What happens in hepatorenal syndrome?
No damage to kidney, but reduced kidney perfusion due to insufficient blood supply to kidneys from portal hypertension
What causes a peptic ulcer?
Can be caused by H.pylori infection, NSAIDs or corticosteroids as they reduce mucosal protection and cause mucosal ischaemia. This causes the mucosa to appear inflamed and friable with a fibrous base and increase in inflammatory cells. (rarer causes are hyperparathyroidism, Zollinger Ellison syndrome, vascular insufficiency, sarcoidosis and Crohn's disease.)
Treatment of diffuse oesophageal spasm?
PPIs for reflux e.g. omeprazole, antispasmodics, nitrates, CCBs, GABA receptor agonists e.g. baclofen. Balloon dilation of longitudinal oesophageal myotmy.
What is the treatment for chronic pancreatitis?
Stop smoking, no alcohol, avoid high fat foods, analgesics, insulin therapy for diabetes, membrane stabalising agents e.g. pregabalin, duct drainage, pancreatic enzyme replacement therapy (PERT), multivitamin supplements, tricyclic antidepressants
What would liver biochemistry show in cirrhosis?
As severity increases, PT and creatinine increase and sodium decreases due to defect in free water clearance. Increase in ALP and aminotransferase. Look for viral markers, seum autoantibodies, immunoglobulins, iron, ferritin, coper, a, antitrypsin.
What causes varices?
Symptoms of varice?
Massive upper GI bleed (much more than Mallory Weiss tear)
Features of C.diff which make it suitable for infection?
Gram positive with terminal bulge due to spore, some hyper virulent strains e.g. ribotype 027, glucosyltransferases that target Rho family GTPases blocking their activation, toxin and b induce actin depolymerisation and cytoskeletal arrangement effecting epithelial tight junctions and permeability, spores allow persistence in environment, ingested by faeces-oral route, germinate in colon on exposure to bile salts
What would investigations show in IBD?
increased WBC, platelets, ESR, CRP, stools and c.diff toxin test to exclude infection, US shows inflammations and free fluid in abdominal wall
Which hiatus hernia is more painful?
Rolling due to volvulus and strangulation formed, so must be treated surgically.
Why dose liver cirrhosis cause itching?
Due to high levels of uric acid that can't be cleared by the liver?
DD for diarrhoea?
Malaria, sepsis, IBD, IBS, mal absorption (coeliac), malignancy, overflow with constipation, medicine (PI as antivirals), throtoxicosis
What is acute cholangitis?
A bile duct duct infection mostly from gall stone obstruction, causing biliary sepsis and septicaemia
What is the treatment of primary biliary cirrhosis?
Ursodeoxycolic acid which improves bilirubin and ATL. Cholestyramine to control pruritus. Steroids improve biochemical and histological disease Fat soluble vitamin supplements Bisphosphonates for osteoporosis Rifampicin and naloxone hydrochloride for opioid antagonists Liver transplant.
What is a 4th degree haemorrhoid and its treatment?
It remains persistently prolapsed. Treated with excisional haemorrhoidectomy or a stapled haemohhoidopexy.
What causes hydatid liver abscess?
Food or water contaminated with dog faeces causing a multi-layered cyst with daughter cysts tat can calcify
What is acute pancreatitis?
inflammation of the pancreatic gland and parenchyma due to acute injury
What are the 3 types of liver abscess?
Pyogenic, amoebic and hydatid
Signs and symptoms of IBD?
diarrhoea, rectal bleeding, abdominal pain, tenesmus, weight loss, fever, vomiting, cramps, muscle spasms
Signs and symptoms of liver cirrhosis?
Astrexis (hepatic flap), parotid gland swelling, spider naevi, jaundice, gynocomastia, hepatomegaly, splenomegaly, ascites, caput medusa, testicular atrophy, nail changes, clubbing, pulmonary empyema, hypertrophic osteoarthropathy
What are the symptoms of chronic
epigastric pain radiating to back, relieved on sitting forward and worse when eating and heavy drinking, weight loss, mal absorption, diabetes, jaundice, oily foul smelling stools
Chronic pancreatitis causes malnutrition, what are some complication of this?
osteoporosis, vision loss, difficulty maintaining weight
What are the two types of hiatus hernia?
Sliding (95%) and rolling
What causes a rectal prolapse and how?
Straining excessively and constipation leading to ulceration of anterior rectal wall so that it bleeds and produces mucus on defaecation.
How are cholesterol stones formed?
By cholesterol crystallization, when there is an excess of cholesterol in the bile duct as there is reduced bile salt and phospho lipids which normally keep cholesterol soluble to form micelles and vesicles
Epidemiology of IBD?
Crohns is more common than UC, and females are more likely to get Crohns, whereas both are equally predisposed in UC. Onset occurs usually around 15-40 years.
What is primary biliary cirrhosis?
An autoimmune illness where T cells are destroying the bile ducts leading to impaired bile formation and impaired bile secretion causing cholestasis causing retained toxic material leading to cirrhosis
What is the treatment for diverticulosis?
Increased fibre, stool softeners
What is a fistula in ano?
Blockage of deep intramuscular gland ducts between the skin and the anal /rectal canal causing a abscess with discharge.
What is gastritis?
Inflammation of the stomach lining due to decreased prostaglandin production causing mucosal damage.