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51 Cards in this Set
- Front
- Back
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Causes of Gasto oesophageal Reflux Disease
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Pregnancy, Obesity, Smoking, Diet, Alcohol, Chronic Lung Disease
Drugs that lower LOS pressure |
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Symptoms of GORD
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Heartburn
Cough Dysphagia Waterbrash Belching Odynophagia |
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Signs of GORD - it may lead to ...
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Ulcerations, Strictures, Barrett's metaplasia, Carcinoma
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Tests for GORD
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Upper GI endoscopy (acid damage shows thickening and ulcerations)
Barium swallow 24h oesophageal pH |
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Management of GORD
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Lifestyle changes (avoid alcohol/hotdrinks/citrus/food pre bed)
Antacids PPI - lanzoprazole, omeprazole |
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Oesophageal Cancer - Risks
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Diet
Smoking Alcohol Obesity Low vitamin diet Achalasia (food stuck is oesophagus, treated with balloon dilation) Barrett's oesophagus |
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Symptoms of Oesophageal Cancer
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Dysphagia
Weight loss Retrosternal chest pain If upper (20%) cough and hoarseness |
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Signs of Oesophageal Cancer
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Lymphadenopathy
Adenocarcinoma or Squamous cell Carcinoma |
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Tests for Oesophageal Cancer
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Barium Swallow
Oesophagoscopy with biopsy CXR CT MRI |
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Management for Oesophageal Cancer
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Radical oesophagectomy
Chemo/radiotherapy |
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Peptic Ulceration Pathology
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Helicobacter pylori, increased acid
Associated with NSAIDs, hyperparathyroidism and Crohns Mucosal erosion >0.5cm, leading to an inbalance between secretions and barriers. Affect the oesophaghus, stomach and duodenum. DU>GU |
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Symptoms of Peptic Ulcers
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Epigastric pain radiates to the back in DU
Nocturnal hunger pain - penetration of DU Nausea Vomiting Weight loss |
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Tests for Peptic Ulcers
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UGI endoscopy
Barium studies Blood tests H. pylori serology/culture |
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Management of Peptic Ulcers
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H.pylori eradication = triple therapy for 7 days of amoxacillin + clarithromycin + a PPI (omeprazole/lanzoprazole)
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Predisposing factors & pathology for Gastric Cancer
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Old Men!
H.pylori Smoking previous cancer family history Normal - chronic gastritis - intestinal metaplasia - dysplasia - adenocarcinoma |
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Symptoms of gastric cancer
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Dyspepsia
Weight loss Anaemia Early Saiety Lymphadenopathy *haematemesis/melena in an acute presentation* |
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Tests & Management for Gastric Cancer
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CT
Endoscopy Biopsy Gastrectomy and Chemotherapy |
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Upper GI bleed caused by ...
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Gastritis
Oesophagitis Varacies Ascities Mallory-Weiss tear Gastric Carcinoma Oesophageal Carcinoma Angiodysplasia |
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Lower GI bleed causes by ...
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Haemorrhoids
Anal fissure Rectal ulcers Colitis Ischaemic Colitis Diverticulitis Meckle's Diverticulum Angiodysplasia Polyps |
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Symptoms of Coeliac disease
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Fatigue
Weight loss/weakness/failure to thrive Anaemia Diarrhoea Abdominal pain/bloating Nausea/vomiting |
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Coeliac disease is associated with
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Type 1 DM
Anaemia Primary Billiary cirrhosis Dermatitis herpetiforms T-cell lymphoma Increased risk of malignancy |
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Tests & Management for Coeliac disease
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Antibodies
alpha-gliandin transglutaminase Duodenal biopsy via endoscopy showing subtotal villious atrophy GLUTEN FREE DIET |
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Symptoms of Crohn's Disease
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Diarrhoea
Abdominal Pain Weight loss/anorexia Fever/malaise |
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Signs of Crohn's
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Increased: ESR, CRP, plalelets, WCC
Decreased: Hb and Albumin ~erythema nodosum |
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Management of Crohn's
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Prednisalone
Hydrocortisone Metronidazole Infliximab is perianal disease Immunosuppressants |
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Symptoms of Ulcerative Colitis
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Diarrhoea +/- blood or mucus
Crampy abdominal pain Fever/malaise Anorexia/weight loss Unusual bowel habits |
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Sign of UC
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Increased ESR
Anaemic Distended tender abdomen |
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Teste for UC
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Bloods, ESR
AXR - may show megacolon which is severe and can causes peritonitis which is an emergency that presents with guaring and rebound tenderness Rectal Examination Sigmoidoscopy History of >6 stools perday |
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Management of UC
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5ASA (aminosalycyclic acid - mesalzine)
Steroids Proctocolectomy if severe Relapses may occur because of stress, infection, diclofenac |
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Colon Cancer is predisposed by ...
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>45years
Obesity Smoking Poor Diet Previous CRC FAP or HNPCC |
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Pathology of CRC
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Normal epithelium becomes small adenoma - mutations - large adenoma - invasive adenocarcinoma
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Symptoms of CRC
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Bleeding + altered bowel opening NOT constipation
Weight loss + loss of appatite Abdominal discomfort Tenesmus Palpable mass |
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Tests for CRC
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Barium enema
Colonoscopy CT |
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Management & staging of CRC
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Hemicolectomy
Radiotherapy if rectum Chemotherapy DUKEs criteria A: mucosa B: muscular layer C: + lymph nodes D: distant metastises |
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Acute Liver failure symptoms
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Onset of hepatic decompensation with encephalopathy, coagulation disturbances + jaundice
Unwell - non specific Jaundice Bruising Ascities Tacycardia Hypotension Hyperventilation Sweet breath smell |
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Test for Acute Liver Failure
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PTR
LFT Albumin Liver Ultrasound |
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Causes of Chronic Liver Failure
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Infection (hepatits A, B, Yellow fever)
Paracetamol overdose Primary billiary cirrhosis alpha-1 antitrypsin deficiency |
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Symptoms/Signs of Chronic Liver Failure
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Bruising, failure to thrive, dark urine
Jaundice Encephalopathy Leuconychia Palmar erythema Clubbing Spider Naevi Gynacomastia Xanthalasma Hepatomegaly Portal hypertension - leads to blocked veins, right heart failure and formation of varacies |
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Tests for Chronic Liver Failure
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FBC, U+Es, Glucose
Hepatitis serology Blood + urine cultre Ascetic tap for MC+S |
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Symptoms of Liver Tumours
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Fever, malasie
Anorexia/weight loss RUQ pain Jaundice is late Hepatomegaly Signs of chronic liver disease |
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Tests for Liver Tumours
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Abdominal Ultrasound
FBC, clotting factor, LFTs MRI ERCP Liver biposy |
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Signs of Alpha1 antitrypsin deficiency
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Dyspnoea, empysema
Cirrhosis Serum alpha1 antitrypsin decreased |
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Signs of Haemochromatosis
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Tiredness, arthralgia, impotence
Slate-grey skin pigmentation Signs of chronic liver disease Increased LFTs + Serum Fe X-Ray will show chonrocalcinosis (also appear in hyperparathyoidism and hypothyroidism) |
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Pathology of Cirrhosis
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Loss of normal architecture of the liver, with bridging fibrosis and nodular regeneration
Anti-michondrial auto-antibodies present in serum |
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Signs of Autoimmune Hepatits
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Fever, malaise, urticarial rash
Polyarthritis Pleuisy Pulmonary infiltration Glomerulonephritis Prenicious anaemia UC DM Abnormal LFT: Increased AST, ALT, albumin, alk phos +ve autoantibodies |
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Causes of Acute Pancreatitis
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Gallstone
Ethanol/alcohol Trauma Steroids Mumps Autoimmune Scorpions Hyperglyceamia ERCP Drugs Primary insults - relsease of pancreatic enzymes - autodigestion - oedema - fat necrosis + haemorrhage |
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Symptoms & Signs of Acute Pancreatitis
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Gradual or Sudden epigastric pain that radiates to the back
Vomiting Increased: amylase, WCC, urea, inflammation Decreased: albumin |
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Causes of Chronic Pancreatits
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Toxins - Alcohol
Idiopathic Genetic Autoimmune Recurrant Obstructive |
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Symptoms & signs of Chronic Pancreatits
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Early disease is aymptomatic
Abdominal or epigastric pain Weight loss, steatorrhoea Exocrine/Endocrine insufficiency - recurrent hypoglycaemia Skin pigmentation Manage with Drugs, Diet, Surgery. |
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Symptoms & Signs of Pancreatic Carcinoma
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RUQ pain
Painless obstructive jaundice - post hepatic Weight loss Itch Hepatomegaly/splenomegaly Abdominal mass + tenderness Palpable gall bladder |
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Test for Pancreatic Carcinoma
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Ultrasound
ERCP +/- Stent CT Biopsy |
