Passmed yr5 first Flashcards
what is nissen fundoplication and when is it used
used for chronic gastro-oesophageal reflux disease. This procedure tightens the lower oesophageal sphincter to reduce reflux of acid back out of the stomach.
low serum copper and reduced serum caeruloplasmin - what is this
Ceruloplasmin is a protein that carries copper to the parts of your body that
features of wilsons disease
liver - hepatitis and cirrhosis
neuroloigcal - basal ganglia degeneration
speech and psych problems
asterixis , chorea, dementia and parkinsonism
green brown rings of iris
blue nails
hemolysis
renal tubular acidosis - fanconi
diagnosis of wilsons disease conirmed by what
the diagnosis is confirmed by genetic analysis of the ATP7B gene
what can help oesophageal spasm
CCB
vomiting and aspiration prodcue what kind of abg picture
metabolic alkalosis and low chlorine
things like peptic ulcer leading to pyloric or nasogastric tube suction
drug cause of metabolic alk
diuretics
mech of met alk
activation of renin-angiotensin II-aldosterone (RAA) system is a key factor
aldosterone causes reabsorption of Na+ in exchange for H+ in the DCT
ECF depletion (vomiting, diuretics) → Na+ and Cl- loss → activation of RAA system → raised aldosterone levels
in hypokalaemia, K+ shift from cells → ECF, alkalosis is caused by shift of H+ into cells to maintain neutrality
1st line mx of NAFLD
weight loss
1st line for achalasia
pneumatic balloon dilation
6 red flags for gastic CA
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain
apple core sign
o ca
dyspepsia over dysphagia think
barrets
plummer vinson triad and oesophageal featires
Plummer-Vinson syndrome presents as a triad of iron deficiency anaemia, atrophic glossitis and oesophageal webs or strictures. Oesophageal webs are mostly located in the upper oesophagus and consist of multiple concentric narrowings. In contrast, this patient’s barium swallow shows one moderate-large narrowing of the lower oesophagus, making oesophageal webs unlikely
severe flare of UC
IV steriods
UC mx summary for inducing remission
start with topical aminosalicylae
no remission in 4w add oral one
then add oral steriod
maintaining mild UC - proctitis and proctosigmoiditis
topical /oralaminosalicylate daily
maintaining left sided and extensive UC
oral amino
if severe relapse or over 2 exacerbations in one year what do you give
oral azathioprine or oral mercaptopurine
probiotics can prevent relapse
severe diarrhoea will show what electrolyte inbalances and abg reading
Severe diarrhoea, particularly in elderly patients may results in renal impairment, hypokalaemia and hyponatraemia
metabolic acidosis
significant loss of bicarbonate and potassium through the gastrointestinal tract,
Which of the following is the most appropriate for post-eradication therapy h-pylori testing?
Urea breath test
first line hepatic encephalopathy
oral lactulose
how does lactulose work in HE
lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
retrosternal CP , radiating back and epiG , dyspnea , episode of vomiting caused this - alcohoic , crackles in lung fields showing RS pleural effusion what is it
Oesophagela perforation - boergaave
how does rifaximin work in HE
antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
what is the mackler triad-boeeherave
vomiting
severe retrosternal chest pain, typically radiating to the back
subcutaneous emphysema
lethargy, puritis , ALP and yGT up
PBC
aziathiopurine class and moa
immunsuppresssant
Azathioprine’s mechanism of action is not entirely understood but it may be related to inhibition of purine synthesis, along with inhibition of B and T cells.
ascites why do we use aldosterone antagonist - moa
lower sodium and hence, water retention. In general, where sodium goes, water follows.
when do you consider fluid restriction in ascites
when sodium is under 125
mx barrets
high dose PPI
barrets with metaplasia only what mx now
endoscoppy 3-5yrly
dysplasia of any grade what is offered in barrets
endoscopic intervention is offered. Options include:
radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia
endoscopic mucosal resection
difference between metaplasia and dysplasia
Metaplasia is the term used to describe the transformation of one mature type of cell into another mature type of cell. Dysplasia is a term used to describe an increased amount of immature cell types, often abnormal
When treating dyspepsia, if either a PPI or ‘test and treat’ approach has failed what should you do
try the other
so ppi for month or eradication therapy if positiv e
fidaxomicin moa
Blocks Clostridium difficile B toxin (TcdB)
main ascites mx
reducing dietary sodium
fluid restriction is sometimes recommended if the sodium is < 125 mmol/L
aldosterone antagonists: e.g. spironolactone
driangae if tense - paracentesis with albumin cover
prophylacitc abx cover reduce risk of SBP
TIPS considered
top diff of this - This patient has osteomalacia, symptoms of diarrhoea and fatigue, and a history of autoimmune thyroid disease.
coeliac
how does coeliac lead to osteomalacia
impaired vitamin D absorption secondary to villous atrophy.
haemochromatosis IX
transferrin saturation - gold
ferritin -not abnormal if caught early
ferritin can be raised in inflmmaotry states
TIBC is high in IDA, and low/normal in anaemia of chronic disease
why is TIBC high in IDA and not in chronic anaeia
high TIBC is because the body still has the capability to transport iron around the body since there is not a high concentration of iron currently.
In because, in anaemia of chronic disease, there is not a lack of iron, but the iron is trapped elsewhere and not able to be used. For example, it is trapped in inflammatory tissue. However, since it is therefore still in the body, the capability of the body to attach to free iron and transport it around is reduced (or normal), represented by TIBC.
second most common association of HNPCC after colorectal cance
endometrial
malnutrition dx weight loss
Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition
his patient’s presentation is suggestive of hepatorenal syndrome (HRS), a type of functional kidney impairment that occurs in patients with advanced liver disease. The key features include ascites, low urine output, and a significant increase in serum creatinine
first line to treat this
erllipressin - vasopressin analgoue
how does vasopressin work
It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.
firm smooth tender pulsatile liver edge what is most likley cause
Right heart failure is associated with a firm, smooth, tender and pulsatile liver edge
copd cause RHSF
what is a must score
MUST (Malnutrition Universal Screen Tool)
what gastro drug increased risk of OP
omeprazole - osteoporosis → increased risk of fractures
stopping mediciations before OGD and breath test
gaviscon
PPI
ranitidine - H2
abx
how long for all
topping medications before OGD (1-4):
1 day = gaviscon
2 weeks = PPIs
3 days = ranitidine
4 weeks = antibiotics
pt with ascities 2ndary to liver cirrhosis with abdo p and fever and distension
how would you confrim most likely dx and what is it
SBP
neutrophil count under 250 from paracentesis
Prescribe prophylactic ciprofloxacin
when do you treat stones in the biliary tree
Asymptomatic gallstones which are located in the gallbladder are common and do not require treatment. However, if stones are present in the common bile duct there is an increased risk of complications such as cholangitis or pancreatitis and surgical management should be considered.
two ways carcinoid syndrome occurs
usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver
what is the double duct sign and when is it seen
the presence of dilatation of both the pancreatic and common bile ducts.
pancreatic cancer
difference between pancreatic ca and PBC and PSC on CT abdo
pancreatic cancer - double duct - extrahepatic duct dilation
PBC - intraheaptic duct dilation
PSC - intra-hepatic duct dialtion
mx of alcoholic hepatitis
prednisilone if indicated
Bile acid malabsorption occurs when
Primary or secondary to cholecystectomy, Crohn’s, coeliac.
you get chronic diarrhoea in bile acid malabsorption how do you test for this
SeHCAT. - s a diagnostic test to check how well your gut is able to absorb bile acids. If the absorption is poor, this can result in chronic (long term) diarrhoea.
give - Cholestyramine - bile acid sequestrant
sliding hiatus hernia.
Which of the following is the first-line management for her condition?
Correct, first-line management includes lifestyle changes (weight loss, avoiding lying flat) and PPIs to reduce acid reflux.
dx ix for hiatus hernia
barium swallow
A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended.
what is going on here
This patient has developed small bowel obstruction secondary to an impacted gallstone.
gallstone ileus what do you see on plain film
In gallstone ileus, a plain abdominal film classically shows small bowel obstruction and air in the biliary tree
anastamotic leak how long psot surgery
Anastomotic leaks can occur up to several weeks after surgery, but most develop within 3 days.
sx anastamotic leak
Low blood pressure, rapid heart rate, fever, stomach pain, nausea and vomiting, drainage from a surgical wound, pain in the left shoulder area, decreased urine output
what is an anastamotic leak
An anastomotic leak is a serious complication that occurs when the contents of a reconnected body channel leak after a surgical anastomosis fails:
An anastomosis is a procedure that connects two ends of a channel together by sealing them. The most common type of surgery that involves anastomosis is bowel resection, but other procedures, like a gastric bypass, also involve anastomosis
autoimmune hepatitis blood results for ALT AST and ALP what would they show
would you see a raised AMA
Autoimmune hepatitis is more likely to show predominantly raised ALT / AST on LFTs than ALP
no AMA raised in PBC
hyposlenism for exmaple in coealiac what vaccine every 5 yr
pnuemoccoal
Bile-acid malabsorption- history of watery diarrhoea which is green in colour, associated with abdominal bloating and cramping- may be treated
Cholestyramine
lead pipe appearance of the colon
uc
Total iron-binding capacity reflects the availability of iron-binding sites on transferrin. The levels, therefore, increase in iron deficiency and decrease in iron overload - what would you see in haemachomatois
As such you would expect a low total iron-binding capacity in haemochromatosis, leaving option 4 as the correct answer.
triad of liver failure
Liver failure = triad of encephalopathy, jaundice and coagulopathy
ix you should do if someone comes in with intermittent abdo pain, diarrhoea suspecting IBS or IBD
In addition to a full blood count (FBC), urea & electrolytes (U&E), coeliac screen, erythryocyte sedimentation rate (ESR) and C-reactive protein (CRP)
faecal calprotectin
what node is lateral to the umbilicus raised in malginancy potentially gastric
Sister Mary Joseph nodule - sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary
plummer vision is triad of -dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
how do you treat
Treatment includes iron supplementation and dilation of the webs
By which mechanism does loperamide act through to slow down bowel movements?
Loperamide is a µ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut
low-flow priaprism caused by
Low-flow: Urological emergency.
Abnormally sustained erection due to impaired venous outflow. Results in increased pressure which impedes arterial blood flow = Ischaemia.
Causes: Sickle cell.
Clinical features: Very painful, fully rigid erection.
Corporal blood gas: pO2 < 3, lactate raised, CO2 raised
