Deck 6 Flashcards
Categories of polyps
Non-neoplastic
Neoplastic
Non-neoplastic polyps
Metaplastic
Hamartomatous
Pseudopolyp
Neoplastic polyp types
Tubular
Tubulo-villous
Villous
What is the most frequent neoplastic polyp
Tubular then tubulo-villous, then villous
Which neoplastic polyp has the most malignant potential
Villous
FAP genetics
autosomal dominant
Loss of APC tumour supressor gene
FAP sx
100-1000s of polyps in 20s
100% risk of GI malignancy by 40yo
Two FAP syndromes
Gardner syndrome
Turcot syndrome
Gardner syndrome sx
Polyps+ :
- Thyroid ca
- Osteomas
- Dental numeracy
Turcot syndrome
Polyps +
CNS neoplasm : esp medulloblastomas
When to do OGD+colonoscopy for FAP FHx
Colonoscopy:
- 12-13 yo
- Every 1-3 years
OGD
- 25 yo
Prophylactic op for FAP
Total colectomy + ileorectal pouch
or
panproctocolectomy and end lieostomy
What is the function of PSA (prostate specific antigen)
Produced by epithelial cells of prostate gland
Liquifies semen allowing sperm to move freely dissolving the cervical mucous
Difference between grading and staging
Stage: size and degree of spread
Grade: how well differentiated a tumour is
When to check PSA after prostectomy
6 wks after op
Then every 6 months for 2 years
Then every year
Hormone therapy for prostate cancer
Bicalumetide (antagonist to androgen receptors)
Stops testosterone binding to cancer cells inhibiting their growth
Voiding sx
Incomplete emptying
Hesitancy
Terminal dribble
Poor flow
Filling sx
Nocturia
Frequency
Urgency
Aetiology of BPH
Unclear, increased ratio of dihydrotestesterone to oestrogen has been suggested
Ix of BPH
Bedside: urine dip
Bloods: PSA
Imaging: Transrectal USS or IVU
Special tests: uroflowmetry
TURP complications
Early: bleeding, infection, TUR syndrome
Late: stricture, retrograde ejaculation
How does proteus lead to struvite stone formatio
Alkalinses the urine (urea ->ammonia)
Reduces solubility of phosphate
RIFlE classification
R: cr *1.5 or UO< 0.5 6hrs
I: cr * 2 or UO < 0.5 12hrs
F: cr *3 or UO <0.3 ml/kg 24hrs or anuric for 12hrs
Loss: failure for >4 wks
End stage: failure > 3months
RIFlE classification
R: cr *1.5 or UO< 0.5 6hrs
I: cr * 2 or UO < 0.5 12hrs
F: cr *3 or UO <0.3 ml/kg 24hrs or anuric for 12hrs
Loss: failure for >4 wks
End stage: failure > 3months
Warm ischaemic time
Start: circulation to donor kidney stops
End: perfusion solution starts flowing
Cold ischaemic time
Start: cold solution starts flowing
End: organ transplanted in recipient
Max between 24-48hrs
What is perfusion solution for organ transplant made off
Ice cold solution:
- impermeable solutes (minimise swelling)
- pH buffer
- free radical scavengers
- membrane stabilisers
- adenosine for ATP synthesis
RFs for undescended testicles
Preterm
Low birth weight
FH
Teratoma age
20-30
Seminoma age
30-40
Where do testicular tumours mets to
Lung
Colon
Bladder
Pancreas
Where does acral lentigenous affect
Palms and soles, under finger nails
Where is Breslow thickness measured from
From glandular cells of epidermis to deepest point of invasion
Features of BCC
Sun exposed area
Slow growing, never metastasise
Pearly papule with a rolled edge
Treatment of BCC
Excision
or
5 FU cream
What is Bowens skin disease
SSC in situ
Could progress to become invasive SSC
slow enlarging, red, well demarcated plaque
Cytological signs of malignancy
- increased mitotic rate
- hyperchromatism (darkened nuclei due to increased DNA concentration)
- Pleomorphism (varied size and shape of cell)
- Increased nuclear to cytoplasmic ratio
What are features of malignancy on histology
Neovascularisation
Necrosis
Haemorrhage
Negative prognostic markers for melanoma
Nodular
High Breslow thickness
Functions of spleen
- immune
- circulatory filteration
- platelet storage
- haemopoiesis until birth
- iron re-utilisation
Functions of spleen
- immune
- circulatory filteration
- platelet storage
- haemopoiesis until birth
- iron re-utilisation
Complications of splenectomy
Immediate: haemorrhage
Early:
- gastric necrosis,
- pancreatitis
Late:
- thrombocytosis
- OPSI (overwhelming post splenectomy infection)
Abx post splenectomy
Pen V or erythromycin (pen allergic) in:
- the first 2 yrs
- <16 yo or >55yo
- immunocompromised
Abx post splenectomy
Pen V or erythromycin (pen allergic) in:
- the first 2 yrs
- <16 yo or >55yo
- immunocompromised
Splenectomy vaccination procedure
Either 2 wks before or 2 wks after op
- Haemphilis influenza
- Pneumococous
- Men B, C
- annual flu jan
Post splenectomy blood film
Increased platelets
Howel jolley bodies (RBC with remnants of nuclei which otherwise should have been removed)
Pappenheimer bodies (siderocytes containing iron)
Target cells
Causes of splenomegally
Infective: EBV, CMV
Haematological: leukaemia, lymphoma
Systemic: sarcoid, amyloid
