23/2 Flashcards
PBC vs PSC, biliary disease, fat embolism, severe depression, pancreatitis
What are the two purposes of prescribing haloperidol in palliative pts?
Nausea
Intense dreamings/hallucinations
What antibodies are tested for in Graves?
TRAb - autoantibodies against the thyroid stimulating hormone receptor
PBC and PSC are diseases of middle age.
Describe the differences between the two
Who gets them?
Which one is linked with UC?
How do they both present?
What is the AB assoc. with PBC
What will bloods look like?
Which one responds to ursodeoxycholic acid?
PSC - repeated scarring and stricture formation in the bile ducts both intra and extrahepatically (hence the “beads on the string” appearance on USS)
PBC - AUTOIMMUNE condition which destroys the bile ducts in the liver
PBC = women (B = Boobs)
PSC = men and UC
FATIGUE
jaundice
puritus
~ fever and RUQ
anti-microchondrial antibodies (AMA) - PBC
Raised ALP in both
PBC = ursodeoxycholic acid helps to reduce the progression (think ursula is a woman = helps pBc)
The clinical presentation difference between fat embolism and pulmonary embolism?
Fat embolism often after trauma and presents with SOB and neurological symtpoms
- confusion
- altered levels of conciousness
- focal deficits
Can also get a petechial rash 24hrs after syndrome appears but this is rare
UNLIKE PE
What classes someone as having severe depression?
What is first line management?
Presence of either of the following on top of typical depressive symptoms:
- psychotic symptoms
- depressive stupor (mutism, profound immobility and refusal to eat and drink –> catatonic)
ECT
Define tenesmus
The frequent urge to go to the bathroom without being able to go - bowel and bladder sensation
Pancreatitis
- severity scale
PANCREAS
PaO2 (<7.9) - HYPOXIA
Age (>55)
Neutrophils (WCC >15) - NEUTROPHILIA
Calcium (<2 - hypocalcemia)
Renal function (urea >16)
Enzymes (lactate dehydrogenase >600)
Albumin (<32)
Sugar (BM >10) - HYPERGLYCAEMIA
3+ points = high risk of severe
What antibiodies are linked with prenicious anaemia?
Intrinsic factor antibodies are most relevant
What is the issue with having too high prolactin?
Messes with the horomonal axis
What med can be used to manage puritis associated with jaundice?
Colestryamine
What antibodies are associated with PSC?
pANCA
What is the goldstandard of investigating bile duct problems?
ERCP
What is ascending cholangitis?
Describe the Reynold’s pentad assocaited with ascending cholangitis
How is it managed?
Ascending cholangitis
= bacterial infection in the bile duct caused by bile stasis due to obstruction. this leads to a back pressure behind the obstruction as well which causes leaky vessels (increased risk of sepsis)
Bacteria in the bile duct
1. RUQ pain
2. Fever
Bile in the blood
3. Jaundice
Bacteria in the blood
4. Hypotension
5. Confusion
Cholecystectomy OR ERCP with removal of blockage
Sepsis management
Gallstone ileus is when a fistula forms between the bile duct and duodenum and gallstone can move down and get stuck in the intestine (most common terminal ileus)
What is the triad that is used to diagnose?
- Penumobilia (air in biliary tract)
- Small bowel obstruction
- Gallstone outside the gallbladder
Cholangitis vs cholecysitis
What is more severe?
What presents with Murphy’s sign
What differentiates cholecysitis from biliary colic?
Cholangitis - infection of the biliary tract
Cholecystitis - inflam of the gallbladder
Cholangitis - more severe obvs
Murphy’s sign = cholecysitis
= take in and hold deep breath while palpating the right subcostal area - pain = positive
Cholecysitis has the presence of fever and more systemic symptoms and pain will be constant unlike biliary colic
