BRS MOCK 1 - pancreatitis, CVD disorders, urological disorders, control of heart function Flashcards
What does the pancreas look like in acute pancreatitis?
Inflamed.
What does the pancreas look like in chronic pancreatitis?
Lots of fibrosis.
Common cause of acute pancreatitis?
Alcohol and gallstones.
What procedure can cause acute pancreatitis?
Endoscopic retrograde cholangio pancreatography
What drugs can cause acute pancreatitis?
S - Sulphonamides and steroids
A - Azothioprine
N - NSAIDS
D - Diuretics
How do gallstone cause acute pancreatitis?
Gallstone gets stuck in the ampulla and bile can’t leave and so you get bile reflux. You also get pressure build up of pancreatic juice as it can’t leave the ampulla. Reflux of activated enzymes from duodenum if gall stone leaves ampulla into duodenum.
How does alcohol cause acute pancreatitis?
Increased permeability of pancreatic duct epithelium and so enzymes diffuse into periductal interstitial tissue. Alcohol can precipitate proteins in the ducts that obstruct the duct and result in upstream pressure.
How does premature, intracellular enzyme activation occur in pancreatitis?
Proenzymes and lysosomal proteases incorporated into same vesicles resulting in trypsin being activated and pancreatic enzymes being activated intracellularly.
What does extracellular/intracellular activation of trypsin in pancreatitis result in?
Activation of elastase which causes vessel destruction and islet necrosis leading to bleeding and hyperglycemia. Activation of complement also causes vessel destruction. Activation of prothrombin leads to thrombosis which leads to ischaemia. Activation of phospholipase A2 leads to fat necrosis which leads to hypocalcemia. Activation of kallikrein leads to vasodilation and plasma exudation that can lead to shock.
Types of acute pancreatitis?
Oedematous pancreatitis. Haemorrhagic pancreatitis. Necrotic pancreatitis.
Why is necrotic pancreatitis dangerous?
Can get infected.
Biomarkers for acute pancreatitis?
Raised amylase. Raised lipase.
Local complications of acute pancreatitis?
Pancreatic necrosis, pancreatic pseudocyst, haemorrhage, thrombosis.
Chronic pancreatitis mechanism?
Alcohol abuse leads to a decrease in citrate and lithostatin concentration which result in calcium precipitation which leads to calcium deposition. This leads to epithelial lesions which leads to enzyme activation.
What can cause heart failure?
Cardiac damage (ischaemia), hypertension and valve disease.
What biomarker for heart failure?
Elevated brain natriuretic peptide (BNP).
What would you see on an xray of a patient with heart failure?
Cardiomegaly.
Treatment for heart failure?
ACE inhibitors, beta blockers.
What might you see in an ECG for a patient with heart failure?
Enlarged QRS complex.
What can be seen in the ventricles in patients with reduced ejection fraction?
Dilated ventricles.
What can be seen in the ventricles in diastolic heart failure?
Thickened ventricular muscle.
What causes Wolff-Parkinson-White syndrome?
Additional accessory conduction pathway (the bundle of Kent) between the atria and ventricles.
ECG findings in atrial fibrilation?
Absent p-waves & ‘irregularly irregular’ rhythm.
ECG findings in Wolff-Parkinson-White syndrome?
QRS pre-excitation & biphasic T wave.
Treatments for atrial fibrilation?
Cardioversion, anti-arrhythmics.