Day 6 Flashcards
Loss of Haustra
ulcerative colitis
drainpipe colon
ulcerative colitis
rose thorn ulcers
chrons
coble stone appearance
chrons
granulomas and increased goblet cells
chrons
crypt abscesses
ulcerative colitis
Features of DKA
Abdominal pain
Polyuria, polydipsia, dehydration
Kussmaul respiration (deeo hyperventilation)
Acetone-smelling breath
Management of DKA
fluid replacement- isotonic saline
insulin- IV infusion at -0.1unit/kg/hour
once blood glucose is <15mmol/l an infusion of 5% dextrose started
Long acting insulin continues, short-acting insulin stopped
COPD stages
Stage 1 (Mild) as his FEV1 is >80% of what is expected.
Stage 2 (Moderate) is an FEV1 which is 50-79% of the predicted value.
Stage 3 (Severe) is an FEV1 which is 30-49% of the predicted value.
Stage 4 (Very severe) is an FEV1 <30% of the predicted value.
Stage 5 is not an option in COPD staging.
COPD initial management
- smoking cessation
- annual influenza vaccine
- pneumococcal vaccine
- pulmonary rehab
Bronchodilator therapy (SABA or SAMA) if still struggling check for steroid responsiveness...
Signs of asthmatic/steroid responsive features
> any previous, secure diagnosis of asthma or of atopy
a higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)
Management of COPD with no asthmatic features
add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)
if already taking a SAMA, discontinue and switch to a SABA
Management of COPD with asthmatic features
LABA + inhaled corticosteroid (ICS)
if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS
if already taking a SAMA, discontinue and switch to a SABA
NICE recommend the use of combined inhalers where possible
When is oral theophylline recommended in COPD
when inhaled therapy can’t be used
When is antibiotic prophylaxis recommended in COPD
> azithromycin prophylaxis
patients should not smoke, > have optimised standard treatments
continue to have exacerbations
other prerequisites include;
:a CT thorax (to exclude bronchiectasis)
: sputum culture (to exclude atypical infections and tuberculosis)
:LFTs and an ECG to exclude QT prolongation should also be done as azithromycin can prolong the QT interval
When should mucolytics be considered in COPD
patients with a chronic productive cough and continued if symptoms improve
Features of cor pulmonale
peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2
Management of cor pulmonale
use a loop diuretic for oedema, consider long-term oxygen therapy
ACE-inhibitors, calcium channel blockers and alpha blockers are not recommended by NICE
tear drop cells on blood film
myelofibrosis
thalassaemia
megaloblastic anaemia
What is myelofibrosis
> myeloproliferative disorder
hyperplasia of abnormal megakaryocytes
resultant release of platelet derived growth factor is thought to stimulate fibroblasts
haematopoiesis in liver and spleen
Features of myelofibrosis
- elderly person with anaemia
- massive splenomegaly
- hypermetabolic symptoms: weight loss, night sweats
Lab findings in myelofibrosis
> anaemia
high WBC and platelet count early in the disease
‘tear-drop’ poikilocytes on blood film
unobtainable bone marrow biopsy - ‘dry tap’ therefore trephine biopsy needed
high urate and LDH (reflect increased cell turnover)
Death in HOCM
Ventricular arrythmia
COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive feature
LABA + ICS
