Deck 5 Flashcards
What is pharyngeal pouch
Diverticulum of pharynx through killian dehisence
Found betwee upper and lower parts of inferior constrictor
Sx of pharyngeal pouch
Old men
halitosis
wt loss
regurgitation
Sx of pharyngeal pouch
Old men
halitosis
wt loss
regurgitation
Pharyngeal pouch Rx
If asymptomatic no rx
Otherwise:
- endoscopic stapling
or - External excision
Differentials for superficial neck lump
Sebaceous cyst
Abscess
Lipoma
Differentials for anterior triangle neck lump
Dermoid cyst Thyroglossal cyst Branchial cyst Carotid body tumour Thyroid Lymph
Differentials for posterior triangle neck lump
- Cystic hygroma
- pharyngeal pouch
- lymph node
Types of necrosis
- coagulative (tissue structure preserved)
- Liquefactive
- Caseous (impossible to tell type of tissue as structure destroyed)
- Fat necrosis
- Fibrinoid
What happens in liquefactive necrosis
Lipid rich tissues denaturation of fats by lysosomes
eg in brain
Example of caseous necrosis
TB
Examples of fat necrosis
Pancreas (lypolysis)
Breast (trauma)
Examples of fibrinoid necrosis
Blood vessels:
- antigen-antibody complex and fibrin deposited in wall of vessels causing necrosis
- type 3 hypersensitivity
- SLE or vasculitis
How are neoplasms classified based on cell type
1 cell type:
- Adenoma
- Sarcoma
- lymphoma
2 cell types, 1 germ line:
- Pleomorphic adenoma
- fibroadenoma
2 germ lines:
teratoma
Physiological and pathological examples of hyperplasia
Physio:
- breast tissue in puberty
- thyroid in pregnancy
Pathological:
- BPH
- parathyroid hyperplasia in renal failure
Physiological and pathological examples of hypertrophy
Physiological:
- skeletal muscle
- uterus in pregnancy
Pathological:
- Graves
- Cardiomyopathy
Examples of metaplasia
Barrets : LES changes from stratified squamous to columnar
Cervix with HPV: changes from columnar to stratified squamous
Carcinoma vs sarcoma spread
Carcinoma: lymphatics (except follicular thyroid)
Sarcoma: haematological
Carcinoma vs sarcoma spread
Carcinoma: lymphatics (except follicular thyroid)
Sarcoma: haematological
What is rheumatic fever
Systematic disease due to untreated pharyngeal strep pyogenes resulting in damage to heart, brain, skin and joints
Which valve does rheumatic disease affect
Mitral (70%)
aortic (40%)
tricuspid (10%)
Criteria for diagnosis of Infective endocarditis
Duke’s criteria (eg presence viridancs, or HACEK in culture etc)
Criteria for dx of rheumatic disease
Modified Jones criteria (eg raised ESR, carditis)
What causes Grey Turners sign
Release of elastase (pancreatitis) leads to breakdown of blood vessel wall leading to bleeding into retroperitoneal space
Pancreatic severity scoring systems
Modified Glasgow score
Ransons
Balthazar
Apache
Ransons score
estimates pancreatitis mortality based on initial and 48 hr values
Balthazar score
CT based severity score for pancreatitis
Why amylase levels might be normal in acute panc
Levels start to fall after 24-48hr after onset
Why amylase levels might be normal in acute panc
Levels start to fall after 24-48hr after onset
Complications of pancreatitis
Early:
- DIC
- ARDS
- Electrolyte disturbance: low calcium
Late:
- chronic
- necrosis and infection
- pseudocyst
When to CT pancreatitis
At least after 72 hrs to allow complications to show
How high should amylase be for dx of pancreatitis
3 times upper limit (normal is 30-110)
What other conditions lead to rise in amylase
Perforation
Trauma
Burns
Differentials for bilat swelling of parotid
Infective: mumps
Inflam: Sjogrens or sarcoid
Differential for unilateral parotid swelling
Obstruction:
- stones
- external neoplasia
Neoplasia of parotid
Infective: mumps
Why submandibular stone more common than other salivary glands
Mucous composition (as opposed to serous in parotid)
Long duct to enter mouth
Ascends against gravity
Difference between submandibular and parotid stones
Parotid: multiple, small, within gland
Submandibular: single, large, intraductal
Parotid neoplasia
Benign: pleomorphic (80 %), Warthins (5%)
Malignant: Mucoepidermoid (10%) and adenoid cystic carcinoma
Complications of parotidectomy
Immediate: CN7, greater auricular n, haemorrhage
Early: haematoma, infection
Late: Freys syndrome, fistula
Criteria to refer dyspepsia for endoscopy urgently
- Dysphagia
- upper abdo mass
- > 55 + wt loss + either abdo pain, reflux, dyspepsia
When does pain happen in relation to gastric and duodenal ulcers
Gastric: during meal time
Duodenal: 2-3 hrs after meal
Non surgical mx of peptic ulcer disease
Lifestyle : NSAIDs, steroids, alcohol
PPIs and H2 receptor antagonists
Antacids (gavascon)
H pylori eradication
What are billroth 1 and Billroth 2 operations
1: Gastroduodonostomy after partial gastrectomy
2: Gastrojejunostomy after partial gastrectomy + closure of duodenal stump
Dumping syndrome def
Rapid passage of food from stomach to small intestine (secondary to gastrectomy, osoephagectomy, bypass)
Results in fluid shift
Early dumping syndrome sx
10-30 mins after food
Bloating, fainting, dizziness
Late dumping syndrome sx
Hypoglycaemia (massive release of insulin)
1-3 hours post food
