notes from quesmed Flashcards
(14 cards)
budd chiari syndrome
obstruction to the outflow of blood from the liver caused by thrombosis in the hepatic veins or inferior vena cava.
budd chiari presentation
classic triad of:
Abdominal pain
Hepatomegaly
Ascites
investigations and management budd chiari
Doppler ultrasonography
Anticoagulation (e.g., low molecular weight heparin and warfarin)
Endovascular procedures (e.g., thrombolysis or angioplasty)
Transjugular intrahepatic portosystemic shunt (TIPS)
Liver transplant
duodenal ulcers
H pylori causes 90% of duodenal ulcers
epigastric pain that improves after eating
Duodenal improves after Dinner
oesophageal cancers
adenocarcinoma (most common in patients with history of GORD)
squamous cell carcinoma (most common in developing world and risk factors of smoking alcohol and achalasia)
enteropathy associated T cell lymphoma
rare but important complication of coeliac disease
weight loss
recurrence of symptoms
often can happen due to non adherence to gluten free diet
wilsons disease
autosomal recessive genetic condition characterized by abnormal copper deposition in organs due to a defective protein that transports copper.
ATPase 2 protein affected
Kayser-Fleischer rings, sunflower cataracts
Abdominal pain, Arthritis, Ascites
- Symptom onset between 6-45 (commonly teenage years)
- Cirrhosis
- Osteopenia
- Parkinsonism (symmetrical)
- Psychiatric disease: psychosis, hallucinations, personality changes
Renal failure
free (non-caeruloplasmin-bound copper) is increased
Deranged LFTs
biopsy to find level of copper
- Avoid foods high in copper content
- Lifelong penicillamine +/- zinc acetate
what is most common form of inherited colorectal cancer (still only 5%, others sporadic)
HNPCC (Lynch syndrome), an autosomal dominant condition, is the most common form of inherited colon cancer
also at a higher risk of other cancers, with endometrial cancer being the next most common association, after colon cancer
haemochromatosis
autosomal recessive
disorder of iron absorption and metabolism resulting in iron accumulation
fatigue
erectile dysfunction
arthralgia (often of the hands)
‘bronze’ skin pigmentation
diabetes mellitus
liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition)
cardiac failure (2nd to dilated cardiomyopathy)
hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
arthritis (especially of the hands)
acute liver failure
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure is common (‘hepatorenal syndrome’)
‘liver function tests’ do not always accurately reflect the synthetic function of the liver. This is best assessed by looking at the prothrombin time and albumin level.
meckels diverticulum
remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.
abdo pain mimicking appendicitis
painless rectal bleeding
intestinal obstruction
if child haemodynamically stable with less severe or intermittent bleeding then a ‘Meckel’s scan’ should be considered
removal if narrow neck or symptomatic
What is the child’s most likely HLA type in coaeliac
HLA DQ2
causes of pancreatitis
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertrigylceridaemia, hypercalcaemia, hypothermia
ERCP
Drugs(azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
retroperitoneal organs
Suprarenal glands
Aorta and inferior vena cava
Duodenum (2nd and 3rd segments)
Pancreas (not tail)
Ureters
Colon (ascending and descending)
Kidneys
Eosophagus
Rectum
