BMJ Q2 Flashcards
Delirium tremens?
It is the most severe form of alcohol withdrawal. Onset is typically three to seven days after cessation of chronic alcohol ingestion.
It is characterised by visual hallucinations, autonomic instability (tachycardia, hypertension, pyrexia), obtundation and confusion. Sweating, tremors and agitation are also features.
Treatment is with benzodiazepines.
Wilson’s disease typically causes?
reduced caeruloplasmin
raised urinary copper
raised free serum copper
Lactulose?
causes hypomagnesaemia associated with diarrhoea
Inhibits proliferation of ammonia-forming organisms in the gut
An isolated raised alkaline phosphatase?
should raised the possibility of biliary disease first and foremost
Increased risk of developing and worsening toxic dilatation in exacerbations of ulcerative colitis?
Hypomagnesaemia and hypokalaemia are both associated with an increased risk of developing and worsening toxic dilatation in exacerbations of ulcerative colitis. Hypokalaemia is unlikely to be successfully corrected without first correcting the magnesium deficit
Budd-Chiari syndrome?
Three year survival in patients with chronic Budd-Chiari syndrome has been reported as 50%
In acute Budd-Chiari syndrome thrombolysis and subsequent anticoagulation is used. Liver transplantation may be required in the rare cases of acute liver failure
In chronic Budd-Chiari syndrome anticoagulation can also be considered but management of complications such as ascites and portal hypertension is key
guidelines on the management of common bile duct stones?
How much Schatzki’s rings are dilated compare with peptic strictures and achalasia?
Schatzki’s rings are dilated to 16-20 mm a slightly larger diameter than benign peptic strictures 13-15mm
Dilatation for achalasia aims to disrupt the lower oesophageal sphincter and so larger diameter dilators (30-40 mm) are often used
Pancreatic carcinoma
The patient has a marked hypocalcaemia associated with malabsorption. Lack of pancreatic enzymes results in increased fats in the small intestine leads to sequestration of calcium and malabsorption of calcium as a consequence. The raised alkaline phosphatase may represent osteomalacia, pancreatic carcinoma in its own right, metastases or even biliary obstruction/disease
cystic lesions of the liver?
pyogenic liver abscess vs amebic
Piogenic:
Prior history of gallstones
Diabetes mellitus, Left shift on white blood cell count, Older adults, ^bilirubin
Amebic
Exposure to resource-limited settings, normal bill and no neuutrophilia
NSAIDs and H pylori
In patients taking non-steroidal anti-inflammatory drugs Helicobacter pylori eradication therapy does not increase the chances of ulcer healing when compared to acid suppression alone but does reduce the chances of recurrent peptic ulceration
Gastric Ca
The incidence of distal stomach tumours is actually decreasing while the incidence of tumours in the proximal stomach is increasing
CT with gastric dilatation is a useful complementary investigation in the staging of gastric carcinoma but endoscopic ultrasonography is superior to conventional CT scanning as it is able to assess depth of infiltration and lymphatic dissemination of tumour
Bowel cleansing preparations would be contraindicated in renal impairment?
Both Klean-prep and Movi-prep are polyethylene gycol based preparations
Ileus clinical symptoms?
Nausea, vomiting, Cramping abdominal pain, Obstipation (ie, inability to pass flatus or stool, Acute mechanical bowel obstruction is characterized by high-pitched “tinkling” sounds associated with the pain. With significant bowel distention, bowel sounds may become muffled, and as the bowel progressively distends, bowel sounds can become hypoactive
