Points from Questions Flashcards by PANOS T

Zollinger-Ellison syndrome (ZES) is a condition caused by

Gastrin-secreting tumours form in pancreas and duodenum; called gastrinomas
Secrete large amounts of gastrin that causes hypersecretion of gastric acid leading to ulcer disease.

MEN associated

Presents with abdominal pain, diarrhoea,
gastro-oesophageal reflux disease

Less common WL, GI bleeding, nausea, and vomiting

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Spleen VS Kidney

Palpable Notch, Dullness on Percussion

Resonant to Percussion
Bilaterally Palpable

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Diclofenac

Osteoarthritis medication (NSAID's)
Decreases production of stomach protective mucous

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Bruising is common in?

Cushing’s
Steroid use
Cirrhosis
Haematological Malignancy

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GAVE - Gastric Antral Vascular Ectasia

Iron deficiency anaemia

dilated small blood vessels in antrum that look like red streaks of watermelon

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Flapping Tremor

Resp, Hepatic, Renal Failure

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Acute Pyelonephritis

Severe upper abdominal pain, nausea, vomiting

Serum Amylase Increases

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Gastric Carcinoma

Indigestion, Loss of apetite (Non-Specific)

Virchows Node

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Mallory Weiss Tear

Alcohol consumption and excess vomiting

Blood after retching

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Systemic Sclerosis

Progressive Dysphagia

Incomplete relaxation of LOS - Reflux - Stricture

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Acute Mesenteric Ischaemia

Triad:
Gastrointestinal Emptying (vomiting, diarrhoea)
Abd Pain,
Cardiac Disease

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Coeliac Disease

WL, Diarrhoea,
Pale conjuctiva,
Low body Weight

Low Folate,
Endoscopic Small Bowel Biopsy (Atrophy)
Serum Antigliadin Abs

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Rectal Cancer

Fresh Blood, Mucus, Tenesmus, Diarrhoea

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Parianal Abscess

Throbbing, Swelling

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Portal Hypertention

Splenomegaly,
UGI Bleeding (oesophageal varices)
Ascites
Acute/Chronic Encephalopathy

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Alanine aminotransferase (ALT)

Alkaline phosophatase (ALP)

Aspartate aminotransferase (AST)

γ-Glutamyl transpeptidase

ALT?

ALP enzyme is present in the canalicular and sinusoidal membranes of the liver, as well as bone, intestine and placenta. Cholecystitis

AST present in hepatocytes, brain and myocardium. A rise may occur in hepatitis and myocardial infarction.

γ-GT is a microsomal enzyme, usually raised in association with alcohol excess/cirrhosis/hepatic metastatic disease and may be raised in phenytoin therapy.

Right Side Colon Cancer

Present much more insidiously (gradual but harmful) than left-sided tumours,

Asymptomatic iron deficiency anaemia rather than change in bowel habit.

PR bleeding is more suggestive of left-sided lesions, as is large bowel obstruction.

bleeding ulcer on the posterior wall of the stomach.

Splenic artery

bleeding ulcer in the first part of the duodenum.

Gastroduodenal artery

Cystitis

is rare in men and would be associated with symptoms such as urinary frequency, urgency, nocturne and dysuria.

Diverticular Disease

A 50-year-old taxi driver has a six-month history of constipation and colicky suprapubic pain that is worse at some times than others, with no discernable pattern. He has had some episodes of diarrhoea and fever.

He drinks little alcohol, and does not smoke, but consumes copious quantities of coffee.

There is some slight tenderness in the suprapubic region, but no other findings on examination.

A 55-year-old publican presents with a haematemesis.

His wife provides a history that he has consumed approximately four cans of lager per day together with liberal quantities of spirits for many years. He has tried to stop drinking in the past but failed.

Examination reveals that he is oriented but distressed. His pulse is 120 beats per minute and blood pressure 108/70 mmHg. He has numerous spider naevi over his chest. Abdominal examination reveals a distended abdomen with ascites.

What would you request next for this patient?

Features of chronic liver disease and is now shocked due to haematemesis.

Bleeding oesophageal varices should be top of the differential list and other diagnoses to consider would include peptic ulceration or haemorrhagic gastritis.

A 63-year-old woman complains of diarrhoea, fresh bleeding on defecation, mucus per rectum and tenesmus.

Rectal Carcinoma

Hepatomegaly

In alcoholic fatty liver disease

Right heart failure is associated with tender smooth hepatomegaly due to hepatic congestion.

Metastatic liver disease is associated with nodular hepatomegaly.

In primary biliary cirrhosis, asymptomatic patients are discovered on routine examination to have smooth hepatomegaly, a raised serum alkaline phosphatase or autoantibodies. Pruritus is often the earliest symptom, preceding jaundice by a few years.

A 62-year-old male with a long history of alcohol abuse presents with acute abdominal pain which radiates through to the back. The following day he is noted to have purplish discolouration in the flanks.

Grey Turner's Sign This, like Cullen's sign, is a representation of intra-abdominal haemorrhage that occurs with aortic dissection and pancreatitis.

Murphy's sign

Characterised by pain on inspiration whilst pressure is applied just below the costal margin in the mid-clavicular line, with pain greater on the right than the same repeated on the left. This is suggestive of acute cholecystitis as the inflamed gallbladder is pushed down during inspiration.

Courvoisier's law

States that in the setting of obstructive jaundice and a palpable gallbladder, gallstones are unlikely to be the cause. This is because patients with gallstones tend to develop a scarred gallbladder that does not allow it to expand enough to be palpable, whereas if a patient has a cholangiocarcinoma (and no gallstones) they can develop high back-pressure in the biliary tree, allowing their gallbladder to expand and become palpable.

A 65-year-old male is admitted with two episodes of haemetemesis. He has a history of ischaemic heart disease (IHD) for which he is taking medication. Which of the following is the likely cause of his presentation?

The history of IHD is important, as the majority of patients will be receiving aspirin. Hence the likely cause of the current presentation with haemetemesis is a non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulceration. He should have an endoscopy and will be commenced on proton pump inhibition.

A 45-year-old male presents with fatigue and joint pains. He has a history of type 2 diabetes for which he takes gliclazide and osteoarthritis for which he occasionally takes NSAIDs. On examination he appears slightly pigmented and has two finger breadth hepatomegaly.

Haemochromatosis This is an autosomal recessive condition associated with excess iron deposition: Liver - cirrhosis Joints - Osteoarthritis Pancreas - diabetes. Iron deposition in the pituiatary and gonads can also cause hypogonadism. The iron deposition in the skin also results in pigmentation.

A 68-year-old male presents with breathlessness and weight loss. He is a smoker of 10 cigarettes daily. On examination he has a raised JVP, two finger breadth pulsatile hepatomegaly and ankle oedema.

Congestive heart failure This is right sided heart failure probably due to chronic obstructive pulmonary disease (COPD) and is typified by raised JVP, pulsatile hepatomegaly (tricuspid regurgitation) and ankle oedema.

A 45-year-old female presents with pruritus and weight loss. She has a history of hypothyroidism which is adequately treated with thyroxine. On examination she appears slightly icteric, has xanthomas around the eyes and has two finger breadth hepatomegaly.

Primary biliary cirrhosis as this is associated with xanthomas as well as pulmonary fibrosis and other autoimmune disorders.

Stimulates acid secretion in the stomach.

Gastrin is secreted from the antrum of the stomach when stimulated by parasympathetic nerves and the presence of amino acids in the stomach. It stimulates gastric motility, growth and acid secretion, and intestinal motility. The secretion of gastrin is inhibited by acid in stomach and somatostatin.

Stimulates bicarbonate secretion from the duodenum, pancreas and liver.

Secretin is secreted from the small intestine when there is acid in the small intestine. It inhibits gastric motility and acid production, and Stimulates bicarbonate secretion from the duodenum, pancreas and liver.

Stimulates insulin secretion from the pancreas.

GLP-1 is secreted from the small intestine when glucose is present. It stimulates the pancreas to secrete insulin.

Stimulates appetite.

Ghrelin is produced from the fundus of the stomach and is responsible for stimulating appetite.

Stimulates enzyme secretion from the pancreas and gall bladder contraction.

CCK is secreted from the small intestine when it contains amino acids and fatty acids. It inhibits gastric motility and acid production, and Stimulates pancreatic enzyme secretion and gall bladder contraction and sphincter of Oddi relaxation. It potentiates secretin's action on bicarbonate secretion.