PassMedicine Flashcards
What is the test used to diagnose liver cirrhosis
Transient elastography
Who should be offered a screening for liver cirrhosis
- People with hepatitis C
- Men who drink >50 units of alcohol per week
- Women who drink >35 units of alcohol per week
- People diagnosed with alcohol-related liver disease
How are patients with liver cirrhosis followed up
- Upper endoscopy to check for varies after initial diagnosis
- Liver ultrasound every 6 months (+/- alfa fetoprotein) for hepatocellular carcinoma
What are the common presenting symptoms of coeliac disease
Bloating
Flatulence
Abdominal pain
Fatigue
Weight loss
Dermatitis herpetiformis
Anaemic
Low Ferritin
Low folate
What is the gold standard test for diagnosing coeliac disease
Endoscopic intestinal biopsy
- villous atrophy
- crypt hyperplasma
- increased intraepithelial lymphocytes
- lamina propria infiltration with lymphocytes
What is barrels oesophagus
Were squamous epithelium is replaced with columnar epithelium
What is the management of Barretts oesophagus
Metaplasia - endoscopic surveillance every 3-5 years
Dysplasia - Endoscopic intervention - Radiofrequency ablation is 1st line, endoscopic mucosal resection can also be done
What are the main signs of acute mesenteric ischaemia
Sudden onset, severe abdominal pain
Vomiting and a rapid episode of bloody diarrhoea
Pain out of proportion with the clinical findings
TriadL Cardiovascular disease (usually AF), raised lactate and soft but tender abdomen.
What VBG findings will there be in acute mesenteric ischaemia
Metabolic acidosis
Elevated lactate
What imaging is used to diagnose ischaemic bowel
CT angiography abdomen and pelvis with contrast
What type of inheritance is haemochromatosis
Autosomal recessive
Who requires an urgent referral for upper GI
- All patients with dysphagia
- All patients with an upper abdominal mass
Patients >55 with weight loss AND:
- Upper abdominal pain
- Reflux
- Dyspepsia
Who requires a non-urgent GI referral
- Patients with haematemesis
-Patients > 55 with:
- Treatment resistant dyspepsia
- Upper abdo pain with low haemoglobin levels
- Raised platelet count and symptoms
- Nausea or vomiting with weight loss, reflux, dyspepsia and upper ando pain
What are the signs of acute cholecystitis
- Pain in RUQ - more severe and persistent than biliary colic
- Pain may radiate to back or right shoulder
- Pyrexia
- Murphys sign positive - arrest of inspiration on palpation of RUQ
- NOT jaundiced
What are the signs of ascending cholangitis
Triad of: Charcots triad
- Fever
- RUQ pain
- Jaundice
If very severe - Reynolds pentad:
- Fever
- RUQ pain
- Jaundice
- Shock (low bp, tachycardia)
- Altered mental status
What are the causes of vitamin B12 deficiency
- Pernicious anaemia (most common)
- Atrophic gastritis (secondary to H pylori)
- Gastrectomy
- Malnutrition (alcoholism)
What is the pathophysiology of pernicious anaemia
Antibodies are created against intrinsic factor (+/- gastric parietal cells)
- Intrinsic factor antibodies bind to intrinsic factor - this blocks vitamin B12 binding sight
- Gastric parietal cell antibodies - caused reduced acid production and atrophic gastritis. This causes reduced intrinsic factor which again causes reduced vitamin B12 absorption.
What is the role of vitamin B12
- Production of blood cells
- Myelination of nerves
A deficiency causes megaloblastic anaemia and neuropathy
What are the features of vitamin B12 deficiency?
Anaemia:
- Lethargy, pallor, dyspnoea
Neurological:
- Peripheral neuropathy (pins and needle), numbness (symmetrical) and affects the legs more than the arms.
- Subacute combined degeneration of the spinal cord (progressive weakness, ataxia, parasthesias, spasticity, paraplegia).
Psychiatric:
- memory loss, poor concentration, confusion, depression, irritability
Other:
- Mild jaundice, glossitis, angular cheilitis
** Increased risk of gastric cancer - vitamin B therapy resolves the anaemia but the atrophic gastritis remains **
what are the signs and symptoms of vitamin C deficiency (scurvy) Vitamin C = Ascorbic acid
- ecchymosis (easy bruising)
- Poor wound healing
- Follicular hyperkeratosis and perifollicular hyperkeratosis (cork screw hairs)
- Gingivitis + bleeding and receding gums
- Sjogren’s syndrome
- Arthralgia
- Oedema
- Weakness, malaise, anorexia, depression
What are the classic features of pancreatic cancer
- Painless jaundice
- Pale stools, dark urine, pruritus
- Abdominal masses (hepatomegaly, gallbladder, epigastric mass)
- Cholestatic liver function tests
- Anorexia, weight loss, epigastric pain
What is Boerhaave syndrome
Rupture of the oesophagus
Causes crepitus on examination
What is the pattern of inheritance of Gilberts syndrome
Autosomal Recessive
Isolated increase of UNCONJUGATED bilirubin
What is the treatment for alcoholic hepatitis
Glucocorticoids (for example, prednisolone)