DD for lower GI bleeds?
haemorrhoids, diverticulitis, IBD, malignancy, polyps. angiodysplasia, infectious diarrhoea, anal fissure
What is a femoral hernia?
Weakness in the femoral canal, lateral and inferior to the pubic tubercle, more common in females, presenting with a mass in the groin.
Treatment of a Mallory-Weiss tear?
Can heal spontaneously, or can use surgery to over sew the tear. IV omeprazole to reduce re-bleeding rates and reduce the need for surgery.
Treatment of peritonitis?
NPO status, nasogastric tube to suction and decompress stomach, IV fluids, antibiotics, analgesics, oxygen and electrolyte replacement, surgery to identify cause and repair, drain peritoneal fluid, colon resection, antimicrobials, ascitic tap if >250PMN/uL and positive culture
What are some complications of acute cholecystitis?
Empyema (pus), perforation and peritonitis
What is the management of ulcerative colitis when there is not a flare up?
5-ASA therapy via rectal or oral and then oral prednisolone, colectomy
Treatment of infective diarrhoea?
Bacterial - fluoroquinolones, azithromycin, susceptibility testing C.diff - metronidazole or oral vancomycin Giardia - metronidazole or tinidazole Cryptosporidium - nitazoxanide Virus - self limited Amoebiasis - metronidazole and intraluminal agent e.g. paromycin or diloxanide
What do investigations show with diverticular disease?
Increased WCC, ESR, CRP and leucocytosis. CT shows paracolic abscess, colonic wall thickening, US shows thickened bowel and large pericolic collections
What is the difference between 2nd and 3rd degree haemorrhoids and what is their treatment?
2nd is prolapse through anus on defecation but spontaneously reduces and 3rd degree is the same but needs digital reduction. Treatment via rubber band ligation, scerolsant injection, infrared coagulation or cryotherapy.
How does smoking affect the two IBD?
Aggravates Crohns but protects against ulcerative colitis
DD for LUQ pain?
gastric ulcer, pancreatitis
DD for LI pain?
diverticular disease, IBD, ectopic pregnancy, ovarian torsion, inguinal or femoral hernia
What is an umbilical hernia?
Weakness in the umbilicus, mainly in males, and is self resolving.
What is skip lesions in the colon referred as?
Causes of liver cirrhosis?
Chronic viral hepatitis, alcoholic liver disease, hemochromatosis, autoimmune hepatitis, Wilson's disease and coeliac disease
What is the pathogenesis behind genetic chronic pancreatitis?
There is a mutation in the PRSSI gene which codes for cationic trypsinogen (the main trysinogen produced by the pancreas).
How does the sliding hiatus hernia occur?
The sphincter and top part of the stomach push upwards into the chest and cause heart burn due to reflux. They can slide back and forth through the hiatus, so symptoms can come and go.
Where is fasciola acquired from and what does it cause?
Fluke acquired from livestock in wetlands. Larvae picked up from plants, leads to hepatitis followed by biliary tract infestation with eoisinophilia
What is the treatment of acute pancreatitis?
IV fluids, nasogastric suction prevents abdominal distension and vomit, analgesics, prophylactic antibiotics, NBM, LMW heparin for DVT, ERCP for gallstone extraction, low fat diet
What are some acute causes of gastritis?
stress, NSAIDs, uraemia, Curling's ulcer, alcohol, spicy food
What type of cell produce HCl acid in the stomach?
What are prebiotics?
non-digestible food supplements that are fermented by host bacteria, altering the microbiota of the host, stimulating the growth of healthy bacteria.
Symptoms of primary biliary cirrhosis?
Fatigue, pruritus, dry mouth and eyes, RUQ discomfort, hepatomegaly, hyperpigmentation of skin, jaundice, pigmented xathelasma, association with other autoimmune diseases
Apart from UC and Crohns, what are other IBDs?
infective colitis, diverticulitis, ischaemic colitis
What is chronic pancreatitis?
structural integrity of the pancreas permanently altered due to chronic inflammation
Diagnosis of varice?
EGD to confirm diagnosis, identify bleeding site, estimate risk of bleeding , stop NSAIDs and start PPI post endoscope
Investigations in liver abscess?
LFT, elevated AST/ALT/ALP/bilirubin, low albumin, US shows hypo echoic mass and CT scan shows huge abscess, CXR shows pneumonia and air under diaphragm from complications
What causes black pigment stones?
A decrease in bile salts causes an increase in solubilization, colonic reabsorption of bilirubin, enterohepatic circulation and therefore an increase in biliary bilirubin secretion and increased stones
Complications of portal hypertension?
Gastro-oesophageal varicies, splenomegaly, thrombocytopenia, low platelet count, anaemia, leucopoenia, haemorrhoids, hepatic encephalopathy due to excess ammonia, loss of memory, confusion, coma, hepatic pulmonary syndrome,
DD for hypogastrium pain?
UTI, appendicitis, IBD, diverticular disease