Irritable bowel Flashcards

1
Q

what initial investigations would you do for someone with lower abdominal symptoms but no red flags

A
FBC
coeliac serology
faecal calprotein 
stool culture
CRP
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2
Q

what are abdominal red flags

A
over 60
rectal bleeding
anaemia 
weight loss
fam hx colorectal cancer
abdo/rectal mass 
woman over 50 with persistant bloating (Ca ovaries)
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3
Q

What are the symptoms of IBS

A
abdo pain 
bloating 
altered bowel habit 
colicky pain 
associated with bowel movement
either diarrhoea or constipation predominant
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4
Q

what is faecal calprotectin

A

IBD test

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5
Q

what type of visual disturbance might you have with a large pituitary tumour

A

bitemporal hemianopia

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6
Q

what might you see on a CT head with a piturity tumour

A

eroding of the putitary fossa

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7
Q

what arteries supply the adrenal glands

A

superior suprarenal artery from inferior phrenic

middle suprarenal artery from the abdominal aorta

inferior suprarenal artery from the renal artery

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8
Q

why are metastases to the adrenal glands common

A

rich blood supply

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9
Q

what is psuedohyponatraemia

A

caused by lab error

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10
Q

how can you differentiate between pituitary and adrenal cushings

A

plasma ACTH levels

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11
Q

how can you screen for cushings

A

low dose overnight dexamethasone supression test

urinary free cortisol

48 hr low dose dexamethason supression test

late night salivary cortisol

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12
Q

in a patient with cushings, what imaging would you do if ACTH was raised

A

pituitary

if ACTH is not raised then image the adrenal glands

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13
Q

how do you differentiate between pituitary and ectopic sources of excess ACTH

A

inferior petrosal sinus sampling

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14
Q

what is a common source of ectopic ACTH

A

lungs

-do CXR

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15
Q

what enzyme does metryropone block

A

11 beta hydroxylase

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16
Q

what enzyme abnormalities can be seen in cushings

A

high sodium
low potassium
high bicarb