Extra Flashcards
Vomiting that relieves pain
Peptic ulcer
Vomiting preceeded by loud gurgling
GI obstruction
Constipation + menorrhagia
Hypothyroidism
Constipation + blood PR
Cancer
Constipation, distension and active bowel sounds
Obstruction
Poor prognostic factors for GI bleeding
Older Low systolic BP Tachycardic Co-morbidities Above = Rockall score Post-endoscopy Rockall score - diagnosis of upper GI malignancy (2), Malory Weiss or no lesion (0), all other diagnoses (1) If signs of recent haemorrhage
Poor urine output
Peripherally shut down
Low GCS
Stain for iron loading
Perls stain
Anti mitochondrial antibodies
PBC
Anti smooth muscle antibodies
Autoimmune hepatitis
Anti nuclear antibody
Autoimmune hepatitis
Anti endomysial
Coeliacs disease
Transglutaminase
Coeliacs disease
Alpha gliadin
Coeliacs disease
What is beri beri?
Thiamine - b1 deficiency
Heart failure with oedema (wet) or neuropathy (dry)
What is pellagra?
Lack of nicotinic acid
3 d’s - dementia, diarrhoea and dermatitis
Also neuropathy, depression, insomnia, other Neuro symptoms
Endemic in China and Africa
ALT higher than AST
ALTernative diagnosis to alcoholic liver dies as
AST higher then ALT
Alcoholic liver disease
Pabrinex
High dose vitamin b’s - including thiamine
What is acute abdomen?
Severe sudden abdominal pain of unknown aetiology
What is the cough test
Ask patient to cough - if in pain, flinching or a protective movement of hands to abdomen
Suspect peritonitis
Blunt or penetrating trauma + acute abdomen
Blunt - splenic rupture (can be delayed)
Penetrating - liver rupture
Signs of peritonitis
Shock, lying still, cough test, rigid abdomen, guarding, no bowel sounds
DDX of peritonitis
Acute pancreatitis has similar signs but doesn’t need laparotomy
Therefore always check amylase and can do erect X-ray - gas under diaphragm in peritonitis
Best way of assessing shock from hypovolaemia
Assess perfusion of organs
Skin - cap refill
Brain - GCS
Kidney - urine output
Also do BP, pulse and RR
Pain of appendicitis
Starts mid-abdomen, peri-umbilical - referred pain
Then lateralises and settles at McBurney’s point
What is Rosvings sign
Pain in RIF when LIF is pressed - sign of acute appendicitis
What is Psoas sign
Pain on extending hip if retrocaecal appendix
Cope sign
Pain on flexion and internal rotation of hip if appendix in close relation to obturator internus
Antibiotics in appendicitis
Cefuroxime and metronidazole
Type of pain in intestinal obstruction
Colicky pain
Signs of ileus aka functional obstruction
Bowel sounds absent - no pain
Indications for gastric surgery
Cancer and pyloric or duodenal peptic ulcers
What is murphys sign?
Lay two fingers over RUQ - ask patient to breathe in
Causes pain and arrest of inspiration due to inflammation
Sign of acute cholecystitis
Only +ve if same test in LUQ doesn’t cause pain
Jaundice and RUQ pain - and fever
Cholangitis
No jaundice if biliary colic or acute cholecystitis
Assessment of severity of pancreatitis
PANCREAS PaO2 55 Neutrophilia WBC >15 x109 Calcium 16 Enzymes - LDH and AST Albumin 10
Raised bilirubin but normal liver enzymes
Gilberts syndrome - enzyme which conjugates bilirubin is dysfunctional therefore high levels or serum bilirubin - Unconjugated therefore can’t go into urine - no bilirubin in urine
Raised ALP but normal GGT
Suspect bone cause of raised ALP
Burning retrosternal pain and dysphagia
Erosive oesophagitis
What drug reduces the pressure of blood coming from the liver
Somatostatin
How does terlopressin work?
Narrows blood vessels to small intestine
What is crigler-Najjar syndrome?
More extreme form of gilberts syndrome - enzyme which conjugates bilirubin is dysfunctioning - usually presents neonatally and requires transfusion
What can exacerbate gilberts syndrome?
enzyme deficit is heightened in intercurrent illness (viral infection) and fasting
What are coryzal symptoms?
Common cold viral infection symptoms
Rotor syndrome
Rise in conjugated bilirubin - in urine
Not itchy
Helicobacter pylori treatment
First line PAC or PMC for a week
Then add bismuth subcitrate for 2 weeks
Cyclizine side effects
Antihistamine causes dry mouth and drowsiness
Hyoscine butylbromide
Anti spasmodic
Anti muscarinic side effects eg. Dry mouth and blurred vision
Metoclopramide side effects
Anti-emetic
Causes oculogyric crisis caused by blockade of central D2 receptors - uncontrollable rolling back of the eyes - also lateral neck flexion, open mouth and protruding tongue
Side effects of omeprazole
Headache and GI upset
Side effects of ondansetron
Anti emetic - headache and constipation
What is Paul bunnell monospot test
Tests for heterophil antibodies
Develop in 90% of patients with mononucleosis
What can giving glucose (for hypoglycaemia or dehydration) cause in an alcoholic
Potentially thiamine deficient therefore can precipitate encephalopathy
Therefore give pabrinex ampoules - vitamin c and b - 3x day
Test correct position of NG tube
Test ph of aspirate
If
Arthritis and conjunctivitis in setting of abdominal pain and diarrhoea
IBD
What can rapid correction of hyponatraemia lead to?
Bulbar palsy (speech and swallowing) and central pontine myelinolysis (limb weakness)
Coffee ground vomit
GI bleeding
