Deck1 Flashcards
What is amyloidosis
- Rare life-threatening condition
- Deposition of abnormal fibrillar protein known as amyloid in the extracellular tissue
Histological fx of amyloidosis
Apple green birefringence under polarised light
Classifications of amyloidosis
AL: primary
AA: Secondary to chronic inflammation
ATTR: hereditary
ATTR amyloid
Autosomal dominant mutation in transthyretin
Similar sx to AL
AL amyloidosis cause
AKA immune origin
Profileration of plasma cells -> produce amyloidal immunoglobulins -> precursor t AL amyloid protein
AL amyloid organs
Kidneys Heart Peripheral nerves Skin GI
AA amyloid cause
Secondary to inflammation
Macrophages produce IL, stimulating hepatocytes -> release amyloid protein A (precursor to amyloid)
Conditions associated with amyloid AA
Rheumatoid
IBD
TB
Sx of amyloid AL
Kidney: Proteinuria, Nephrotic syndrome
CVS: arrhythmia
NS: peripheral neuropathy
GI: bleeding, obstruction
Sx of amyloid AA
Hepatosplenomegally
Protienuria
Dx of amyloid
Tissue biopsy
Amyloidosis rx
AL: chemo targetting plasma cells producing amyloid antibodies
AA: control the primary cause
ATTR: transplant affected organs (kidneys, liver) but tend to recurr
Prognosis amyloid
1-2yrs
Most common cause of death secondary to amyloid
Cardiac failure or fatal arrhythmia
Thyroid cancer ass with amyloid
Medullary carcinoma
Thyroid cancer ass with amyloid
Medullary carcinoma
Causes of aneurysm
Atherosclerosis
Trauma
Infection
FHx (genetic disposition)
How does atherosclerosis lead to aneurysm
Weakens mechanical structure and reduces recoil -> more pressure of vessel wall
Obstrucs vasa vasorum (degenerative ischaemia of the vessel wall)
Atherosclerosis risk factors
Modifiable:
Smoking
High chol diet
HTN
Nonmodifiable:
Age
DM
Male
Operative mortality of AAA repair
Elective: 3-5% (MI, CVA, rupture)
Emergency: 50% make it to hospital, 50% of those who make it survive an operation
Classification of aortic dissection
Complications of AAA open repair
Immediate: haemorrhage, trash foot
Early: Mesenteric ischaemia, Spinal ischaemia, MI, CVE
Late: Pseudoaneurysm, graft infection, Aorto-enetric fistula, impotence
Causes of aortic stenosis
Calcification
Bicuspid congenital valve
Infection and damage: rheumatic fever
Autoimmune: SLE
Which nerve initially picks up appendicitis pain
Lesser splanchnic (T10) Refers to umbilicus
Scoring system for appendicitis
Alvarado
Causes of transudate ascites
Raised portal pressure:
Cirrhosis
R sided heart failure
Buddchiari
Reduced oncotic pressure:
Nephrotic syndrome
Hypoprotienaemia (secondary to hepatic failure)
Causes of exudate ascites
Inflammation (pancreatitis)
Infection
Malignancy
Post radiation
Pathophysiology of atherosclerosis
- Endothelial dysfunction: migration of macrophages -> foam cells and lipid core
- Migration of vascular smooth muscle : forming fibrous cap
- stenosis of vessel, rupture of cap could lead to thrombosis
What is a fibroadenoma of breast
Proliferation of epithelial and stromal cells in breast
Causes of mastalgia
Cyclical
Non cyclical: meds (hormone contraception, antidepressants, antipsychotics)
Extramammary: chest wall/shoulder
Mx of cyclical mastalgia
Better fitting bra
Pain diary
Flax seed oil/primrose oil
Danazol (antigonadortrophin)
Abscess def
Pus filled collection surrounded by granulation (macrophages) or fibrotic tissue
Peri-ductal mastitis affects what part? which group of patients
Inflammation of subareolar ducts presents usually as young smokers
Periductal mastatitis sx
Nipple retraction
Painful tender red breast
Nipple discharge
Abscess
Causes of nipple discharge
Benign:
- intraductal papilloma
- ductal ectasia
- periductal mastitis
- Gestational
Malignant
Commonest cause of developing cholangiocarcinoma
PSC
Chronic liver disease
HIV/Hep C
Commonest risk factor for cholangiocarcinoma in developing world
parasitic liver flukes
Primary sclerosing cholangitis (PSC) pathophysiology
Non infective non malignant inflammation and stricture of intra and extra hepatic ducts
Associated with UC and HIV
Primary billary cirrhosis pathophysiology
Progressive inflammation and dammage of the interlobular bile ducts leading to cirrhosis, cholestasis
Associated with autoimmune conditions eg sjogrens or rheumatoid arthritis
Tumour markers for Cholangiocarcinoma
C19-9
CEA (carcinoembryonic antigen)
What are different types of bone tumours
Benign: fibroma, osteochondroma
Malignant:
- primary:
- marrow: Myeloma, Ewings
- stromal tissue: Osteosarcoma, chondrosarcoma - Secondary:
Thyroid, breast, bronchus, Kidney, prostate
Age of Ewings
5 to 20
Principles of limb salvage surgery in the setting of bone tumours
Every pt should be considered if the tumour could be removed with adequate margins
Adequate margins: acceptable low local recurrence.
Remaining limb needs to have: reasonable degree of movement and minimal pain
What is the minimum requirement for a viable limb
4 components: bone, vessels. nerves, adequate soft tissue
If 2/4 removed, still might be salvageable
But any more needs amputation to be considered
Risk factors for C diff
Periop abx use
immunosuppression
Old
PPIs
Dx of c diff
Acute diarrhoea (>2 stools in 24hrs) with no alternative cause Stool culture for C diff toxins A and B Pseudomembranes on colonoscopy
C diff Rx
Depends on severity (WCC>15, rising Cr, Temp >38)
Low severity: PO metronidazole
High: PO vanc +/- PO metronidazole
Stop the culprit abx
Causes of gynocaomastia
Physiological: puberty /age
Pathological:
- Too much oestrogen
Leydig tumour
Obesity
Liver disease - Too little testosterone
Klinefelters
Renal disease - Meds: digoxin, spironolactone
