GI and endocrine Flashcards
(224 cards)
1
Q
management of hypoglycaemia if conscious
A
- initially 10-20g glucose PO either liquid/sugar lumps - can repeat after 10-15 minutes
- then snack providing sustained carbohydrate given
2
Q
management of hypoglycaemia if unconscious
A
- community/can’t get access = IM glucagon
- 20% IV glucose - 10g
3
Q
treatment of hypoglycaemic coma (follows profound hypo lasting >5 hours causing cerebral oedema)
A
IV mannitol and dexamethasone
with IV glucose and constant glucose monitoring to keep glucose level at 5-10mmol
4
Q
criteria for diagnosing DKA
A
- urine ketones ++ or in blood >3mmol/l
- capillary blood glucose >11mmol/L or known T1DM
- ABG - pH <7.3 or HCO3 <16mmol
5
Q
drugs which can cause diabetes
A
steroids
antipsychotics
thiazides
6
Q
steps 1, 2, 3 and 4 for T2DM drug management
A
1) if >48, metformin 500mg BD after food - if metformin not tolerated or CI: give gliptin or gliclazide or pioglitazone
2) if >58 16 weeks later: metformin + sulphonylurea (gliclazide 40mg OD) or pioglitazone or SGLT2 inhibitor
- if >58 6 months after use INSULIN
3) if >58 triple therapy:
- metformin + sitagliptin + gliclazide
- metformin + pioglitazone + gliclazide
- metformin + gliclazide + SGLT2 inhibitor
4) if not tolerated, side effects or contraindicated AND BMI >35
- metformin + gliclazide + GLP-1 mimetic
7
Q
chief cause of death in diabetes
A
CVD - 75% have heart attack/stroke
8
Q
how to check for diabetic nephropathy
A
check for microalbuminuria (ACR >3 but dipstick not positive for protein)
keep BP under control
9
Q
when to avoid metformin
A
if eGFR <36
10
Q
what procedures to stop metformin for
A
before GA or contrast containing iodine
11
Q
diabetes drugs causing hypoglycaemia and weight gain
A
sulphonylureas - e.g. gliclazide
pioglitazone
12
Q
which diabetes drug can cause fractures, fluid retention and increased LFTs
A
pioglitazone
13
Q
which diabetes drug is contraindicated in CCF or osteoporosis
A
pioglitazone
14
Q
diabetes drug increasing the risk of UTI/thrush
A
SGLT-2 inhibitors e.g. empaglifozin
15
Q
what is Charcot’s arthropathy
A
diabetic foot injury:
osteoporosis, fracture, acute inflammation and disorganisation of architecture
usually presents as hot swollen foot after minor trauma
16
Q
what is necrobiosis lipoidica
A
inflammatory condition where shiny, red-brown or yellow patches develop in the skin usually on the shins
associated with diabetes
17
Q
what is the SINBAD system used for
A
to document severity of diabetic foot ulcer:
site, ischaemia, neuropathy, bacterial infection area and depth
18
Q
antibiotic treatment for osteomyelitis (often in diabetic foot disease)
A
flucloxacillin +/- gentamicin/metronidazole for at least 7 days put o 6 weeks
19
Q
annual screening for diabetic foot disease
A
- palpating pulses
- 10g monofilament on sole of foot (neuropathy)
20
Q
what do the antibodies do in graves
A
stimulate TSH receptor
21
Q
what is acropachy
A
soft tissue swelling of hands and clubbing of fingers (periostitis)
in graves disease
22
Q
complication of carbimazole
A
agranulocytosis - warn to come for FBC if sore throat
23
Q
management of graves
A
- BBs for rapid symptom control (or CCB)
- carbimazole - usually euthyroid within 4-8 weeks
- repeat TFTs monthly and alter dose according to T4 level
24
Q
when is radioiodine for graves disease contraindicated
A
pregnancy
age <16
thyroid eye disease
25
causes of Addison's disease
- autoimmune (most common)
- TB
- metastases
- HIV
- APS
- meningococcal septicaemia
- secondary - pituitary disorders (tumours, irradiation, infiltration)
26
which endocrine disorder causes hypotension
ONLY Addison's
27
electrolyte imbalances in Addison's
hyponatraemia (in 90%)
| hyperkalaemia
28
how does the short Synacthen test work
plasma cortisol measured before and 30 minutes after given 250mcg of Synacthen IM
should cause a rise in cortisol - in adrenal insufficiency this doesn't occur
29
cortisol levels to investigate for Addison's
- <100 = urgent investigation
| - 100-500 = refer to endocrinology
30
ACTH levels in primary insufficiency (Addison's) vs secondary
primary/Addison's = ACTH high
secondary = ACTH normal/low
31
management of adrenal crisis
high dose hydrocortisone and IV fluids (with dextrose if hypoglycaemic)
6 hourly hydrocortisone until patient stable
32
drugs which can cause hypothyroidism
lithium
amiodarone
carbimazole
33
secondary causes of hypothyroidism
- pituitary failure
| - associated with Down's syndrome, Turner's and coeliac disease
34
TFTs in primary vs secondary hypothyroidism
- primary = increased TSH, low T4, low/normal T3
| - secondary = low/normal TSH, low T4, low/normal T3
35
antibodies present in hypothyroidism (usually)
anti-TPO
36
when to lower dose of levothyroxine for hypothyroidism
elderly
ischaemic heart disease
NB: increase dose in pregnancy
37
when should TFTs be checked after changing dose of levothyroxine
after 8-12 weeks
goal is TSH 0.5-2.5
38
complications of levothyroxine
- hyperthyroidism
- AF
- worsening of angina
- reduced bone mineral density
- interacts with iron and calcium carbonate - five at least 4 hours apart
39
most common cause of primary hyperparathyroidism
solidary adenoma
40
cause of secondary hyperparathyroidism
decreased vit D / chronic renal failure
= hypocalcaemia, leading to more PTH secreted = hyperplasia
serum calcium level will be low/normal but PTH will be high
41
treatment of secondary hyperparathyroidism
correcting underlying cause - vit D deficiency, renal failure
42
cause of tertiary hyperparathyroidism
when secondary continues for a long time - parathyroid hyperplasia = baseline PTH increases dramatically
when treating secondary and reduced need for increased PTH - PTH still high as it used to be producing large amounts = hypercalcaemia
43
characteristic XR finding of hyperparathyroidism
pepper pot skull
44
investigation results for hyperparathyroidism
- raised calcium
- LOW phosphate
- PTH raised or normal (inappropriately given the raised calcium)
45
definitive management of primary and tertiary hyperparathyroidism
total parathyroidectomy
46
when can you do conservative management for hyperparathyroidism
if calcium <0.25 mmol/l above upper limit of normal
AND patient >50
AND no evidence of end organ damage
calcimimetic agents e.g. cinacalcet
47
complications post parathyroidectomy
- hypocalcaemia
| - recurrent laryngeal nerve injury
48
ECG findings in hypercalcaemia
- bradycardia
- short QT
- wide T waves
- prolonged PR
- BBB
- arrhythmia
- HTN
- arrest?
49
what is premature arcus senilis
white/grey opaque ring in corneal margin - sign of hyperlipidaemia
50
cholesterol level to refer for familial hyperlipidaemia
consider if >7.5
refer if >9 or LDL >7.5
51
primary prevention for hyperlipidaemia
if QRISK2 >10% or T1DM >40 or DM >10 years or CKD if eGFR <60
atorvastatin 20mg OD
if non-HDL hasn't fallen by 40%+ then consider titrating up to 80mg
52
secondary prevention for hyperlipidaemia (known IHD/CVD/PAD)
atorvastatin 80mg OD
53
what is primary hypoparathyroidism
decreased PTH secretion e.g. secondary to thyroid surgery
LOW calcium, high phosphate, low/inappropriately normal PTH
54
treatment of hypoparathyroidism
alfacalcidol
| diet rich in calcium and vit D
55
what is Trousseau's sign
carpal spasm if brachial artery occluded by inflating BP cuff - sign of hypoparathyroidism
56
what is Chvostek's sign
tapping over parotid causes facial muscles to twitch - sign of hypoparathyroidism
57
how is pseudohypoparathyroidism characterised
similar findings to hypoparathyroidism - but PTH is elevated due to PTH resistance
58
when to FNAC a thyroid nodule
any nodule ?1cm
59
any patient with thyroid lump + stridor =
same day referral - may be recurrent laryngeal nerve involvement
60
TFTs in a non toxic/simple goitre
normal - non-functioning nodules
61
what is Riedel's
rare cause of hypothyroidism - dense fibrous tissue replacing normal thyroid parenchyma = hard, fixed painless goitre
associated with retroperitoneal fibrosis
62
when to give FFP in active bleeding
if fibrinogen level <1/litre
if PT/APTT >1.5 normal
63
when should endoscopy be offered in acute GI bleed
should be offered immediately after resuscitation in patients with severe bleed - all patients within 24 hours
64
what to do before endoscopy in ?varices
give terlipressin 2mg QDS before endoscopy - stop once haemostasis achieved
also give ciprofloxacin 200mg IV for 72 hours before
65
definitive management of oesophageal varices
- band ligation
| - transjugular intrahepatic portosystemic shunts (TIPS) if band ligation unsuccessful
66
type of laxative to use in opioid induced constipation and impaction
osmotic - Macrogol/movicol 1st line, lactulose 2nd line
add stimulant (Senna) if response inadequate
67
what is Beriberi
HF with general oedema or neuropathy - due to lack of B1 (thiamine)
68
what is pellagra
diarrhoea, dementia, dermatitis
due to lack of nicotinic acid (B6)
69
what is Kwashiokor
malnutrition due to severe deficiency of proteins/essential amino acids
can cause abdominal distension with fatty liver
70
investigation results in Kwashiokor
- hypoalbuminaemia
| - normo and microcytic anaemia
71
what is Marasmus
malnutrition due to severe energy (calories) deficiency
hypoalbuminaemia found
72
how should refeeding be started if at risk of refeeding syndrome
started at <50% energy requirements if eaten little/nothing for 5+ days - increase slowly over 4-7 days
73
drugs which can cause GORD
- TCA
- anticholinergics
- nitrates
- CCB
- NSAIDs
74
when to do an upper GI endoscopy for GORD
- >55
- symptoms >4 weeks/despite treatment t
- dysphagia
- relapsing symptoms
- weight loss
If endoscopy is negative - do 24 hour oesophageal pH monitoring
75
how is oesophagitis graded on endoscopy
Savary-Miller grading (1-5 - 5 is Barrett's)
76
management of endoscopically proven oesophagitis
- full dose PPI for 1-2 months
| - if no response - double dose PPI for 1 month
77
management of endoscopically negative oesophagitis
- full dose PPI for 1 month
| - if no response - H2 receptor antagonist or pro kinetic for 1 month
78
most common type of oesophageal carcinoma in UK
adenocarcinoma (most likely in GORD/Barrett's)
79
what is bird beak sign
back up of food in oesophagus (in achalasia - where the LOS doesn't open fully during swallowing)
80
most common type of hiatus hernia
sliding (GOJ moves above the diaphragm)
other type = rolling (GOJ remains below diaphragm and separate part of stomach herniates through oesophageal hiatus)
81
what is diagnostic of hiatus hernia on CXR
retrocardiac air-fluid level
82
pharmacological management of hiatus hernia
PPI (also H2 antagonists but less effective)
only do surgery if high doses of meds not helping (respiratory complications, risk of strangulation)
83
drugs which can cause a peptic ulcer
- NSAIDs
- SSRIs
- corticosteroids
- bisphosphonates
84
most common type of peptic ulcer
duodenal
85
when is endoscopy required for a peptic ulcer
IDA
weight loss
progressive dysphagia
epigastric mass
86
management of H. pylori negative peptic ulcer
PPIs until ulcer healed
87
management of H. pylori positive peptic ulcer
- PPI + amoxicillin + clarithromycin OR
| - PPI + metronidazole + clarithromycin
88
most common type of gastric carcinoma
>90% adenocarcinoma
89
infection associated with gastric cancer
H. pylori
90
when to do 2 week referral for suspected gastric cancer
dyspepsia AND:
- progressive dysphagia, persistent vomiting, IDA, epigastric mass etc
- >55 and unexplained persistent dyspepsia
- dysphagia
- unexplained upper abdo pain and weight loss
91
management of proximal gastric carcinoma (5-10cm from OG junction)
subtotal gastrectomy
92
management of gastric carcinoma if tumour <5cm from OG junction
total gastrectomy
93
what is Trousseau sign
migratory thrombophlebitis - sign of pancreatic cancer
94
endocrine tumours of the pancreas - by cell type and hormone secreted
- Gastrinoma (G cells)
- Glucagonoma (alpha cells)
- Insulinoma (beta cells)
- Somatostatinoma (gamma cells)
95
genes associated with coeliac disease
HLA-DQ2 and HLA-DQ8
96
duodenal biopsy findings in coeliac disease
- villous atrophy
- crypt hyperplasia
- increase in intraepithelial lymphocytes
- lamina propria infiltration with lymphocytes
97
why are people with coeliac offered pneumococcal vaccine
may have functional hyposplenism
98
drugs which can cause acute pancreatitis
- mesalazine
- azathioprine
- NSAIDs
- bendroflumethiazide
- furosemide
- sodium valproate
- steroids
- pentamidine
99
indications of severe pancreatitis
- hypocalcaemia, hyperglycaemia
- hypoxia
- neutrophilic
- elevated LDH and AST
100
what does a Glasgow Prognostic score of >3 suggest
severe acute pancreatitis
101
what does an APACHE II score of >8 suggest
severe acute pancreatitis
102
amylase level diagnostic of acute pancreatitis
3x normal
>1000
103
VACCINE mnemonic for acute pancreatitis management
- Vital signs monitoring
- Analgesia/abx (NOT morphine, don't usually give abx)
- Catheterise (due to potential for 3rd space losses)
- IV access and fluids
- NG tube
- ERCP
- Surgery if infection and necrosis
104
when does spontaneous bacterial peritonitis occur
in patients with ascites secondary to chronic liver disease
105
antibiotics to treat SBP
IV cefotaxime
106
when to give antibiotic prophylaxis to patients with ascites (risk of SBP)
- previous episode of SBP
| - fluid protein <15g/L and Child-Pugh score 9+ (until ascites has resolved)
107
location of femoral hernia (more common in women)
lateral and inferior to pubic tubercle (medial to femoral pulse)
108
how quickly should femoral hernias be treated
within 2 weeks - due to high strangulation risk
109
when would an umbilical hernia require repair
if >1.5cm or >4 years
110
what may cause acalculous cholecystitis
seen in hospitalised and v ill patients - gallbladder stasis, hypo perfusion, infection
111
pain management given in acute cholecystitis
usually parenteral morphine/pethidine
112
definition of significant portal hypertension
hepatic venous pressure gradient of >=10mmHg
113
pre-hepatic causes of portal HTN
blockage of portal vein before the liver:
- congenital atresia/stenosis
- portal vein thrombosis
- splenic vein thrombosis
- extrinsic compression - e.g. tumours
114
hepatic causes of portal HTN
- cirrhosis
- chronic hepatitis
- fibropolycystic disease
- schistosomiasis
- toxins
- nodular
- idiopathic
- granulomata e.g. sarcoid
115
post-hepatic causes of portal HTN
- Budd-Chiari (hepatic vein obstruction)
- constrictive pericarditis
- right heart failure
- veno-occlusive disease
116
viruses (other than hep A-4) which can cause viral hepatitis
CMV, EBV, adenovirus, HSV
117
common type of hepatitis in travellers
hep A (faeco-oral route)
118
most common type of hepatitis worldwide
hep B (transmitted through body fluids/blood)
119
how is hep C transmitted
via IVDU, haemodialysis, sexual contact, needle stick injuries, vertically
120
what does hep D require to replicate
presence of hep B
121
what does a fibroscan do
measures 'stiffness' of liver using 50-MHz wave from US probe - for liver cirrhosis
122
who to do screening for liver cirrhosis
- people with hep C
- men drinking >50 units of alcohol a week
- women drinking >35 units of alcohol a week
- diagnosed with alcohol-related liver disease
123
what can be given for pruritis in liver cirrhosis
colestyramine
124
prevention of liver cirrhosis
- immunisation against hep B
| - sensible drinking
125
investigation results in NAFLD
ALT>AST
126
what is the ELF blood test
enhanced liver fibrosis test
127
how much ascitic fluid needed to be detectable on clinical examination
>1.5L
USS can detect >500ml
128
types of hepatitis increasing risk of ascites
hep B/C
129
management of ascites
- treat cause
- salt restriction to <90 mmol/day
- diuretics (usually spironolactone)
- paracentesis
- prophylactic abx to reduce risk of SBP
- transjugular intrahepatic portosystemic shunt (TIPS) if needing frequent paracentesis
130
what does UC never spread beyond
ileocaecal valve (and continuous disease)
so basically never beyond large bowel
131
endoscopy results in Crohn's
deep ulcers, skip lesions, 'cobblestone' appearance
132
endoscopy results in UC
widespread ulceration with preservation of adjacent mucosa
133
type of IBD increasing the risk of colorectal cancer
UC (higher risk than Crohn's)
134
pANCA in Crohn's vs UC
Crohn's = negative
UC = positive
135
what indicates bowel stricture in Crohn's
small bowel enema - 'Kantors string sign' in terminal ileum
136
drugs increasing the risk of diverticulae perforation
NSAIDs
opioids
steroids
therefore avoid these - give paracetamol for analgesia
137
what is notorious for concealing colon cancer
diverticular disease
138
presentation of acute diverticulitis
- severe abdo pain in LLQ (may be RLQ in some asian patients)
- N+V
- change in bowel habit (constipaiton more common)
- urinary sx (irritation of bladder)
- PR bleeding?
- tachycardia, low pyrexia
139
treatment of acute diverticulitis
- abx (metronidazole)
| - fluids, liquid diet, analgesia
140
Rosving's sign
pain felt in the RIF on pressing over the LIF (appendicitis)
141
Psoas sign
pain on extending hip if retrocaecal appendicitis
142
Cope sign
pain on flexion and internal rotation of right hip if appendix is in close relation to obturator internus
143
prophylactic abx to give in appendicitis to reduce post op infection
Metronidazole 500mg/8hr + cefuroxime 1.5g/8hr
144
what might an ABG show in bowel obstruction
high lactate - ischaemia?
145
what are haustra
transverse bands in large bowel - DON'T cross the full diameter of the bowel
146
what are valvulae conniventes
transverse bands of small bowel - DO cross the full diameter of bowel
147
3, 6, 9 rule
- dilated small bowel = >3cm is abnormal
- dilated large bowel = >6cm is abnormal
- dilated caecum = >9cm is abnormal
148
management of bowel obstruction is absence of signs of ischaemia/strangulation
drip and suck - NBM, insert NGT to decompress bowel
IV fluids and correct electrolyte disturbance
149
when does bowel obstruction require urgent surgery
- closed loop bowel obstruction/evidence of ischaemia
- SBO with no surgical history
- failure to improve within 48 hours of conservative measures
150
what can paralytic ileus occur in association with
- chest infection
- MI
- stroke
- AKI
- trauma
- severe hypothyroidism
- electrolyte disturbance
- DKA
151
congenital causes of colorectal carcinoma
- HNPCC
- FAP
- Gardner's syndrome
152
screening for colorectal cancer
- faecal occult blood tests (offered every 2 years to those aged 60-74)
- sigmoidoscopy screening at 55, if normal, bowel screening at 60
- FIT testing
153
Duke's staging for CRC
- A = confined to bowel wall
- B = invasion through bowel wall
- C = LN involvement
- D = distant mets
154
type of CRC more likely to benefit from radiotherapy
rectal carcinoma
don't usually give for colon cancer - due to toxicity of adjacent organs
155
chemotherapy given in Dukes C CRC (LN involvement but no distant mets)
5-FU
156
what is IBS-C
loose stools <25% of the time
| constipation >25% of the time
157
what is IBS-D
loose stools >25% of the time
| hard stools <25% of the time
158
what is IBS-M
both hard and soft stools >25% or the time
159
diagnostic criteria for IBS
```
6+ months
diagnosed clinically if:
- abdo pain relieved by defectation/or associated with bowel frequency/stool form AND at least 2 of:
- altered passage of stool
- abdo bloating
- aggravated by eating
- passage of mucus rectally
```
160
grading I-IV of haemorrhoids
I = don't prolapse
II = prolapse on straining, reduce spontaneously
III = prolapse on straining, can be reduced manually
- IV = permanently prolapsed, can't be reduced
161
when would haemorrhoids show pain
if thrombosed/ strangulated
162
treatment of acutely thrombosed external haemorrhoids
- if presents within 72 hours - consider referral for excision
- otherwise give stool softeners, ice packs, analgesia - usually settles within 10 days
can develop skin tags
163
most common form of anorectal abscess
peri-anal abscess - risk factors include IBD, DM (poor wound healing), underlying malignancy
164
usual pathogens causing peri-anal abscess
colonised by gut flora e.g. E. coli
those caused by staph. aureus are more likely to be infection of skin rather than digestive tract
165
gold standard investigation for peri-anal abscess
MRI - but rarely used except for complications/associated with IBD
usually is a clinical diagnosis - but can do transperineal USS
166
when are abx used in peri-anal abscesses
if systemic upset secondary to abscess - don't seem to help with healing of wound after drainage
may be used if diabetes/immunosuppression
167
common complication of peri-anal abscess
fissure in ano (up to 30%) - reduced by early surgical drainage
168
location of anal fissure
longitudinal or elliptical tears of the squamous lining of the distal anal canal (>6 weeks = chronic)
MOST COMMON on posterior midline
169
what if an anal fissure is not on the posterior midline
consider underlying cause e.g. IBD
170
acute vs chronic appearance of anal fissure
- acute = clear edge, linear
| - chronic = deeper, may be associated with external skin tag
171
management of acute anal fissure (<6 weeks)
- dietary
- bulk forming laxatives - if not tolerated, try lactulose
- lubricants e.g. petroleum jelly
- topical anaesthetics, analgesia
172
management of chronic anal fissure (>6 weeks)
- continue management of acute
- topical GTN first line (2x a day for up to 8 weeks)
- if not effective after 8 weeks - consider secondary care referral
173
when does sigmoid volvulus occur
in cases of long-standing chronic constipation - large sigmoid loop full of faeces and distended with gas twists on its mesenteric pedicle to create a closed-loop obstruction
174
complications of sigmoid volvulus
- bowel obstruction
| - venous infarction = perforation and faecal peritonitis
175
investigations to do in sigmoid volvulus
- plain abdo XR (coffee bean sign)
- may need barium enema
- CT scan allows assessment of bowel wall ischaemia
176
management of sigmoid volvulus
- LL position
- decompression - sigmoidoscope passed into rectum
- need for surgical intervention if indication of ischaemia (sigmoidectomy with primary anastomosis)
177
barium swallow - achalasia
bird's beak sign
178
management of achalasia
- CCB/nitrates may reduce pressure in LOS (only effective in 10%)
- heller myotome
- pneumatic dilatation for older unfit patients
179
most common cause of chronic pancreatitis
alcohol excess
| can also be due to CF, haemochromatosis, ductal obstruction
180
what is a subphrenic abscess
collection of infected fluid between diaphragm, liver and spleen - develops after surgery e.g. splenectomy
181
antibiotics used in liver abscess (as well as drainage)
amoxicillin, ciprofloxacin and metronidazole
open surgery if ruptured/peritonitis/>5cm
182
imaging used for hepatocellular carcinoma
CT/MRI
alpha fetoprotein usually elevated
avoid biopsy
183
main risk factor for cholangiocarcinoma
primary sclerosing cholangitis
184
tumour markers in cholangiocarcinoma
Ca19-9
CEA
Ca125
all often elevated
185
what can be used to reduce ammonia in hepatic failure (which can cause encephalopathy)
lactulose
186
what is an epigastric hernia
lump in midline between umbilicus and xiphisternum (in linea alba)
surgical repair is essential - high risk of strangulation/incarceration
187
most common type of anal cancer
80% SCC
188
risk factors for anal cancer
- HIV
- immunosuppression
- cervical cancer
- smoking
189
usual cause of fistula-in-ano
when an abscess heals
can also be caused by Crohn's, diverticulitis, surgery and cancer
190
management of fistula-in-ano
Seton procedure (allows drainage to help fistula to heal)
fistulotomy etc.
191
causes of hypopituitarism
- most commonly = anterior pituitary tumours
- infections - abscess, meningitis, encephalitis, TB
- head injury
- congenital
192
presentation of hypopituitarism
- asymptomatic
- ACTH deficiency - Addison's
- TSH deficiency - hypothyroidism
- gonadotrophin deficiency - oligomenorrhoea, loss of libido, dyspareunia, infertility, osteoporosis
- GH deficiency - short stated, dyslipidaemia
- ADH deficiency - polyuria, polydipsia, hypernatraemia
- stroke-like symptoms
193
acute pituitary failure symptoms
sudden onset headache, vomiting, visual impairment, decreased consciousness
194
cause of acute pituitary failure
haemorrhage/infarction of pituitary
195
management of acute pituitary failure
hydrocortisone replacement, surgery, resuscitation, IV fluids
196
what is Sheehan's syndrome
post partum pituitary necrosis - due to severe hypotension/shock during delivery
197
what condition can a pituitary adenoma be associated with
MEN I
198
conditions associated with phaeochromocytoma
- MENII
- neurofibromatosis
- von Hippel-Lindau
199
management of phaeochromocytoma
surgery - stabilise with alpha and beta blockers first
200
what can cause pseudo-Cushing's
alcohol excess/severe depression
causes false positive dexamethasone suppression test
201
what is adrenal-genital syndrome
congenital adrenal hyperplasia - 95% 46XX with ambiguous genitalia
autosomal dominant
leading cause of pseudo-hermaphrodism
202
how might someone with adreno-genital syndrome present when born
salt losing crisis at 7-14 days = vomiting, weight loss, extreme tiredness, severe dehydration
203
most common cause of hyperaldosteronism
bilateral idiopathic adrenal hyperplasia
used to be thought to be due to adrenal adenoma (Conn's syndrome)
204
how does adreno-genital syndrome happen
low cortisol = anterior pituitary secretes lots of ACTH = production of adrenal androgens
205
first line investigation in hyperaldosteronism
plasma aldosterone/renin ration
high aldosterone and low renin
206
management of hyperaldosteronism
- adrenal adenoma = surgery
| - bilateral hyperplasia = aldosterone antagonism e.g. spironolactone
207
what causes secondary hyperaldosteronism
excessive renin - e.g. from diuretics, HF, hepatic failure, nephrotic syndrome, malignant HTN
208
causes of hypoaldosteronism
- primary adrenal insufficiency
- congenital adrenal hyperplasia
- NSAIDs, heparin
- ciclosporin
- diabetic nephropathy
209
electrolyte abnormalities in hypoaldosteronism
- hyponatraemia (salt craving)
- hyperkalaemia
- metabolic acidosis
210
investigations for hypoaldosteronism
measure plasma renin activity (PRA), serum aldosterone and serum cortisol
211
drugs which can cause hirsutism
- phenytoin
| - corticosteorids
212
topical treatment for hirsutism on the dace
topical eflornithine
213
what is hypertrichosis
androgen-independent hair growth:
familial, phenytoin, ciclosporin, anorexia
214
plasma osmolality and glucose in HHS
osmolality >320
glucose >30
215
2 types of diabetes insipidus
cranial (not secreting enough ADH)
nephrogenic (insensitive to ADH
216
causes of cranial DI
- idiopathic
- head injury
- pituitary surgery
- craniopharyngiomas
- haemochromatosis
217
causes of nephrogenic DI
- genetic
- hypercalcaemia/hypokalaemia
- lithium
- tubulointerstitial disease
218
what urine osmolality excludes DI
>700
because urine osmolality is LOW in DI (and plasma osmolality is high)
219
how is nephrogenic DI managed
thiazides
| low salt/protein diet
220
why does SIADH feature hyponatraemia
secondary to dilutional effects of excessive water retention
221
cancers causing SIADH
SCLC
| pancreatic
222
neurological causes of SIADH
stroke
SAH
subdural haemorrhage
meningitis/ encephalitis / abscess
223
infectious causes of SIADH
TB
| pneumonia
224
drugs which can cause SIADH
```
sulfonylreas
SSRIs
TCAs
carbamazepine
vincristine
cyclophosphamide
```
