Passmedicine Flashcards
Features of biliary colic
Colicky abdominal pain, worse postprandially, worse after fatty foods
May radiate to the right shoulder
Nausea and vomiting are common
What condition is associated with pigmented gallstones?
Sickle cell
(this is because sickle cell anaemia results in increased red cell haemolysis and thus pigmented gallstones)
Pigmented gallstones are associated with haemolytic anaemia and liver cirrhosis
What is whipples procedure
Operation to remove the head of the pancreas
Why do you need to sort out jaundice?
Patients with unrelieved jaundice have a much higher incidence of septic complications, bleeding and death
What is murphys sign?
You hook your fingers under the liver border and ask the patient to breath in -on inspiration the gallbladder will descend onto the fingers - in acute cholecystitis this will cause the patient to jump because it will be sore
Why are patients with Crohn’s more likely to develop bile duct stones?
Normally bile salts are absorbed in the terminal ileum.
In Crohn’s, absorption is impaired and so they may develop bile duct stones - these can pass into the common bile duct and cause obstructive jaundice
This bacteria causes chronic diarrhoea in immunocompromised patients
Mycobacterium avium complex
Most common causative organism of ascending cholangitis
E. coli
then followed by Klebsiella
What is Lemierre syndrome?
Starts with sore throat and fever - bacteria then spread through the lymphatic vessels
Internal jugular then swells and pus-containing tissue moves from the original location to other organs (most commonly the lungs)
Which bacteria causes Lemierre syndrome?
Fusobacterium necrophorum
Isograft
Transplant to identical twin
Autograft
Transplanting a tissue in your body to a different site (e.g. using saphenous vein for coronary artery bypass)
Allograft
When you donate e.g. a kidney to another human
Duodenal ulcers and eating
Pain relieved by eating
Gastric ulcers and eating
Pain worsened by eating
Are gastric or duodenal ulcers more common?
Duodenal ulcers more common
“tinkling” bowel sounds
SMALL BOWEL obstruction
“A 40 year old women with a history of Crohn’s disease presents with abdominal pain and distension. She describes constipation for the past 4 days”
Intestinal obstruction
Histological scoring system for prostate cancer?
Gleason score
Score of 6 or less - cancer cells look like normal cells, likely to grow slowly
Score 7 - intermediate risk for aggressive cancer
Score 8 and above - cancer likely to spread more rapidly
FIGO staging system
Used for gynaecological malignancy
Complications of hernia repair (early and late)
Early - bruising, infection
Late - chronic pain, recurrence
Which medication should you avoid in bowel obstruction?
Avoid metoclopramide as can it is a pro-kinetic and may cause perforation
What part of the colon is most likely to be affected in ischaemic colitis?
The splenic flexure
How might oesophageal candidiasis present?
With odynophagia and episodic dysphagia
What would you give as prophylaxis to prevent variceal bleeding?
Propanolol/ Endoscopic band ligation
What is a faecal occult test?
Looks for occult (hidden) blood in the stool
If NAFLD is found incidentally, which test should you perform?
Perform an enhanced liver fibrosis test to assess for more severe liver disease
Management of NAFLD
The mainstay of treatment is lifestyle changes (particularly weight loss) and monitoring
What is pellagra?
A deficiency of vitamin B3 (niacin)
Sun-burn like dermatitis rash
Diarrhoea
Cognitive deficit
Pellagra (vitamin B3 deficiency)
What tests would you do if you suspected liver cancer
FBC, clotting, LFTs, hepatitis serology, ALPHA FETOPROTEIN
The most common presenting complaint of Crohn’s in adults?
Diarrhoea
The most common presenting complaint of Crohn’s in children?
Abdominal pain
Nausea medication you should avoid in parkinsons?
Metaclopramide
A 41-year-old man with cerebral palsy is admitted with abdominal pain and diarrhoea. His carers report him passing 5-6 watery stools per day for the past four days. On examination he has a mass in the left side of the abdomen.
Constipation overflow
