passmed Flashcards
misoprostol does what to msucosa
prevents damage as stabalises mast cells
in zoling - recurrent ulcers what can you not give
nsaid , steriods, bisphosphonates
laxative abuse leads to what
melancoliss coli - cell necrosis and apop
tx of ith and lft
itch - cholestryamine and uacid for lft
signs of Acute intermittent porphyria
classically urine turns deep red on standing
raised urinary porphobilinogen (elevated between attacks and to a greater extent during acute attacks)
assay of red cells for porphobilinogen deaminase
raised serum levels of delta aminolaevulinic acid and porphobilinogen
what is gallstone ileus
This patient has patient has a small bowel obstruction and pneumobilia. This is a typical picture for gallstone ileus. He also gives a history that reflects chronic cholecystitis. In gallstone ileus, a gallstone enters the small intestine where it lodges in the ileocaecal valve. It is usually on a background of chronic cholecystitis. A rarer condition is Bouveret’s syndrome which is similar but the gallstone lodges in the duodenum.
gallstone ileus usually forms on background of what
chornic cholecystitis
why do you give oral vanc over IV
Oral vancomycin has low systemic absorption, making it effective at managing intestinal infections
ascites, low urine output, and a significant increase in serum creatinine - hepaotrenal syndroem what si first line
terlipressin, a vasopressin analogue, is the recommended first-line treatment for HRS according to UK guidelines. It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.
how does terlipressin work
terlipressin, a vasopressin analogue works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.
In order to see the typical villous atrophy on OJD biopsy, the inflammation must be ongoing and therefore the patient must have been consuming gluten for at least - how long?
6 weeks
before upper GI endoscopy how long should omeprazole be stopped before and why
Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy
Proton pump inhibitors (PPIs) such as omeprazole can reduce the size of ulcerative gastro-oesophageal malignancy, which can make them unidentifiable during endoscopic examination
A long history of watery green diarrhoea post cholecystectomy is caused
by bile-acid malabsorption, a condition which can also be idiopathic, or seen in patient’s with Crohn’s disease
The initial treatment of bile acid malabsorption is with
bile acid sequestrants such as cholestyramine
bile acid malabsoprtion can lead to
It can lead to steatorrhoea and vitamin A, D, E, K malabsorption.
in chronic liver disease suspecting a dx of liver cirrhosis what is the most sensitive lab finding
thrombocytopenia
Patients with cirrhosis often develop a rise of >2.5 in the ratio of the AST to ALT,
triad of plummer vision syndrome
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
adenocaricnoma fo o cause
GORD and barrets
Metabolic ketoacidosis with normal or low glucose:
think alochol
how do you treat alcohol ketoacidosis
infusion of saline & thiamine.
Carcinoid syndrome
usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
diarrhoea , n and vomit , flushing , resp sx and wheezing
tx
ocretotide
wilsons disease findings
ALT raised; urinary copper raised; serum caeruloplasmin reduced
Caeruloplasmin is a protein in the blood that carries copper and helps metabolize iron
A 50-year-old man has 9 months of fatigue, dyspepsia, and anorexia. He also has vague upper abdominal pain and last week, noticed numbness and tingling in both feet. The pain does not change with eating and he has lost weight.
He appears pale. Vibration and proprioception are impaired in both lower limbs, and he has an enlarged left supraclavicular node.
diagnostic test of chocie with gastric cancer
endoscopy and biopsy
what single lab test indicates liver cirrhosis
Thrombocytopenia (platelet count <150,000 mm^3) is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
investigation of choice for perianal fistula
MRI pelvis
gluten tests how long should you be eating it for
Patients must eat gluten for at least 6 weeks before they are tested
o cancer features
dysphagia: the most common presenting symptom
anorexia and weight loss
vomiting
other possible features include: odynophagia(painful swallowing), hoarseness, melaena, cough
need endoscopy
what medications shoudl you stop in c diff infections
Opioids should be stopped in C. difficile infections
During a Clostridium difficile infection, medications which are anti-motility and anti-peristaltic should be held. Anti-peristaltic drugs such as opioids can predispose to toxic megacolon by slowing the clearance of the Clostridium difficile toxin. If possible, antibiotics should also be held to allow normal intestine flora to be re-established, though the antibiotics used to treat the Clostridium difficile should be continued.
Patients with Crohn’s who develop a perianal abscess require incision and drainage
true
A nurse undergoes primary immunisation against hepatitis B. Levels of which one of the following should be checked four months later to ensure an adequate response to immunisation?
Anti-HBs
dypepsia tx if no alarm features
Review medications for possible causes of dyspepsia
2. Lifestyle advice
3. Trial of full-dose proton pump inhibitor for one month OR a ‘test and treat’ approach for H. pylori
if symptoms persist after either of the above approaches then the alternative approach should be tried
