body is unable to absorb enough nutrients from food due to lack of small intestine
Consequences of short bowel syndrome: (5)
L D
G D
B O
N D
K D
- Liver disease
- Gallbladder disease
- Bacterial overgrowth (small intestine)
- Nutrient deficiencies
- Kidney disease
Total parenteral nutrition (TPN):
- A method of feeding that bypasses the GI tract
When is TPN useful?
How is TPN delivered?
- When all or part of a persons GI tract doesn’t work
- Into a vein
Urea cycle defect:
- Leads to hyperammonaemia
- Must restrict diet (protein)
- Supplementation required to stop muscle atrophy
Medium chain aceyl-CoA dehydrogenase deficiency (MCAD):
- Defect in fatty acid oxidation
- Can lead to hypoglycaemia, potentially fatal to babies
Clinical features of Acute (fulminant) liver disease:
N
D
J
B E
A
H E
V
S
- Nausea
- Diarrhoea
- Jaundice
- Bleeding easily
- Ascites (fluid in belly)
- Hepatic encephalopathy
- Varices
- Splenomegaly
Chronic liver disease clinical features: (3)
- Similar symptoms to acute
- liver cirrhosis
- Portal hypertension
Chronic liver disease and portal hypertension:
Effects (3)
- Ascites
- Oesophageal varices
- Splenomegaly -> thrombocytopenia
Stigmata of chronic liver disease: (2)
- Spider nevi
- Palmar erythema
Common causes of liver disease:
A
F
H
P B C
P S C
- Alcoholism
- Fat
- Hepatitis A/B/autoimmune
- Primary biliary cholangitis
- Primary sclerosing cholangitis
How to test for liver dysfunction: (3)
- Serum fibrosis score
- Fibrosis markers or fibroscan
- Liver biopsy (best but invasive)
Paracetamol overdose:
- why?
- Treatment
- Narrow therapeutic window, >10g can cause toxicity
- N-acetylcysteine
Rotavirus epidemiology:
- Global prevalence
- Peak incidence group
- Uncommon in ……
- Seasonal peak
- Most common cause of diarrhoea world wide
- 6-24months
- Uncommon in >5 year olds
- Winter peak
Norovirus epidemiology:
- Most common cause where?
- Peak incidence group
- Seasonal peak
- Most common cause in the UK & US
- 6-18 months
- Winter peak
Rotavirus pathophysiology:
- Replicates in….
- Activation of …..
- Replicates in enterocytes, causing damage but little inflammation
- Activation of enteric nervous system may contribute to pathogenesis
Rotavirus clinical features:
(wide spectrum) (4)
▪ severe diarrhoea
▪ Vomiting in 90% children
▪ Fever
▪ Can be Asymptomatic
Rotavirus & norovirus transmission:
- Breathe in aerosolised vomit/faeces and swallow
Rotavirus diagnosis:
S E M
S E I
M D
▪ Stool electron microscopy
▪ Stool enzyme immunoassays
- Molecular diagnosis (PCR of faeces)
Norovirus pathophysiology:
▪ No enterotoxins
▪ Enterocytes infected
▪ Histo blood group antigens (HBGA) may function as a receptor for norovirus
Norovirus clinical features:
V
D
H
M
A C
- Vomiting in children
- Diarrhoea in adults
- Headaches
- Myalgia
- Abdo cramps