practical classes Flashcards
Risk factors for Barrett oesophagus
High BMI alcohol Smoking Drugs which relax LOS Genetic
How does a patient with oesophageal cancer present
Asymptomatic or
Heart burn, chest pain, dyspepsia, blood in stool, iron deficient anaemia
Diverticular disease
Outpouchings as a result of herniation of the mucosa and submucosa through the bowel wall at sites of weakness
Sigmoid colon most commonly affected
Can be present with intestinal obstruction
Complications of diverticular disease
Diverticulitis and perforation
-> peritonitis
Alcohol toxicity
350mg/dl to 600mg/dl
No antidote for alcohol toxicity
Chronic alcoholic liver disease progression
Fatty change - steatosis
Cirrhosis
Fibrosis
- hepatitis
What enzyme is raised in chronic alcohol misuse
Gamma-glutamyltransferase
Liver function tests
Bilirubin, albumin, total protein
ALT, AST, ALP
GGT
PT
Why do patients with chronic liver disease have a tendency to bleed
Dynamic disequilibrium between procoagulant and anti-coagulant states in individuals with cirrhosis
Other causes of steatosis - non alcoholic steatohepatitis
Obesity
Insulin resistance
Hyperglycaemia
High levels of fat
Symptoms/signs of acute hepatitis
Jaundice
Polymorphs/neutrophils in liver
Risks of a liver biopsy
Bleeding Pain Infection Collapsed lung/haemothorax Injury to other organs
Causes of cirrhosis
Alcohol
Viral hepatitis
Primary biliary cirrhosis (autoimmune)
Primary haemocromatosis (genetic - iron overload)
Wilson’s disease (genetic - Cu build up)
Alpha-1 antitrypsin deficiency (genetic increased risk of COPD and liver disease - inflammation of blood vessels)
Cryptogenic (unknown cause)
Complications of cirrhosis
Portal hypertension (cirrhosis, oesophageal varices, splenomegaly, encephalopathy)
Liver failure (jaundice, hypoproteinaemia, bleeding, hepatic encephalopathy)
Ascites
Hepatocellular carcinoma
Causes of bleeding in an alcoholic patient
Oesophageal varices Peptic ulcer Mallory Weiss tear (when a patient vomits against a closed cardiac sphincter - NSAIDS and Helicobacter - alcohol irritates gastric mucosa and exacerbates effects above) Haemorrhagic gastritis Reflux oesophagitis with ulceration
Alcohol related deaths
Sudden death in fatty liver due to metabolic acidosis - cardia arrhythmias
Haemorrhage - oesophageal varices, acute gastritis and peptic ulcers
Liver failure
What is hepatocellular carcinoma associated with
Alpha feto protein
Causes of acute renal failure
Hypovolaemic shock
Drugs
Congestive cardiac failure
Causes of chronic renal failure
Glomerlunephritis Chronic use of drugs (aspirin) Chronic pyelonephritis Hypertension Diabetes mellitus Autoimmune diseases Obstruction of urinary tract
Causes of urinary tract obstruction
Calculi/stones
Stricture in ureter/urethra
Benign prostatic hyperplasia
Cancer of bladder/prostate
Renal cell cancer
Yellow/pale variegated appearance
Patient may present with haematuria/loin discomfort
Symptoms of cystitis
Pain or burning when peeing Needing to pee more often/urgently Urine that's dark, cloudy, smells Pain low down in stomach Achy, sick tired feeling
Benign Prostatic Hyperplasia
Affects 50% of men over 60 years
Symptoms due to urethral obstruction: frequency in micturition, nocturne, poor stream, UTIs, bladder outlet obstruction
Prostatic cancer
Raised prostatic specific antigen, MRI, Needle core biopsies for diagnosis, CT
Radical prostatectomy
Complications of Radical prostatectomy
Bleeding, UTI, incontinenct, ED, narrowing of urethra or bladder neck, cysts
