PASSMED REVIEW KEY CONCEPTS Flashcards
How can you monitor/look for a carcinoid tumour?
Urinary 5-HIAA (as carcinoid tumours release serotonin)
What surgery is done for a distal transverse or descending colon cancer?
Left hemicolectomy
why do PPIs cause hyponatremia?
As they can cause medication-induced syndrome of inappropriate anti diuretic hormone secretion
What conditions is oesophageal adenocarcinoma associated with?
GORD
Barrett’s oesophagus
If a pt takes once-daily insulin, how should this be altered on the day before and day of surgery?
Reduce dose by 20%
Why does large-volume paracentestsis for the treatment of ascites required albumin cover?
As it reduces paracentesis-induced circulatory dysfunction and mortality
How is an unruptured sigmoid volvulus primarily managed?
Flatus tube insertion (inserting a tube into the rectum to relieve flatulance)
Which area of the colon is the most likely area to be affected by ischaemic colitis?
Splenic flexure
Whats the most common cause of melanosis coli?
Prolonged laxative use
How should you treat a severe flare of UC?
In hopsital with IV corticosteroids
What is mild UC?
< 4 stools/day, only a small amount of blood
What is moderate UC?
4-6 stools/day, varying amounts of blood, no systemic upset
What is severe UC?
> 6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
How do you induce remission in mild/moderate UC/
Typical aminosalicylates
If remission is not achieved within 4 weeks, add a high-dose oral aminosalicylates
(If extensive disease then start with topical aminosalicylate and a high-dose oral aminosalicylate:)
How do you induce remission in severe colitis?
should be treated in hospital
intravenous steroids are usually given first-line
If after 72 hours there is no improvement, consider adding IV Ciclosporin to IV corticosteroids
OR consider surgery
How do you maintain remission of mild/moderate UC/
Topical aminosalicylates along or/with an oral aminosalicylate
How should you maintain remission of UC following a severe relapse or 2 or more exacerbations in th past year?
oral azathioprine or oral mercaptopurine
What features of appendicitis are included in the Alvarado score?
Right lower quadrant tenderness
Elevated temperature
Rebound tenderness
Migration of pain to right lower quadrant
Anorexia
Nausea or vomiting
Leukocytosis
Leukocyte left shift >75% neutrophils
If a patient is taking a PPI or H2 receptor blocker, what advice should be given prior to an endoscopy?
To stop taking it at least 2 weeks before to ensure it doesnt mask serious underlying pathology
What type of bacteria is c.diff?
Gram positive rod
What causes c.diff?
Leading cause is now second and third generation cephalosporins
Clindamycin
PPIs
How is c.diff categories into mild, moderate, severe and life threatening?
Mild - normal WCC
Moderate. Raised WCC and 3-5 loose stools a day
Severe - raised WCC over 15x10 9, or an acutely raised creatinine >50% above baseline, or a temperature >38.5, or evidence of severe colitis
Life threatening - hypotension, partial or complete ileus, toxic megacolon, CT evidence of severe disease
How is c.diff diagnosed?
C.diff toxin positive test
(Not that c.diff antigen shows exposure to bacteria and not current infection)
Outline the pathophysiology of c.diff?
A bacteria that’s often encountered in hospital. When normal gut flora are suppressed by broad spectrum antibiotics -> exotoxin causes intestinal damage -> pseudomembranous colitis
How often is c.diff found in the digestive system?
1 in 30 adults
Outline treating the first episode of c.diff?
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
How often does a pt with c.diff have a recurrent episode?
20%
50% if after their second epdiese
How should you manage a recurrent episode of c.diff?
If within 12 weeks of symptoms resolution then oral fidaxomicin
If after 12 weeks then oral vancomycin or fidaxomicin
How should you manage life threatening c.diff infections?
oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered
What medications should be stopped during a c.diff infection?
Anti-motility and anti-peristaltic drugs e.g. opioids - Can predispose to toxic megacolon by slowing the clearance of c.diff
Antibiotics (other than ones using to clear c.diff) - to allow normal intestine flora to be re-established
How do you manage alcoholic ketoacidosis?
Infusion of saline and thiamine
How much does your risk of oesophageal adenocarcinoma increase by if you have Barrett’s oesophagus?
50-100 fold
Whats the subdivision of Barrett’s oesophagus?
Short <3cm
Long >3cm
The length of the affected segment correlates strongly with the chances of identifying metaplasia.
What should you do if on endoscopy for Barrett’s oesophagus, dysplasia of any grade is identified?
Endoscopic intervention - radio frequency ablation or endoscopic mucosal resection
What should you do if on endoscopy for Barrett’s oesophagus, metaplasia is identified?
Endoscopy is recommended every 3-5 years
Whats the risk of each cancer with lynch syndrome (HNPCC)?
80% colorectal cancer
60% endometrial cancer
10% Ovarian cancer
