Eye / Abdomen Flashcards
Acute onset, painful red eye - hx questions
- Change in visual acuity
- Photophobia
- Recent viral URTI
- Contact with anyone with conjunctivitis
- Recent trauma
- FB sensation in eye
- Contact lense wearer
- Hyperopia
- Discharge or tearing from the eye
- Pruritis
- Exposure to UV or chemicals
- Headaches / vomiting
- FMHx glaucome
DDx acute red eye
- Acute angle closure glaucoma
- Iritis / uveitis
- Keratitis
- Scleritis / episcleritis
- Foreign body
- Chemical keratitis
- UV keratitis
- FB
Emergency mx acute angle closure glaucoma
- Urgent referral to Ophthalmologist
- Position patient supine
- Analgesia - morphine
- Anti-emetic
- Do not patch the eye
- (consider timolol / pilocarpine / acetazolamide?)
Mx of mild, intermittent GORD symptoms
- Weight loss if overweight
- Eating smaller meals
- Drinking fluids between meals rather than with meas
- Avoiding lying down after eating
- Avoiding eating or drinking 2-3 hours prior to bed or vigorous exercise
- Elevate head of bed
- Smoking cessation
Physical examination of the eye - important steps
- Visual acuity
- Inspection of eye surface, cornea and sclera
- Evert eyelid for foreign body
- Stain with fluorescein for corneal abrasion
- Assess red reflexes
- Assess pupil shape and light reflex
- Slit lamp examination
DDx for presentation of Amaurosis Fugax (transient monocular or binocular visual loss)
- Giant cell arteritis
- Carotid artery disease
- Retinal vein occlusion
- Optic neuropathy
- Retinal vasospasm
- Optic nerve compression by a lesion
- Idiopathic amaurosis fugax
DDx for progressive peripheral visual loss
- pituitary adenoma
- craniopharyngioma
- meningioma
- malignant sellar tumour
Physical signs of chronic liver disease
- spider naevi
- palmar erythema
- leukonychia
- gynaecomastia
- hepatosplenomegaly
- signs of portal hypertension (collateral vessels on anterior abdominal wall, caput medusa)
- ascites
- varices
Mx for patients with chronic hepatitis and cirrhosis
- hepatocellular carcinoma surveillance 6 monthly
- medication monitoring for adherence to antivirals
- appropriate vaccinations: Hep A, influenza, pneuomoccoal
- lifestyle modification, smoking cessation, minimise alcohol
- weight loss advice
Signs of haemochromatosis
- arthralgia
- loss of libido
- skin pigmentation
- hepatomegaly
- hypogonadism
- gynaecomastia
- symmetrical small joint arthropathy MCP + PIPs
DDx for hyperferritinaemia
- acute inflammation (infection)
- chronic inflammation (systemic lupus erythematosus)
- malignancy
- haemophagocytic lymphohistiocytosis
- hereditary hyperferritinaemia-cataract syndrome
- iron overload syndromes (haemochromatosis)
- secondary iron overload (
DDx for hepatitis on bloods
- Viral hepatitis
- Non-alcoholic fatty liver disease
- Alcoholic liver disease
- Drug-induced hepatitis (paracetamol)
- Hereditary conditions (haemochromatosis)
- Autoimmune hepatitis
DDx for presentation of dyspepsia
- GORD
- NSAID induced gastritis
- Oesophageal carcinoma
- H.pylori induced gastritis
- Functional dyspepsia
- Angina
- Biliary colic
Basic eye examination in pt with unilateral red eye
- Visual acuity
- General inspection of cornea, sclera, lids
- Evert eye lids to look for FB
- Pre-auricular LN
- Examine pupils with light reflex
- Examine cornea with fluorescein 1% drops and cobalt blue light
Examination findings in suspected acute angle closure glaucoma
- mid dilated pupil
- poor pupillary reactivity to light
- cloudy cornea
- injected / red conjunctiva
- increased IOP
- decreased visual acuity
Features that would be concerning for a dx other than irritable bowel syndrome
- FMHx IBD, bowel ca, coeliac, autoimmune disease
- diet related symptoms (gluten)
- dysphagia
- severe large volume diarrhoea
- steatorrhea
- severe abdominal pain
- fever
- nocturnal symptoms interfering with sleep
- PR bleeding
- recent travel
Initial invx to help make dx irritable bowel syndrome
- FBC
- CRP
- Coeliac serology
- Faecal calprotectin
3 non-pharm mx options for irritable bowel syndrome
- food diary to identify and avoid triggers
- regular meal times with portion control
- referral to dietician for low FODMAP diet
- referral to psychologist for CBT
- additional fibre for constipation dominant IBS
Potential pharm mx options for irritable bowel syndrome
- Loperamide
- Hyoscine butyl bromide (Buscopan)
- SSRI - Citalopram
- TCA - Amytriptilline
- Mebeverine
