clinical Flashcards
(118 cards)
1
Q
chronic pancreatitis signs
A
Asymptomatic weight loss pain steatorrhea diabetes malabsorption jaundice duodenal obstruction (uncommon) upper GI haemorrhage Men ages 30-40 long term heavy drinking Cystic fibrosis gallstones high triglycerides lupus
2
Q
chronic pancreatitis symptoms
A
Pain exacerbated by food and alcohol
3
Q
chronic pancreatitis investigations
A
AXR Ultrasound EUS CT blood tests (low albumin, increased glucose, LFT) pancreatic function tests. faecal serum enzymes (elastase) ERCP/MRCP
4
Q
chronic pancreatitis diagnosis
A
MRCP/CT
5
Q
chronic pancreatitis treatment
A
Abstinence enzyme supplements analgesia coelic plexus block ERCP for pain relief it stones or strictures surgery antioxidant therapy low fat diet and insulin in necessary
stenting, bypass, thoracoscopic, splanchnectomy, resection
6
Q
pancreatic carcinoma signs
A
Hepatomegaly jaundice mass tenderness splenomegaly Virchow’s lymphadenopathy palpable gallbladder
7
Q
pancreatic carcinoma symptoms
A
Pain jaundice weight loss anorexia, fatigue, steatorrhea tender fat nodules thrombophlebitis ascites portal hypertension
8
Q
pancreatic carcinoma investigations
A
Blood tests & tumour markers USS, CT, MRI if jaundice then ERCP and stent if not then percutaneous biopsy then laparoscopy/laparotomy
9
Q
pancreatic carcinoma treatment
A
Staging; (fitness, ECg, CXR)
Often advanced disease. Radicle surgery (whipple’s). palliation of jaundice; cholechoduodensotomy
pain control
10
Q
dyspepsia signs
A
Anorexia Loss of weight Anaemia Recent onset Melaena Swallowing problems
11
Q
dyspepsia symtpoms
A
Pain in upper abdomen, retrosternal pain. Anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn
12
Q
dyspepsia investigations
A
History and examination bloods (serology, ferritin, IgA) drug history (steroids, nitrates, NSAIDS) >55yrs Endoscopy <55 test for H. Pylori
13
Q
gastritis symptoms
A
Nausea bloating Pain vomiting indigestion burning hiccups loss of appetite
14
Q
gastritis investigations
A
Serology of IgG
urea breath test
ELISA stool antigen test
biopsy for rapid urease test from endoscopy.
15
Q
gastritis signs
A
Vomiting blood
black stools
16
Q
peptic ulcer pains and signs
A
Epigastric pain nocturnal hunger nausea, vomiting weight loss anorexia haematemesis, melaena or anaemia
17
Q
peptic ulcer investigations
A
endoscopy
18
Q
peptic ulcer treatment
A
Eradication therapy
antacid medication (omeprazole, PPI)
cease NSAIDS
19
Q
peptic ulcer complications
A
Bleeding, perforation
Fibrosis, strictures, obstruction
20
Q
gastric outlet obstruction symtpoms and signs
A
Vomiting fermented food, early satiety, distension, weight loss, gastric splash, dehydration, alkalosis
21
Q
gastric outlet obstruction investigations
A
Bloods; low Cl, Na, K renal impairment
Endoscopy, aspiration of gastric contents
22
Q
gastric outlet obstruction treatment
A
Endoscopic balloon dilatation surgery
23
Q
gastric cancer pathology
A
Adenocarcinomas
maybe GALT or GIST
24
Q
gastric cancer symtpoms and signs
A
Dyspepsia, early satiety, nausea, vomiting, weight loss, GI bleeding, iron deficiency, gastric outlet obstruction
25
gastric cancer investigations
Staging; CT MDT discussion regarding fitness, imaging
Endoscopy and biopsy to make a histological diagnosis
26
gastric cancer treatment
chemo and surgery
27
ulcerative colitis signs
Fever >37
| tachycardia >90/min
28
ulcerative colitis symptoms
Bloody diarrhoea, abdominal pain, weight loss, anaemia
29
ulcerative colitis investigations
```
Albumin <30g/;
Hb <10g/dl
raised CRP
blood tests
stool calprotectin
biopsy
```
30
ulcerative colitis diagnosis
frequency >6 stools a day/blood
31
ulcerative coliti treatment
```
Surveillance colonoscopy
5ASA, then prednisone, then immunomodulators, then biologic agents then surgery
nutritional support
total colectomy
ileostomy
```
32
ulcerative colitis complications
Colonic carcinoma
haemorrhage
perforation
toxic dilatation
33
Crohn's disease symptoms and signs
Diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, low grade fever, malabsorption
34
Crohn's disease investigations
Blood tests
stool calprotectin
biopsy
35
Crohn's disease diagnosis
Presence of non-caseating granulomas
36
Crohn's disease treatment
```
Steroids
(5ASA?)
thiopurines
methotrexate
immunosuppressants
biologics (anti TNF alpha)
elemental feeding
antibiotics for peri anal disease
resection
```
37
Crohn's disease complications
```
Cancer
strictures
malabsorption
fistula
abscesses
```
38
ischaemic enteritis symtpoms
Gut pain
| bloody diarrhoea
39
ischaemic enteritis signs
```
60
constipation
atherosclerosis
hypotension
blood clots
blockage
```
40
ischaemic enteritis investigations
Ct angiogram
stool sample
colonoscopy
41
ischaemic enteritis diagnosis
colonoscopy
42
ischaemic enteritis treatment
IV fluids
antibiotics
surgery
colonoscopy
43
colorectal cancer symtpoms and signs
Right sided; anaemia, polypoid, vague pain, weakness, obstruction
left sided; annular, bleeding, altered bowel habit, obstruction
44
colorectal cancer investigations
```
FOBT
sigmoidoscopy
barium colonoscopy enema
digital rectal exam
fecal occult blood testing
CT
```
45
colorectal cancer treatment
Surgery
post op chemo
radiotherapy for rectal
46
spontaneous bacterial peritonitis pathology and aetiology
Aerobic gram negative organisms
| Endotoxins in ascites
47
spontaneous bacterial peritonitis signs and symptoms
Abdominal pain, fever, rigors, renal impairment, sepsis, tachycardia, temperature.
Jaundice, encephalopathy,
infection
48
investigations for spontaneous bacterial peritonitis
Ascitic tap; fluid proteins, cultures and WCC
neutrophil count >0.25*10*9
protein <25g/L
49
treatment for spontaneous bacterial peritonitis
IV antibiotics, ascitic fluid drainage, IV albumin infusion
50
alcoholic hepatitis symptoms
```
Loss of appetite
nausea
abdominal tenderness
vomiting
fever
fatigue
weakness
```
51
alcoholic hepatitis signs
Ascites
confusion
liver and kidney failure
52
alcoholic hepatitis investigations and diagnosis
Low albumin, raised prothrombin time
Raised bilirubin
raised GGT and AlkP
alcohol history and exclusion of other causes.
Glasgow hepatitis score
53
alcoholic hepatitis treatment
```
Supportive
treat infection
treat encephalopathy
treat alcohol withdrawal
protect against GI bleeds
airway protection and ITU. Nutritional support, thiamine. Frequent high energy feeds.
only steroids of severe enough (>9).
```
54
fatty liver steatosis to steatohepatitis investigations
USS, biopsy, raised Alanine amino transferase
55
fatty liver steatosis to steatohepatitis complications
1/4 cirrhosis
56
radiation colitis symptoms
Anorexia, abdominal cramps, diarrhoea, malabsorption
57
radiation colitis investigations
```
Complete blood count
bile acid conc.
b12 absorption
acid breath test
lactose intolerance test
colonoscopy CT MRI
```
58
appendicitis signs and symptoms
```
Dull pain
vomiting
swelling
fever
unable to pass gas
painful urination
cramps
diarrhoea
```
59
appendicitis investigations
```
Rectal exam
urine test
blood test
CT
US
```
60
appendicitis management
appendectomy
61
hepatic encephalopathy signs
Hyperventilation
decreased body temperature
tremor
bradykineasia
62
hepatic encephalopathy investigations
Elevated blood ammonia
EEG
CT
63
hepatic encephalopathy treatment
Bowel clear out, lactulose, enema, antibiotics. Support through ITU, airways and nasogastric tubes
64
liver failure symptoms
```
Confusion to coma
Nausea
loss of appetite
fatigue
diarrhoea
sleepy
```
65
liver failure signs
```
Jaundice
bleeding easily
swollen
mental changes
coma
```
66
investigations for liver failure
```
AST:ALT
GGT
ALP
LDH
platelets
USS
bilirubin
albumin
prothrombin
creatine
```
67
liver failure treatment
liver transplant
68
acute liver injury signs and symptoms
```
Jaundice
pain
abdominal swelling
nausea
vomiting
malaise
disorientation
sleepy
```
69
acute liver injury investigations
```
AST:ALT
GGT
ALP
LDH
platelets
USS
bilirubin
albumin
prothrombin
creatine
```
70
acute liver injury treatment
Poison reversal
antibiotics
liver transplant
prevent severe bleeding
71
cholestasis investigations
```
Bile acid
ALT
ultrasound
autoimmune screen
virology screen
```
72
cholestasis treatment
Dietary substitution
vitamins
surgery
ursodeoxycholic acid
73
primary biliary cholangitis investigations
Raised serum alkaline phosphatase and anti-mitochondrial auto-antibody
74
primary biliary cholangitis diagnosis
MRCP
ERCP
US
75
primary biliary cholangitis treatment
Fibrates
urseodeoxycholic acid
liver transplant
antihistamines for itching
76
cholangio carcinoma symptoms
Obstructive jaundice (itching, painful, non-specific
77
cholangiocarcinoma investigations
Lab, radiology, angiography, ERCP, cytology.
78
cholangiocarcinoma treatment
Surgical only curative option
Palliative; bypass, stenting, chemotherapy, PDT.
79
cirrhosis symptoms
```
Leg swelling
spider naevi
poor appetite
sickness
weakness
weight loss
nosebleeds
hair loss
ascites
forgetfullness
jaundice
```
80
cirrhosis investigations
US
81
cirrhosis treatment
Liver transplant
treat underlying cause
82
Gastro-oesophageal reflux signs
Dysphagia, weight loss, vomiting Alarm features
83
Gastro-oesophageal reflux diagnosis
Diagnosed on characteristic symptoms
however an endoscopy may be performed
84
gastro-oesophageal reflux treatment
Lifestyle measures
pharmacological; alginates, H2RA, proton pump inhibitors
anti-reflux surgery if a anatomical cause or refractory
85
achalasia symptoms
Progressive dysphagia for solids and liquids, weight loss, chest pain, regurgitation and chest pain
86
achalasia investigations
Manometry
endoscopy
87
achalasia treatment
Pharmacological; nitrates, calcium channel blockers
endoscopic; botulinum toxin, pneumatic balloon dilatation
radiological balloon dilatation
surgical myotomy
88
achalasia complications
Aspiration pneumonia
lung disease
squamous cell carcinoma
89
hypermotility sigs and symptoms
Severe episodic chest pain with dysphagia
90
hypermotility investigations
Manometry, Ba swallow
91
hypermotility treatment
Smooth muscle relaxants
92
oesophageal cancer symptoms and signs
```
Progressive dysphagia
weight loss
anorexia
chest pain
cough
Pneumonia
vocal cord paralysis
haematemesis
```
93
oesophageal cancer investigations
Staging by CT, endoscopic ultrasound, PET scan and bone scan.
94
oesophageal cancer diagnosis
Diagnosis by endoscopy and biopsy
95
oesophageal cancer treatment
Surgical oesophagectomy, either adjuvant or neoadjuvant chemotherapy
nutritional support
if non-operable then radiotherapy and chemotherapy.
palliation; endoscopic, chemo, radio, brachytherapy
96
Eosinophilic oesophagitis symptoms
Dysphagia
| food bolus obstruction
97
eosinophilic oesophagitis investigations
endoscopy
98
eosinophilic oesophagitis diagnosis
Eosinophilic infiltration upon microscopy of biopsy
99
eosinophilic oesophagitis treatment
Topical/swallowed corticosteroids
dietary elimination
endoscopic dilatation
100
barrett's oesophagus symptoms
```
Heartburn
dysphagia
vomiting blood
pain
weight loss
loss of appetite
```
101
barrett's oesophagus investigation
endoscopy
102
barrett's oesophagus treatment
Endoscopic mucosal resection
radio-frequency ablation
oesphagectomy
103
gallstones symtpoms
Asymptomatic
dyspeptic symptoms
biliary colic
jaundice (maybe obstructive, painful
104
gallstone investigations
Blood tests, USS, EUS, cholecystography, CT, radioisotope scan, IV cholangiography, MRCP, PTC, ERCP
105
gallstone treatment
Asymptomatic
| non-operative (dissolution, lithotripsy (risky)). Operative; laparoscopic cholecystectomy
106
gallstone complications
Empyema
perforation
acute pancreatitis
107
coeliac disease investigations
```
IgG
Serology
IgA
distal dueodenal biopsy
HLA
```
108
coeliac disease diagnosis
Gold standard is distal duodenal biopsy
109
coeliac disease treatment
Withdraw gluten refer to dietitian
110
bile duct obstruction symtpoms
```
Dark urine
itching
nausea
vomiting
fever
light coloured stool
```
111
bile duct obstructions signs
Jaundice, steatorrhea, weight loss
112
bile duct obstruction investigations
```
Blood test
MRI
x-ray
MRCP
ERCP
radionuclide scan
```
113
acute pancreatitis symptoms
```
Bending forward aids discomfort temporarily.
pyrexia
dehydration
circulatory failure
abdominal tenderness
```
114
acute pancreatitis signs
Intense Upper abdominal pain. Vomiting, nausea. Anorexia. Diarrhoea. Radiation to back.
collapse.
115
acute pancreatitis investigations
```
Elevation of serum amylase
ERCP
EUS
blood tests
AXR
CT (contrast)
LFT
ABG
```
116
acute pancreatitis diagnosis
```
Glasgow criteria;
PaO2 <8kPa
Age 55
Neutrophils 15*109/l
Calcium <2mmol/l
renal function urea >16 mmol/l
enzymes: AST/ALT >200iu/L or LDH >600iu/L
albumin < 32g/l
sugar: glucose >10mmol/L
>3 criteria
also CRP>150 mg/l
```
117
acute pancreatitis treatment
Analgesia, I.V fluids. Blood transfusion. Monitor urine. Naso-gastric tube. O2, maybe insulin. Nutritional support.
aspiration for necrosis. Cholecystectomy if gallstones.
support CV, resp. and renal
monitor BP, pulse, CVP
lipid lowering drugs
surgery; resection if malignancy,
118
acute pancreatitis complications
```
Mutlii-organ failure
necrosis
abscess (drain + antibiotics)
pseudocyst (endoscopic drainage) – jaundice, infection, haemorrhage, rupture.
Sepsis
```
