wednesday 17th Flashcards
causes of metabolic alkalosis
hypokalaemia
loop diuretics
hyperaldosteronism
cushings
vomiting
liquorice
casues of a metabolic acidosis with raised anion gap
K- ketones: DKA, Alcohol
U- urate : renal failure
L - actate- sepsis, shock , hypoxia, metformin
T - toxins : salicylic,methanol
causes of a hyperchloreamic metabolic acidosis
addisons
diarrhoea
renal tubular acidosis
ureterosigmoidostomy
side effects of 5-ASA drugs
mesalazine - agranulocytosis, pancreatitis, headache
sulfa- oligospermia, headache, lung fibrosis
when shoudl prophylactic abx for SBP be offered? what one?
if ascitic protein <15g/l or had an episode of SBP
cipro
what neutrophil count is diagnostic of SBP
> 250
management of SBP
IV cefotaxime
symptoms of SBP
ascites, fever, pain
IX for budd chairir
USS with dopple flow
what hormones do renal cell carcinomas produce
EP, PTH, ACTH
what investigations should be done in a newly diagnosed cirrhotic patient
endoscopy for varices
USS for HCC(+AFP)
serum and urine osmolality findings in. SIADH
low serum osmol
high urine osmol - dumping all sodium
sodium high or low in diabetes insipidus
hypernatraemia
serum and urine osmolalities in SIADH vs DI
SIADH - low serum osmol , high urine osmol
DI- high serum osmol, low urine osmol
antibodies in addisons
anti-21-hydroxylase
when do you measure cortisol in a short synachten test- what is a normal result
before giving and after 30 mins - normally cortisol should double
most common cause of hyperaldosteronism
bilateral idiopathic adrenal hyperplasia
what test can differentiate between bilat idio adrenal hyperplasia and adrenal adenoma causing conns
adrenal venous sampling
first adn seconds investigatin in hyperaldosetrone
renin:aldosterone ration
high res CT following to find cause
rhyme for remebering reflex spinal levels
1,2 buckle my shoe 3,4 kick the door 5,6 pick up sticks 7,8 shut the gate
becks triad for cardiac tamponade
Distant heart sounds
Distended jugular veins
Decreased arterial pressure (low BP)
drugs that potentiate warfarin eg. CYP450 inhib
ODEVICES
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin/Cimetidine
Ethanol (acute intoxication)
Sulphonamides
drugs that decrease warfarin activity eg CYP450 inducers
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronically)
Sulphonylureas
what diameter is bad sign for melanoma
> 6mm
treatment of mild - mod UC proctitis
rectal 5-asa
rectal 5-asa and oral 5asa
rectal and oral 5asa + oral steroid
remission therapy in UC
5-asa either rectally or orally
maintenance therapy in UC if >2 exacerbations in a year
oral mercaptpurine or azathioprine
mangement of chrons - lifestyle, inducing remission adn maintenance
lifestyle - STOP SMOKING
inducing - steroids
maintain oral azathio or mercaptopurine
what cancers are most assoc with UC and Crohns respectively
UC - colorectal cancer
Crohns - small bowel
difference between low anterior resection and an abdominoperoneal resection
rectum removed in both anal canal left in anterior resection
if you have a rectal cancer causing obstruction what is surgical tx
defunctioning loop colostomy
treatment of colorectal caner obstruction
stent or resection
lymphatic drainage above and below pectinate line
above - iliac
below - inguinal
symptoms of diverticulosis
pr bleed
altered bowel habit
abdo pain
bloating
abx for diverticulitis
co-amoxiclav
complications of diverticulosis
Diverticulitis
Haemorrhage
fistula
Perforation
abscess
diverticular phlegmon
investigations in diverticular disease
FBC
CRP
erect CXR
AXR
CT?
management of thrombosed haemorrhoids
if <72 hrs - excise
if >72 hours - stool softeners analgesia
initial mangement of bowel obstruction
NBM
IV fluids
nasogastric tube with free drainage
what i sleft in subtotal colectomy
sigmoid and rectum
what is worse with eating duodenal or gastric
gastric
what inscision is used for an open cholecystectomy
kocher
what inscion is used for a liver trasnplant
mercedes benz
what inscions is used for a kidney transplant and where is it
LIF rutherford -morrison inscion
how do you check NG placement
aspiration and pH
