BMJ Qs 1 Flashcards
(26 cards)
Hydatid disease
Tapeworm Echinococcus granulous
Welsh farmer
On ERCP we can see cystic compression of the biliary tree
Benzimidazole
Hepatic abscess
Streptococcus milleri
Ameba
Clue ^Temp ^WBC
Alcoholic hepatitis
Tender hepatosplenomegaly and fever are consistent with a diagnosis of alcoholic hepatitis, which frequently occurs on a background of cirrhosis.
Lab: leucocytosis, low platelets, ^ MCV
Liver function tests typically show an AST elevated greater than the ALT with at least a 2:1 ratio, transaminases are typically only slightly elevated; rarely over 300 and virtually never over 500. The alkaline phosphatase may well be significantly elevated giving the liver profile an ‘obstructive’
Liver mass on CT
Cholangiocarcinoma
Liver cysts
Poly cystic liver disease
Hydatidic disease
SBP
Bacteria
Medications that causes cholestasis
Co-amoxiclav
Response t IF in Hep. c
Favorable : Genotypes 2-3
Female
Young
Non -Black age
4 Repetic iro
No cirrhosis
Haemochromatosis
aim
lower end of normal range
1 Ferritin < 50 ug | L
PBC
primary biliary cirrhosis presents with tiredness and itching, in association with clinical (splenomegaly) and biochemical pancytopenia) evidence of portal hypertension
Campylobacter infection and others
pain in their right iliac fossa is a prominent feature
Reactive arthritis can develop following infection with a number of enteric pathogens including Shigella, Salmonella, Campylobacter and Yersinia
Gastric adenomas
Neoplastic progression is greater with polyps larger than 2 cm in diameter
occurs in
28.5-40% of villous adenomas
5% of tubular adenomas
Current BSG guidance
Wernicke’s encephalopathy
confusion, oculomotor signs, and ataxia affecting gait and stance
Wernicke’s encephalopathy is a medical emergency, requiring urgent intravenous thiamine, Vitamin B1.
The episode has been precipitated by intravenous dextrose administration which has exhausted his vitamin B reserves, hence B vitamins must be administered to all alcoholic patients requiring dextrose
Multiple endocrine neoplasia
Hypergastrinaemia may be the cause of the diarrhoea.
There is also hypercalcaemia as a result of the parathyroid hyperplasia indicative of this condition. There may not necessarily be a family history, sporadic cases make up 10% of new cases.
The infertility would fit with a prolactinoma
Pancreatitis acute
A poor prognostic indicator in the first 48 hours of acute pancreatitis include calcium <2 mmol/L
Poor prognostic indicators in the first 48 hours of acute pancreatitis include:
Age >55 years
WCC >15 ×109/L
Glucose >10 mmol/L
Urea >16 mmol/L
Albumin <30 g/L
AST >200 U/L
Calcium <2 mmol/L
LDH >600 U/L
PaO2 <8 kPa
Barrett’s oesophagus surveillance
low-grade dysplasia
repeat endoscopy in 6 months
Secretin CCK Gastrin VIP
Secretin is secreted from the small intestine when there is acid in the small intestine. It inhibits gastric motility and acid production and stimulates bicarbonate secretion from the pancreas and liver.
CCK stimulates gallbladder emptying and pancreatic enzyme release.
Gastrin stimulates gastric acid secretion and gastric motility.
Motilin stimulates intestinal peristalsis.
VIP induces smooth muscle relaxation, stimulates secretion of water into pancreatic juice and bile, and causes inhibition of gastric acid secretion; whilst in the intestine it greatly stimulates secretion of water and electrolytes
Aorto-enteric fistula
The strongly positive faecal occult blood (FOB) suggests significant GI haemorrhage.
Aorto-enteric fistulae (AEF) are now known to occur following endovascular repair of abdominal aortic aneurysms (AAA) and secondary to aortic grafting of any kind, presumably because of mechanical forces of dislodged or migrating devices.
This patient may well have had an aorto-bifemoral graft as treatment for peripheral vascular disease
Perforation
In this case, the clinical presentation may represent a perforation or ‘post-polypectomy syndrome.’ CT scan of the abdomen and pelvis can differentiate the two diagnoses via the absence or presence of free air
f the diagnosis is post-polypectomy syndrome (pain and inflammatory reaction to transmural diathermy injury) then this can be managed by admission and antibiotics/intravenous fluids. If perforation is detected, surgery may be required but often conservative management will be successful
Drug reaction to nevirapine
Rashes are common on starting treatment with nevirapine, occurring in ~15% of patients. Acute hepatitis is also common and fatal reactions
Paracetamol overdose
INR > 2.0 en las primeras 48 hours
INR >3.5 en las primeras 72 horas
Refer to specialist unit
Other factors which drive referral to a specialist unit include:
Encephalopathy or raised intracranial pressure (ICP) - signs of CNS oedema include BP >160/90 mmHg (sustained) or brief rises (systolic >200 mmHg), bradycardia, decerebrate posture, extensor spasms, and poor pupil responses
Renal impairment (creatinine >200 μmol/L) - monitor urine flow and daily U&E and serum creatinine (use haemodialysis if >400 μmol/L)
Systolic BP <80 mm Hg despite adequate fluid resuscitation
Hypoglycaemia
Metabolic acidosis (pH <7.3 or bicarbonate <18 mmol/L)
Sigmoid volvulus
A sigmoid volvulus would cause large bowel obstruction
Differential diagnosis
Toxic Meg’s a colon
Intestinal pseudo-obstruction
prescription and administration of oral bowel-cleansing agents
ake OCP pill as usual but take extra precautions against pregnancy for 1 week
Ascitis of Budd-Chiari Sd
presentation may be less acute, sudden onset of ascites, right upper quadrant pain and nausea is characteristic The ascites is associated with portal hypertension as indicated by a serum-ascites albumin gradient (SAAG) >11 g/L. Hepatomegaly is present due to venous congestion of the liver and the transaminases are usually only mildly deranged.
