First 50 Flashcards
Carcinoid syndrome
Flushing, diarrhoea, pain
Also bronchospasm and hypotension
Usually from liver metastasis secreting excess serotonin
Urinary 5- HIAA and plasma chromogranin A y to investigate
Manage with somatostatin analogues eg octeotride (slows down production of serotonin)
Diarrhoea use cyproheptadine
Felty syndrome
Rheumatoid arthritis, splenomegaly, low white cell count (neutropenia)
Complications of RA
respiratory- pulmonary fibrosis, pleural effusion, methotrexate pneumonitis
Ocular- keratoconjunctivitis sicca, steroid induced cataracts
Osteoporosis
Increased infection risk
Depression
Feltys
Amyloidosis
Management of colorectal cancer- how to stage
Order CEA carcinoembryonic antigen
CT of chest, abdomen, pelvis
Colonoscopy
If tumour below peritoneal reflection, use MRI for mesorectum evaluation
Treatment of colorectal cancer
Resectional surgery only curative option
If HNPCC family- panproctocolectomy (remove entire colon, rectum and anal canal)
Right hemicolectomy- if cancer in caecal, ascending or proximal transverse colon (ileo colic)
Left hemicolectomy- distal transverse, descending (colo colon)
Anterior resection surgery- if in sigmoid colon, upper rectum or lower rectum (colo-rectal)
Anastomosis is needed to restore continuity
Hyperkalemia
ECG changes- tall t waves, small p waves, widened QRS, sinusoidal pattern and asystole
Metabolic acidosis causes hyperkalemia
AKI, potassium sparring diuretics, ace inhibitors, addisons disease, rhabdomyolysis, heparin
Oesophageal cancer
Adenocarcinomas usually near gastroesophageal junction ie
Lower third, squamous cell tumours in upper 2/3rds of oesophagus
Adeno risk factors include GORD , Barrett’s, smoking, obesity
Squamous including smoking, alcohol, achalasia, nitrosamine rich diet
Presents with dysphagia, anorexia and weight loss, vomiting, odynophagia (pain with swallowing), melaena, hoarseness
Upper GI endoscopy and biopsy for diagnosis
Endoscopic ultrasound for staging
Barium swallow shows narrowing of oesphageus
+ CT of chest abdomen and pelvis, FDG PET if nothing can be seen
Treat
- surgical resection- Ivor Lewis type oesophagectomy common
Biggest risk of surgery is anastomotic leak
Adjuvant chemotherapy
How to calculate units of alcohol in a drink
Volume in ml * percentage alcohol as decimal (ABV)
Divided by 1000
Eg 750 ml bottle win 12%
750*12/1000
9 units
No more than 14 units recommended per week
Crohs management
Affects terminal ileum
Can be anywhere mouth to anus
Inducing remission- glucocorticoids eg prednisolone. Second line mesalazine. Metronidazole for isolated peri anal disease
Maintaining remission- stopping smoking is priority, first kine azathioprine or mercaptopurine, methotrexate second line
Surgery- ileocaecal resection
Complications of crohns include small bowel cancer, colorectal cancer, osteoporosis
Iliopsoas abscess
Collection of pus in iliopsoas compartment
Primary is bacterial ie staph aureus
Secondary as cause of crohns, diverticulitis, colorectal cancer, UTI, femoral catheter,
Clinical features include fever, back/flank pain/limp/weight loss
In supine position, knee flexed and hip externally rotated. ask patient to lift thigh against hand, causing pain due to psoas muscle contraction
Manage with antibiotics, percutaneous drainage
Autoimmune hepatitis
Most common in young females.
Type 1- anti-nuclear antibodies or anti smooth muscle antibodies
Type 2- anti liver kidney/microsomal type 1 antibodies- children only
Type 3- soluble liver kidney antigen
Fever, jaundice, amenorrhea, raised IgG/ANA/SMA/LKM1
Management with steroids or other immunosuppressants eg azathioprine, liver transplant
Pernicious anaemia
Autoimmune disorder affecting gastric mucosa causing Vit B12 deficiency
Antibodies to intrinsic factor and antibodies to gastric parietal cells reduce acid production
Atrophic gastritis secondary tomb pylori, gastronomy, malnutrition can also cause B 12 deficiency
B12 needed in myelination (neuropathy)
And rbc production (megaloblastic anaemia)
Features- lethargy, pallor, dyspnoea
Peripheral neuropathy
Mild jaundice and glossitis
Constipation
Stools less than 3 times weekly, discomfort with stool passage
First line laxative- bulk forming laxative eg ispaghula
Second line- osmotic laxative, such as macrogol
Complication- overflow diarrhoea, acute urinary retention
Coeliac disease management
Gluten free diet
Remove wheat, beer, rye, oats
TTG antibodies
Patients have functional hyposplenism
So offered pneumococcal vaccine
Avascular necrosis
Death of bone tissue secondary to loss of blood supply
Bone destruction and loss of joint affecting epiphysis of long bone eg femur
Caused by long term steroid, chemo, alcohol excess and trauma
