Monday 16th Flashcards
pneumoperitoneum
an abnormal finding suggestive of a perforated abdominal viscus (e.g. a perforated duodenal ulcer)
Rigler’s sign
double wall sign
AXR: intestinal perforation
- numerous loops of small bowel outlined by gas both within the lumen and free within the peritoneal cavity
- Ascites is also seen, with mottled gas densities over bilateral paracolic gutters
- serosal surface should not be visible as it is normally in contact with other intra-abdominal content of similar density (other loops of bowel, omentum, fluid)
- gas abuts the serosal surface rendering it visible
- Film obtained supine = absence of air-fluid levels, ascites pools in the paracolic gutters, with fluid mixed in with gas bubbles
Molluscum contagiosum
- common skin infection
- Viral
- Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels
- majority of cases occur in children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years
- characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter
- Lesions appear in clusters in areas anywhere on the body (except palms and soles)
- Children: lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur
- Adults: sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen
- Rarely, lesions can occur on the oral mucosa and on the eyelids
- Self-limiting. Spontaneous resolution usually occurs within 18 months
- Treatment is not usually recommended
- use simple trauma or cryotherapy
→ Itching = emollient + mild topical corticosteroid (e.g. hydrocortisone 1%)
→ infected (e.g. oedema, crusting) = topical antibiotic (e.g. fusidic acid 2%)
Patients with an uncertain tetanus vaccination history
- booster vaccine + immunoglobulin
- unless the wound is very minor and < 6 hours old
Bishop’s score
used to predict whether induction of labor will be required.
- A score of 5 or less suggests that labour is unlikely to start without induction
- vaginal PGE2 for cervical ripening and labour induction
Induction of labour
Indications:
- prolonged pregnancy, e.g. > 12 days after estimated date of delivery
- prelabour premature rupture of the membranes, where labour does not start
- diabetic mother > 38 weeks
- rhesus incompatibility
Method:
- membrane sweep
- intravaginal prostaglandins
- breaking of waters
- oxytocin
First cervical smear is inadequate
smear should be repeated within 3 months.
Negative hrHPV: test of cure (TOC) pathway
Individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
Positive hrHPV
- samples are examined cytologically
- if the cytology is abnormal → colposcopy
Positive hrHPV: Abnormal cytology
- borderline changes in squamous or endocervical cells
- low-grade dyskaryosis
- high-grade dyskaryosis (moderate)
- high-grade dyskaryosis (severe)
- invasive squamous cell carcinoma
- glandular neoplasia
Positive hrHPV: Normal cytology
test is repeated at 12 months
Cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months
- if the repeat test is now hrHPV -ve → return to normal recall
- if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
- If hrHPV -ve at 24 months → return to normal recall
- if hrHPV +ve at 24 months → colposcopy
If the sample is ‘inadequate’
- repeat the sample within 3 months
- if two consecutive inadequate samples then → colposcopy
Bell’s palsy
- acute, unilateral, idiopathic, facial nerve paralysis
- aetiology is unknown, ?HSV
- peak incidence is 20-40 years and the condition is more common in pregnant women
- lower motor neuron facial nerve palsy - forehead affected*
- post-auricular pain (may precede paralysis)
- altered taste
- dry eyes
- hyperacusis
- no treatment
- prednisolone only
- combination of aciclovir and prednisolone
- Now recommended that prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell’s palsy
- Eye care: prescription of artificial tears and eye lubricants
Prognosis: if untreated around 15% of patients have permanent moderate to severe weakness
Benign ethnic neutropaenia
Common in people of black African and Afro-Caribbean ethnicity
-
Neutropaenia
< 1.5 * 109
- predisposes to severe infection
Neutropaenia: Causes
- Viral: HIV, EBV, hepatitis
- Drugs: cytotoxics, carbimazole, clozapine
- benign ethnic neutropaenia
- haematological malignancy: myelodysplastic malignancies, aplastic anaemia
- rheumatological conditions
- SLE: mechanisms include circulating antineutrophil antibodies
- Rheumatoid arthritis: e.g. hypersplenism as in Felty’s syndrome
- severe sepsis
- haemodialysis
Post op complications: Right-hemicolectomy + ileostomy
- patients may develop significant volume depletion, electrolyte and acid-base disturbances (metabolic acidosis) if the ileostomy output increases or if dietary intake is disrupted or altered
- Hence, it is important to monitor fluid balance including stoma output in these patients.
Cancer: Caecal, ascending or proximal transverse colon
Right hemicolectomy
Ileo-colic
Cancer: Distal transverse, descending colon
Left hemicolectomy
Colo-colon
Cancer: Sigmoid colon
High anterior resection
Colo-rectal
Cancer: Upper rectum
Anterior resection (TME)
Colo-rectal
Cancer: Low rectum
Anterior resection (Low TME)
Colo-rectal (+/- Defunctioning stoma)
Anal verge
Abdomino-perineal excision of rectum
No Anastomosis
Hartmans procedure
When resection of the sigmoid colon is performed and an end colostomy is fashioned
Excessive administration of sodium chloride
cause of hyperchloraemic acidosis
- therefore Hartmans solution may be preferred where large volumes of fluid are to be administered
