Gastrointestinal conditions 3 Flashcards
Final part of GI conditions
1
Q
What is Peptic ulcer disease?
A
A break in the mucosal lining of the stomach or duodenum more than 5mm in diameter, with depth to submucosa
2
Q
What causes Peptic ulcer disease?
A
Imbalance between the damaging action of acid and pepsin and protective mechanisms
2 major aetological factors - H. Pylori or NSAID overuse
Most common causes: H. Pylori, NSAIDs, Alcohol, Bisphosphonates, Smoking
Rare causes: Zollinger-Ellison syndrome (Gastrin-secreting tumour)
3
Q
What are the Risk Factors for Peptic ulcer disease?
A
Helicobacter Pylori infection NSAID use Smoking Increasing age Personal history Family history Patient in intensive care
4
Q
What are the symptoms of Peptic ulcer disease?
A
Abdominal pain (Epigastric tenderness) Nausea Vomiting Weight loss Anorexia Diarrhoea Anaemia
5
Q
What are the signs of Peptic ulcer disease?
A
GI bleeding
Hypotensive or septic shock
Succussion splash
6
Q
What are the investigations for Peptic ulcer disease?
A
if <55 and no red flags - H pylori breath test/stool antigen test - FBC - Stool occult blood test - Serum Gastrin if >55 or red flags present - Upper GI endoscopy + biopsy - If ulcer present: Repeat endoscopy 6-8 weeks FBC Serum amylase Clotting screen LFT Urea breath test for H. Pylori Blood antibody test
7
Q
How do you manage Peptic ulcer disease?
A
Acute: Fluids/Resuscitation needed if ulcer is perforated or bleeding Close monitoring of vital signs Endoscopy Surgical treatment Endoscopy: - If Ulcer is bleeding, haemostasis with: Injection sclerotherapy, laser coagulation, electrocoagulation Surgery: if perforated
8
Q
What are complications of peptic ulcer disease?
A
Perforation
Gastric outlet obstruction
Upper GI bleeding
Perforation
9
Q
What is a Perianal abscess?
A
A pus collection in the perianal region
10
Q
What is a perianal fistula?
A
An abnormal chronically infected tract communicating between the perineal skin and either the anal canal or the rectum
11
Q
What causes perianal abscesses/fistulae?
A
Bacterial infection
Fistulae develops as a complication of an abscess
Fistulae can develop as a complication of Crohn’s disease
12
Q
What are the Risk factors for perianal abscesses and fistulae?
A
IBD Diabetes Mellitus Malignancy MSM (men who have sex with men) Immunocompromised Crohns/diverticular disease 20-60 years old Male sex
13
Q
What are the symptoms of Perianal abscesses and fistulae?
A
Painful, hardened tissue in the perianal area Pus discharge from rectum Lump or nodule Tenderness at edge of anus Fever Constipation Pain with bowel movements Constant and throbbing pain while sat down
14
Q
What are signs of perianal abscesses and fistulae?
A
Seen on rectal exam
Swollen, red, tender lumps at edge of anus
15
Q
What investigations are done for perianal abscesses and fistulae?
A
DRE usually normal
STD screening
Proctosigmoidoscopy
performed to exclude associated diagnoses
Transperitoneal US may be a useful adjunct
16
Q
How do you manage Perianal abscesses and fistulae?
A
Prompt drainage
Medication for pain relief
ABx not needed unless diabetic or immunosuppressed
Probe is inserted to explore fistulae
Dye inserted into external opening to allow you to find the internal opening
Low fistula - fistuloltomy
High fistula - seton
17
Q
What are the complications of perianal abscesses and fistulae?
A
Recurrence
Damage to internal anal sphincter
Incontinence
Persisting pain
18
Q
What is Peritonitis?
A
Inflammation of the peritoneal lining of the abdominal cavity. It can be localised to one part of the peritoneum or generalised
19
Q
What are the types of Peritonitis?
A
Localised
Primary generalised
Secondary generalised
Primary
20
Q
What causes localised peritonitis?
A
Appendicitis
Cholecystitis
DIverticulitis
Salpingitis
21
Q
What causes Primary generalised peritonitis?
A
Bacterial infection of the peritoneal cavity without an obvious source
22
Q
What causes Secondary generalised peritonitis?
A
Caused by bacterial translocation from a localised focus
Could be non-bacterial due to spillage of bowel contents, bile and blood
23
Q
What are the risk factors for peritonitis?
A
Ascites
Nephrotic syndrome
24
Q
What are the symptoms of Peritonitis?
A
Usually continuous, sharp, localised exacerbated by movement and coughing
May be vague in those with liver disease and ascites (due to confusion)
25
What are the signs of peritonitis?
```
Check vitals and look for signs of dehydration or compromised perfusion
Localised peritonitis (Tenderness on exam, Guarding, Rebound tenderness)
Generalised peritonitis (Very unwell, Systemic signs of toxaemia, lie still, shallow breathing, rigid abdomen)
```
26
What blood tests are done for Peritonitis?
```
FBC
LFT
U&E
Amylase
Clotting
Blood culture
Pregnancy test
ABG
```
27
What other tests are done for Peritonitis?
```
Erect CXR (Check for perforation)
AXR (Obstruction)
USS or CT abdomen
Laparoscopy
If ascites - ascitic tap
```
28
How do you manage localised peritonitis?
Depends on cause
| Some may need surgery and some are treated with antibiotics
29
How do you manage generalised peritonitis?
```
Risk of death from sepsis or shock
IV Fluids
IV Abx
Urinary catheter
NG tube
Central venous line
Laparotomy
Primary peritonitis
```
30
How do you treat SBP?
Quinolone antibiotics
- OR -
Cefuroxime + Metronidazole
31
What are the complications of Peritonitis?
```
Early
- Septic shock
- Respiratory failure
- Multiorgan failure
- Paralytic ileus
- Wound infection
- Abscesses
Late
- Incisional hernia
- Adhesions
```
32
What is a pilonidal sinus?
Forceful insertion of hairs into the skin of the natal cleft in the sacrococcygeal area. This promotes a chronic inflammatory reaction, causing an epithilialised sinus.
33
What causes a pilonidal sinus?
Hair in the natal cleft
More common in hairy people
Ingrowing of hairs excites a foreign body inflammatory reaction and may cause secondary tracks to open laterally +/- abscesses with foul-smelling discharge
34
What are Risk Factors for Pilonidal sinus?
```
Male
16-40
Family history
Stiff hair
Hirsutism
```
35
What are symptoms of Pilonidal sinus?
Painful natal cleft
Discharging swelling
Often recurrent
36
What are the signs of pilonidal sinus?
Midline openings or pits between the buttocks
Hairs may protrude from the swelling
If infection or abscess, swelling will become tender
May be fluctuant and discharge pus or blood-stained fluid on compression
37
What are the investigations for Pilonidal Sinus?
None needed
Bloods (Sign of infection)
- Leucocytosis
- Fasting glucose (Diabetics at risk)
38
What is the management of Pilonidal sinus?
Pre-op antibiotics
Acute pilonidal abscess (incision and drainage)
Chronic pilonidal sinus (Excision under GA with exploration)
Prevention (Good hygiene and shaving)
39
What are the complications of Pilonidal sinus?
Pain
Infection
Abscess
Recurrence
40
What is Portal Hypertension?
Abnormally high pressure within the hepatic portal vein
| - Hepatic venous pressure >10mmHg
41
What causes portal hypertension?
Cirrhosis is the most common cause
Collagen deposition and fibrosis
Sodium retention and vasoactive substances such as NO
3 categories:
Pre-Hepatic
Hepaitc
Post-Hepatic
42
What are pre-hepatic causes of portal hypertension?
Blockage of portal vein before the liver
- Congenital stenosis
- Portal vein thrombosis
- Splenic vein thrombosis
- Extrinsic compression
43
What are hepatic causes of portal hypertension?
```
Cirrhosis
Chronic hepatitis
Schistosomiasis
Granulomata
Myeloproliferative disorder
```
44
What are post-hepatic causes of portal hypertension?
Blockage of hepatic veins or venules
- Budd-Chiari syndrome
- Constrictive pericarditis
- Right Heart failure
45
What are the Risk Factors for Portal hypertension? (Same as cirrhosis)
```
Alcoholic liver disease
Hepatitis C/B
Continued alcohol consumption increases rate of progression of cirrhosis from any cause
Male
Older age
Hypertension
Hyperlipidaemia
```
46
What are the symptoms of Portal hypertension?
```
Jaundice
History of alcohol abuse
Risk for Viral hepatitis
Family history (e.g. Haemochromatosis)
Haematemesis/melaena
Lethargy, irritability, chenges in sleep
Abdominal distention
Abdominal pain and fever
Pulmonary involvement
```
47
What are the signs of portal hypertension?
```
Caput medusae
Splenomegaly
Ascites
Jaundice
Spider naevi
Palmar erythema
Gynaecomastia
Testicular atrophy
```
48
What investigations are done for Portal Hypertension?
```
LFTs
U&Es
Blood glucose
FBC
Clotting screen (Prolongation of PT in liver failure)
Ferriting
Hepatitis serology
Autoantibodies (ASMA in AI hep)
Alpha1-antitrypsin
Ceruloplasmin
Abdominal sultrasound
Doppler ultrasound
Hepatic venous pressure
```
49
How do you manage Portal hypertension?
Telipressin and prophylactic antibiotic
Endoscopy in 12hrs, treat with Band ligation or Injection sclerotherapy
IF not enough, TIPS
Liver transplant most curative
Beta blockers for prophylaxis of variceal bleed
50
What are the complications of Portal hypertension?
Bleeding from oesophageal varices
Ascites + complications (SBP, Hepatorenal syndrome, hepatic hydrothorax)
Pulmonary complications (Hepatopulmonary syndrome)
Liver failure
Hepatic encephalopathy
Cirrhotic cardiomyopathy
51
What is the triad of Hepatopulmonary syndrome?
```
Hepatic dysfunction
Hypoxaemia
Extreme vasodilation (Intrapulmonary vascular dilatation)
```
52
What is Primary Billiary cirrhosis?
AI chronic inflammatory liver disease involving progressive destruction of intrahepatic bile ducts, leading to cholestasis, and ultimately, cirrhosis
53
What causes primary biliary cirrhosis?
AI disease
Environmentally triggered in those predisposed
High concordance in twins
Strong Family histories
Characterised by chronic AI granulomatous inflammation which leads to fibrosis, cirrhosis and portal HTN
54
What are the Risk Factors for Primary biliary cirrhosis?
Women
45-55
Northern European descent
Family history
55
What are the symptoms of Primary Biliary cirrhosis?
Incidental finding (Raised ALP)
Vague symptoms (Fatigue, weight loss, pruritus)
Discomfort in RUQ
Complication of liver decompensation
May present with assocaited symptoms (e.g. Sjorgen's syndrome, arthritis, raynaud's phenomenom)
56
What are the Signs of Primary Biliary cirrhosis?
```
Early - no signs
Late
- Jaundice
- Skin pigmentation
- Scratch marks
- Xanthomas
- Hepatosplenomegaly
- Ascites
- Signs of chronic liver disease
```
57
What are the investigations for PBC?
LFT (High ALP + GGT, Raised bilirubin, Low albumin, High PT time)
Clotting: Prolongation of PT
Antimitochondrial antibodies (AMAs hallmark of PBC)
High IgM
High cholesterol
TFTs
US (Exclude gallstones)
58
What is Primary sclerosing cholangitis?
A chronic cholestatic liver disease chatacterised by progressive periductal or intrahepatic and extrahepatic bile ducts, leading to reactive proliferation and fibrosis, and eventually cirrhosis
59
What causes primary sclerosing cholangitis?
```
Periductal inflammation with peridcutal concentric fibrosis
Portal oedema
Bile duct proliferation
Expansion of portal tracts
Progressive fibrosis
Development of biliary cirrhosis
```
60
What are the Risk factors for Primary sclerosing cholangitis?
Male
IBD
Genetic predisposition
61
What are the symptoms of Primary sclerosing cholangitis?
```
Asymptomatic, diagnosed after persistent ALP
Present with:
- Intermittent jaundice
- Pruritis
- RUQ pain
- Weight loss
- Fatigue
```
62
What are the signs of Primary sclerosing cholangitis?
```
No signs
Jaundice
Hepatosplenomegaly
Spider naevi
Palmar erythema
Ascites
```
63
What are the investigations for Primary sclerosing cholangitis?
LFT (High ALP, mildly elevated ALT+ AST, low albumin + high bilirubin)
Serology (IgG high in kids, IgM high in adults, ASMA and ANA in 30%, pANCA in 70%)
ERCP - beaded appearance
LIver biopsy (Fibrosis, obliterative cholangitis)
64
What is a Rectal prolapse?
Abnormal protrusion of the full thickness (Or only the mucosal layer) of rectum through the anus
65
What causes a rectal prolapse?
Straining
Abnormal rectal anatomy or physiology (e.g. Pelvic floor weakness, poor fixation of rectum or reduced anal sphincter pressure)
66
What are the Risk Factors for rectal prolapse?
```
Constipation
Cause of increased straining
Cystic fibrosis (Children)
Previous trauma to the anus/perineum
Neurological conditions (e.g. Cauda equina syndrome, MS)
```
67
What are the symptoms of Rectal prolapse?
```
Protruding anal mass
Initially with defecation
May need digital replacement
Constipation
Faecal incontinence - in 75%
PR mucous or bleeding
Emergency! (Irreducible or strangulated)
```
68
What are the signs of Rectal prolapse?
Prolapse may be seen on straining
May be ulcerated or necrotic if vascular supply is compromised
Reduced anal sphincter tone
69
What investigations can be done for Rectal prolapse?
```
Proctosigmoidoscopy
Defecating proctogram or barium enema
Anal sphincter manometry
Pudendal nerve studies
Sweat chloride test (test for CF - >30)
```
70
What is Viral Hepatitis?
Viruses, formed of 6 different types
| Other can infect liver include: CMV, EBV, yellow fever and Herpes
71
What are the 6 types of Viral hepatitis?
```
A
B
C
D
E
G
```
72
Which of the Hepatitis' viruses are RNA viruses?
Hepatitis A and E
73
What is the incubation period for HAV/HEV?
3-6 weeks
74
What conditions do Picornavirus and Calicivirus cause?
Picornavirus - HAV
| Calicivirus - HEV
75
What are the Risk Factors for Hepatitis A infection?
Living in endemic regions
Close personal contact with an infected person
MSM
Known food-borne outbreak
International travel
Illicit drug use
Contact with a child or employee in a childcare centre
76
How are HAV/HEV transmitted?
Faecal-oral route
77
What are the presenting symptoms of Hepatitis A/E?
```
Prodromal period
- Malaise
- Anorexia
- Fever
- Nausea and vomiting
Hepatitis symptoms:
- Dark Urine
- Pale stools
- Jaundice aroudn 3 weeks
- Occasionally itching and jaundice last several weeks in HAV infection
```
78
What are the signs of Hepatitis A/E?
```
Pyrexia
Jaundice
Tender hepatomegaly
Spleen may be palpable
Absence of chronic liver disease (Some spider naevi appear transiently)
```
79
What investigations are done for Hep A/E?
```
LFTs (High AST, ALP, ALT and bilirubin)
High ESR
Low Albumin + High platelets
Hep B and C serology
Hep A - IgM (acute), IgG (recovery phase)
Hep E - IgM (Raised), igG
Urinalsysis (Bilirubin, urobilinogen)
```
80
What is the management of Hep A/E?
No specific management other than bed rest and symptomatic treatment
Prevention and control (notifiable disease)
81
What are the complications of Hep A/E?
Fulminant hepatic failure
Cholestatic hepatitis
Post-hepatitis syndrome
82
What is the prognosis of someone with Hep A/E?
Recovery 3-6 weeks
May relapse in recovery
No chronic sequelae
Fulminant hepatic failure has mortality of 80%
83
What is Hepatitis D?
A defective virus that may co-infect with HBV or superinfect people who already carry HBV
84
What type of virus is HBV?
Acute or chronic condition caused by a partial dsDNA virus
85
How is HBV transmitted?
Sexual contact
Blood
Vertical transmission
86
What type of virus is HDV?
ssRNA coated with HBsAg
87
What are the Risk Factors for HBV?
```
Living
In endemic regions
Close personal contact with an infected person
MSM
Known food-borne outbreak
International travel
Illicit drug use
Contact with a child or employee in a childcare centre
Infants of HBEAg/HBsAg
```
88
What are the symptoms of HBV?
```
Incubation period: 3-6 months
1-2 week prodrome
- Malaise
- Headache
- Anorexia
- Nausea and Vomiting
- Diarrhoea
- RUQ pain
- Serum sickness type illness may develop
Jaundice
Recovery 4-8 weeks later
Chronic carriage may be diagnosed after routine LFT testing
```
89
What are the acute signs of HBV?
```
Jaundice
Pyrexia
Tender hepatomegaly
Splenomegaly
Cervical lymphadenopathy
Occasionally: Urticaria and Maculopapular rash
```
90
What are the chronic signs of HBV?
May be no findings
| May have signs of chronic liver disease or decompensation
91
What investigations are done fro HBV?
Viral serology
LFTs (High AST, ALT, ALP, bilirubin)
High PT
Liver Biopsy
92
What is seen on Viral serology for acute HBV infection?
HBsAg positive
IgM anti-HBsAg negative
+/- HBeAg
93
What is seen on Viral serology for chronic HBV infection?
HBsAg Positive
IgG Anti-HBcAg
+/- HBeAg (correlates with severity)
94
What is seen on Viral serology for HBV cleared?
Anti-HBsAg antibody positive
| IgG anti-HBcAg
95
What is seen on Viral serology for HBV vaccinated?
HBsAg positive
96
What is seen on Viral serology for HDV infection?
Detested by IgM or IgG against HDV
| PCR used to detect HDV
97
How do you manage HBV infections?
Prevention: Blood screening, safe sec, instrument sterilisation
Passive immunisation
Active immunisation
Symptomatic treatment
Indications for antiviral treatment (Interferon alpha > Nucleoside/nucleotide analogues)
98
What are indications for antiviral treatment?
HBeAg positive
Or negative with signs of chronic hepatitis
Compensated cirrhosis
Decompensated cirrhosis
99
What is HCV?
A hepatitis C infection, often following a chronic course
100
What type of Virus is hepatitis C?
Ss-RNA
101
How is HCV transmitted?
Transmitted by percutaneous blood exposure
| Sexual activity, perinatally, intranasal drug activity or accidental blood contact
102
What does liver biopsy show?
```
Chronic hepatitis
IV or intranasal drug use
Blood transfusion or organ transplant
Birth between 1945 and 1965
Heavy alcohol use
IL-28 gene polymorphism
HIV
Incarceration/institutionalism
Haemodialysis
Healthcare work
Tattoos
Multiple sex partners
Infected mother
Male sex
```
103
What are the symptoms of HCV
90% of infections are asymptomatic
10% become jaundiced with mild flu-like illness
May be diagnosed after incidental abnormal LFT or in older patients with complications of cirrhosis
104
What are the signs of HCV?
No signs
May be signs of chronic liver disease
Extrahepatic manifestations (Skin rash, Renal dysfunction due to glomerulonephritis)
105
What are the investigations of HCV?
```
HCV serology (Anti HCV antibodies - IgM + IgG (acute), IgG (Chronic))
Reverse transcriptase PCR
LFT
(Acute: High ALT, AST and bilirubin
Chronic: 2-8x AST+ALT)
Liver Biopsy (Diagnose cirrhosis)
```
106
What is the management of HCV?
Prevention
- Screen blood, blood products and organ donors
- Needle exchange schemes for IV drug users
- Instrument sterilisation
- No vaccine available
Medical
- Acute (mainly supportive)
- Chronic (Pegylated interferon alpha, Ribavirin)
Duration: HCV 1/4 - 24-48 weeks; HCV 2/3 - 12-24 weeks
107
What are the complications of HCV?
Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma
Less common Prophyria cutanea tarda, cryoglobulinaemia, glomerulonephritis
108
What is Vitamin A deficiency?
A condition that causes Xerophthalmia (ocular manifestations)
109
What is the cause of Vitamin A deficiency?
Inadequate intake
| Fat malabsorption
110
What is Xerophthalmia?
Dryness of conjunctiva and cornea of eye with inflammation and ridge formation
111
What are the Risk factors for Vitamin A deficiency?
Diet mainly consisting of rice
112
What are the signs and symptoms of vitamin A deficiency?
Night blindness progressing to complete blindness
Dry/Dull/thick conjunctival xerosis and corneal xerosis
Drying/Scaling of skin
113
What investigations are done for Vitamin deficiencies?
```
A:Eye tests and serum retinol binding protein
B: Clinical diagnosis
C: Clinical diagnosis
D:
Low calcium, phosphate, vit D and raised ALP
LOoser's xones and osteopenia on CXR
E: Clinical diagnosis
K: Increased PT time
```
114
How do you manage vitamin deficiencies?
```
Supplements
- in Vit. D treat underlying cause
Vit A - supplements
Vit B - Pabrinex
Vit C (Ascorbic acid)
Vit D (Treat underlying cause)
Vit E / K (supplements)
```
115
What are the complications of Vitamin deficiencies?
```
A:Blindness and Respiratory infections
B: Wernicke's encephalopathy
C: Scurby
D: Bone deformities and calcium deficiency
E: Visual loss and weakness
K: Anaemia
```
116
What is caused by Vitamin B1 deficiency?
Beri beri - leading to Wernicke's encephalopathy
Can be: Dry - nervous system involvement
Wet - Cardiovascular involvement
117
What is caused by Vitamin B2 (Riboflavin) deficiency?
Angular stomatitis, Cheilitis
118
What is caused by Vitamin B6 (pyridoxine) deficiency?
Polyneuropathy
119
What is caused by Vitamin C deficiency?
Scurvy
120
What is caused by vitamin D deficiency?
Rickets / Osteomalacia
121
What is caused by Vitamin E deficiency?
Haemolysis
| Neurological deficit
122
What is caused by Vitamin K deficiency?
Bleeding disorders
123
Who are the vitamin deficiencies common in?
```
A: Southern/east asian people
B: Alcoholics
C: Pregnancies
D: MEDC's and women
E: Very rare
K: Rare but not as rare in infants
```
124
What are the risk factors of general vitamin B deficiencies?
Increased tea/coffee/rice consumption
| Alcoholism/Starvation/Vomiting/GI surgery
125
What are the Risk Factors for Vitamin C deficiency?
Pregnancy
126
What are the Risk Factors for Vitamin D deficiency?
Lack of sunlight
CKD
Vitamin D resistance
127
What are the Risk factors for vitamin E deficiency?
Cystic fibrosis/chronic cholestatic hepatobiliary diseae/short bowel syndrome
Abetalipproteinaemia
128
What are the Risk factors for Vitamin K deficiency?
Anticoagulatns
Antibiotics that interfere with Vit K absorption
Infants with low Vit K breast milk
129
What are the symptoms and signs of Vitamin B deficiency?
```
B1
Dry: Numbness, confusion, difficulty moving legs, pain
Wet: Palpitations, SOB, Oedema
B2
Angular stomatitis
B6
Polyneuropathy
```
130
What are the signs and symptoms of vitamin c deficiency?
```
Fatigues
Weakness
Cachexia
Gingivitis
Bleeding gums
Halitosis
petechiae/rash
```
131
What are the signs and symptoms of Vitamin D deficiency/
Rickets: Hypotonia, Short, bow legs and bossing of frontal/parietal bones
Osteomalacia: Bone pain, weakness and malaise - can cause trousseauchvostek sign
132
What are the signs and symptoms of Vitamin E deficiency?
```
Weakness
Hyporeflexia
Ataxia
Loss of vibrational sense
Visual field decline
```
133
What are the signs and symptoms of Vitamin K deficiency?
Ecchymosis
melaena
Epistaxis
134
What occurs in people who are Calcium deficient?
```
CATs go Numb
Confusion
Arrhythima
Tetany
Numbness
```
135
What is tetany?
intermittent Muscular spasms caused by calcium deficiencies
136
What is Vitamin B12/Folate deficiency?
Having insufficient vitamin B12/Folate
137
What causes Vitamin B12 deficiency?
```
B12 found in meats and animal protein food
Pernicious anaemia common cause
Veganism
Gastrectomy
Drugs (Colchicine, metformin)
```
138
What causes folate deficiency?
Found in vegetables /fruit
| Caused by: Decreased dietary intakes / decreased absorption
139
What are the Risk factors for B12 deficiency?
Low dietary intake
Drugs: Metformin, H2 antagonism/PPI
Malabsorption (Coeliac, crohns, IBD, surgery, disease)
140
What are the Risk Factors for Folate deficiency?
```
Low dietary intake
Drugs: Trimethoprim, methotrexate, sulfasalazine
Malabsorption (IBD, Coeliac, congenital)
Alcoholism
Pregnancy
Prematurity
```
141
What are the symptoms of B12 deficiency?
```
Typical anaemia (Fatigue, lethargy, dyspnoea, faintness, palpiataions, headaches)
Neurological symptoms ( paraesthesia, numbness, congnitive changes)
```
142
What are the symptoms of Folate deficiency?
Very few unless pregnant
| General anaemia symptoms
143
What are the signs of Vitamin B12 deficiency?
Pallor
Heart failure (severe anaemia)
Glossitis
Angular stomatitis
Neuropsychiatric: Irritability, dementia, depression
Neurological: Subacute combined degeneration of the spinal cord, peripheral neuropathy
144
What investigations are done for diagnosing Vitamin B12 deficiency?
```
Measure serum B12
Blood film (Hypersegmented neutrophils, Oval macrocytes, circulating megaloblasts)
Pernicious anaemia tests (anti-intrinsic factor antibodies, anti-parietal cell antbodies, Schilling test - specific for B12)
```
145
What is a volvulus?
Malrotation of a loop of bowel around the axis of its mesentry that results in bowel obstruction and potential ischaemia
146
What are the types of volvulus?
Sigmoid (65%)
Caecal (30%)
Volvulus neonatum - in neonates typically affects midgut
147
What are the risk factors for a volvulus?
```
Malrotation - neonatal
Enlarged colon
Hirschprung disease
Pregnancy
Abdominal adhesions
Chronic constipaiton
Increased fibre diet
```
148
What are the symptoms of a volvulus?
```
Severe colicky abdominal pain and swelling
Absolute constipation
Vomiting
May be history of TIAs
Neonatal volvulus is aorund 3months
```
149
What are the signs of a volvulus?
```
Signs of bowel obstruction with distention and tenderness
- Absent or tinkling bowel sounds
fever
tachycardia
signs of dehydration
```
150
What investigations are done in volvulus?
Abdominal X-ray - Coffee bean sign (sigmoid) or embryonic sign (caecal)
Erect CXR ( Check for perforation)
Water-soluble contract enema
CT scan
151
What is Wilson's disease?
An autosomal recessive disorder characterised by reduced biliary excretion of copper and accumulation of copper in the liver and brain, especially in the basal ganlis
Also known as hepatolenticular degeneration
152
What causes wilson's disease?
Mutation in Chromosome 13 codes for ATP7B in hepatocytes
Interferes with transport of copper into the intracellular compartments for incorporation into ceruloplasmin
Excess copper damages hepatocyte mitchochondira, leading to cell death and release of copper
This copper depostis in tissues and imparis funciton
153
What are the Hepatic symptoms of Wilson's disease?
```
Hepatitis, Liver failure, cirrhosis
May also be:
- Jaundice
- Easy bruising
- Variceal bleeding
- Encephalopathy
```
154
What are the Neurological symptoms of wilson's disease?
```
Dyskinesia
Rigidity
Tremor
Dystonia
Dysarthria
Dysphagia
Drooling
Dementia
Ataxia
```
155
What are the Psychiatric symptoms of Wilson's disease?
Conduct disorder
Personality change
Psychosis
156
What are the signs of Wilson's disease?
```
Hepatosplenomegaly
Jaundice
Ascites/oedema
Gynaecomastia
Kayser-Fleisher rings (Slit lamp)
Sunflower cataract (Slit lamp)
```
157
What investigations are done for suspected wilson's disease?
LFTs (High AST, high ALT, High ALP)
Serum caeruloplasmin (low) - is an acute phase protein so may give false negative
Serum copper - raised
24hr copper levesl - increased
LIver biopsy - copper content
Genetic analysis - wilsons
MRI - degeneration in basal ganglia, fronto-temporal, cerebellar, brainstem
