Review of posters 04/05/2016

Question 1

Diverticulosis

Answer 1

Presence of diverticula

Question 2

Diverticulitis

Answer 2

Inflammation and infection of the diverticula.

Question 3

Pathophysiology of diverticulitis

Answer 3

Outcropping (diverticula) has a neck. This can become blocked by faeces-which means the faeces there is stagnent. This allows bacteria time to infect the diverticula causing diverticulitis.

Question 4

Symptoms of diverticulitis

Answer 4

Fever
Severe LIF pain 
Constipation
Tachycardia
Febrile

Question 5

Where does diverticulitis normally occur?

Answer 5

Sigmoid colon

Question 6

On examination of diverticulitis, what would you observe/

Answer 6

Tenderness, rigidity and gaurding

Question 7

Treatment of mild diverticulitis.

Answer 7

Antibiotics- ciproflaxacin and metronidazole.

Question 8

Treatment of severe diverticulitis

Answer 8

Hospital admission, fluids, antibiotics.

Question 9

Do people with diverticular disease but without acute diverticulitis have symptoms?

Answer 9

nope

Question 10

What dietary advice would you give someone with diverticular disease?

Answer 10

Increase dietary fibre.

Question 11

If someone is symptomatic however does not have acute diverticulitis- what investigations would you perform?

Answer 11

Colonoscopy, barium enema, flexible sigmoidoscopy

Question 12

What would investigations into acute diverticulitis show?

Answer 12

raised CRP and ESR

Ultrasound and colonscopy showing thickening of the colonic wall.

Question 13

What is non-alcoholic fatty liver disease?

Answer 13

Presence of fat deposits in the liver.

Question 14

How does NAFLD occur?

Answer 14

Intake of too much fat in diet. (same consequences would be seen with alcohol however would not be called NAFLD)

Question 15

What is non-alcoholic steatohepatitis?

Answer 15

Development of NAFLD (condition worsened)

Question 16

How is fat content in a healthy liver balanced?

Answer 16

By oxidation of triglycerides and fatty acid export keeping the fat content low. And lipogenesis and uptake of free fatty acids offering a balance by taking in fat to the liver.

Question 17

Pathophysiology of NAFLD.

Answer 17

Lipoproteins circulate in the blood- these are made up of triglycerides. Hormone induced lipase breaks this down into free fatty acids which are taken up by the liver hepatocytes. The free fatty acids in the liver hepatocyte can either go on to re-form the triglycerides (bad) or go through oxidation (good).
PPAR alpha- comes into play when there is excess energy. If it is effective- it will increase oxidation of free fatty acids, however if it is defective it will increase storage as triglycerides. This allows fat to build up in the liver.

Question 18

How does NAFLD develop onto NASH

Answer 18

Inflammation occurs. Fat accumalation, liver cell necrosis and fibrosis.

Question 19

When does NAFLD progress to become irreverisble?

Answer 19

Both NASH and NAFLD are reversible. However if NASH was to develop further to cirrhosis- this would not be reversible

Question 20

What is the treatment of NAFLD and NASH?

Answer 20

WEIGHT LOSS AND EXERCISE.

Question 21

How would you investigate NAFLD or NASH?

Answer 21

Ultraosund

liver biopsy

Question 22

Ventricular septal defect

Answer 22

This is a common congenital defect where there is a hole between the ventricles allowing blood to flow through.

Question 23

Describe the consequences of ventricular septal defect

Answer 23

Left to right shunt occurs. Due to blood being under more pressure in the left side of the heart than the right- blood will move from a higher pressure to a lower pressure.
This will increase the amount of blood in the right side of the circulation and can cause pulmonary hypertension.

Question 24

Describe the two types of ventricular septal defect.

Answer 24

Small VSD- may be asymptomatic- no abnormal ECG or CXR findings.
Large VSD- significant left to right shunt. Pulmonary arteries may be more prominent on CXR due to increased flow. Also shows cardiomegaly.
Echo- will assess hole size and haemodynamic consequence.

Question 25

Treatment of VSD

Answer 25

Surgical intervention- this should happen when the atria start to become affected.

Question 26

Atrial septal defect

Answer 26

Hole between the atria

Question 27

Where can ASD occur?

Answer 27

Sinus venosus- by the SVC or IVC
Ostrium secundum- mid septum
Ostrium primun- lower part of septum

Question 28

What happens in ASD

Answer 28

Significant left to right shunt results in right heart overload and dilatation.

Question 29

Symptoms of ASD

Answer 29

Breathlessness, exercise intolerance, atrial arrhythmias

Right ventricular heave

Question 30

Investigations and treatment of ASD

Answer 30

Prominent pulmonary arteries on CXR

Right bundle branch block and right axis deviation on ECG

Question 31

Patent ductus arteriosus

Answer 31

Ductus arteriosus (connection between the proximal left pulmonary artery and the descending aorta) fails to close

Question 32

What symptoms/signs would you see from patent ductus arteriosus?

Answer 32

Machine like murmur

Question 33

treatment of patent ductus arteriosus?

Answer 33

Indometacin (prostaglandin inhibitor)

Question 34

Co-arctation of the aorta

Answer 34

Narrowing of the aorta at the ductus arteriosus

Question 35

Symptoms of co-arctation of the aorta

Answer 35

Often asymptomatic
Hypertension in upper limbs
Weak, delayed pulses in lower limbs

Question 36

Treatment of co-arctation fo the aorta

Answer 36

Baloon dilatation
stenting in older children
Surgical repair in neonates.

Question 37

Cyanotic heart disease

Answer 37

Fallots tetralogy

Question 38

What is fallots tetralogy

Answer 38

A large malaligned ventricular septal defect
An overiding (aorta is directly over the ventricular septal defect) aorta
Right ventricular outflow obstruction
Right ventricular hypertrophy

Question 39

Treatment of cyanotic heart disease

Answer 39

Pulmonary shunts
Postural manoeuvres (squatting)