Internal Medicine: Gastro intestinal system/Endocrinology Flashcards

Question

How can we treat retinopathy?

Answer 1

Development or progression of retinopathy may be accelerated by rapid improvement in glycaemic control, pregnancy and in those with nephropathy.

Answer 2

Poor glycaemic control. This lead to renal hypertrophy associated with a raised glomerular filtration rate. 3 main ways: -Glomerular damage -Ischaemia resulting from hypertrophy of afferent and efferent arterioles - Ascending infection

Answer 3

``` Swelling of the hands, feet, and face Weight gain Trouble sleeping or concentrating Poor appetite Nausea Weakness Itching (end-stage kidney disease) and extremely dry skin Drowsiness (end-stage kidney disease) Blood in the urine (rare) Abnormalities in the hearts' regular rhythm, because of increased potassium in the blood Muscle twitching ``` As kidney damage progresses, your kidneys cannot remove the waste from your blood.

Answer 4

Urine should be checked regularly for the presence of protein. Albumin creatinine ratio (ACR) is <2.5 in healthy men, <3.5 mg/mmol in healthy women

Answer 5

Aggressive treatment of blood pressure with a target below 130/80 mmHg has been shown to slow the rate of deterioration of renal failure considerably. Angiotensin-converting enzyme inhibitors or an angiotensin receptor II antagonist are the drugs of choice. Oral hypoglycaemic agents partially excreted via the kidney should be avoided. Insulin sensitivity increases and drastic reductions in insulin dosage may be needed.

Answer 6

Due to a high level of blood suger for a long period of time, your nerves get damaged. Lifestyle/not enough exercise are the causes. The feet and the legs are most effected.

Answer 7

Loss of sense, pain sensation and temperature sensation in the feet. In later stage complaining of more loss of sense and loss of balance.

Answer 8

- Acute painful neuropathy: Duloxetine, tricyclics, gabapentin or pregabalin, mexiletine, valproate and carbamazepine all reduce the perception of neuritic pain somewhat. - Mononeuropathy and mononeuritis multiplex: full spontaneous recovery is the rule for most episodes of mononeuritis over 3-6 months. - Diabetic amyotrophy: careful metabolic control of the diabetes.

Answer 9

Ketoacidosis Retinopathy Nephropathy Neuropathy

Answer 10

Reflux occurs when the antireflux mechanisms (peristalsis, diaphragm, LOS, intra-abdominal oesophagus, mucosal valve and gastric emptying) fail, allowing acidic gastric contents to make prolonged contact with the lower oesophageal mucosa. The sphincter relaxes transiently independently of a swallow (Transient Lower Esophageal Sphincter Relaxation, TLESR) after meals and this is the cause of almost all reflux in normals and about two-thirds in GORD patients.

Answer 11

Heartburn (which is aggravated by bending, stooping or lying down) is the major feature. Also regurgitation of food and acid into the mouth occurs. Sliding hiatus hernia: The oesophageal-gastro junction and part of the stomach 'slides' through the hiatus so that it lies above the diaphragm.

Answer 12

The clinical diagnosis can usually be made without investigation. If investigation is required, there are two aims: - Assess oesophagitis (endoscopy) - Document reflux by intraluminal monitoring. Excessive reflux is defined as a pH < 4 for more than 4% of the time.

Answer 13

Approximately half of patients with reflux symptoms in primary care can be treated successfully with simple antacids, loss of weight and raising the head of the bed at night. Precipitating factors should be avoided, with dietary measures, reduction in alcohol consumption and cessation of smoking.

Answer 14

Any hepatitis which lasts 6 months or longer.

Answer 15

Hepatitis A is a virus that can infect the liver. In most cases, the infection goes away on its own and doesn't lead to long-term liver problems. The hepatitis A virus is found in the stool of an infected person. It is spread when a person eats food or drinks water that has come in contact with infected stool.

Answer 16

Feeling very tired. Feeling sick to your stomach and not feeling hungry. Losing weight without trying. Pain on the right side of the belly, under the rib cage (where your liver is). A fever. Sore muscles. Yellow skin (jaundice), dark urine, and clay-colored stools.

Answer 17

Your doctor will ask questions about your symptoms and where you have eaten or traveled. You may have blood tests if your doctor thinks you have the virus. These tests can tell if your liver is inflamed and whether you have antibodies to the hepatitis A virus. These antibodies prove that you have been exposed to the virus.

Answer 18

Hepatitis A goes away on its own in most cases. Most people get well within a few months.

Answer 19

Acute hep. B: Hepatitis B is a virus that infects the liver. Most adults who get hepatitis B have it for a short time and then get better. Chronic hep. B: Sometimes the virus causes a long-term infection, called chronic hepatitis B. Over time, it can damage your liver. Causes Have sex with an infected person without using a condom. Share needles (used for injecting drugs) with an infected person. Get a tattoo or piercing with tools that were not cleaned well. Share personal items like razors or toothbrushes with an infected person.

Answer 20

Many people with hepatitis B do not know they have it, because they do not have symptoms. If you do have symptoms, you may just feel like you have the flu. Same as hepatitis A

Answer 21

A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing, liver biopsy.

Answer 22

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

Answer 23

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure. Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

Answer 24

The disease being discoverd only following a routine of biochemical test: mild elevation of ALT HCV- RNA can be detected using ELISA-3 test from 1-8 weeks after infection.

Answer 25

If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment.The medicines usually used to treat hepatitis C are interferons combined with ribavirin plus a protease inhibitor such as boceprevir (Victrelis) or telaprevir (Incivek). They are used for 6 months to a year and help your body get rid of the virus.

Answer 26

Inflammation of the liver. Infection with the hepatitis D virus (HDV), or delta agent, occurs only in people who are already infected with the hepatitis B virus (HBV).

Answer 27

See hepatitis B

Answer 28

The diagnosis is made by finding anti-delta antibody in a patient with chronic liver diseas who is HBsAg positive. It can be confirmed by finding HDV in the liver or HDV RNA in the serum by PCR

Answer 29

Vaccination against hepatitis B will also prevent hepatitis D virus infection. Also see hepatitis C

Answer 30

Inflammation of the liver. People usually get hepatitis E by drinking water or eating food that?s been contaminated by feces (stool) from someone infected with hepatitis E.

Answer 31

See hepatitis A

Answer 32

Blood test (antibodies)

Answer 33

Anti-viral therapy when needed. Most peeps have it without knowing.

Answer 34

See picture I send you guys

Answer 35

Overactivity of the thyroid. Graves' disease is the most common cause. It's an autoimmune disease: Antibodies bind to TSH receptors which stimulates thryroid hormone production. Other causes: ● Solitary toxic adenoma ● Toxic multinodular goitre ● de Quevain's thyroiditis

Answer 36

Hyperthyroidism (thyroid overactivity, thyrotoxicosis) is common, affecting perhaps 2-5% of all females at some time and with a sex ratio of 5 : 1, most often between the ages of 20 and 40 years. Nearly all cases (>99%) are caused by intrinsic thyroid disease; a pituitary cause is extremely rare

Answer 37

The eye signs, of lid lag and 'stare' ``` ● Restless (Always on the go) ● Tremor of the hands ● Palpitations ● Itchy skin ● Eye problems ```

Answer 38

Is often clinically obvious, but biochemical confirmation is needed before treatmet is started. ● Serum TSH levels (suppressed) ● T4 and T3 levels (raised) ● Thyroid peroxydase (TPO) and thyroglobulin antibodies are present in most cases of graves' disease.

Answer 39

● Antithyroid drugs ● Surgery ● Radioactive Iodine (RAI)

Answer 40

Underactivity of the thryroid (primary or secondary) Athropic (autoimmune) hypothroidism is the most common cause and is associated with antithyroid autoantibodies leading to lymphoid infiltration and eventually athropy and fibrosis. Hashimoto's thyroiditis Postpartum thyroiditis

Answer 41

``` ● tiredness ● Weight gain ● constipation ● feeling cold ● Mental slowing ● depression ```

Answer 42

● Serum TSH level (raised) ● T4 levels (suppressed) ● Thyroid specific antibodies

Answer 43

Replacement therapy with levothyroxine (T4) for life

Answer 44

The term inflammatory bowel disease (IBD) describes a group of disorders in which the intestines become inflamed. The likeliest cause is an immune reaction the body has against its own intestinal tissue. Two major forms of inflammatory bowel disease are recognized: Crohn's disease (CD), which can affect any part of the GI tract Ulcerative colitis (UC), which affects only the colon.

Answer 45

Although both conditions have a worldwide distribution, the highest incidence rates and prevalence have been reported from northern Europe, the UK and North America. In north America, prevalence rates of CD are lower in Hispanic and Asian people (4.1, 5.6/100 000, respectively) compared with white individuals (43.6/100 000). Jewish people are more prone to inflammatory bowel disease than any other ethnic group.

Answer 46

``` Abdominal cramps and pain Diarrhea that may be bloody Severe urgency to have a bowel movement Fever Weight loss Loss of appetite Iron deficiency anemia due to blood loss ```

Answer 47

``` Smoking NSAID Hygiene Nutritional factors Psychological factors ```

Answer 48

``` Your doctor makes the diagnosis of inflammatory bowel disease based on your symptoms and various exams and tests: Stool exam Complete blood count Barium X-ray Biopsy ```

Answer 49

Chronic inflammatory condition that may affect any part of the gastrointestinal tract from the mouth to the anus but has a particular tendency to affect the terminal ileum and ascending colon (ileocolonic disease) Not sure what it causes, but possible causes: genetic factors, environmental factors (hygiene, nutritional, psychological factors)

Answer 50

Major: diarrhoea, abdominal pain and weight loss. | Constitutional symptoms of malaise, lethargy,anorexia, nausea, vomiting and low-grade fever may be present

Answer 51

``` Your doctor makes the diagnosis of inflammatory bowel disease based on your symptoms and various exams and tests: Stool exam Complete blood count Barium X-ray Biopsy ```

Answer 52

-Stop smoking -diarrhoea can be controlled with loperamide, codeine phosphate or co-phenotrope. -Induction of remission:Glucocorticosteroids are commonly used to induce remission in moderate and severe attacks of CD -Aminosalicylates -Antibiotics -Exclusive enteral nutrition -Maintenance of remission: Conventional maintenance therapies include azathioprine, mercaptopurine , methotrexate Anti-TNF agents Surgical management of Crohn's disease

Answer 53

Inflamed condition of the intestines. Can affect the rectum alone (proctitis), can axtend proximally to involve the sigmoid and descending colon (left-sided colitis), or may involve the whole colon (extensive colitis).

Answer 54

Major: diarrhoea with blood and mucus, sometime accompanied by lower abdominal discomfort. General features: malaise, lethargy and anorexia with weight loss. Aphthous ulceration

Answer 55

Blood tests Iron deficiency anaemia: in moderate to severe attacks ESR and CRP: often raised, liver biochemistry may be abnormal, with hypoalbuminaemia in severe disease pANCA may be positive Stool cultures and clostridium difficile toxin Should be performed to exclude infective causes of colitis. Colosnoscopy Imaging: plain abdominal X-ray is essential in patients with severe attacks to exclude colonic dilatation.

Answer 56

Proctitis: Rectal 5-ASA suppositories - Left-sided colitis: topical 5-ASA - Extensive colitis: 5-ASA or oral prednisolone (if patient does not respond to 5-ASA) - Severe colitis: admitted to hospital and treated initially with hydrocortisone 100 mg. - Surgical management: May be life-saving, is curative and eliminates the long-term risk of cancer. - Acute disease: subtotal colectomy with end ileostomy and preservation of the rectum

Answer 57

Irritable bowel syndrome (IBS) is a disorder of the intestines. ``` Affective disorders, e.g. depression, anxiety Psychological stress and trauma Gastrointestinal infection Antibiotic therapy Sexual, physical, verbal abuse Pelvic surgery Eating disorders ```

Answer 58

Belly pain, cramping or bloating, and diarrhea or constipation

Answer 59

``` Diagnostic criteria (Rome III 2006) In the preceding 3 months, should be at least 3 days/month of recurrent abdominal pain or discomfort associated with two or more of the following: 1. Improvement with defecation. 2. Onset associated with a change in frequency of stool. 3. Onset associated with a change in form of stool ```

Answer 60

Explore dietary triggers Alter the microbiota Anti-diarrhoeal drugs Smooth muscle relaxants for pain

Answer 61

Cirrosis results from the necrosis of liver cells followed by fibrosis and nodule formation. The most common causes of cirrhosis are alcohol, hepatitis B, D and C. Non-alcoholic fatty liver disease.Blockage of the bile duct.

Answer 62

The symptoms of cirrhosis of the liver vary with the stage of the illness. In the beginning stages, there may not be any symptoms. As the disease worsens, symptoms may include: Loss of appetite Lack of energy (fatigue), which may be debilitating Weight loss or sudden weight gain Bruises Yellowing of skin or the whites of eyes (jaundice) Itchy skin Fluid retention (edema) and swelling in the ankles, legs, and abdomen (often an early sign) A brownish or orange tint to the urine Light colored stools Confusion, disorientation, personality changes Blood in the stool Fever

Answer 63

Physical examination (is liver enlarged?) Blood test Biopsy CT Scan

Answer 64

reduction/no alcohol If caused by virus, medical treatment Liver transplantation

Answer 65

A peptic ulcer consists of a break in the superficial epithelial cells penetrating down to the muscularis mucosa of either the stomach or the duodenum; there is a fibrous base and an increase in inflammatory cells

Answer 66

Duodenal ulcers affect approximately 10% of the adult population and are two to three times more common than gastric ulcers. Ulcer rates are declining rapidly for younger men and increasing for older individuals, particularly women. Both DUs and GUs are common in the elderly.

Answer 67

``` Recurrent, burning epigastric pain Pain occurs at night Nausea Vomiting Anorexia and weight loss (with duodenal ulcers) ```

Answer 68

Diagnosis of H. pylory is necessary. Non invasive Serological tests detect IgG antibodies. 13C-Urea breath test: Quick and reliable test for H. pylori. Stool antigen test: useful in the diagnosis of H. pylori infection and for monitoring efficacy of eradication therapy. Invasive (endoscopy) Biopsy urease test Histology Culture

Answer 69

H. pylory erication therapy | Stopping smoking

Answer 70

See peptic ulcer.

Answer 71

By definition acute pancreatitis is a process that occurs on the background of a previously normal pancreas and can return to normal after resolution of the episode. In chronic pancreatitis there is continuing inflammation with irreversible structural changes.

Answer 72

Acute: Gallstones, Alcohol, Infections, Pancreatic tumours, Drugs, Latrogenic, Hyperlipidaemias, Idiopathic Chronic: Alcohol, Tropical, Hereditary, Trypsinogen and inhibitory protein defects, Systic fobrosis, Idiopathic, trauma, Hypercacaemia

Answer 73

Blood tests: serum amylase, urinary amylase, serum lipase, c-reactive protein level are raised. Chest X-ray, to exclude gastroduodenal perforation Abdominal ultrasound scan MRI ERCP

Answer 74

- A multiple factor scoring system should be used at the end of the first 24h after presentation to allow identification of the 25% of patients with a predicted severe attack, this should be repeated at 48h. - Nasogastric suction prevents abdominal distension and vomitus and hence the risk of aspiration pneumonia. - Baseline arterial blood gases: key predictive factor for severity of an episode. - Prohylactic antibiotics - Analgesia requirements for pain control - Feeding. In patients with a severe episode there is little likelihood of oral nutrition for a number of weeks. - Anticoagulation

Internal Medicine: Gastro intestinal system/Endocrinology Flashcards

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