For IPE Flashcards
What is the alcohol recommendations?
14u spread out over at least 3 days with no binging. No safe level
What are some differentials of severe oral ulcers?
Crohns and coealiac Behcets trauma Erythema multiforme lichen planus infections
What is leukoplasia and what is the consequence of it?
Oral muscoal white plaque that doesnt rub off
Pre malignant lesion
What is angular stomatitis? What are the causes?
Fissuring of the mouth corners
causes include poorly fitting dentures, candidiasis and iron deficiency
What are the indications for an upper GI endoscopy?
Haematemesis and malena Dysphagia Dyspepsia Duodenal biopsy Persistent vomiting Iron deficient anaemia cancer
Where does a sigmoidoscopy view up to?
Splenic flexure
What is the indications for a lower GI endoscopy?
Rectal bleeding Iron deficiency Persistent diarrhoea positive FOB Assessment or suspiscion of IBD Colon cancer surveliance
What is the management of achalsia?
Balloon dilation or Heller’s cardiomyotomy
Botulinum toxin if non invasive procedure needed
CCB and nitrates may also help
Where do gastric ulcers tend to occur?
Lesser curvature
Why may urea be out of proportion to creatinine in a upper GI bleed?
Blood acts as massive protein rich meal leading to increased urea and no change on creatinine
What must be given along side normal management of upper GI bleed if varices suspected?
Teripressin
What is used if bleeding cannot be stopped in a varices bleed?
Sengstaken Blakemore tube - compresses varices
What are some causes of bloody diarrhoea?
Camplybacter, shingella and salmonella, E coli, IBD and pseudomembranous colitis
ischaemic colitis
With someone with explosive diarrhoea what are the first bits of management?
isolate and send sample to the lab
Use PPE
What is seen on histology with a patient with gastric adenocarcinoma?
Signet ring cells- contain large amount of mucin which displaces the nucleus to one side
What is a MALT associated?
chronic H pylori infection
What is found on duodenal biopsy in a patient with suspected coeliac?
Crypt hyperplasia
Vilious atrophy
increased intraepithelial lymphocytes
Lamina propria infiltrated with lymphocytes
In a patient with new onset jaundice what are some important questions to ask?
Blood transfusions IV drugs Body piercings and tattoos Sexual activity Travel abroad Family history Alcohol use All medications - now and in the past
What is the significance of a painless palpable gallbladder?
Courvisiers law - Likely to be a pancreatic or cholangiocarcinoma
What is the management of acute liver failure?
Nurse with head up in ITU - protect airway and insert NG tube
Insert urinary and central venous catheter
Monitor Obs and weight daily
Check bloods daily
Avoid hypoglycaemia with a glucose infusion
Treat cause
Get nutritional advice- thiamine and folate supplements
Treat seizures with phenytoin
If renal failure develops consider dialysis
Try to avoid sedatives and other hepatic metabolism of medications
Consider PPI against stress ulcer
Treat complications
Why is lactulose given in hepatic encephalopathy?
Metabolized by bacteria flora to short chain fatty acids which decreased colonic ph and traps NH3 in the colon reducing levels of ammonia in the blood which is thought to contribute to encephalopathy.
