Peer Tutoring Flashcards
What is air under the diaphragm called?
Pneumoperitoneum
65 year old male with a history of alcoholism and gallstones presents with severe epigastric pain, which radiates to his back. He has vomited 5 times in the last 5 hours.
Acute pancreatitis
Causes of pancreatitis
G - gallstones E - ethanol T - trauma S - scorpion bites M - mumps A - autoimmune S - steroids H - hyperlipidaemia E - ERCP D - drugs
A 16 year old female presents with fever, nausea and pain in the RIF. The pain had originated around the umbilicus. A pregnancy test performed on the ward was negative.
Acute appendicitis
49 year old obese female presents with a one day history of continuous right upper quadrant pain, fever and vomiting. On examination Murphy’s sign is positive.
Acute cholecystitis (fat forty something female)
A 22 year old male presents with a one week history of diarrhoea and abdominal pain. Has lost 10kg in the last 2 months. On examination he has generalised abdominal tenderness, particularly in the RIF. A blood sample taken on admission reveals a deficiency of vitamin B12
Crohn’s disease
A 73 year old lady has a longstanding history of intermittent LIF pain and constipation. In the last few days this has become more severe and she has felt nauseous and unable to eat. Examination reveals tenderness and guarding in the LIF.
Diverticulitis
An 18 year old female medical student attends A+E after gaudie night. Having vomited several times, she notices bright red blood in her vomit.
Mallory-Weiss tear
A 70 year old male with a history of several years o the heartburn reports intermittent haematemesis. Biopsies taken from the spdistal oesophagus at the subsequent endoscopy and reported showing intestinal-type-metaplasia.
Barrett’s oesophagus
What can Barrett’s Oesophagus lead to?
Adenocarcinoma
A 55 year old male alcoholic presents with a large volume of bright red haematemesis. On examination he has palmar erythema and spider naevi.
Oesophageal varices
A 65 year old female smoker presents with a 2 month history of weight loss, epigastric pain and haematemesis. On examination she has signs of anaemia and you note Virchow’s node in her left supraclavicular fossa.
Gastric carcinoma
A 40 year old woman presents to the liver clinic with raised ALP, GGT and AST following a routine blood test. Later she develops progressively worsening lethargy, pruritus and jaundice. A liver biopsy reveals chronic inflammation of the bile ducts.
Primary Billiary cirrhosis
A 43 year old Scottish male presents with tiredness, jaundice, spider naevi and palmar erythema. He drinks around 8 units of alcohol a week, on examination his skin appears “slate grey” . Iron studies reveal raised ferritin, serum iron and massively elevated transferrin saturation.
Hereditary haemochromatosis
A 34 year old IV drug abuser is seen by the prison doctor with acute onset of jaundice. Investigations reveal abnormal LFT’s and positive serology for HBsAg and anti HHc IgM.
Hep B
A 52 year old female presents with symptoms and signs of chronic liver disease. She suffers from emphysema despite never being a smoker. There is a family history of similar problems.
Alpha 1 antitripsin deficiency
A 36 year old male smoker gives a several month history of retro sternal pain. He says it’s worse at night in bed and when tying his shoe laces. Food and acid occasionally regurgitate into his mouth.
GORD
Risk factors for GORD
Smoking Alcohol Obesity Pregnancy Hiatus hernia Antidepressants
Non pharmaceutical advice would you offer him to prevent recurrence of GORD
Smoking cessation
Weight loss
Reduced alcohol intake
Smaller portions - avoid food before bed
Medications for GORD
Antacid first
PPI
Alarm symptoms in GI disease
Weight loss Hoarseness Anaemia Haematemesis Loss of appetite
What is Barrett’s oesophagus?
Squamous cell to columnar cell metaplasia
What treatment is recommended for Barrett’s oesophagus?
High grade - resection
Low grade - PPI, monitor regularly
60 year old female presents with a 2 day history of constant pain in the RH. The onset was shortly after the ingestion of a large meal. The pain has also rediated to the right shoulder and sub scapular region. She reports nausea, 2 episodes of vomiting and has been phrexiak for the last 24 hours, she is not jaundiced.
Acute Cholecystitis
