CSP visceral and vascular Flashcards
GORD
Acid from the stomach refluxes through the lower oesophageal sphincter, irritating the lining of the oesophagus as its lining is more sensitive than the stomachs.
Acidic taste in mouth
Bad breath
Bloating
Heart burn
Feeling sick or being sick
Belching
Dysphagia
Nocturnal cough
Hoarse voice
GORD lifestyle advise
- Reduce tea, coffee or alcohol
- Weight loss
- Avoid smoking
- Smaller lighter meals
- Avoid heavy meals before bed
- Stay upright or lie on left hand side after meals
Esophageal Ca. referral
Endoscopy within 2 weeks (NICE)
Evidence of GI bleed
Melaena - black, tarry stool
Or coffee ground vomiting
Dysphagia
Over 55
Nausea and vomiting
Upper abdominal pain and reflux
Weight loss
Lung
Dry cough
SOB
Px thats worse when you cough or sneeze
Coughing blood
Cyanosis
Finger clubbing
Supraclavicular lymph node pain
Lung Ca. Extrapulmonary manifestations:
Laryngeal nerve palsy - Due to compression Hoarse voice
Phrenic nerve palsy - SOB due to diaphragm weakness
Vena Cava compression - Facial swelling, Difficulty breathing
Horners syndrome - Pancoast tumour pressing on sympathetic ganglion: Ptosis, Myosis, Anhidrosis
Diaphragm irritation
Phrenic nerve C3-5 - irritation via
Thyroid
Hyper/Hypo
Hypo - Constipation, irritability/concentration, sensitivity to cold, fatigue, dry skin, brittle nails, weight gain
Hypo Causes:
Primary: Low T3 and T4, high TSH
Hashimoto’s - Most common cause. Autoimmune inflammation of thyroid gland. Initially causes a goitre and followed by atrophy of thyroid gland.
Iodine deficiency
Secondary:
Pituitary gland fails to producer enough TSH.
Hypo management
Levothyroxine: synthetic T3 and T4
Side effects: sweating, chest pain, headaches, diarrhoea and being sick.
CVS RF:
- Men aged 45 and above
- Women aged 55 and above
- Family Hx
- Smoking
- Hypertension
- High cholesterol
- Diabetes
- Obesity
- Sedentary lifestyle
- Stress
- Alcohol consumption
Angina types
Narrowing of coronary arteries reduces blood flow to the myocardium. During times of high demand there is insufficient blood to meet the demand.
Stable - It usually happens during activity, relieved by rest or medication, typically lasts 5 mins.
Unstable - unpredictable and occurs at rest, maybe 20 minutes or longer. MEDICAL EMERGENCY.
Angina S/S
- Burning.
- Pressure.
- Squeezing.
- Dizziness.
- Fatigue.
- Nausea.
- Shortness of breath.
- Sweating.
Angina management
Refer to cardiology (urgently if unstable)
- Immediate relief: GTN spray causing vasodilation. Use when symptoms start then repeat after 5 mins if symptoms still present call an ambulance.
- Long term relief: beta blocker or calcium channel blocker
MI explained
Occurs when a coronary artery is blocked, preventing oxygen-rich blood from reaching a part of the heart muscle, leading to tissue death (infarction).This is typically caused by a ruptured atherosclerotic plaque, leading to a blood clot (thrombus) that obstructs the artery.
If the blockage persists, cells start to die (necrosis) within 20-40 minutes.
MI
- Chest pain or discomfort, often radiating to the left shoulder, arm, or jaw in men or right arm in women
- Pressure or tightness in the chest
- Nausea and vomiting
- Dizziness
- Dyspnoea
- Cold sweat
- SOB
Stroke
FACE - Facial drooping
ARMS - Weakness in LEXT or UEXT
SPEECH - slurred or strange
TIME - act fast
- 5Ds, 3Ns, 1A
- Balance and posture
- Coordination
- Gait disturbance
- H/A (SNOOPPPP)
- Astereognosis - inability to identify something by touch
- Facial drooping - does not affect forehead (bells palsy)
CAD
More trauma related, tear in the inner lining of the carotid artery, leading to blood entering the arterial wall and forming a clot or hematoma. This can restrict blood flow to the brain, potentially causing ischemic stroke.
VBI
usually related to atherosclerosis or degenerative changes in the vertebrobasilar arteries - older Smoker, diabetes, obesity, Prev Hx of heart disease, 60+ - reduced blood flow to the posterior part of the brain (brainstem, cerebellum, and occipital lobes)
CAD/VBI S/S
- Unilateral neck pain – can precede vascular symptoms by 30 days
- Temporal H/A
- Neck stiffness
- 5D, 3N, 1A – cranial nerve symptoms – so test these
- Extension and rotation bring on symptoms
- Dix-Hallpike
- Interruption of blood flow to the back of the head
H/A
Tinnitus?
SNNOOPPPP?
Nosebleeds?
Visual changes?
CVS risk factors?
SNNOOPPPP
Systemic signs
Neuro signs
Older than 50
Onset is sudden and acute
Papilledema. High intercranial pressure presses on optic nerve, may be visible loss of disc margin in eyes
Positionalpositional. Commonly worse when. Lying down and better when sitting up. Hints at brain tumour
Pattern change. Sudden change in symptoms from headache, e.g. Dull ache to stabbing Px
Precipitated by Valsalva manoeuvre. Tensing whole body e.g. to pass bowls. Increases intra-abdominal and thoracic pressure and decreases venous drainage from veins draining the brain (cerebral veins). Leads to increase in intercranial pressure.
