What is the most common micro organism is amoebic liver abscess?
What happens in ascites?
Fluid leaks out of capillaries due to build up of pressure in the portal vein so fluid leaks out into abdominal cavity, increasing chance on infection.
What does the secretion of TGF do in cirrhosis?
Further stimulates stellate cells for a cascade of myofibroblasts proliferation which eventually produce matrix causing fibrosis.
What are the two types of gallstone?
Cholesterol and Bile pigment stones
How would IBD investigations differentiate between UC and Crohns?
Serology shows Crohns pANCA negative and UC is pANCA positive. Colonoscopy would show the different ulceration.
What is the treatment of a fistula in ano?
Drainage, antibiotics, fistulotomy and excision. May need a seton suture to maintain continence.
What causes refractory ascites?
Occurs secondary to metastatic malignancy caused by peritoneal infiltration by tumour, liver metastases and lymphatic obstruction, heart failure, advanced liver disease
What is treatment for hydatid abscess?
Albendazole and percuatnous aspiration, injection of scolicidal agent and re aspirate. (PAIR), surgery.
What is a 1st degree haemorrhoid and its treatment?
It remains in the rectum an treated with fluids, fibre, stool softener and topical analgesic.
What happens in hepatic pulmonary syndrome?
Endothelin 1 is secreted and binds to capillary cells and cause NO secretion for vasodilation, so not all will be replenished by o2 due to increase pressure, leucocytes also migrate to pulmonary capillaries to further stimulate NO secretion, causing insufficient o2 supply throughout the body, causing difficulty breathing
What causes an abscess?
Gut organisms, mainly in women, in the perianal area.
What are the ulcer management risk scales?
Pre endoscopy - Rockall score / Glasgow Blatchord Post endoscopy - Forest scale
What is extracorporeal shock wave uthotripsy?
A shock wave directed radio-logically or by US onto gallstones.
What are the causes of peritonitis?
blood borne or genital tract organisms, cirrhosis with ascites, ruptured appendicitis or diverticulitis, IBD, perforation, pancreatitis, surgery, spontaneous, PID, TB
What is midgut dysmotility and its symptoms?
Disordered motility and visceral sensation after the SI, causing abdominal pain from eating which is not relieved by opening the bowels, abdominal distension, postprandial fullness, nausea, anorexia, weight loss
Treatment of gastritis?
H. pylori - PPI, amoxicillin and clarithromycin, metronidazole Antacids or H2 receptor antagonists, PPI, Ranitidine
What main bacteria can cause infective diarrhoea?
salmonella (reptiles), shigella, campylobacter (puppies), Yersinia, E.coli, C.diff (antibiotics, in hospitals, community acquired, antimicrobials), mycobacterium avium complex (watery)
Symptoms of acute pancreatitis?
epigastric pain radiating to the back, nausea, vomiting, peri-umbilical and flank bruising
What symptoms are specific to amoebic liver abscess?
Diarrhoea, cough (anchovy paste suggesting broncho pleura fistula formation), history of travel to endemic areas in 5 month
What is an incisional hernia?
Weakness caused by a surgical repair that has not fully healed
What is used to detect scleroderma and what is the treatment?
Manometry or barium swallow, treat the reflux and the benign stricture.
How is fibrosis caused in liver cirrhosis?
Stellate cells and Kupffer cells are activated by cytokines and their receptors, reactive oxygen intermediates and paracrine and autocrine signals causing stellate cells to become swollen, lose retinoids, secrete cytokines (TNF-a, IL-6, IL-1B, TGF) and up regulate receptors for proliferative and fibrogenic cytokines via the CCL2 receptor e.g. PDGF and TGFB1.
What is diverticulitis and the symptoms?
When diverticulum in the intestines become inflamed from infection, LI pain, fever, constipation, diarrhoea, and decreased appetite. May be due to accumulation of pus from an abscess leading to perforation.
What is the treatment of Crohns disease?
Continued monitoring of complications, diet, TNF-a antagonists, methotrexate, colectomy, B12 and folate supplements, thrombosis prophylaxis, stop smoking, corticosteroids, antibiotics
What is an anal fissure and what is it caused by?
A tear in the sensitive skin liner lower anal canal, distal to the dentate line, causing pain on defecation. Caused by hard faeces or secondary to Crohn's or ulcerative colitis. Spasm could also constrict the inferior rectal artery causing ischemia, making it difficult to heal.
Symptoms of ischaemic colitis?
Sudden abdominal pain, passage of bright red blood, shock, distended and tender abdomen, thumb printing seen a splenic flexure on x-ray
Symptoms of gastritis?
functional dyspepsia, red mucosa, epigastric pain, vomiting, haematemesis
What does Ranson's criteria measure on admission of acute pancreatitis?
glucose, AST, LDH, Age, WBC
What are the investigations and results for peptic ulcer?
H.pylori test is a 13C urea breath test, stool antigen test, serological test and biopsy urease test. If younger than 55yrs and is H.pylori positive due to the tagged CO2 being present, start treatment immediately. If older than 55, may need endoscopic diagnosis and cancer exclusion.
What is ulcerative colitis called if it reaches the transverse colon?
Extensive colitis (20%)