CBL 2 W3-4 GI and Endocrine Flashcards
What is schistosomiasis ?
Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma.
What type of tick causes Lyme disease
Ixodes Ricinus in the UL
What is zika virus?
Virus transmitted via mosquitos in Africa, South Asia, Carribean etc.
What is the most common mosquito to transfer malaria?
P.Falciparum
What is the first line treatment for severe Malaria?
IV Artemisinin
Where are travellers usually to catch Dengue?
Southeast Asia
Treatment for dengue
supportive (no admission, Paracetemol)
What antibodies are produced in response to dengue?
Memory IgG antibodies
Type of mosquito for dengue
aedes species
Dengue shock, capillary leak syndrome treatment
aggressive IV fluid management (note NOT anti virals)
Is dengue serious?
First time, no, second time more serious!
What is Dengue shock?
Severe dengue occurs as a result of secondary infection with a different virus serotype. Increased vascular permeability, together with myocardial dysfunction and dehydration, contribute to the development of shock, with resultant multiorgan failure.
Effects of dengue on the liver?
Severe Dengue can cause fatty liver and acute liver failure.
Dengue symptoms
Most asymptomatic but:
High fever
Headache
Body aches
Nausea
Rash.
Note:Most will also get better in 1–2 weeks.
Malaria symptoms
Fever and Flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells.
What are neglected tropical diseases?
associated with poverty (lack of resources etc) but are mostly preventable and treatment
What is rabies?
(mention where and who affected, and how is it acquired?)
Asia, Africa,
40 percent under 15
From dogs (that are not vaccinated)
What is Leishmaniasis?
What is Lymphatic Filariasis
What is Trachoma?
What are the symptoms of Rabies?
headache, fatigue, hallucinations, tingling of wound, Insomnia, aggression, hydropobia, excessive salavation, throat spasms
What is management of Rabies?
HRIG vaccine
Direct immunoglobulin into wound injected
What is prognosis of Rabies?
What is the incubation time of rabies?
In terms of their relation to connective tissue, compare endocrine and exocrine glands.
Exocrine maintains relationship to surface via duct system while endocrine is seperated with its own connective tissue capsule.
Where is the pituitary gland located?
In the Sella Turcica of the Sphenoid bone and enclosed by a connective tissue capsule.
Note: Close proximity to the oral cavity
What is the infundibulum?
It connects the hypothalamus with the pituitary gland, comprising of both blood vessels and nerves.
What are the two parts of the pituitary gland and what are there general functions?
Anterior = Hormonal
Pituitary = Nervous
What are the cells present in the anterior pituitary gland and what do they produce?
-Somatotrophs = GH
-Mammotrophs = Prolactin (act on the breast)
-Corticotrophs = ACTH (adrenocorticotropic hormone) (acts on the kidney)
-Throtrophs - TSH (act on thyroid)
-Gonadotrophs FSH and LH (reproductive hormones)
What cell type is the majority cell type in the Anterior Pituitary?
Somatotrophs
What is the Hypophyseal portal system?
Blood vessels connecting the hypothalamus to the anterior pituitary.
What is the posterior pituitary composed of?
Unmeylinated axons of the neurosecretory cell bodies that originate in the SUPRAOPTIC AND PARAVENTRICULAR NUCLEI OF THE HYPOTHALAMUS.
What 2 structures would you expect to see on a histilogical slide of a posterior pituitary?
1.Herring Bodies = Dilations of axons to store hormones
2.Pituicytes = Support cells
What does the Supraoptic nucleus of the hypothalamus store?
ADH
What does the Paraventricular Nucleus of the hypothalamus store?
Oxytocin
What are the main 2 cell types of the thyroid?
1.Follicular cells
2.Parafollicular / C cells
What do the Follicular cells produce and why?
T3 and T4 to regulate metabolic rate as well as body growth and development
What do the Parafollicular / C cells produce?
Calcitonin
What are the effects of Calcitonin?
1.Decreases blood calcium
2.By decreasing bone reabsorption by the osteoclastes
3.Increase bone formation by osteoblasts
Where are the Parathryroid lobes located?
Sit posteriorly on either side of the thyroid.
Where is the thyroid located and describe its appearance?
1.(Anterior + Lateral surface) of Upper trachea
2.Bilobed
What is Goitre?
Swelling of the neck (i.e thyroid)
Describe the production of T3 and T4 in the thyroid.
- Follicular cells produce THYROGLOBULIN
2.This is stored in the centre of the follicle as COLLOID
3.Thyrotrophs of the Ant.Pit release TSH
4.This stimulates the reabsorption of Thyroglobulin
5.And then it is broken down my lysosomal action to T3 and T4
6.Released into bloodstream :)
What is the purpose of Thyroglobulin?
Storage form of T3 and T4.
What is the effect of Hyperthyroidism on Colloid levels?
Decreases
What is the effect of Hypothyroidism on Colloid levels?
Increases
Where is the adrenal gland located?
Suprarenal = above the kidney
What are the 2 parts of the adrenal glands?
1.Cortex
2.Medulla
What hormones and produced in the Cortex of the Adrenal gland?
-Mineralocorticoids
-Glucocorticoids
-Androgens
What hormones does the Medulla of the Adrenal glands produce?
Catecholamines
-Adrenaline
-Noradrenaline
What are the 3 zones of the adrenal cortex?
1.Zona Glomerulosa
2.Zona Fasciculata
3.Zona Reticularis
What happens in the Zona Glomerulosa ?
Production of Mineralcorticoids e.g Aldosterone
What happens in the Zona Fasciculata?
Influenced and controlled by ACTH that is released from the anterior pituitary gland, this is where GLUCOCORTICOIDS (e.g Corticoids) are produced
What happens in the Zona Reticularis?
Production of androgens (sex hormones)
What hormones are secreted from the Enteroendocrine cells?
GASTRIN = stimulates gastric acid secretion
CHOLECYSTOKININ (CCK) =stimulates gall bladder contraction
MOTILIN = stimulates gastric and intestinal motility
SECRETIIN = stimulates pancreatic enzyme secretion and inhibits gastric acid secretion
What does secretin inhibit?
Gastric acid secretion
Where are the Enteroendocrine cells located?
Diffusely arranged in the GI epithelium
What does Oxytocin do?
Stimulates Uterine Contraction and Milk Ejection
What does ADH do?
-Increases H2O permeability and absorption in renal collecting ducts
-Vasocntricts to increase BP
What are the 7 tropic hormones?
1.GH
2.TSH
3.ACTH
4.PRL (prolactin)
5.FSH
6.LH
What are Hypothalamic Hypophysiotropic hormones?
Hormones that are released by the hypothalamus and act on the Ant.Pit.
List the Hypothalamic Hypophysiotropic.
1.Growth Hormone Releasing Hormone
2.Growth hormone inhibiting hormone (Somatostatin)
3.Thyroid Releasing Hormone
4.Corticotrophin releasing hormone
5.Prolactin releasing hormone
6..Prolactin inhibiting hormone (Dopamine)
7.Gonadotrophin releasing hormone
List the categories of causes for Primary Hyposecretion.
Genetic, Dietary (lack of iodine), Chemical / Toxic, Autoimmune diseases or Latrogenic (surgical removal)
What is Primary Hyposecretion?
Too little hormone is secreted due to abnormality within gland
What is Secondary Hyposecretion?
Gland is normal but too little hormone is secreted due to deficiency of its Tropic Hormones.
What is Tertiary Hyposecretion?
Gland is normal but too little hormone is secreted due to deficiency of Hypothalamic Releasing Hormone.
Of all of the pituitary hormones, which one when deficient would be a threat to life?
Cortisol
What are the causes of Hypersecretion?
Tumours
What is primary hypersecretion?
Abnormality is WITHIN the gland
What is secondary hypersecretion?
Excessive stimulation from OUTSIDE the gland
What are the consequences of high ACTH?
Cushing’s Disease
What are the consequences of high Prolactin?
Impaired reproductive function
What are the consequences of high ADH?
Fluid retention and Low plasma osmorality
What are the consequences of high hGH in children?
Gigantism
What are the consequences of high hGH in adults?
Acromegaly
Describe the pathway of synthesis and secretion of Thyroid hormone.
- Iodine Trapping
=Iodine /Na+ Co transporter transports Iodine into follicular cells
2.Endosome containing colloid with the hormones inside fuse with lysosomes to cleave the T3 and T4 where it then leaves the follicle
How is Radioactive Iodine used diagnostically and what does it indicate?
-Used to investigate Thyroid hormone production in thyroid.
-Thyroid mops up Iodine (takes it up), so the AMOUNT OF IODINE ABSORBED BY THE THYROID IS IN DIRECT CORRELATION TO THE HEALTH OF THE THYROID
How are thyroid hormones transported in the plasma?
As they are Lipophillic they need to bind binding proteins :
-Thyroid Binding Globulin
-Thyroid Pre-Binding Albumin
-Thyroid Binding Albumin
How does Thyroid hormones increase basal metabolic activity?
By increasing the no. of Na+/K+ ATPase pumps
What are the actions of T3 and T4?
Increase metabolism:
-Increase BMR (Basal metabolic rate)
-Calorigenic effect (increased production of heat as a bi product of metabolism)
-Carbohydrate metabolism (increased absorption of glucose, glycogenolysis, and gluconeogensis.
-Lipid Metabolism (Lipolysis to increase circulating Free Fatty Acids and FFA oxidation, decreases cholesterol)
-Protein metabolism (increased protein synthesis and protein breakdown)
What is primary hypothyroidism?
Problem within the Thyroid gland which causes failure of thyroid gland to respond to TSH
Name 4 causes of Primary Hypothyroidism.
1.Thyroiditis e.g Hashimoto’s disease
2.Severe iodine deficiency
3.Severe deficiency of one or more synthesis enzymes
4.Removal or dysfunction of thyroid gland
Name 2 examples of Thyroiditis.
1.Hashimoto’s
2. Chronic Lymphocytic thyroiditis
What is Secondary Hypothyroidism?
Deficient TSH production
What is Tertiary Hypothyroidism?
Deficient TSH secretion due to deficient TRH secretion
What are the 3 causes of Hyperthyroidism from most common to most rare.
1.Autoimmune (e.g Grave’s)
2.Thyroid Adenoma
3.TSH-secreting adenoma
What causes goitre in Grave’s disease?
The inflammation of the thyroid glands on the neck due to antibodies that mimic TSH and stimulate the thyroid
What would you expect your T4, TSH and TRH to be in Primary Hypothyroidism?
T4 decreases
TSH increases
TRH increases
What would you expect your T4, TSH and TRH to be in Secondary Hypothyroidism/ Pituitary Hypothyroidism?
T4 decreases
TSH decreases
TRH increases
What would you expect your T4, TSH and TRH to be in Hypothalamic Hypothyroidism (Tertiary)?
T4 decreases
TSH decreases
TRH decreases
What would you expect your T4, TSH and TRH to be in Graves’ disease?
T4 increases
TSH decreases
TRH decreases
What is Exophthalmos?
The out bulging of the eyes you see in Grave’ disease
How does Emotional stress or Chemical stress affect Cortisol secretion?
- E.g Anxiety and Hypoglycaemia
- Hypothalamus release Corticotropic releasing hormone
3.Acts on the Post. Pit portal system and acts on the Corticotroph cells within the Ant.Pit
4.Zona Fasciculata RELEASES CORTISOL
5.ACTH and Corticotrophin Releasing Hormone are now downregulated
Describe the Diurnal rhythmic release of ACTH.
ACTH release follows a wake sleep cycle (diurnal rhythm)
-low in late night 11pm-3am
-Peak at 7-9am when you wake up
= this pattern is reversed in people with night shifts
As there are cues from light that affects the ACTH release
What hormone does ACTH control (i.e initiate release of)?
Cortisol
How would you take a cortisol measurement to check for deficiency?
Take a blood sample at 8-9am when it is supposed to be high when you suspect deficient cortisol levels.
Note: Due to pulsatile release of cortisol random measurement timings would be useless
How does cortisol travel in the blood?
Bound to Transcortin (85 % are bound in the blood)
If a patient has Cushings what would be used to diagnose?
-Urinary free cortisol would be high
-Cortisol levels would have to be monitored over a 24hr period
How do glucocorticoids affect muscle?
Catabolic affect = breaks amino acids down favouring a negative nitrogen balance and therefore a loss of muscle
How do glucocorticoids affect Liver?
Anabolic = Gluconeogenesis and Glycogenesis
How do glucocorticoids affect fat cells?
Lipolysis (Free fatty acid mobilisation)
How do glucocorticoids affect Immune system and inflammation?
Supresses it
Note: Good clinical intervention to treat the symptom of inflammation of an autoimmune disease
What are the signs of Cushings Disease?
-Fat deposition in belly and face
-Easily bruised
-‘Moon face’ = fat depositions and redness
-Dorsocervical fat depositions - i.e on the back between the shoulder pads
-Striae
-Osteoporosis (inc pathological fractures)
-Suppression of immune system
-Delayed healing of fracture and soft tissue injuries
Name the 3 actions of aldosterone.
-Increased Na+/H2O absorption
-Increased K+/H+ secretion
-Increased Blood Volume / BP
What 3 things does Aldosterone deficiency lead to?
- Increased loss of Na+ and H2O in the urine
= Dehydration, Plamsa depletion and Hypotension
2.Renal retnetion of K+
=Hyperkalaemia and cardiac excitability which can cause ventricular fibrillation
3.Renal retention of H+
=Metabolic acidosis
What is Conn’s Syndrome
A rare case of primary hyperaldosteronism with 75% of cases due to Adrenal adenoma carcinoma
What is secondary hyperaldosteronism?
Rare overactivity of the RAAS due to renin secreting tumour which can affect the heart
If one of the adrenal glands is destroyed, how does the body compensate?
Hypertrophy of the other adrenal gland
What is Addison’s Disease?
Destruction of BOTH adrenal cortices causing a lack of glucocorticoids, mineralocorticoids and adrenal androgens.
What are the effects of lack of glucocorticoids?
-Hypoglycaemia
-Reduction in fat and protein metabolism
-Weight loss
-Poor exercise tolerance
-Poor stress tolerance –> Death
What are the effects if lack of mineralcorticoids?
-Decrease in Na+
-Increase in K+
Increase in H+
-Hypovolaemia 9decreased blood volume)
-Decrease in cardiac output –>Circulatory collapse –> Shock –> Death
Describe the differing effects of a lack of adrenal androgens between men and women.
Not a major effect especially with men since they produce testosterone. More damaging in women due to their libido, can cause depression but not fatal.
What is the treatment for Addision’s disease?
Hormone replacement
List the symptoms of Addison’s disease.
-Bronze pigmentation of skin
-Hypoglycemia
-Postural hypotension
-changes in distribution of body hair
-GI disturbance
-Limb weakness
-Weight loss
List a signs you would notice on Inspection of a patient with Addison’s.
-Dark Palmar creases
-Brown buccal (cheek) pigmentation - could be referred by dentist due to hyperpigmentation of the gums
What is the Adrenal Medulla composed of?
-Cell bodies NOT axons
-Chromaffin cells
Compare Adrenal stimulation with sympathetic activation.
-A exerts effects on ALL cells while S exerts on SOME
-A effects are delayed with prolonged effects while S is immediate and rapidly ceases
-A only has generalised effects while S is localised
What triggers the release of catecholamines from Chromaffin cells?
An increase in Ca2+ triggers the release/
What type of receptors does Noradrenaline act on?
Mainly Alpha and a little Beta action
What type of receptors does Adrenaline act on?
Mainly Beta and a little Alpha action.
What is the difference between Adrenaline and Noradrenaline in terms of function?
Adrenaline : More cardiac stimulation and increasing metabolism
Noradrenaline : More constriction of blood vessels
What is Pheochromocytoma?
A catecholamine secreting tumour
What are the symptoms of Pheochromocytoma?
-Hypertension
-Headache
-Sweating
-Palpitations
-Chest pain
-Anxiety
-Glucose intolerance
-Increased metabolic rate
What is the first line treatment for Hyperthyroidism?
Thiourylenes
=CARBINMAZOLE
What is the inactive and active form of the Thiourylene used in Hyperthyroidism?
Inactive: Carbinmazole
Active: Methimazole (activated in body)
What is the pharmacological action of Carbinmazole?
Reduces Thyroid hormone synthesis by:
-Inhibiting iodine oxidation and iodination of tyrosine
Is Carbinmazole slow or fast acting?
Slow
What are common side effects of Carbinmazole?
Skin rashes and Pruritis (itchy skin) , Hypothyroidism (see regimes to combat this)
What are rare side effects of Carbinmazole?
Agranulocytosis = Deficiency in granulocytes means vulnerable to infection - very serious;
Arthralgia = Joint stiffness; Hepatitis
What are the 2 regimes for prescribing Carbinmazole?
1.Titration Regime
2.Block and replace
Describe the Titration regime in hyperthyroidism.
1.Start with a dose of 20-40mg for the first 2 weeks to figure out the regime
2.Dosage gradually reduced to 10mg-15mg/day
For those at an increased risk of Hypothyroidism
Describe the Block and replace regime in hypothyroidism.
Up to 18mnths treatment until remission for those who are taking anti-thyroid long term.
E.g Graves disease
Block: Carbinmazole 40mg/ day + Replace: Levothyroxine Sodium 100-150 um/day
For those who are taking anti-thyroid long term.
E.g Graves disease
If remission isn’t achieved after 18mnths in Hyperthyroidism patients, what are the next steps?
Radioiodine or Surgery
What is the second line treatment for Hyperthyroidsim?
Radioactive Iodine
Who is contraindicated for Radioactive Iodine?
!Women advised to avoid pregnancy for 6 months after treatment and men not to father children for up to 4 months.
What other drug can be given in conjunction to first line treatments for hyperthyroidism?
Propanol
Note: Inhibits T4–>T3 conversion but mainly treats the cardiovascular effects of an overactive thyroid - e.g reduces palpitations
What drug is required if a Hyperthyroid patient needs to have surgery?
Removes thyroid or nodules and then will need Levothyroxine for life
What is the contraindication of Levothyroxine?
Pregnant women!
They must be put on a low dose and have to avoid the block and replace as these drugs can cross the placenta causing foetal hypothyroidism and can be transferred via breast milk.
What treatment is used to treat Hypothyroidism?
Levothyroxine
What is the pharmacological action of Levothyroxine?
The thyroid gland makes thyroid hormones which help to control energy levels and growth. Levothyroxine is taken to replace the missing thyroid hormone thyroxine.
What are the 2 types of Schistosomiasis in terms of where in the body they can affect?
Intestinal and Urogenital
Where is Schistosomiasis prevelant?
It is estimated that at least 90% of those requiring treatment for schistosomiasis live in Africa.
What is the treatment for Schistosomiasis?
Praziquantel
What is the transmission of Schistosomiasis?
Transmission occurs when people suffering from schistosomiasis contaminate freshwater sources with faeces or urine containing parasite eggs, which hatch in water.
What are the symptoms of Intestinal Schistosomiasis?
-Abdominal pain
-Diarrhoea
-Blood in the stool.
Advanced disease:
-Liver enlargement
-Frequently associated with an Accumulation of Fluid in the Peritoneal Cavity and Hypertension of the abdominal blood vessels
-Enlargement of the spleen (some cases)
What are the symptoms of Urogenital Schistosomiasis?
-Haematuria (blood in urine). -Kidney damage and fibrosis of the bladder and ureter are sometimes diagnosed in advanced cases.
What is possible complication of Advanced Urogenital Schistosomiasis?
Bladder Cancer and Infertility
How may Urogenital Schistosomiasis present in a women?
Genital lesions, Vaginal bleeding, Pain during sexual intercourse and Nodules in the vulva.
How may Urogenital Schistosomiasis present in men?
Can induce pathology of the seminal vesicles, prostate and other organs.
Symptoms of Lyme’s disease?
-Severe headaches and neck stiffness.
-Rashes on other areas of the body.
-Facial palsy (loss of muscle tone or droop on one or both sides of the face)
-Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
-Intermittent pain in tendons, muscles, joints, and bones.
What is the treatment for Lyme’s Disease?
10-14 day course of Doxycycline or Amoxicillin
What are the symptoms of Zika Virus?
-high temperature
-headache
-sore, red eyes
-conjunctivitis
-swollen joints and joint and muscle pain
-rash and itching all over the body
What type of mosquito transmits Zika Virus?
Aedes
What is Zika Virus associated with?
Guillain-Barré syndrome, neuropathy and myelitis in adults and children.
Who are most at risk of Zika Virus complications?
Pregnant women
What is the management of Zika Virus?
Bed rest etc, avoid NSAIDs
What is Capillary Leak Syndrome?
In severe dengue disease, plasma leakage occurs later in infection, after the waning of fever.
What is the treatment of Capillary Leak Syndrome
Fluid management
What is the function of Oxytocin?
Uterine contractions during labour
What are the 4 cell types of the Crypts of Liberkuhn at the base of the villi?
-Enterocytes
-Goblet Cells
-Paneth Cells
-Enteroendocrine cells
What are Paneth cells?
Located in the Crypt of Lieberkühn in the small intestine that releases fluid to destroy forgien bodies
What are the antibodies to show up on a blood test to indicate Hashimoto’s Hypothyroid disease?
Anti-thyroid peroxidase antibody
What are the characteristic histological changes / features in a patient with Hashimoto’s Thyroiditis and why?
Anutoimmune causes -Infiltration of lymphoid follicles
-Macrofollicular (from the compensation of the cells) and Microfollicular (from the destruction of the autoantibodies.
-Colloid follicles are bigger and have fluid stuff in the middle from the destruction effects
What other diseases can affect the Thyroid that produces the same effects as Hashimoto’s Thyroiditis?
Type 1 Diabetes
Addisions
What is the most common extra-articular manifestation of rheumatoid arthritis?
Rheumatoid Nodules
=due to the effects of RA on the arthiritis.
Which organs can you see the collagen connective tissue capsule?
-Spleen
-Thymus
-Endocrine Organs
What is the defining histological feature of the Anterior Pituitary gland?
The different coloured cells - some highly coloured and some not so much
What are the defining histological features of the Pituitary gland?
-2 very different looking parts with a connective tissue divide (Infundibulum)
-One side (posterior) is stained differently with flecks of Herring bodies
-The other side has multiple different colours (some very colourful and some not so much)
What are the defining histological features of the Posterior Pituitary gland?
Flecks of Herring bodies
What are the defining histological features of the Adrenal gland?
Three distinct layers of the CORTEX (Zona glomerulosa - circles of cuboidal cells, Zona Fasciculata - Long cells, Zona Reticulum (the inner layer)
and then the MEDULLE
What are the defining histological features of the Thyroid?
The whole tissue is SIMPLE CUBOIDAL with the Colloid Vesicles being a circle of cells with a massive gap in the middle.
What cells type are Lymphoid follicles (from autoimmune disease) usually made up of?
B-lymphocytes (that make antibodies)
What are Hurthle Cells?
Follicular cells (e.g in the thyroid) that have enlarged and degraded.
What are the histological features of Hashimoto’s Thyroiditis that are in common with Rheumatoid arthiritis and what is not seen?
Hurthle Cells = Seen in both
Autoimmune changes: Lymphoid Follicles NOT seen
Which Rib is the Liver located?
T5
(below the nipple-T4)
How would you identify T4 on a patient?
In line with the Nipple
Describe the location of the liver.
T5 extending from the right mid-axial line to the left mid-clavicular line just above the Transpyloric Vein.
Where is the Transpyloric Vein located?
Halfway between the jugular notch and pubic symphysis across the abdomen horizontally.
Which ribs are where the Spleen is location?
T9-11 on the left towards the back of the patient (it curves round)
How would you treat a ruptured spleen?
Remove the spleen completely and for the rest of their life they will require pneumococcal vaccine as they will be more vulnerable to pneumonia etc.
What is a typical patient with Pyloric Stenosis?
Affects newborns (defect upon birth)
What are the typical symptoms of Pyloric Stenosis?
-Projectile Vomiting
What is the management for Pyloric Stenosis?
Surgery i.e Pyloromyotomy,
= An incision is made in the wall of the pylorus. The lining of the pylorus bulges through the incision, opening a channel from the stomach to the small intestine.
Does the superior mesenteric vein go to the pancreas or portal vein?
Pancreas
Does the inferior mesenteric vein go to the pancreas or the Liver?
Liver = Portal Vein
Where does the Pancreatic duct merge with the Duodenum?
Into the Duodenal Papillae of DI (1st part of the duodenum)
What is the most common cause of Pancreatitis and what usual other cause is there?
MOST common: Gall Stones
Common: Alcohol, Complication of ERCP
What colour would a leak from the Duodenum look like and why?
Green due to BILE.
What is a Subphrenic Abscess?
Infected collections bounded above by the diaphragm, and below by the transverse colon and mesocolon, and the omentum.
Describe the CXR findings of a patient with a Subphrenic Abscess?
Fluid above the diaphragm (i.e boobs) and will present as white.
List the commonly seen drugs to cause Kidney Injury?
-Metformin
-ARBs
-ACE inhibitors
What are common infections that Diabetic patients get due to Glucose in the urine?
UTIs and Thrush
What drugs can cause UTIs?
SGLT2 inhibitors (-floxin)
What is a common place of pain radiation for a GI problem?
Shoulder tip radiation
What are the common causes of referred shoulder tip pain?
-Ectopic Pregnancy
-Ruptured Ovarian Cyst
-Perforation of the viscus due to Gallstones or Pancreatitis
What are the general causes to think of with a patient presenting with Pelvic Ache?
-Ovarian Cyst
-Endometriosis
Describe the location of Renal Colic?
Loin to Groin
What does Leukonychia indicate? Is it extremely indicative?
-Can just be congenital
=SO NO, NOT A INDICATIVE SIGN
But can also indicate:
-GI issues: Renal and Liver issues
What are the general causes of Dupuytren’s Contracture
-Alcohol
-Epileptic Medications
-Idiopathic (Billbob)
What is Gynecomastia?
Male Breasts
What are the general causes of gynecomastia?
-Medications
-Liver Disease
-Fat
-Congenital
What is the difference between Spider Naevi and Caput Medusae?
Caput medusae are a cluster of swollen VEINS around the umbilicus due to circulatory hepatic caused issues and are painless; while Spider Naevi although indicating similar issues are red/purple spots with little branches due to vascular lesions causing dilation of the ARTERIES.
What is meant by a Satellite Lesion?
Dermatological phrase to describe smaller lesions near the edges of a principal lesion
What is the main treatment for treating a Candida infection?
Fluconazole
What is Oxybutynin (drug class) and what does it do?
Anti-Cholinergic that DECRESES URINARY FREQUENCY
How do Anti-Cholinergic drugs
They block Acetyl Choline (decrease sympathetic stimulation)
What is Tapentadol?
VERY STRONG ANALGESIA:
Stronger than Tramadol (morphine based)
What does Florid Diarrhoea mean?
Florid MEAN THE WORST
What is the definition of Diarrhoea?
Higher frequency and/or Looser stool
What is Lichen Sclerosis?
Rare skin disease that causes itchy and painful patches of thin, white, wrinkled-looking skin. In women, these may occur on the vulva and/or the skin around the anus. In men, it typically affects the head of the penis.
(Remember patient at Clinical Experience)
What is Latch-Key Incontinence and what does is usually mean?
Poor bladder control that is triggered by associations (such as putting the key in the door).
=Usually means Obstructive bladder disorder
What is the most common type of incontinence?
Mixed
-Stress (being the most dominating)
-Urge
Who are most at risk of Recurrent UTIs and why?
Peri/Post Menopausal Women due to low Oestrogen which causes a weakening of the pelvic floor causing more incontinence (urge/stress) and therefore increases their risk of UTIs.
What 2 main conditions should you think about if a patient looks tanned (and hasn’t been on holiday / somewhere sunny)?
-‘Bronzed’ Diabetes
-Haemochromatosis
What is Angular cheilitis?
Skin lesions around the mouth due to inflammatory skin process of variable etiology occurring at the labial commissure, the angle of the mouth.
What can cause Angular Cheilitis?
Vitamin B12 deficiency and Folate deficiency
(which causes the saliva to pool around the mouth causes the craggyness)
What is Hidranenitis Supperativa
Idiopathic Chronic Inflammatory disease causing pus-filled painful lumps around the groin and under the arm pit.
What are some risk factors for Hidranenitis Supperativa?
Excessive sweating
-Androgen deficiency
What are the common antibiotics used for Hidranenitis Supperativa?
-First line: Flucloxacillin
CONTRAINDICATED IN PENICILLIN ALLERGIES
-Tetracycline
-Doxycycline
-Erythromycin
What is an infection that can be caused by continued use of Tetracycline?
Oral Thrush
What main complication are patients with Hidranenitis Supperativa at risk of?
Sepsis
Where would you expect to see a scar due to a Diverticulitis Resection Surgery?
Down the midline below the umbilicus
What common issue with the bones can cause GI type abdominal pain (mainly in the upper quadrants)?
Costochondritis
What is Costochondritis?
Chronic Inflammation of the cartilage at the costochondral joint
What is another name for Costochondritis?
Devil’s Grip
What is Duloxetine?
It is an SSRI for depression and can also be used in adjuvant therapy for pain relief.
What urinary symptoms would signify a AAA and not a UTI?
Urinary retention and suprapubic swelling
What is the rule for the normal size of the intestines?
3,6,9
3=Small intestine
6=Large Intestine
9=Cecum
What is the required positioning for an AXR?
Diaphragm to pubic symphysis
What is Volvis on an AXR?
When the cecum and sigmoid area twist and cause LARGE BOWEL OBSTRUCTION
What is Idiopathic Thrombocytopenia?
Low Platelets causing gum bleeding and rashses
What common medical problem can be caused by poor dental hygiene?
Bacteremia
What is Bacteremia and what are the possible complications?
Bacteria in the blood from poor dental hygiene
=Causes body to be immunosuppressed and increase issues with heart valves
What is Parotiditis?
One sided bulge = Parotid stones
Is inflammation of the salivary glands uni or bilateral?
Bilateral
What well known infection causes inflammation of the salivary glands?
Mumps
What is a Sebaceous Cyst?
Enlarged salivary gland
Where in the face can you get arthiritis?
TMJ joint
What is meant by Hemorrhagic appearance and what 2 oral infections can cause it?
Redness
=Bacterial Tonsilitis and Glandular Fever
How do you know if tonsillitis looks recurrent?
If they are enlarged AND CRAGGY
What is Leukoplakia?
White plaque on tongue and/or gums and/or cheeks
What can pathology Leukoplakia indicate?
Cancer
A patient has Leukoplakia, what test might you want to do to rule out a sinister cause?
Biopsy (rule out cancer)
A child has recurrent tonsilits, what could this indicate that they are insufficient in?
IgA
Note: Not serious and therefore not usually treated or formally diagnosed
If a child has an Atypical Recurrent disease what can that indicate? Give an example of an Atypical disease.
IgA AND IgM deficiency which is associated with autoimmune disorder.
PNEUMONIA
Note: Atypical are disorders that don’t usually come up
What is the onset for Idiopathic Thrombocytopoenia?
QUICK (over a day or 2)
How can Idiopathic Thrombocytopaenia be triggered?
By an infection
What could Idiopathic Thrombocytopaenia indicate?
The patient could have an autoimmune disorder
1/3rd of colonic fissures can be felt where?
Rectum
Other than GI etc, why else would a Rectal exam be performed?
To check for a Neuro disorder (Hypotonia)
(=Anal Tone)
What are the 2 common neurological disorders that can cause a reduction in anal sphincter tone?
-Cauda Equina
-Cancer Lesion
Is it normal to feel/find faeces on a rectal exam?
YES! In fact, if you don’t it could indicate an OBSTRUCTION
What position should the patient be in for a rectal exam?
Left lateral
What is a Rectal Prolapse?
Weakening of the rectal wall allowing bowel contents to bulge through it
What common skin condition can you see on the buttocks?
Dermatitis
If a patient has haemorrhoids why would you want to do a follow up?
To see if the bleeding has stopped after treatment, if not –> COULD INDICATE CANCER
A patient keeps soiling themselves. Other than Florid Diarrhoea, what other rectal cause can cause this?
Anal Fistula
How are Anal warts transmitted and mention a common type.
-Sexually
=Condylomata
What is an abscess on the rectum?
An infected anal fissure
What is meant by Gastroenteritis?
NON-SPECIFIC term used to characterise 4 symptoms together:
-ACUTE Diarrhoea
-Nausea
-Vomiting
-Abdominal pain
Loosely associated with Infective Diarrhoea.
List the common causative agents of Gastroenteritis?
-Bacterial: Campylobacter, E.Coli, Salmonella
-Viral (30-40%): Norovirus and Rotavirus
-Parasites: Giardiasis, Cryptosporidiosis
What is the prognosis for most Gastroenteritis cases?
SELF-LIMITING infection
What is Clostridium Difficile Associated Disease?
Gram Positive, Anaerobic, Spore Forming Bacterium that lie dormant in 3-5% of the population and is AWAKENED by certain antibiotics that can cause PSEUDOMEMBRANOUS COLITIS
What antibiotics are known for causing Clostridium Difficile Colitis?
‘C’ Antibiotics
1.Co-Amoxiclav
2.Cephalosporins
3.Clindamycin
How long after the start of an antibiotic treatment can Clostridium Difficile Colitis occur?
5-10 days after
What are the symptoms of a patient with Clostridium Difficile Associated Disease?
-Profuse WATERY diarrhoea
-Colic abdominal pain
-Fevers
-Rigors
NOTE: Sever abdominal pain is NOT common with this
Describe the pathophysiology of Clostridium Difficile Associated Disease.
1.Clostridium Difficile bacteria produces ENTEROTOXINS A and B
2.Triggers inflammatory process
3.Leads to vascular permeability and pseudomembrane formation
=(Accumulation of inflammatory cells, fibrin and necrotic debris which contributes to the pseudomembrane)>
A patient presents with watery stool and colic abdominal pain as well as a fever. What tests in what order would you like to do?
1.Arrange FBC
2.Stool testing
3.AXR
4.Consider colonoscopy
What blood results and U&E results would you expect from a patient with Clostridium Difficile Colitis?
Blood–>
INCREASE:
-White blood cells
-CRP
DECREASE :
-Albumin
U&E–>
DERRANGED
(due to dehydration)
What COULD come up on an AXR for a patient with suspected Clostridium Difficile Colitis?
Colonic dilatation
i.e >6cm
A patient has been diagnosed with Clostridium Difficile Colitis. What are the next steps in order of priority?
1.INFECTION CONTROL
=isolated to side room with barrier and nursing precautions
2.STOP ALL CAUSATIVE AGENTS AND:
-Antibodies
-PPIs
3.ANTIBIOTIC THERAPY
-Non-severe:10-14day course of oral Metronidazole
-Severe:IV Metronidazole and Oral Vancomycin
4.CONSIDER SURGERY
=Only in fulminant disease (SUDDEN AND SEVERE ONSET)
What antibiotics are used for Clostridium Difficile Colitis?
Non-severe:
10-14day course of oral Metronidazole
-Severe:
IV Metronidazole and Oral Vancomycin
Why does a patient with hyperthyroidism get:
-heat intolerance
-Increased appetite
Why does a patient with hyperthyroidism get:
-Cardiovascular effects (and what are they)?
-Acts on SA node
=Increase Heart rate
-Ionotropic actions - action on muscle to increase contractibility
=Cardiac Output and Stroke Volume
-Increased peripheral resistance
=contracts smooth muscle
Why does a patient with hyperthyroidism get:
-CNS stimulation
Increase motor neurone stimulation
Why does a patient with hyperthyroidism get:
-Exophthalmos
Eyes are swollen (palpabrae superioris muscle)
+ Deposition of fat behind the eyes pushes the eyes out
What is pulse pressure?
Difference between systolic and diastolic blood pressure.
Why does a patient with hyperthyroidism get:
-Increased pulse pressure?
Systolic = INCREASED
-increased contraction of the heart
Diastolic = DECREASED
-lowered peripheral resistance due to metabolites being released
Describe the pathophysiology of Grave’s.
Autoimmune disease with autoantibodies mimicking T3 and T4.
What are the causes of Hyperthyroidism?
Graves
-Postpartum thyroiditis
-Thyroid hormone secreting tumour
-Consumption of extra iodine (e.g seaweed)
What is Postpartum Thyroiditis?
Why might Goitre occur in a patient with a deficient iodine diet?
The body needs iodine to produce thyroid hormone. If you do not have enough iodine in your diet, the thyroid gets larger to try and capture all the iodine it can, so it can make the right amount of thyroid hormone.
