Flashcards in Review of posters 04/05/2016 Deck (39):
Presence of diverticula
Inflammation and infection of the diverticula.
Pathophysiology of diverticulitis
Outcropping (diverticula) has a neck. This can become blocked by faeces-which means the faeces there is stagnent. This allows bacteria time to infect the diverticula causing diverticulitis.
Symptoms of diverticulitis
Severe LIF pain
Where does diverticulitis normally occur?
On examination of diverticulitis, what would you observe/
Tenderness, rigidity and gaurding
Treatment of mild diverticulitis.
Antibiotics- ciproflaxacin and metronidazole.
Treatment of severe diverticulitis
Hospital admission, fluids, antibiotics.
Do people with diverticular disease but without acute diverticulitis have symptoms?
What dietary advice would you give someone with diverticular disease?
Increase dietary fibre.
If someone is symptomatic however does not have acute diverticulitis- what investigations would you perform?
Colonoscopy, barium enema, flexible sigmoidoscopy
What would investigations into acute diverticulitis show?
raised CRP and ESR
Ultrasound and colonscopy showing thickening of the colonic wall.
What is non-alcoholic fatty liver disease?
Presence of fat deposits in the liver.
How does NAFLD occur?
Intake of too much fat in diet. (same consequences would be seen with alcohol however would not be called NAFLD)
What is non-alcoholic steatohepatitis?
Development of NAFLD (condition worsened)
How is fat content in a healthy liver balanced?
By oxidation of triglycerides and fatty acid export keeping the fat content low. And lipogenesis and uptake of free fatty acids offering a balance by taking in fat to the liver.
Pathophysiology of NAFLD.
Lipoproteins circulate in the blood- these are made up of triglycerides. Hormone induced lipase breaks this down into free fatty acids which are taken up by the liver hepatocytes. The free fatty acids in the liver hepatocyte can either go on to re-form the triglycerides (bad) or go through oxidation (good).
PPAR alpha- comes into play when there is excess energy. If it is effective- it will increase oxidation of free fatty acids, however if it is defective it will increase storage as triglycerides. This allows fat to build up in the liver.
How does NAFLD develop onto NASH
Inflammation occurs. Fat accumalation, liver cell necrosis and fibrosis.
When does NAFLD progress to become irreverisble?
Both NASH and NAFLD are reversible. However if NASH was to develop further to cirrhosis- this would not be reversible
What is the treatment of NAFLD and NASH?
WEIGHT LOSS AND EXERCISE.
How would you investigate NAFLD or NASH?
Ventricular septal defect
This is a common congenital defect where there is a hole between the ventricles allowing blood to flow through.
Describe the consequences of ventricular septal defect
Left to right shunt occurs. Due to blood being under more pressure in the left side of the heart than the right- blood will move from a higher pressure to a lower pressure.
This will increase the amount of blood in the right side of the circulation and can cause pulmonary hypertension.
Describe the two types of ventricular septal defect.
Small VSD- may be asymptomatic- no abnormal ECG or CXR findings.
Large VSD- significant left to right shunt. Pulmonary arteries may be more prominent on CXR due to increased flow. Also shows cardiomegaly.
Echo- will assess hole size and haemodynamic consequence.
Treatment of VSD
Surgical intervention- this should happen when the atria start to become affected.
Atrial septal defect
Hole between the atria
Where can ASD occur?
Sinus venosus- by the SVC or IVC
Ostrium secundum- mid septum
Ostrium primun- lower part of septum
What happens in ASD
Significant left to right shunt results in right heart overload and dilatation.
Symptoms of ASD
Breathlessness, exercise intolerance, atrial arrhythmias
Right ventricular heave
Investigations and treatment of ASD
Prominent pulmonary arteries on CXR
Right bundle branch block and right axis deviation on ECG
Patent ductus arteriosus
Ductus arteriosus (connection between the proximal left pulmonary artery and the descending aorta) fails to close
What symptoms/signs would you see from patent ductus arteriosus?
Machine like murmur
treatment of patent ductus arteriosus?
Indometacin (prostaglandin inhibitor)
Co-arctation of the aorta
Narrowing of the aorta at the ductus arteriosus
Symptoms of co-arctation of the aorta
Hypertension in upper limbs
Weak, delayed pulses in lower limbs
Treatment of co-arctation fo the aorta
stenting in older children
Surgical repair in neonates.
Cyanotic heart disease
What is fallots tetralogy
A large malaligned ventricular septal defect
An overiding (aorta is directly over the ventricular septal defect) aorta
Right ventricular outflow obstruction
Right ventricular hypertrophy