Wilson

Question 1

Def

Answer 1

Mutation in the enzyme that transports copper the enzyme is found in the liver therefore copper accumulate in the liver because it cannot be transported out

Question 2

What if the copper get into the bloodstream

Answer 2

Haemolytic anaemia creams negative lead to jaundice

Question 3

Neuro findings

Answer 3

Psychiatric finding - aggression, sexual exhibitism, decline in performance
Similar to Parkinson - rigidity
Ataxia
Dystonias

Question 4

Eye manifestations

Answer 4

Rings - decsement membran

Sunflower cataracts - in the lens

Question 5

What are the levels of ceruplodsmin

Answer 5

They are usually LOW

Question 6

Labs

Answer 6

Low ceruloplsnin in blood
High excretion of cu in urine
Genetic testing of the ATP7b gene

Question 7

Tx

Answer 7

Chelators- d - penicilliamine
Avoid foods that are high in copper like chocolate

Zinc

Question 8

Why is Wilson’s bad

Answer 8

Fenton reaction leading to radicals

Question 9

Effects on liver

Answer 9

Fatty liver
Acute hepatitis
Chronic hepatitis
Cirrhosis

Question 10

Rome criteria

Answer 10

For IBS diagnosis

Need to have Recurrent abdominal pain at least one day per week for the past three months that is associated with 2 or more of the following

1. Pain related to defection
2. Change in stool frequency
3. Changes in form of stool or appearance

Question 11

What differentiates ibd from ibs

Answer 11

No nighttime pain
Patients well look
An alteration between constipation and diarrhoea whereas ibd is mainly diarrhoea

Question 12

Dx of ibs

Answer 12

Ovarian cancer - bloating early satiety and diarrhoea

Endometriosis often minimise

Both these in women which is more comin for ibs anyway

Question 13

Typical age for ibs

Answer 13

Younger people <40

Question 14

Tx IbS

Answer 14

CBT- if psych component
Increase fibre
Try exclusion diet

Drugs :
Loperamide first diarrhoea 
Laxatives soidum docusate 
Smasmolytics for pain 
If doesn’t work can try low dose TCA for the pain

Question 15

Symptoms of ibs that suggest organic

Answer 15

Night time pain 
Diarrhoea disturbing sleep 
Bleeding 
Weight loss 
Fever

Question 16

What to do to rule out organic

Answer 16

Fecal cal protection- iBD
Inflammatory markers -IBD
Celiac - look for antiensomesial ab’s

Question 17

Ques med criteria

Answer 17

Symptoms made worse by eating 
Passage of mucous 
Abdominal boosting 
Altered passage (straining  or urgency ) 
Relief of pain by defection

Question 18

What is IBS linked too

Answer 18

STRESS