Liver and GI (& GU!) Flashcards

Question

What is stage 4 CKD?

Answer 1

eGFR 15 - 29 ml/min.

Answer 2

eGFR < 15 ml/min.

Answer 3

- diabetes - family history - old age - recurrent UTIs

Answer 4

Nitrofurantoin

Answer 5

At term due to risk of neonatal haemolysis.

Answer 6

Trimethoprim - teratogenic effects.

Answer 7

Reiter’s syndrome (reactive arthritis).

Answer 8

Autosomal dominant.

Answer 9

- cardiovascular disease - kidney stones - polycystic liver disease - subarachnoid haemorrhage (due to Berry aneurysms)

Answer 10

Crohn's and UC

Answer 11

Very dilated oesophagus. | Small / absent gastric bubble.

Answer 12

Aspiration pneumonia.

Answer 13

- CXR | - barium swallow

Answer 14

- osteoporosis | - dermatitis herpetiformis

Answer 15

- gastric ulcer pain is worse with eating | - duodenal ulcer pain is relieved by eating

Answer 16

Blood in stool.

Answer 17

- achalasia - barret's oesophagus - corrosive oesophagitis - diverticulitis - oesophageal web - familial - GORD - hiatal hernia - alcohol & smoking

Answer 18

- norovirus | - rotavirus

Answer 19

- E. coli - Salmonella (non-typhoidal) - campylobacter

Answer 20

herniation of the mucosa and submucosa through the muscular layer of the colonic wall

Answer 21

Colonic smooth muscle over-activity.

Answer 22

Inflammation of diverticula, may be caused by infection.

Answer 23

- ageing - low fibre diet - obesity - smoking - sedentary lifestyle

Answer 24

Uncomplicated - oral antibiotics and liquid diet. | Complicated - IV antibiotics, abscess drainage, surgical resection.

Answer 25

- complicated disease - recurrent disease - immunocompromised

Answer 26

Vancomycin (125mg orally 4x per day for 10 days).

Answer 27

Intussusception

Answer 28

- post-surgery adhesions - hernia - volvulus - intussusception

Answer 29

- post-operative ileus - appendicitis - peritonitis - hypothyroidism - hypokalaemia - hypercalcaemia

Answer 30

Mesenteric ischaemia - narrowed / blocked arteries restrict blood flow to the small intestine. Ischaemic colitis - temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow.

Answer 31

- clotting abnormalities (e.g. factor V leiden) - high cholesterol - reduction of blood flow (heart failure, low BP) - previous abdominal surgery - heavy exercise - surgery involving the aorta

Answer 32

- liver cirrhosis - hepatitis - primary biliary cholangitis - parasitic infection (schistosomiasis) - thrombosis of portal / splenic veins

Answer 33

- most self-resolve in a few days - endoscopic therapy (coagulation) - transfusions if Hb is low - surgical repair - PPI

Answer 34

Alcoholic liver disease

Answer 35

Terminal ileum

Answer 36

Endodermal yolk sac tumour

Answer 37

5-alpha reductase inhibitor (e.g. finasteride)

Answer 38

Long-term irreversible complication of Wernicke’s encephalopathy.

Answer 39

Leucocyte extravasation

Answer 40

Cardiac tamponade: - muffled heart sounds - hypotension - raised JVP

Answer 41

Inflammation of the gallbladder, usually occurs when a gallstone completely obstructs the gallbladder neck or cystic duct. There may be infection of the gallbladder.

Answer 42

Obstruction of the cystic duct causing inflammation of the gallbladder, without gallstones.

Answer 43

- RUQ pain and tenderness - fever - nausea & vomiting - palpable gallbladder - Murphy's sign

Answer 44

Pain on inspiration when the right subcostal area is palpated.

Answer 45

- right shoulder (due to phrenic nerve irritation) | - around the right side to the back (intercostal nerve irritation)

Answer 46

Abdominal ultrasound

Answer 47

- abdominal ultrasound - MRCP (if ultrasound doesn't detect the stone) - blood cultures - FBC (elevated WCC) - LFTs (generally normal) - serum lipase / amylase (exclude pancreatitis)

Answer 48

- analgesia - IV antibiotics - laparoscopic cholecystectomy

Answer 49

- gallbladder perforation - gangrenous cholecystitis - sepsis

Answer 50

Gallstone formation in the gallbladder or other parts of the biliary tree.

Answer 51

Gallstones in the common bile duct.

Answer 52

Intermittent RUQ pain caused by gallstones irritating the bile ducts (worse after eating, particularly fatty foods).

Answer 53

- 90% are cholesterol stones | - 10% are black / brown pigment stones

Answer 54

- female - increasing age - diabetes / metabolic syndrome - obesity - pregnancy - rapid weight loss / prolonged fasting - medications (e.g. oestrogen, GLP-1 analogues)

Answer 55

High bilirubin / red cell turnover states - i.e. haemolytic anaemia.

Answer 56

Stasis and infection.

Answer 57

- bile becomes supersaturated with cholesterol due to excessive amounts of cholesterol produced by the liver, compared with solubilising agents (bile salts and lethicin) - there is accelerated nucleation (crystallisation) - gallbladder hypomobility contributes to stone formation

Answer 58

- severe colicky epigastric / RUQ pain - often triggered by meals (particularly fatty meals) - lasts 30 minutes - 8 hours - may be associated with nausea & vomiting

Answer 59

- abdominal ultrasound - LFTs (normal or elevated ALP/bilirubin if there is cholestasis) - MRCP (if common bile duct stones are suspected but have not been picked up on ultrasound)

Answer 60

- avoid fatty foods - analgesia - laparoscopic cholecystectomy if symptomatic - clear bile duct stones (ERCP / laparoscopic cholecystectomy)

Answer 61

- biliary colic - acute cholecystitis - acute pancreatitis - acute cholangitis

Answer 62

Infection and inflammation of the biliary ducts - surgical emergency with high mortality from sepsis.

Answer 63

- E. coli - Klebsiella - Enterococcus

Answer 64

- obstruction of the common bile duct | - infection introduced during ERCP

Answer 65

- cholelithiasis - benign / malignant strictures - injury to the bile ducts (e.g. surgical, endoscopic, radiological) - history of primary sclerosing cholangitis

Answer 66

- obstruction of the common bile duct leads to bacterial seeding and contamination of the biliary tree - sludge formation provides a growth medium for bacteria - bile duct pressure increases as the obstruction progresses, promoting extravasation of bacteria into the bloodstream - this leads to sepsis if untreated

Answer 67

- Charcot's triad (jaundice, fever, RUQ pain) - pale stools - pruritus

Answer 68

endoscopic retrograde cholangiopancreatography

Answer 69

- ERCP - abdominal ultrasound - FBC (raised WCC) - ABG (raised lactate, metabolic acidosis) - LFTs (raised ALP, bilirubin, and transaminases) - blood cultures

Answer 70

- acute cholecystitis - acute pancreatitis - acute appendicitis - acute pyelonephritis

Answer 71

- sepsis 6 - ERCP for biliary decompression (with sphincterotomy / stent placement) - elective laparoscopic cholecystectomy in stabilised patients

Answer 72

3 in, 3 out: - O2 to target saturations - IV fluids - IV antibiotics - blood cultures - serial lactates - monitor urine output

Answer 73

- sepsis | - acute pancreatitis

Answer 74

Chronic autoimmune disease of the small intra-hepatic bile ducts. Obstruction of the bile ducts results in chronic inflammation and fibrosis.

Answer 75

- peak incidence 45-60 - affects females much more than males (10:1) - associated with other autoimmune conditions (rheumatoid arthritis, Sjogren's)

Answer 76

- T lymphocyte-mediated damage to bile duct epithelial cells, with autoantibody involvement - cholestasis occurs as a result of autoimmune bile duct damage - this leads to bile acid retention, causing further liver damage and progressive loss of bile ducts - this results in liver fibrosis and eventually cirrhosis - bile acids, bilirubin, and cholesterol build up in the blood

Answer 77

- pruritus - jaundice - xanthelasma (cholesterol deposits on eyelids) - xanthoma (cholesterol deposits on in) - GI disturbance - abdominal pain - pale stools - signs of liver cirrhosis

Answer 78

- raised ALP - raised bilirubin and transaminases (later in disease course) - autoantibodies (AMA are most specific, ANA may also be seen) - liver biopsy (usually not required as raised ALP and presence of specific autoantibodies normally sufficient for diagnosis) - imaging (abdominal ultrasound / MRCP) to exclude bile duct lesion or PSC

Answer 79

- obstructive bile duct lesion | - PSC

Answer 80

- ursodeoxycholic acid (reduces intestinal cholesterol absorption) - obeticholic acid (bile acid analogue, decreases circulating bile acids) - cholestyramine (bile acid sequestrant, binds bile in the GI tract to prevent its absorption) - prednisolone / azathioprine - liver transplant

Answer 81

Hepatocellular carcinoma

Answer 82

Intra- or extra-hepatic bile ducts become strictured and fibrotic, causing cholestasis. Chronic bile obstruction eventually leads to liver inflammation, fibrosis and cirrhosis.

Answer 83

affects males more than females

Answer 84

Immune-mediated condition with a genetic component.

Answer 85

- male - history of IBD - first degree relative with PSC

Answer 86

- pruritus - jaundice - RUQ pain - vitamin deficiency (ADEK) - hepatomegaly - signs of liver cirrhosis - fever

Answer 87

- LFTs - elevated ALP (transaminases and bilirubin elevated as the disease progresses) - autoantibodies (ANA, ANCA) - MRCP ('beads on a string' appearance)

Answer 88

- cholestyramine (bile acid sequestrant to relieve pruritus) - ERCP to dilate and stent strictures - liver transplant

Answer 89

- hepatocellular carcinoma - cholangiocarcinoma - cirrhosis and liver failure

Answer 90

Inflammation of the pancreas, presenting with rapid onset of inflammation (both local and systemic) and symptoms.

Answer 91

- gallstones (50%) | - alcohol (25%)

Answer 92

- idiopathic - gallstones - ethanol - trauma - steroids - mumps - autoimmune - scorpion venom - hyperlipidaemia - ERCP - drugs (azathioprine)

Answer 93

- inflammation damages acinar cells, resulting in the release of digestive enzymes - this is due to abnormal intra-cellular calcium accumulation which activates intra-cellular proteases, releasing stored digestive enzymes - proteases cause autodigestion and lipases cause fatty necrosis

Answer 94

Systemic inflammation and the release of pancreatic proteases results in lung damage.

Answer 95

- severe epigastric pain - pain radiates to back - pain improves leaning forward - nausea & vomiting - anorexia - abdominal tenderness - hypovolaemia - pleural effusion

Answer 96

- hypotension - oliguria - dry mucous membranes - tachycardia - decreased skin turgor

Answer 97

Serum amylase / lipase - greater than 3 times the upper limit of the normal range.

Answer 98

- serum amylase / lipase - FBC (elevated WCC and haematocrit) - CRP elevated - creatinine may be elevated - LFTs - CXR - abdominal ultrasound (gallstones) - CT abdomen (for complications) - ERCP / MRCP

Answer 99

- abdominal aortic aneurysm - ascending cholangitis - acute cholecystitis - MI - mesenteric ischaemia

Answer 100

- IV fluids - nil by mouth - analgesia - anti-emetics - ERCP / cholecystectomy for gallstones - IV antibiotics for infection - drain abscess

Answer 101

High - acute renal failure. Medium - sepsis / acute lung injury. Low - chronic pancreatitis.

Answer 102

Chronic inflammation in the pancreas, resulting in fibrosis and loss of pancreatic function.

Answer 103

Cystic fibrosis

Answer 104

- alcohol - repeated episodes of acute pancreatitis - family history - coeliac disease

Answer 105

- dull epigastric pain - pain worse around 30 minutes after eating - pain radiates to the back - steatorrhoea - weight loss and malnutrition - jaundice - nausea and vomiting - diabetes mellitus / glucose intolerance

Answer 106

- CT / MRI abdomen - shows pancreatic calcifications, enlargement, and dilation of ducts - endoscopic ultrasound - secretin-enhanced MRCP - demonstates abnormal exocrine function - biopsy and histology - shows fibrosis, loss of acini

Answer 107

- alcohol and smoking cessation - dietary supplementation - pancreatic enzyme replacement therapy - blood glucose monitoring - analgesia - ERCP for duct stenting and stricture dilatation

Answer 108

- exocrine insufficiency - diabetes mellitus - osteoporosis - pancreatic cancer

Answer 109

- ethanol is directly toxic to the liver, resulting in the development of steatosis due to altered lipid metabolism - steatosis initially develops in hepatocytes surrounding the central vein - there is progression to hepatitis with activation of Kupffer cells (and hepatic stellate cells )which induce inflammation - Mallory-Denk bodies are seen within hepatocytes - fibrosis and cirrhosis develop following deposition of extracellular matrix proteins by hepatic stellate cells

Answer 110

- fatigue, malaise, nausea, anorexia - abdominal pain - jaundice - hepatomegaly - spider naevi - ascites - caput medusae - asterixis

Answer 111

Engorged superficial epigastric veins.

Answer 112

- LFTs (AST:ALT ratio >2 is strongly suggestive) - increased prothrombin time - liver ultrasound - CT/MRI abdomen - liver biopsy - endoscopy (assess for oesophageal varices)

Answer 113

- non-alcoholic steatohepatitis - acute / chronic viral hepatitis - Wilson's disease - autoimmune hepatitis

Answer 114

- stop drinking alcohol - smoking cessation - liver transplant - corticosteroids for alcoholic hepatitis - treat complications

Answer 115

- ascites - hepatic encephalopathy - portal hypertension - oesophageal varices - hepatocellular carcinoma

Answer 116

Decreased ammonia metabolism by the damaged liver results in build-up of ammonia in the blood.

Answer 117

Increased resistance in the liver as a result of fibrosis / cirrhosis, results in an increase in blood pressure in the portal vein.

Answer 118

Pressure measurement - catheterisation via the internal jugular vein.

Answer 119

- catheterisation via internal jugular vein and blood pressure measurement - doppler ultrasound - upper GI endoscopy (for oesophageal varices)

Answer 120

TIPSS - transjugular intrahepatic portal systemic shunt.

Answer 121

Propanolol

Answer 122

Terlipressin (vasopressin analogue) causes vasoconstriction and slows bleeding.

Answer 123

- elastic band ligation | - injection scleropathy (to cause clotting)

Answer 124

Single-stranded RNA virus.

Answer 125

Faecal-oral (contaminated food and water).

Answer 126

IgM anti-hepatitis A serology.

Answer 127

- supportive care (analgesia) | - resolves in 1-3 months

Answer 128

- nausea and vomiting - anorexia - jaundice - dark urine and pale stools - hepatomegaly - fever - RUQ pain

Answer 129

Contact with blood or bodily fluids (needle-sharing, sexual intercourse).

Answer 130

70% of patients are asymptomatic.

Answer 131

Patients are asymptomatic until they develop chronic liver disease.

Answer 132

- jaundice - hepatomegaly - fever - nausea and vomiting - fatigue - RUQ pain - signs of cirrhosis

Answer 133

Active infection

Answer 134

Marker of viral replication, indicates high infectivity.

Answer 135

- vaccination - previous infection - current infection (if other markers are also present)

Answer 136

Past or current infection.

Answer 137

Direct measure of viral load.

Answer 138

- supportive care and antiviral therapy | - liver transplant

Answer 139

- hepatocellular carcinoma - liver cirrhosis - liver failure

Answer 140

- over 95% achieve seroconversion without treatment within 2 months - some patients become chronic hep B carriers (viral DNA integrated into their own DNA)

Answer 141

Single stranded RNA (positive-sense)

Answer 142

- IVDU - sexual transmission is uncommon - contaminated blood transfusion / medical equipment

Answer 143

Patients usually asymptomatic

Answer 144

- fatigue, myalgia, anorexia - jaundice - ascites - hepatic encephalopathy

Answer 145

- hep C antibody (current / past infection) - hep C RNA PCR (current infection) - serum aminotransferases elevated

Answer 146

- direct acting antiviral treatment for 8-12 weeks | - liver transplant

Answer 147

- some young, healthy patients develop an immune response that eradicates the virus - the majority of infected patients have chronic infection and progressive liver damage

Answer 148

Single stranded RNA virus (negative sense).

Answer 149

Attaches itself to the hep B surface antigen.

Answer 150

Faecal-oral

Answer 151

Normally produces a mild illness that clears in a month without treatment. Rare to progress to chronic hepatitis and liver failure.

Answer 152

Chronic inflammatory disease of the liver - characterised by the presence of circulating autoantibodies, inflammatory changes on liver histology, and response to immunosuppressive treatment.

Answer 153

- genetic predisposition | - environmental triggering agents (viruses, drugs, etc)

Answer 154

HLA-DR3 and HLA-DR4 are associated with type 1 AIH.

Answer 155

T-cell mediated response against hepatocytes, with auto-antibody involvement. This leads to chronic inflammation and liver fibrosis.

Answer 156

- fatigue, malaise, anorexia - abdominal pain - hepatomegaly / splenomegaly - jaundice - encephalopathy - pruritus - fever - nausea - ascites - spider naevi

Answer 157

- LFTs (greater increase in aminotransferases than ALP and bilirubin) - serum autoantibodies - serum immunoglobulin concentration - liver biopsy

Answer 158

- ANA - anti smooth muscle antibody - pANCA - anti soluble liver / pancreas antigens - anti liver-kidney microsome 1 antibody - anti liver cytosol antibody

Answer 159

- corticosteroid (prednisolone) - plus immunosuppressant if necessary (azathioprine) - liver transplant

Answer 160

- steroid complications - hepatocellular carcinoma - liver failure

Answer 161

Autosomal recessive iron storage disorder resulting in excessive total body iron, and iron deposition in tissues.

Answer 162

Autosomal recessive mutation in the human haemochromatosis protein (HFE) on chromosome 6.

Answer 163

Regulates the expression of hepcidin.

Answer 164

- hepcidin expression is too low - hepcidin is a negative regulator of iron, so this results in ongoing duodenal absorption of iron despite adequate iron stores - there is also continued release of iron from macrophages (from erythrophagocytosis) - serum iron and transferrin saturation is high - this leads to iron accumulation in multiple organisms

Answer 165

Usually presents after 40 (later in females due to iron loss from menstruation).

Answer 166

- chronic fatigue - bronze / grey skin discolouration - joint pain - hypogonadism (impotence, loss of libido) and erectile dysfunction - memory and mood disturbance - hepatomegaly - diabetes mellitus - arrhythmias - congestive heart failure

Answer 167

- serum ferritin elevated - total iron binding capacity reduced (fasting transferrin saturation) - genetic testing confirms Dx - LFTs may be normal

Answer 168

- liver biopsy with Perl's stain - fasting blood glucose - ECG and echocardiogram

Answer 169

- phlebotomy | - manage complications

Answer 170

- type 1 diabetes - liver cirrhosis - hepatocellular carcinoma - infertility - congestive heart failure - bone loss

Answer 171

Autosomal recessive disease causing copper accumulation in tissues.

Answer 172

Mutation in the ATP7B copper-binding protein on chromosome 13.

Answer 173

- ATP7B normally produces a protein involved in the excretion of excess copper in the bile, where it is subsequently eliminated in the stool - faulty ATP7B production results in high levels of free copper, causing toxicity by oxidant damage - this leads to cell injury, inflammation, and death - excess copper is stored in the liver, which causes hepatitis and eventually fibrosis due to inflammation and cell injury - the basal ganglia and movement co-ordination areas of the brain are most sensitive to copper accumulation

Answer 174

Patients present with either hepatic problems, or neurological / psychiatric problems.

Answer 175

Ceruloplasmin

Answer 176

- jaundice - RUQ tenderness - spider naevi - ascites - GI bleeding (varices)

Answer 177

- behavioural abnormalities - tremor - dysarthria - dysphagia - incoordination - ophthalmoplegia - dysdiadochokinesia

Answer 178

Slowness in alternating hands from prone to supine position.

Answer 179

Brown circles surrounding the iris. Seen in Wilson's disease due to copper deposition.

Answer 180

Liver biopsy

Answer 181

- liver biopsy - 24 hour urine copper - serum ceruloplasmin (low) - LFTs (raised transaminases and bilirubin, low albumin)

Answer 182

- trientine (copper chelator) - zinc (blocks copper absorption) - dietary restriction of liver and shellfish - liver transplant

Answer 183

Copper chelator, enhances urinary excretion of copper.

Answer 184

- liver failure | - oesophageal varices

Answer 185

Autosomal co-dominant disorder in which there is insufficient production of A1AT, resulting in lung and liver damage.

Answer 186

Allele mutations in the SERPINA1 gene.

Answer 187

Autosomal co-dominant.

Answer 188

- A1AT is made in the liver, and nomally inhibits neutrophil elastase (enzyme that digests connective tissues) - deficiency results in lung damage because excess protease enzymes attack connective tissue - liver damage occurs because the abnormal A1AT protein becomes trapped and accumulates, leading to fibrosis over time

Answer 189

- productive cough - shortness of breath on exertion - hepatomegaly - ascites - hepatic encephalopathy - jaundice / scleral icterus

Answer 190

Bronchiectasis and emphysema.

Answer 191

- serum A1AT - genetic testing for A1AT gene - liver biopsy - CT chest - LFTs (elevated transaminases, ALP, and bilirubin)

Answer 192

- stop smoking - short / long acting bronchodilators - inhaled corticosteroids - pulmonary rehabilitation - lung transplant - liver transplant - manage hepatic complications

Answer 193

Hepatocellular carcinoma

Answer 194

- chronic hep B / C infection - alcoholic liver disease - non-alcoholic steatohepatitis - haemochromatosis - A1AT deficiency - PBC / PSC

Answer 195

Causes methylation of the P16 gene, leading to hepatocellular carcinogenesis.

Answer 196

- weight loss - anorexia - abdominal pain - nausea & vomiting - jaundice - pruritus - cirrhosis (ascites, spider naevi, caput medusae, varices, asterixis)

Answer 197

- alpha fetoprotein - liver ultrasound - CT / MRI abdomen - liver biopsy

Answer 198

No, HCC is generally considered resistant to chemotherapy and radiotherapy.

Answer 199

- surgical resection of individual tumours - liver transplant - kinase inhibitors - transcatheter arterial embolisation - radiofrequency ablation

Answer 200

Inhibit cancer cell proliferation (e.g. sorafenib).

Answer 201

Rare disorder characterised by narrowing and occlusion of hepatic veins.

Answer 202

- nausea & vomiting - RUQ pain - jaundice - hepatomegaly - altered consciousness level & asterixis (due to hepatic encephalopathy) - loin pain

Answer 203

- serum paracetamol - LFTs (raised transaminases) - serum creatinine elevated - ABG (lactic acidosis)

Answer 204

Hypoglycaemia

Answer 205

- activated charcoal (within 1 hour) - acetylcysteine to prevent liver damage - refer to psychological support

Answer 206

Aminosalicylate - e.g. mesalazine.

Answer 207

Calculi form in the renal pelvis before travelling down the ureters. They may be symptomatic until they irritate or become stuck in the ureters.

Answer 208

Vesico-ureteric junction

Answer 209

Calcium based - calcium oxalate (more common) - calcium phosphate

Answer 210

- calcium oxalate / calcium phosphate - uric acid - struvite - cystine

Answer 211

Produced by bacteria, associated with infection.

Answer 212

Cystinuria - autosomal recessive disease.

Answer 213

Complex renal stone occupying the majority of the renal collecting system - associated with high risk of sepsis.

Answer 214

Upper UTI - bacteria hydrolyse the urea in urine to ammonia, producing struvite.

Answer 215

- UTI - obesity - excessive uric acid intake - dehydration - previous renal stones - hyperparathyroidism - anatomical urinary tract abnormalities

Answer 216

- acute severe spasmodic flank pain radiating to the ipsilateral groin - nausea and vomiting - urinary frequency / urgency - haematuria - costovertebral angle and flank tenderness - restlessness - fever (if infection)

Answer 217

Acute severe spasmodic flank pain, radiating to the ipsilateral groin.

Answer 218

- urine dipstick (haematuria, nitrites & leucocytes if UTI) - non-contrast CT KUB (renal ultrasound in pregnant patients) - U&Es - X ray KUB - shows calcification

Answer 219

- acute appendicitis - ectopic pregnancy - ovarian cyst - bowel obstruction

Answer 220

Obstruction with or without infection.

Answer 221

- decompression (ureteric stent or percutaneous nephrostomy tube) - antibiotics for infection - stone removal after drainage complete and infection cleared

Answer 222

- analgesia (strong - e.g. diclofenac) - anti-emetic - hydration

Answer 223

``` Stone less than 10mm - consider watchful waiting. Stone greater than 10mm: - tamsulosin - shock wave lithotripsy - ureteroscopy - percutaneous nephrolithotomy ```

Answer 224

Oral alkalinisation therapy - potassium citrate.

Answer 225

An acute drop in kidney function leading to a rise in serum creatinine or a fall in urine output.

Answer 226

- creatinine rise > 25 micromol/L in 48 hours - creatinine rise > 50% from baseline in 7 days - urine output < 0.5 ml/kg/hour for > 6 hours

Answer 227

- hypovolaemia / haemorrhage - sepsis - third-spacing of fluid (acute pancreatitis) - heart failure - hepatorenal syndrome - renal artery stenosis

Answer 228

- acute tubular necrosis - rapidly progressive glomerulonephritis - interstitial nephritis - thrombosis - haemolytic uraemic syndrome

Answer 229

- strictures - tumour - prostate hyperplasia - renal calculi - ascending UTI - urinary retention

Answer 230

- underlying renal disease - sepsis - IV iodinated contrast - hypovolaemia - pancreatitis - renal stones - older age - nephrotoxic drugs

Answer 231

- ischaemia - drug-induced - contrast-induced

Answer 232

- obstruction increases intratubular pressure | - this causes tubular ischaemia and atropy

Answer 233

- ibuprofen - lithium - antibiotics (cefotaxime, gentamicin, vancomycin) - immunosuppressants (methotrexate, sulfasalazine) - ACE inhibitors and ARBs

Answer 234

- U&Es (hyperkalaemia) - serum creatinine - urine output - renal tract ultrasound for obstruction

Answer 235

STOP AKI - screen for and treat sepsis - toxins - stop nephrotoxic drugs - optimise volume status and BP - prevent harm: treat underlying cause and complications (hyperkalaemia) Emergency renal replacement therapy if not responding to treatment.

Answer 236

Reduction in kidney function present for more than 3 months.

Answer 237

ml/min/1.73m^2

Answer 238

- diabetes - hypertension - older age - glomerulonephritis - polycystic kidney disease - nephrotoxic drugs - obstructive uropathy - SLE - AKI

Answer 239

- kidney no longer activates vitamin D, leading to hypocalcaemia - hypocalcaemia stimulates increased PTH secretion, increasing bone resorption - bones become brittle and weak due to mineral loss

Answer 240

Low rate of blood flow through the glomerulus results in increased renin secretion.

Answer 241

- treat underlying cause (diabetes, hypertension, glomerulonephritis) - reduce CVD risk - atorvastatin 20 mg - manage complications (vitamin D and iron supplementation) - dialysis and transplant

Answer 242

- AKI - hypertension - cardiovascular disease - anaemia - bone disease - metabolic acidosis - arrhythmias (hyperkalaemia) - uraemic pericarditis

Answer 243

Adenocarcinoma arising from the kidney tubules, most common form of renal cancer.

Answer 244

Clear cell renal carcinoma

Answer 245

Specific kidney tumour affecting young children.

Answer 246

- smoking - obesity - hypertension - end-stage renal failure - von-hippel lindau - haemodialysis

Answer 247

Rare genetic multi-system disorder characterised by the development of benign tumours, with potential for malignant transformation.

Answer 248

- haematuria - loin pain - weight loss - fatigue - anorexia - night sweats - renal mass

Answer 249

Within the renal fascia, renal vein, inferior vena cava.

Answer 250

Cannonball lung metastases

Answer 251

- polycythaemia (unregulated EPO) - hypercalcaemia (secretion of PTH mimicking hormone) - hypertension - Stauffer's syndrome

Answer 252

Paraneoplastic syndrome seen in RCC. Causes abnormal LFTs without liver metastasis.

Answer 253

Abdominal / pelvic ultrasound.

Answer 254

CT thorax, abdomen, pelvis.

Answer 255

- abdominal / pelvic ultrasound - CT thorax, abdomen, pelvis - biopsy (or pathology post-resection) - FBC - increased haematocrit - LFT derangement - serum creatinine - elevated - urinalysis - haematuria / proteinuria

Answer 256

Surgical resection (partial or radical nephrectomy). Other options are arterial embolisation or radiofrequency ablation. Chemotherapy / radiotherapy.

Answer 257

Transitional cell carcinoma

Answer 258

- smoking - increased age - aromatic amine exposure (dye and rubber industries) - pelvic irradiation - bladder stone (chronic inflammation)

Answer 259

Painless haematuria

Answer 260

Cystoscopy and biopsy.

Answer 261

- transurethral resection of bladder tumour - post-TURBT intravesical chemotherapy - radical cystectomy - intravesical BCG - chemotherapy / radiotherapy

Answer 262

Adenocarcinoma

Answer 263

- increasing age | - family history

Answer 264

- seminal vesicles - peri-prostatic tissue - bladder neck

Answer 265

- bone - liver - lungs

Answer 266

Gleason score

Answer 267

- LUTS - erectile dysfunction - lethargy, anorexia, weight loss - haematuria - asymmetric, firm, nodular prostate on DRE

Answer 268

Urinary marker of prostate cancer.

Answer 269

Prostate biopsy (guided by ultrasound / MRI).

Answer 270

- benign prostatic hyperplasia | - chronic prostatitis

Answer 271

- radical prostatectomy - radiotherapy - androgen deprivation therapy - brachytherapy (insertion of radioactive source into prostate)

Answer 272

- undescended testes - male infertility - family history

Answer 273

``` Usually painless lump on the testicle. - non-tender - hard - irregular - not fluctuant - no transillumination Gynaecomastia may be present. ```

Answer 274

Scrotal ultrasound

Answer 275

- teratoma | - yolk sac tumour

Answer 276

- seminoma | - choriocarcinoma

Answer 277

Royal Marsden

Answer 278

- radical orchidectomy - chemotherapy - radiotherapy

Answer 279

- infertility - hypogonadism - secondary cancers

Answer 280

Liquefies semen

Answer 281

LUTS - urinary frequency - urinary urgency - urine retention - hesistancy - terminal dribbling - weak flow - incomplete empyting

Answer 282

- DRE | - serum PSA (normal)

Answer 283

1. tamsulosin (alpha blocker). | 2. finasteride (5-alpha reductase inhibitor).

Answer 284

Abnormal enlargement of testicular veins within the pampiniform plexus.

Answer 285

'Bag of worms' appearance.

Answer 286

Doppler ultrasound

Answer 287

- usually conservative | - surgical intervention if symptomatic

Answer 288

Fluid in the tunica vaginalis causing scrotal swelling.

Answer 289

- soft - non-tender - transluminous

Answer 290

Conservative

Answer 291

Prehn's sign is positive in epididymitis, negative in testicular torsion.

Answer 292

Relief of pain on elevation of the affected testicle.

Answer 293

IM ceftriaxone and oral doxycycline.

Answer 294

Rotation of the testicle around the spermatic cord. Without intervention, leads to ischaemia and loss of the testis.

Answer 295

- sudden severe pain in scrotum and lower abdomen on affected side - swelling, redness, tenderness of testicle - upward retraction of testicle

Answer 296

Immediate surgical detorsion.

Answer 297

Epididymal cyst (lump on posterior aspect of testicle) - self-resolves.

Answer 298

- haematuria - oliguria - proteinuria (sub-nephrotic range) - hypertension (due to fluid overload)

Answer 299

- SLE - post streptococcal glomerulonephritis - small vessel vasculitis (granulomatosis with polyangiitis) - anti-GBM disease (Goodpasture's) - IgA nephropathy

Answer 300

Kidney biopsy

Answer 301

- treat underlying cause - blood pressure control (ACEi / ARB) - corticosteroids to reduce kidney damage

Answer 302

IgA nephropathy

Answer 303

Glomerulonephritis caused by IgA immune deposits in the mesangium.

Answer 304

IgA vasculitis

Answer 305

Asymptomatic with microscopic haematuria.

Answer 306

Glomerulonephritis occuring 1-3 weeks after a beta haemolytic strep infection (strep pyogenes). Presents with nephritic syndrome.

Answer 307

Immune complexes of streptococcal antigens, antibodies, and complement proteins get stuck in the glomeruli and cause inflammation.

Answer 308

Anti-streptolysin antibodies.

Answer 309

Thrombosis occurs in small vessels throughout the body, usually triggered by the shiga toxin.

Answer 310

- haemolytic anaemia - AKI - thrombocytopenia

Answer 311

- E. coli | - shigella

Answer 312

Shearing forces created by blood clots.

Answer 313

Impaired blood flow through the kidney, due to blood clots.

Answer 314

Symptoms manifest around 5 days after gastroenteritis (with bloody diarrhoea). - oliguria - haematuria - abdominal pain - confusion (uraemia) - bruising - pallor

Answer 315

- FBC (anaemia and thrombocytopenia) - peripheral blood smear (schistocytes) - serum creatinine (elevated) - stool culture on sorbitol MacConkey (E. coli O157 does not ferment sorbitol) - PCR for shiga toxin from stool samples

Answer 316

Supportive care: - anti-hypertensives - blood transfusions - haemodialysis

Answer 317

Anti-GBM disease - a rare small vessel vasculitis. Anti-GBM antibodies target type IV collagen in the kidneys and lungs, leading to life-threatening glomerulonephritis or pulmonary haemorrhage.

Answer 318

Inflammation of blood vessels.

Answer 319

- constitutional features (lethargy, anorexia, weight loss, myalgia / arthralgia) - renal manifestations (nephritic syndrome) - pulmonary manifestations: cough, dyspnoea, haemoptysis, pulmonary haemorrhage

Answer 320

- serum anti-GBM antibodies - renal biopsy (crescentic glomerulonephritis) - CXR / CT chest

Answer 321

- plasmapheresis - immunosuppression - steroids and cyclophosphamides - haemodialysis - supportive pulmonary measures (intubation and ventilation)

Answer 322

GN often occuring secondary to Goodpasture's syndrome.

Answer 323

Very acute illness with rapid deterioration in renal function. Presents with nephritic syndrome.

Answer 324

Renal biopsy shows crescentic glomerulonephritis.

Answer 325

- immunosuppression - plasmapheresis - haemodialysis - anti-hypertensives

Answer 326

- purpuric rash on legs - nephritic syndrome - joint pain (due to IgA deposition)

Answer 327

- corticosteroids | - ACE inhibitor / ARB for hypertension control

Answer 328

Problem with the glomerular filtration barrier, primarily involving the podocytes. This results in the classic triad of proteinuria, hypoalbuminaemia, and oedema.

Answer 329

> 3g per 24 hours.

Answer 330

- minimal change disease - focal segmental glomerulosclerosis - membranous nephropathy

Answer 331

- diabetes - drugs - autoimmune - neoplasia - infection

Answer 332

- oedema | - frothy urine (due to proteinuria)

Answer 333

- urinalysis - 24 hour urinary protein (> 3 g/day) - urine protein:creatinine ratio - renal biopsy - U&Es - lipid profile (hyperlipidaemia)

Answer 334

Loss of albumin increases cholesterol formation.

Answer 335

- fluid and salt restriction - loop diuretics (for oedema) - treat underlying cause - ACE inhibitor / ARB to reduce proteinuria - statin for hyperlipidaemia

Answer 336

Venous thromboembolism due to increased clotting factors.

Answer 337

Anticoagulation (e.g. LMWH)

Answer 338

Primary FSGS, or secondary to severe obesity or reflux nephropathy.

Answer 339

- circulating factor damages podocytes, leading to podocyte foot process effacement - this causes them to spread out and reduces the effectiveness of the filtration barrier

Answer 340

Primary - immunosuppression with steroids. Secondary - treat underlying cause. Blood pressure control (ACE inhibitor).

Answer 341

Glomerular basement membrane thickening in the absence of significant cellular proliferation, leading to nephrotic syndrome.

Answer 342

Can be primary or secondary to SLE, viral hepatitis, prostate cancer, NSAID use.

Answer 343

- autoimmune reaction against antigens in the filtration barrier, with autoantibody development and immune complex deposition - this leads to thickening of the glomerular basement membrane

Answer 344

Anti-phospholipase A2 receptor antibodies.

Answer 345

- serum anti-phospholipase A2 receptor antibodies | - renal biopsy

Answer 346

- blood pressure control (ACE inhibitor) - primary: immunosuppression - secondary: treat underlying cause

Answer 347

Most common cause of nephrotic syndrome in children.

Answer 348

Majority of cases are idiopathic, but drugs, infection, or malignancy may be causes.

Answer 349

Immune dysfunction leads to the production of a permeability factor that disrupts the filtration barrier. This leads to the fusion of podocyte foot processes.

Answer 350

Prednisolone

Answer 351

Focal segmental glomerulosclerosis.

Answer 352

Nephritic syndrome

Answer 353

- iliac and para-aortic lymph nodes - liver - lungs

Answer 354

Infection of any part of the urinary tract (kidney to urethra). Presents with characteristic symptoms and bacteriuria.

Answer 355

Pyelonephritis

Answer 356

Infection of the bladder / urethra.

Answer 357

Healthy, non-pregnant females.

Answer 358

- male - diabetes - infant < 3 months - catheters - pregnancy

Answer 359

- klebsiella pneumoniae - e. coli - enterococci - proteus mirabilis - staphylococcus saprophyticus

Answer 360

Proteus mirabilis

Answer 361

Klebsiella pneumoniae

Answer 362

Staphylococcus saprophyticus

Answer 363

- recent sexual intercourse - diabetes - history of UTIs - catheters

Answer 364

- longer urethra - anti-microbial properties of prostatic secretions - drier periurethral area

Answer 365

- dysuria (burning pain) - increased urinary frequency - urgency - incontinence

Answer 366

- nausea & vomiting - fever - flank pain and costovertebral angle tenderness - pyuria

Answer 367

- haemodynamic instability (tachycardia and hypotension) - tachypnoea - changes to mental status - reduced urine output - pyrexia

Answer 368

- midstream urine MC&S - urine dipstick - leucocytes and nitrites, haematuria - U&Es (renal function may be impaired) - ultrasound - may show obstruction

Answer 369

Females - 3 days | Males - 7-14 days

Answer 370

Trimethoprim / nitrofurantoin / cefalexin

Answer 371

Oral ciprofloxacin (14 days)

Answer 372

Piperacillin / tazobactam

Answer 373

IV co-amoxiclav

Answer 374

3 in: - oxygen - antibiotics - fluids 3 out: - serial lactates - blood cultures - urine output

Answer 375

Suprapubic tenderness / discomfort.

Answer 376

- very tender prostate on DRE - fever, chills, malaise - voiding symptoms (dysuria)

Answer 377

- urinalysis (haematuria, leucocytes) - midstream urine MC&S - blood cultures in febrile patients

Answer 378

Ciprofloxacin (14 days).

Answer 379

Chlamydia (caused by chlamydia trachomatis).

Answer 380

Gonorrhoea (caused by neisseria gonorrhoea).

Answer 381

Males - testicular pain, dysuria. | Females - vaginal discharge, dysuria.

Answer 382

Nucleic acid amplification testing.

Answer 383

- 1g single oral dose of azithromycin OR | - 7 day course of doxycycline BD

Answer 384

Males - dysuria, frequency, discharge. | Females - pelvic pain, dysuria, vaginal discharge.

Answer 385

- nucleic acid amplification testing | - swab of infected areas for microscopy and culture

Answer 386

Single dose of IM ceftriaxone.

Answer 387

Non-contrast CT-KUB

Answer 388

- vesico-ureteric junction - pelvic brim - pelvico-ureteric junction

Answer 389

Common genetic disorder characterised by the development of multiple renal cysts and progressive renal impairment.

Answer 390

PKD1 and PKD2

Answer 391

- ultrasound (multiple bilateral cysts) - LFTs - MR angiography for cerebral aneurysm screening - genetic testing - urine protein:creatinine ratio

Answer 392

- blood pressure control with ACE inhibitors - cyst decompression - nephrectomy - renal transplant if CKD - treat complications (infected cysts)

Answer 393

- polycystic liver disease - pancreatic cysts - cerebral aneurysms

Answer 394

- EPO secretion - acid-base balance - waste product excretion - activation of vitamin D - regulation of BP (RAA system) - fluid volume balance

Answer 395

Hyperkalaemia

Answer 396

Over 45 with unexplained visible haematuria with no UTI / haematuria persists after resolution of UTI.

Answer 397

You can palpate above a true mass.

Answer 398

- diabetes mellitus - hypertension - pelvic fracture - prostatectomy - liver disease - renal failure

Answer 399

Inflammatory bowel disease involving the full thickness of the intestinal wall. Affects discrete parts of the GI tract, leaving normal areas in between ('skip lesions').

Answer 400

Not auto-immune, but immune-mediate. Caused by environmental trigger in genetically susceptible individuals.

Answer 401

- family history - genetics (NOD2 mutation) - smoking - infectious gastroenteritis

Answer 402

- diarrhoea (may be bloody) - right lower quadrant pain (terminal ileum) - fatigue, malaise, weight loss, anorexia - aphthmous mouth ulcers - joint pains - inflammatory eye disease

Answer 403

Colonoscopy - take multiple samples for biopsy.

Answer 404

- colonscopy and biopsy - upper GI endoscopy (if upper GI symptoms) - FBC (anaemia) - faecal calprotectin

Answer 405

- ulcerative colitis - pseudomembranous colitis - diverticulitis - coeliac disease - IBS

Answer 406

- corticosteroids / immunosuppressants (azathioprine) / anti-TNF agents - surgery for fissures and strictures - bowel resection - stop smoking - vitamin & mineral supplements

Answer 407

- intestinal strictures - GI haemorrhage - osteoporosis - GI dilatation and perforation - anaemia - bowel cancer

Answer 408

Chronic inflammatory disease of the GI tract. Characterised by diffuse, continuous inflammation of the large bowel, limited to the mucosa. Affects the rectum with a variable length of colon involved proximally.

Answer 409

- proctitis - proctosigmoiditis - left-sided colitis - pancolitis

Answer 410

Immune mediated disease, possibly initiated by inflammation in response to colonic bacteria. Occurs in genetically susceptible people in response to environmental triggers.

Answer 411

- family history - non-smoker - NSAIDs

Answer 412

- crypt abscesses filled with granulocytes - continuous inflammation involving the intestinal mucosa - goblet cell depletion

Answer 413

- persistent diarrhoea (may contain blood / mucus) - abdominal pain (usually left lower quadrant) - increased frequency of defecation - faecal urgency / incontinence - tenesmus - fatigue, malaise, anorexia, weight loss - pallor - aphthous mouth ulcers - eye / joint / skin involvement

Answer 414

Persistent painful urge to pass stool even when the rectum is empty.

Answer 415

- arthritis - erythema nodosum - uveitis - primary sclerosing cholangitis

Answer 416

Colonoscopy (or flexible sigmoidoscopy) with biopsy.

Answer 417

- colonoscopy with biopsy - stool microscopy & culture (negative) - FBC (anaemia) - faceal calprotectin

Answer 418

AXR - exclude toxic megacolon, bowel obstruction, perforation.

Answer 419

- Crohn's disease - pseudomembranous colitis - diverticulosis - coeliac disease - IBS

Answer 420

Aminosalicylates (mesalazine). | Second line - add corticosteroid.

Answer 421

- systemic corticosteroids - methotrexate - anti-TNF agent

Answer 422

- if pharmacological management of moderate / severe UC is ineffective - acute severe UC if IV corticosteroids are ineffective - acute severe UC with toxic megacolon / bowel perforation

Answer 423

- toxic megacolon - bowel obstruction - bowel perforation - anaemia - fistulas & strictures - colorectal cancer - PSC

Answer 424

Chronic functional bowel disorder characterised by abdominal pain and altered bowel habits.

Answer 425

Disorder not associated with structural or biochemical abnormalities. Symptoms are thought to be the result of dysregulation between the gut and the brain.

Answer 426

- female - young - stressful life events - anxiety / depression

Answer 427

- abdominal pain - diarrhoea (not nocturnal) - tenesmus - constipation - bloating & distention - nausea

Answer 428

Rome IV: recurrent abdominal pain occurring on average at least one day per week over the last 3 months (6 months since symptom onset). - pain related to defecation - associated with a change in stool frequency / form

Answer 429

Investigations for exclusion: - faecal calprotectin - FBC - CRP - coeliac serology - endoscopy

Answer 430

- Crohn's disease - ulcerative colitis - colorectal cancer - coeliac disease

Answer 431

- dietary changes (low FODMAP diet, avoid lactose / gluten, avoid excaerbating foods) - laxatives / loperamide - CBT - tricyclic antidepressants

Answer 432

Functional GI disorder, characterised by: - bothersome post-prandial fullness - bothersome early satiation - bothersome epigastric pain / burning

Answer 433

After failure of PPI trial - tricyclic antidepressant / psychotherapy.

Answer 434

Systemic autoimmune disease condition triggered by dietary gluten peptides, causing inflammation and damage to the small intestine.

Answer 435

- HLA-DQ2 | - HLA-DQ8

Answer 436

- gliadin enters the lamina propria, where it is deaminated by tissue transglutaminase - deaminated gliadin is more immunogenic, and it binds to antigen-presenting immune cells - T helper cells are activated and secrete pro-inflammatory cytokines, and activate B cells - B cells produce auto-antibodies (anti-tTG and anti-endomysial) - immune system activation leads to chronic inflammation and damage, resulting in intra-epithelial lymphocyte activation, villous atrophy, and crypt hyperplasia

Answer 437

- weight loss - fatigue - loose stools - steatorrhoea - mouth ulcers & angular stomatitis - anaemia - dermatitis herpetiformis

Answer 438

Blistering, itchy rash on extensor surfaces.

Answer 439

Small bowel endoscopy with biopsy (multiple samples from both the duodenal bulb and distal duodenum).

Answer 440

- intra-epithelial lymphocytes - villous atrophy - crypt hyperplasia

Answer 441

- elevated IgA-tTG - anti-endomysial antibodies - skin biopsy shows granular IgA deposits in dermatitis herpetiformis - FBC (anaemia) - HLA typing

Answer 442

- gluten-free diet | - steroids & immunomodulatory drugs if refractory coeliac disease

Answer 443

Dapsone (oral sulphonamide antibiotic) and topical steroid cream.

Answer 444

Reflux of stomach contents into the oesophagus, characterised by symptoms of heartburn and acid regurgitation.

Answer 445

- high BMI - smoking - pregnancy - hiatus hernia

Answer 446

Inappropriate relaxation of the lower oesophageal sphincter, allowing stomach contents to wash back into the oesophagus. Acidity of stomach contents results in damage to the oesophageal epithelium over time.

Answer 447

- heartburn - regurgitation - dyspepsia - cough - hoarse voice - dysphagia - nausea and vomiting

Answer 448

- pH monitoring via nasal tube | - gastroscopy (may be normal or show oesophagitis, Barrett's oesophagus)

Answer 449

- PPIs - histamine receptor antagonists - antacids

Answer 450

Inhibit H+/K+ ATPase in parietal cells, preventing gastric acid production.

Answer 451

Ranitidine

Answer 452

Inflammation caused by reflux of stomach contents into the oesophagus, resulting in ulcer formation, bleeding, and peptic strictures.

Answer 453

Metaplasia in the cells of the lower portion of the oesophagus - stratified squamous epithelium replaced by simple columnar epithelium with goblet cells.

Answer 454

Oesophageal adenocarcinoma

Answer 455

- GORD - smoking - obesity - male - older age - hiatus hernia

Answer 456

Endoscopy with tissue biopsy.

Answer 457

- PPIs - stop NSAIDs - weight loss - reduce alcohol intake - smoking cessation - Nissen fundoplication - regular endoscopies to monitor progression

Answer 458

Fundus of stomach is wrapped and stapled around the lower oesophagus - used to treat GORD / Barrett's oesophagus.

Answer 459

- squamous cell carcinoma | - adenocarcinoma

Answer 460

Adenocarcinoma

Answer 461

- older age - radiotherapy - smoking - obesity - Barrett's oesophagus - GORD

Answer 462

Middle third of the oesophagus.

Answer 463

Distal third of the oesophagus.

Answer 464

- weight loss - dysphagia - persistent indigestion / heartburn - retrosternal pain - food regurgitation - persistent cough - hoarse voice - haematemesis - dark stool

Answer 465

- endoscopy and biopsy - CT - PET-CT

Answer 466

- chemotherapy - radiotherapy - endoscopic mucosal resection - oesophagectomy - oesophageal stent

Answer 467

Adenocarcinoma

Answer 468

Intestinal (also has better prognosis than diffuse).

Answer 469

Distal - antrum / pylorus. | Proximal - cardia.

Answer 470

Distal (proximal more likely in countries with low incidence).

Answer 471

- smoking - high salt intake - low fruit and vegetable intake - H. pylori infection - EBV - family history

Answer 472

Causes inflammation, and secretes CagA into host cells (oncogenic protein).

Answer 473

- anorexia, lethargy, weight loss, malaise - dyspepsia - nausea and vomiting - haematemesis - melaena - early satiety and post-prandial fullness (due to obstruction) - lymphadenopathy (Virchow node) - Sister Mary Joseph nodule

Answer 474

- acanthosis nigricans (skin hyperpigmentation) - dermatomyositis - erythma gyratum repens (ring-shaped appearance, involves limbs and trunk)

Answer 475

Gastroscopy and biopsy.

Answer 476

- liver - lung - peritoneum - bone

Answer 477

- resection (endoscopic submucosal dissection / gastrectomy) - chemotherapy (adjunct or primary treatment for non-operable cancer) - trastuzumab

Answer 478

Trastuzumab (herceptin)

Answer 479

- family history - familial adenomatous polyposis - hereditary nonpolyposis colorectal cancer - IBD - increased age - diet (low fibre, high red / processed meat intake) - obesity - smoking & alcohol - sedentary lifestyle

Answer 480

- familial adenomatous polyposis | - hereditary nonpolyposis colorectal cancer

Answer 481

- autosomal dominant - malfunctioning of tumour suppressor genes results in development of adenomas along the colon - adenomas have the potential to become cancerous

Answer 482

- autosomal dominant - increases risk of a number of cancers - does not cause adenomas, tumours develop in isolation

Answer 483

- change in bowel habit (diarrhoea) - unexplained weight loss - rectal bleeding - unexplained abdominal pain - IDA - abdominal / rectal mass

Answer 484

Bowel obstruction - vomiting, abdominal pain, absolute constipation.

Answer 485

FIT tests (faecal immunochemical tests).

Answer 486

Human Hb in stool (to detect bleeding).

Answer 487

- colonoscopy and biopsy - CT colonography - CT chest, abdomen, pelvis - serum CEA (carcinoembryonic antigen)

Answer 488

Colonoscopy and biopsy.

Answer 489

CEA (carcinoembryonic antigen).

Answer 490

- surgical resection (with end-to-end anastomosis or stoma) - chemotherapy - radiotherapy

Answer 491

- nerve damage - bladder / ureter / bowel damage - post-operative ileus - failure of anastomosis - incisional hernia - intra-abdominal adhesions

Answer 492

Proctosigmoidectomy with creation of Hartmann's pouch (sealed remnant of rectum). Remaining colon is redirected to a colostomy. May be reversed later/

Answer 493

The development of gastric and duodenal ulcers - characterised by dyspepsia, abdominal discomfort, and nausea.

Answer 494

Erosion - superficial or partial break within the epithelium or mucosal surface. Ulcer - deep break through the full thickness of the epithelium or mucosal surface.

Answer 495

- H. pylori (95% duodenal ulcers, 70-80% gastric ulcers). - drugs (NSAIDs, corticosteroids) - alcohol - Zollinger-Ellison syndrome - malignancy

Answer 496

Hyper-secreting gastrinoma in the pancreas leads to hypergastrinaemia. This leads to peptic ulcer development.

Answer 497

- inhibition of COX-1 enzymes | - COX-1 enzymes have a protective effect on the gastric mucosa

Answer 498

Gram negative, spiral-shaped bacterium with flagella.

Answer 499

- urease (converts urea into water and ammonia) buffers gastric acid and raises pH - H. pylori bind strongly to the gastric epithelium and secrete effector molecules into host cells via their type IV secretion system (CagA and VacA - disrupt tight junctions and induce apoptosis)

Answer 500

- epigastric pain - dyspepsia - heartburn - distention and bloating - upper GI bleed (haematemesis, melaena)

Answer 501

- upper GI haemorrhage - perforation - gastric outlet obstruction

Answer 502

- acute severe abdominal pain and tenderness - abdominal guarding - features of shock

Answer 503

- nausea & vomiting - upper abdominal pain and tenderness - early satiety - distention - succussion splash

Answer 504

Upper GI endoscopy and biopsy

Answer 505

- upper GI endoscopy and biopsy - FBC (anaemia) - ECG (exclude cardiac pathology) - H. pylori testing

Answer 506

- urea breath test - serum IgG against H. pylori - stool antigen test - histology & culture from biopsy

Answer 507

4-8 weeks PPI treatment.

Answer 508

Eradication therapy - 7 day course: - PPI - amoxicillin - clarithromycin / metronidazole

Answer 509

- faecolith (hard collection of stool) - lymphoid hyperplasia - fibrous stricture - carcinoid tumour

Answer 510

- obstruction of lumen causes stasis and bacterial overgrowth - increase in intra-luminal pressure causes peri-umbilical pain - increased pressure causes venous and lymphatic congestion, and eventually compromises arterial blood supply to the appendix - results in gangrene, perforation and generalised peritonitis

Answer 511

Pain in the right iliac fossa on palpation of the left. Indicates appendicitis.

Answer 512

- pregnancy test - abdominal ultrasound - contrast-enhanced abdominal CT / abdominal MRI in pregnant women

Answer 513

- intussusception - peptic ulcer disease - ectopic pregnancy - ovarian torsion - cholecystitis

Answer 514

- pre-operative antibiotics (co-amoxiclav) - laparoscopic appendicectomy - temporary drain insertion in some cases

Answer 515

Gives the risk of adverse outcomes following upper GI bleeding.

Answer 516

Oesophageal motility disorder characterised by oesophageal aperistalsis and insufficient lower oesophageal sphincter relaxation in response to swallowing.

Answer 517

- Rovsing - psoas - obturator

Answer 518

- muscle weakness (abdominal wall surgery) - older age - pregnancy - increased intra-abdominal pressure (cough, constipation, weight lifting)

Answer 519

Reducible - watch and wait. | Non-reducible - surgery.

Answer 520

- bowel obstruction | - strangulation hernia (compression of blood supply)

Answer 521

Sliding - stomach moves upwards and slides over the oesophagus. Paraoesophageal - stomach moves upwards alongside the oesophagus.

Answer 522

Barium swallow.

Answer 523

Direct - via defect in the posterior wall of the inguinal canal. Indirect - via inguinal ring.

Answer 524

Small tear in the skin of the distal anal canal, caused by passage of hard stool.

Answer 525

- severe pain during defecation - bright red blood - constipation - may be itchy

Answer 526

- stool softeners - leave to heal - sphincterectomy is gold standard

Answer 527

Infection in anal gland.

Answer 528

- immunosuppression - IBD - diabetes

Answer 529

- fever and chills - constant anal pain - pus in stool

Answer 530

Surgical removal and drainage.

Answer 531

- visible fistula - blood - pus

Answer 532

- drain infection | - surgical repair

Answer 533

Bulging veins in anus.

Answer 534

- constipation | - increased abdominal pressure

Answer 535

Endoscopy - DRE not helpful.

Answer 536

- bulging pain in anus - feeling of incomplete emptying - itchy - bleeding

Answer 537

Gold standard is rubber band ligation. Also stool softeners.

Answer 538

- watery diarrhoea - fever - dehydration

Answer 539

Stool sample MC&S

Answer 540

Congenital outpouching of all three layers of the small bowel, highly vascular so causes bleeding.

Answer 541

Pharyngeal pouch

Answer 542

- dysphagia - halitosis - regurgitation of undigested food - hoarseness - chronic cough

Answer 543

Small bowel

Answer 544

Haematemesis from tear in the oesophageal mucosa.

Answer 545

- bulimia - alcoholism - hyperemesis gravidarum - chronic cough - gastroenteritis

Answer 546

- terlipressin - banding / clipping - thermocoagulation

Answer 547

- Rockall score - ECG - endoscopy

Answer 548

Oesophageal rupture. | Characterised by vomiting, chest pain and subcutaneous emphysema.

Answer 549

Vomiting, chest pain, subcutaneous emphysema - oesophageal rupture.

Answer 550

Inflammation of the stomach mucosa.

Answer 551

- autoimmune - H. pylori - bile reflux - NSAIDs - stress

Answer 552

- epigastric pain - nausea and vomiting - dyspepsia

Answer 553

- H. pylori testing | - endoscopy and biopsy

Answer 554

- treat underlying cause | - H. pylori eradication

Answer 555

Incomplete obliteration of the vitelline duct.

Answer 556

- intussusception - volvulus - hernia

Answer 557

- 2 years old - 2 ft from ileocaecal valve - 2 inches long - 2% of the population

Answer 558

Sigmoid colon (smallest luminal diameter and highest pressure).

Answer 559

- LIF pain and tenderness - LIF mass - constipation - tachycardia - fever - nausea

Answer 560

Bloods - raised WCC, ESR & CRP. | Imaging - CXR, AXR, CT

Answer 561

- pneumoperitoneum - dilated bowel loops - obstruction - abscess

Answer 562

- bacterial infection of ascitic fluid - bowel perforation - pelvic inflammatory disease - peritoneal dialysis infection - gall bladder perforation - appendicitis

Answer 563

- antibiotics (oral / IV ciprofloxacin or metronidazole) - analgesia - liquid diet - surgical resection in rare cases

Answer 564

Poorly differentiated, signet ring cells.

Answer 565

Upper abdominal mass AND - dysphagia (any age) - over 55 with weight loss and upper abdominal pain / reflux / dyspepsia

Answer 566

1. rectum 2. sigmoid colon 3. descending colon

Answer 567

Cancer confined to the submucosa.

Answer 568

Invasion through muscularis without lymph node involvement.

Answer 569

Invasion through muscularis with lymph node involvement.

Answer 570

Distant metastasis

Answer 571

- surgical adhesions - tumour - strangulated hernia - volvulus - intussusception - inflammatory strictures - gallstone ileus

Answer 572

- volvulus (sigmoid) - tumour - diverticular disease - strictures

Answer 573

- abdominal pain - nausea and vomiting (early in SBO, late in LBO) - constipation (early in LBO, late in SBO) - distention - tinkling bowel sounds / absent bowel sounds - resonant percussion

Answer 574

- decompression with NG tube aspiration - IV fluids - antibiotics

Answer 575

- endoscopic decompression of volvulus | - bowel resection (with anastomosis or stoma formation)

Answer 576

False - acquired diverticula only involve outpouching of the mucosa and submucosa, not all three layers. True diverticula are congenital.

Answer 577

- colonoscopy | - barium enema

Answer 578

- splenic flexure | - rectosigmoid junction

Answer 579

Acute - embolus, low perfusion (heart failure), thrombus. | Chronic - atherosclerosis.

Answer 580

- abdominal pain disproportionate to examination findings (widespread as ischaemia progresses) - nausea & vomiting - diarrhoea - rectal bleeding - abdominal distention (later in presentation)

Answer 581

- atherosclerosis - age - smoking - AF - hypercoagulability - chronic organ failure

Answer 582

- FBC (leucocytosis) - ABG (elevated lactate) - CT with IV contrast (oedematous bowel, progressing to pneumatosis) - CT angiography

Answer 583

Supportive care - IV fluids, oxygen, analgesia, antibiotics, blood transfusion. Interventions - endovascular thrombectomy, exploratory laparascopy, bypass, excision of necrotic bowel. Treat underlying cause of low perfusion.

Answer 584

- bowel necrosis | - bowel perforation

Answer 585

Reticulo-endothelial dysfunction.