What are mixed gallstones made up of?
Calcium salts, cholesterol and pigment
Questions to ask in a diarrhoea presentation?
times per day, blood, mucus, recent travel, pets, day care exposure, children, food exposure, sexual history, immunosuppressed, diabetes, medications, dehydrated, generalised tenderness, hyperactive bowel sounds
What is dyspepsia and what does it present with?
Postprandial fullness or early satiation or epigastric pain or burning for >4weeks a year. Presents with reflux, indigestion, heartburn, acid taste, boating.
What is the difference between a direct and indirect inguinal hernia?
Direct is due to weakness in abdominal wall, medial to inferior epigastric vessels Indirect is due to congential weakness of the internal inguinal ring, lateral to the inferior epigastric vessel (more common)
DD for LL pain?
kidney stones, UTI, constipation, IBD, diverticular disease
Complications of peptic ulcer?
Perforation, peritonitis, pancreatitis, gastric outlet obstruction from surrounding oedema or scarring which can lead to projectile vomiting and metabolic alkalosis, haemorrhage
How is gastric obstruction caused in gastritis?
There is increased inflammation which extends into the muscle lining of the stomach at the gastro duodenal sphincter so it cannot empty leading to severe vomiting, hypokalemia due to electrolyte loss and metabolic alkalosis, treat with pylori plathy
Treatment of ischaemic colitis?
Treat the symptoms, but surgery may be needed if gangrene, perforation or stricture formation
What is the scoring system called for acute pancreatitis and when do you do it?
The Ranson and Glasgow scoring system, on admission and 48hrs post presentation, The acute physiology and chronic health evaluation score (APACHE) assesses the severity based on physiological lab values.
Why does liver cirrhosis cause oedema?
Due to ascites, not all fluid will be returning to the heart, so the heart will think it has not got enough blood (hypovalaemia) so will cause vasodilation to increase blood flow to organs so the kidney will active RAAS system to increase sodium and water reabsorption leading to oedema. It is also encouraged by hypoalbuminaemia.
Prevention of recurrent variceal bleeding?
Non-selective BB e.g. propanol to reduce pulse rate and lower portal pressure Repeated Variceal banding if CI to BB TIPS if all else fails
What do panneth cells secrete?
Antimicrobial peptides to keep the microbes in the intestine in check
Treatment of pyogenic liver abscess?
Antibiotics e.g. amoxicillin-clavulinic acid, percutaneous aspiration US/CT guided, surgery to drain or remove abscess
Risk factors for gallstones?
age, female, obesity, Scandinavian, South America, smoking, parity
Symptoms of peptic ulcer?
Recurrent, burning epigastic pain, worse when hungry, nausea, vomiting, anorexia, weight loss, heartburn, flatulence. Back pain suggests penetrating posterior ulcer, severe ulceration can be symptomless and persistent and severe pain suggests penetration into other organs.
Treatment of achalasia?
Palliative treatment, nifedipine or sildenafil for durable relief, intrasphincteric injection with botulin toxin A, surgical division of LOS (Heller operation laproscopically), endoscopic dilation of LOS with hydrostatic balloon under x-ray control to weaken sphincter
What are the two main problems caused by cirrhosis?
Liver damage and portal hypertension
Management of refractory ascites?
Repeated paracentesis, diuretics (oral spironolactone and furosemide), intra peritoneal chemo, transjugular intrahepatic porto systemic shunt, peritoneovenous shunt, sodium restriction, albumin replacement, lose weight
Signs and symptoms of pre hepatic portal hypertension?
Bleeding at young age, normal liver function, blockage seen on US. Treat with anticoagulation.
What do M cells do in the intestine?
M cells sample antigens in the lumen for translocation of microbial peptide to activate immune cells resulting in chronic inflammation
Risk factors of a pilonidal sinus?
Male, obese, Caucasian, Asian, Middle East, sitting down a lot, lots of body hair
In who is ischaemic colitis common?
The young with contraceptives, thrombophilia and vasculitis.
Factors that help H.pylori infect?
Gram negative rod bacteria, flagella for motility, lipopolysaccharides for adherence, urease to convert urea and water to CO2 and ammonia, has VacA which causes apoptosis of cells, CagA disrupts cellular integrity and structure and promotes inflammation.
What is the most common micro organism is hydatid abscess?
Echinococcus granylosis (tapeworm)
What is diverticular disease?
Pouches of mucosa in large intestine extruding through the colonic muscular wall via weakened areas near blood vessels to form a diverticular (mainly in the sigmoid).
Complications of peritonitis?
dehydration, abscess formation, multi organ failure, toxaemia, septicaemia, septic shock, ARDS, bowel obstruction
How would you treat an anal fissure?
Local anaesthetic gel, fluids, fibre, stool softener, glyceryl titrate, diltiazem ointments, lidocaine ointment, GTN ointment or Botulin toxin or internal spichterectomy if severe.
Treatment of hernias?
What causes pernicious anaemia?
Burning to the stomach, destroys parietal cells which make intrinsic factor which produces B12, essential for red blood cell formation, causing low blood count and pernicious anaemia
What do investigations of an appendicitis show?
raised WCC, ESR and CRP, US shows inflamed appendix or mass, pregnancy test to rule it out