points to learn Flashcards
what does GORD usually present with
hiatus hernia
what is the GS for hernia
BS
what is achalasia
abnormal relaxation of LOS
what is oesophageal carcinoma associated with
plummer vinson syndrome
what are oesopahgeal varices caused by
portal hypertension causes dilated collateral veins at the site of portosystemic anatomoses
what is the most common cause for portal hypertension
cirrhosis
what is the treatmetn for oesophageal varices
- resus, antibiotics, terlipressin, early OGD + EVL
- bleed stops = propranolol and banding
- bleed continues = EVL or SB tube
- bleed continues = TIPSS
what is a gastric lymphoma
derived from MALT and associated with B cell lymphomea
what are the symptoms of gastruc lymphoma
stomach pain, ulcers, >60, hpylori
what does GIST look like on histology
spindle cells
most common cause of PUD
h pylori
h pylori tests
urease breath test, faecal antigen test, serology IgG
GS for gastroparesis
oesophageal manometry
intestial failiure 1 causes
obstructin, surgical resection, congenital, malabsorption
intestinal failure 2 causes
sepsis, abdo surgery, coeliac, crohns, malignancy,short bowel syndrome
presentation of intestinal failure 2
abdo fistulae
causes of intestinal failure 3
short bowel syndrome
symptoms ofIBS
bloating, urgency, tenesmus, mucus, worrsening after food
tests for IBS
lower GI endoscopy if <50
treatment for IBS
stop opiates and analgesia loperamide laxaiev mebervine - anti spasmodic amitryptiline - anti depressant
genes for coeliac disease
HLA DQ2 and DQ8
causes of coeliac
childhood diabetes, herpetitis formis
what happens if coeliac patients stops responding to gluten free diet
t celll lymphoma
pathophysiolgy of coeliac
mediated by t cells wihch exist in IELs, IEL ediated change leads to increasing loss of enterocytes wihch line intestines
tests for coeliac
biopsy
IgA anti TTA
what is the cause of mesenteric ischaeima
embolus from AF blocking SMA
symtpoms of acute mesenteric ishccaeimi
gassless abdomen and cramping pain
tests of mesenteric ishcamei
metabolic acidosiss,
CXR = bowel wall thickening
complications of mesenetic ischamei
repurfusion injury - causes inflammation
treatmnet for mesenteric ischaemia
fluids, met, gent
chronic mesenteric ischaemic symptoms
colicky post prandial pain, upper abdo bruit
tests for mesenteric ischaemi
CT angiogram, laparotomy
what causes meckels diverticulum
vitello - intestinal duct incomplete regression
rules of 2 for meckels diverticulum
2% of pop
2 inch long
2 feet from ileocaecal valve
males, presents before 2 years old
features of crohns
increased goblet cells, crypt absesses
where does crohns present
any part of GI tract but commonly the terminal ileum and proximal colon
tests for crohns
barium follow thorugh - shows cobblestoning
test for meckels diverticulum
radionucleotide scan, laparotomy
where does UC affectt
rectum
features of UC
goblet cell depletion
complications of UC
toxic megacolon - treat with IV hydrocortisone, LMWH, fluids
inx = abdo xray
tx = emergency colectomy
treatment of crohns and UC
- 5SAS (masalazine) - only Uc
- corticosteroids - prednisolone
- immunosuppressents - azathioprine
- anti TNF therapy - infliximab
treatment for smalll bowel obstruction
supine abdo xray
what genes are colorectal cancer assoc with
HPNCC and FAP iwth APC mutation
symtpoms of left sided colorectal canecr
fresh rectal bleeding and obstrctun, tenesmus
sympotms of right sided colorecatl cancer
anaemia, abdo pain
diagnostic scoring for colorectal canecr
DUKES a - limited to mucosa b - extends through muscularis mucosae c - reginal lymph node involvement d - distal mets
how to determine cause of jaundice
radiology
when does chronic liver disease occur
when hepatic stellate cells become activtaed and casue fibrosis
what is the path of NAFLD
steatosis - steatohepatitis - fibrosis - cirrhosis
inx for staeatosis
US
inx for NASH
liver biopsy
what destroys bile ducts in PBC
T cells
gillberts syndrome
congenital, unconjugated bilirubiemia
inx for PSC
ERCP
markers for autoimmune hep
SMA and ANA, IgG
treatment for autoimmune hep
corticosteroids (predisolone), azathioprine, useodeoxycholic acid
haemochrmatosis
increased ceruloplasm, iron overload
wilsons disease
decreased ceruloplasim, neurological and heaptic symptoms
A1AT symptoms
lung emphysema, liver deposition of mutant protein, cell damage
budd chiari
thrombosis of hepatic veins due to hypercoagulation
fulmaninat hepatic failure
severe hepatic failure in which encelopathy develops in under 2 weeks in a patient with a previously normal liver ,causedby hep a
physiology of cirrhosis
bands of fibrous tissue separating nodules of regenerative hepatocytes
invetsigations of haemangioma
US - echogenic spot, well demarcated
CT - venous enhancement form periphery to centre
MRI - high intensity area
what is the most common benign liver tumour
hemangioma
what is focal nodular hyperplasia
benign nodule formation of normal liver tissue - hyperplastic response to abnormal arterial flow
what are the investigations for focal nodular hyperplasia
US - nodule with varying echogenicity
CT - hyperplasic mass with central scar
MRI - iso or hypo intense
FNA - normal hepatocytes and kupffer cells with central core
what is hepatic adenoma
benign
composed of normal hepatocytes, no portal tract, central veins or bile duct.
who normally gets hepatic adenoma
females
invetsigations of hepatic adenoma
US - fillling defect
CT - diffuse arterial enhancement
MRI - hypo or hyper intense lesion
FNA - may be needed
treatment of hepatic adenoma
stop hormones and lose weight
males = surgical excision
females <5cm/ reducing in size = annual MRI
>5cm/increasing = surgical excisoin
in hepatic adenoma, which gender has a bigger risk of malignant transformatoin
males
what is a hyatid cyst caused by
ecginococcus antibodies from undercoooked meat from street vendors or sheep parasites
treatment for hyatid cyst
conservative- open cystectomy
radical - pericystectomy
medical - albendazole
what is polystatic liver disease
embryonic ductal plate malforamtion of the intrahepatic biliary tree, numerous cysts throught liver parenchymal
treatment for polystatic liver disease
surgyer - patients with advanced liver failure
pharmacological - somatostain analouges for symptom relief and liver volume reduction
what are the symptoms of liver abscess
leukocytosis, high fever, abdo pain, complex liver lesion
what causes liver abscesses
abdominal or biliary infection, dental procedure
invetsigation for liver abscess
echo
treamtent for liver abscess
broad spec empirical treatment with antibiotics + aspiration or drainage
what causes HCC
cirrhosis from hep b, c, alcohol, alfatoxin
how to investigate HCC
AFP >100
treatment for HCC
<5mc or less than 3 tumours which are less than 3cm = surgeyr liver transplant
cholethiasis def
stone formation in the gall bladder
what is cholecystitis
inflam of gallbladder, usually assoaciated with gallstone
symptoms of cholethiasis
colicky pain (comes and goes), worse with fatty foods
treatment of cholethiasis
elective cholecystectomy
symptoms of cholecystitis
made worse by eating, murphys sign
treatment of cholecystsitis
urgent cholecystectomy - ursodeoxycyclic aicd if unfit for surgery
choledocolithiasis def
gallstone lodged in common bile duct
treatment of choledocolithiasis
ERCP
treatment for gallstone ileus
urgernt laparotomy
what is biliary colic
when a gallstone temporarily blocks the cystic duct - constricts sphincter of oddi
how to treat biliary collic
morphine .. buprenophrine, lose weight
diagnostic score for pancreatitis
glasgow prognostic score “pacnreas” >3 = severe
how to treat pancreatitis
fluids, correct elecrolytes and P2
what organism infects pancreas
e coli
treatment for pacnreatic adenocarcinom
inoperable - ERCP or PTC adn stent insertion
operable - laparoscopy and staging, ECRP stent
complete rectal prolapse treatment
bulking agent and education of manual reduction, delormes proceure, perineal rectopexy
incomplete rectal prolapse treatment
dietry advice and treatment of conspitaion (children) , treatment similar to haemorrhoids - sclerotiontherapy (adults)
GI bleeding scorea
blatchford score and rockall score
what causes an epigasic heria
weakness in linea alba- males
what is paediatric inguiinal hernia
<1 year olds males, common in preterm of LBW infants, processes vaginalis - <1s operate within 24 hours
femoral hernia def
females
bowel enters femora canal, mass in upper medial thigh or above inguinal ligmanet, flattens groin crease
order of bundle in femoral hernia
NAV (Lateral to medial)
where is the femoral hernia in relatin to public tubercle
inferior and lateral
where is inguinal hernia in realtion to pubic tubercle
above and medial
if you cough and hernia returns, what is it
direct
how to treat campylobacter
azithromycin
complication of ecoli 1057
HUS
how to treat c diff
severe = vanco
non- severe = oral metro
treatment and investiation of acute travellers diarrhoea
fluoroquinole single dose or azithroycin, stool culture
how to treat enteric fevre
empirical treatment - ceftriaxone
how to investigate amoebas
stoop microscopy
how to treat and investigate giardiasis
metro , stool microscopy
what oral ulcer presents with genital warts
bechets
what is hairy leukoplakia
shaggy, white, side of tongue HIV+ patietns and EBV
white patch you can rub off
candidias
gingivitis
vit c def, CCBs
bullk lax
ispagula husk, hyprophobic agetns eg polysaccharides, cellulose
used in mild/chronic diarrhoea assoc with diverticular disease or IBS
osmotic lax
lactulose/ macrogols
osmotically activae agents eg sugar, alcohol
use in bowel prop and hepatic encelopathy
caution in heart failure
stimulative laxative
eg semma, bisacodyl
increase elcetrolytes and thus water secretion from the colonic mucosa
use in constipate secondary to opioid use
anti emetics that act on CTZ
dopamine antagonists eg procholorperazine and metochloperamide
5HT3 receptor antagonists eg ondansetron
canabinoids
anti emetics that act on VN
H1 antihistmaies eg cyclizine
anticholinergics eg hyosine
glycogenosis
glycogen synthesis from glucose
glycogeniin, aloha4/6 glycosidic bonds, UDP glucose, glycogen synthase
glycogenolysis
breakdown of glycogen to form glucose
glycogen phosphorylase, glucose 6 phosphotase
occur sbetween meals to maintain BGL
glycogenolysis
the synthesis of glucose wihtin the body from non carb subsrates eg lactate, amino acids and glycerol
oxaloacetate 4c, TCA cycle, liver
occurs during prolonged periods of starvation eg overnight
gonnorhoea
direct contact of mucosal surfaces with infectious secreion
low abdo pain, diarrhoea, recatl bleeding, anal discharge
protoscopy - inflammed mucosa, purulent exudate
chlmaydia
anal discomfort / itch
doxycyline
syphilus
oral sec
ulcers in mouth, warrt like lesions
HSV
ano-genital or oral - genital
perianl mucosa
pain, ulcers, painful defacation, bleeding, mucus
HPV
anal warts
