Treatment of peptic ulcer if H.pylori negative?
PPIs to stop excess gastric secretion, stop the initiating factors, use selective COX2 inhibitors instead of NSAIDs in future to prevent recurrence, follow up with endoscopy and biopsy. Surgery of vagotomy or partial gastrectomy if uncontrolled haemorrhage, antacids
How do you diagnose infective diarrhoea?
Stool culture (SSYC and Shiga toxin), ova and parasite, Cryptosporidium and Giardia antigen, C.diff toxin A and B PCR, faecal leukocytes (inflammation), BMP and electrolytes if dehydrated., CT scan, colonoscopy, biopsy
What is 5-ASA?
It treat UC and is activated by bacteria in the colon as it breaks down azo bonds to release 5-ASA. Released in the microsphere and acts via PPAR-Y signalling pathway to induce and retain remission and reduce inflammation.
Treatment of dyspepsia?
Stop smoking and alcohol, reduce weight around stomach and gaviscon in the day to reduce reflux. PPI before dinner and breakfast. Stop NSAIDs. Check for red flags (weight loss, dysphagia, mass, vomiting) for malignancy. Anti-reflux surgery. If functional (non ulcer) have diet review and antidepressants.
How do you diagnose primary biliary cirrhosis?
Positive anti mitochondrial antibody (AMA), positive antigen M2 and increased GGT and alkaline phosphatase, liver biopsy shows portal tract infiltration of lymphocytes and pasma cells and granulomas in zone 1, increased IgM as failure to switch to IgG, increased serum cholesterol, US shows diffuse alteration in liver architecture
What is acute cholecytitis and its symptoms and signs?
Severe pain in the RUQ following the impaction of a stone in the cystic duct or neck of gall bladder causing fever, raised WCC, abnormal liver biochemistry, focal tenderness, muscle guarding and thicken gall bladder wall
Treatment of anal prolapse?
Increase fluids and fibre, stool softeners, and if severe, surgical rejection rectopexy.
What microorganisms commonly causes biliary disease?
E.coli, K.pneumoniae, Bacterioides (anaerobes), Enterococci, clonorchis sinensis, opisthorchis spp., fasciola hepatica
What is the treatment of pruritus ani?
Enhanced toilet hygiene, capsaicin, no spicy food, anaesthetic cream keeping the area dry, avoid perfumed soaps and moisturised creams..
Signs and symptoms of acute cholangitis?
Causes RUQ pain radiating to LUQ and epigastrium, fever, jaundice (dark urine, pal stools, itchy skin), rigors and can be tachycardia during an attack. Increased WBC, leucocytosis, abnormal liver biochemistry, increased serum bilirubin and alkaline phosphatase. U/S shows dilated common bile duct and the cause of obstruction. ATL and PTT increased, decreased potassium absorption
Treatment of cirrhosis?
Avoid alcohol, aspirin, NSAIDs, reduce salt intake, adjust medications, manage symptoms e.g. cramps, hernias, treat complications, liver transplant.
What is a hiatus hernia?
Part of the stomach herniating through the oesophageal hiatus of the diaphragm caused by obesity and constipation
Treatment of a pilonidal sinus?
Excision of sinus tract with pre op antibiotics, complex tracts can be laid open and packed individually or skin flap can be used to cover the defect, keep clean, remove hair, drain pus.
DD for appendicitis pain?
IBD, inflamed Meckels diverticulum, acute salpingitis in women, terminal ileitis from Crohn's, mesenteric lymphadenitis
Treatment of peptic ulcer if H.pylrori positive?
Eradicate H.pylori with antibiotics, to increase healing and reduce recurrence, anti-secretary treatment if haemorrhage or perforation, antacids
What part is mainly affected in ulcerative colitis?
inflammation of rectal and sigmoid colon in 50% (proctitis)
What is a problem with probiotics?
Quality control and formulation restrict the clinical availability.
DD for RI pain?
Appendicitis, ectopic pregnancy, ovarian torsion, inguinal or femoral hernia
What makes up brown pigment stones, where are they found and when?
Calcium, salts of fatty acids and calcium bilirubinate. Found in bile stasis and biliary infection and cause recurrent bile duct stones post cholecystectomy.
In the presence of abdominal pain, what constitutes functional diarrhoea?
Passage of several stools in rapid succession, usually first thing in the morning A formed first stool, later ones are more mushy and watery Urgency of defecation Anxiety about bowel movement Exhaustion after defecation
What causes a fistula in ano?
Perianal sepsis, abscesses, Chron's disease, TB, diverticular disease, rectal carcinoma, immunocompromised
DD for RL pain?
kidney stones, UTI, constipation
What is diffuse oesophageal spasm and its symptoms?
Severe oesophageal dysmotility causing retrosternal chest pain and dysphagia, can accompany GORD. Can cause marked contractions on swallowing in oesophagus, but can be asymptomatic.
Epidemiology of DU?
in 10% of adults, 2.3x more common than GU, more common in elderly and developing countries.
What does Ranson's criteria measure after 48 hours of acute pancreatitis?
calcium, Hct, paO2, BUN, base defecit, sequestration of fluids (CHOBBS)
What are potential complications of hernias?
strangulation, incarceration, fistula formation, femoral are irreducible
How dose a mechanical lithotripsy work?
it facilitates fragmentation by increasing bile salt content to solubilise stones, uses oral chendeoxycholic acid and ursodeoxycholic acid
What would Achalasia show on investigations?
CXR - dilated pesophagus, fluid behing heart and absent fundal gas shadow Manometry - aperistalsis of oesophagus and failure of lower sphincter relaxation Oesophagoscopy and CT scan exclude carcinoma Barium swallow - lack of peristalsis and synchronous contractions inn oesophagus body with dilatation. Lower end shows bird beak due to lack of relaxation.
Treatment of varice?
IV Octreotide inhibits vasodilation and decreased bloodflow. IV Terlipressin restricts portal inflow by splenic arterial constriction (CI if IHD), somatostatin is similar Endoscopic banding around large veins to cut off blood supply. Transjugular intrahepatic porto systemic shunting to create a bypass with a metal stent between portal and hepatic venous circulation to relieve hypertension. Balloon tamponade with sengstaken Blakemore tube to prevent blood flow to bleeding point Injection sclerotherapy produces vessel thrombosis Endoscopic haemostasis by dilute adrenaline injection with coagulation of vessel, thermal therapy and mechanical dips to the vessel.
DD for RUQ pain?
Pancreatitis, Gastric ulcer, gallstones, biliary colic, acute cholangitis, acute cholecystitis