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59 Cards in this Set
- Front
- Back
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" Relapsing remitting disorder of the colonic mucosa" is what and afects which distribution
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-Ulcerative colitis
affects rectum (proctitis=50%)and entir colon (pan colitis) |
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hyperaemic haemmorhagiic granular colonic mucosa +/- psuedopolyps
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UC
fem>male //15-30yrs |
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-Gradual onset bloody/ mucus diarrhoea
-crampy abd discomfort ->freq -Tenesmus -Urgency |
UC
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A pie sac - which two diseases and which more prominent
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A-pthous Ulcers
P-yoderma gangrenosum I-ritis, uveitis, conjuncitivits E-rythema Nodosum Sclerosing cholanbgitis & chronic active hepatitis A-rthritis C-lubbing |
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Investigations of UC
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Stool MC&S - exclude infection
AXR - mucosalthickening / islands, colonic distension Erect CXR - perferation Sigmoidoscopy - inflamed friable mucosa Rectal Biopsy - Inflammatory infiltrate / dereased goblet cell/ distal glands / mucosal ulvers / crypt abcesses Colonoscopy |
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Truelove & witts is classification for what?
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UC
------- -motions /day -Rectal bleeding -Temp @ 6am -ESR -Haem -Pulse |
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Complications of UC (5)
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Perforation
Bleed Toxic Dilitation Venous Thromb Colonic CA |
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Inducing remission in UC
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-Asacol (5-aminosalycillic acid) mesalazine
-Pred (40,30,20) -steroid enemas ----------- Azothiprine Ciclosporin infliximab Surgery |
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Surgery for UC
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Proctocolectomy & terminal iileostomy
----------------- colectomy with ileo-anal pouch |
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Indications for surgery (4)
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>Haem
Failure to respond perf toxic mega |
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chronic inflammatory GI disease characterised by transmural granulomatous inflammation
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Crohn's
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Crohn's affects which part
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Any!
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Differenc in lesion progression UC & Crohn's
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Crohn's can have skip
UC Anus-> proximally |
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Crohn's presents with / features
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ABDN PAIN
diarrhoea weight loss (malab) tenderness perianal disease (A PIE SAC) |
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Cobblestones
Rosethorn ulceration Stricture fistula formations intraperitoneal abscess |
Crohn's
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Therapies in Crohn's mild, severe, therapy
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Mild
----------- Pred (30) SEVERE ----------- Hydrocortisone IV Topical Steriods Metronidazole Standard therapies --------------------- Azathioprine Elemental diet Methotrexate |
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Surgery should be orientated around ? in Crohn's
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-minial resection of strictures/affected areas
-temp defunction of severe disease |
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KRAS2
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Pancreatic Carcinoma
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smoking, alcohol, DM, chronic panceatitis
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pancreatic Carcinoma
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3 types of panceatic carcinoma
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>ductal adenocarcinoma
ampullary tumour pancreatic islet |
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what is a concern in painless obstructive jaundice with palpable gall bladder
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Head of Pancreas Ca
----------- epigastric mass, hepatomegaly, slpenomegaly, lympadenopathy, Ascites bloods(^ca-19-9) us/ct |
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Treatement of Pancreatic Ca
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-depends on metastatic spread
(<3cm and no mets= Whipples, pancreatoduodenectomy) otherwise palliative stenting, pain relief, post op-chemo |
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Villous atrophy and malabsorbtion (from a T-cell mediated autoimmune DX)
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Coeliacs
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What can coeliacs not eat
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Wheat
Barley Rye (Oats) |
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What is the most common HLA assosiation with coeliacs
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HLA DQ2, also DQ8
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When is are the two peaks of coeliacs?
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infancy & 5th decade
(can get anytime) |
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-steatorrhoea
-ABD Pain -Bloating -N&V -Apthous Ulcers -angular stomitis -weight loss -incidental fever |
Coeliacs
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Which antibodies do you test for? (coeliacs)
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alpha-gliadin
transglutaminase anti-endomysial* |
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what would you find on duodenal biopsy (coeliacs)
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subtotal villous atrophy & crypt hyperplasia
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tx for coeliacs
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Gluten Free diest
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Complication of coeliacs (8)
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-Anaemia
-lactose intolerance -osteoporosis -GI T-cell lymphoma -hyposplenism -Malig (GOBBB) gastric, oesophageal, brain, bladder, breast -myopathies -neuropathies |
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Epigastric pain -> back, with relief on sitting formawards suggests
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Pancreatitis
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Risk factors for chronic pancreatitis (5)
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-alcohol
-familial -CF -heamachromatosis -pancreatic duct obstruction |
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Features on chronic pancreatitis (4)
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-bloating
-steatorrhoea -weight loss -brittle diabetes |
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Medical Treatment Chronic Panreatitis
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-analgesia
-lipase -fatsoluble vitamins -reduced alchohol and fat |
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Surgical treatment Chronic Panceatitis
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pancreatectomy
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Complications of Chronic Pancreatitis
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-pseudocyst
-Diabetes -Biliary Obstruct -Local Arterial anueryms -splenic vein thrombosis -Gastric varicies |
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malabsorbtion in the terminal ileum affects what vitamin
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B12 (glossitis)
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Causes of Liver Failure (11~)
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-Alcoholic Hep
-primary Biliary Cirrhosis -alpha1-antitrypsin def. -viral / auto immune hep. -Fatty Liver -haemachromotosis -wilsons -Malignancy -veno-occlusive / bud chiari -Paracetamol |
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Complications of Liver failure
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-bleeding
-infection -ascites -hypoglycaemia -encephalopathy -cerebral oedema |
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Causes of Cirrhosis (6)
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-Alcoholic
-hepatitic B & C -Autoimmune (PBC, PSC) -Genetic (Haemachromatosis, Wilsons, alpha1-AT) -Cryptogenic, veno occlusive -Drug related |
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Severity of Cirrhosis
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Child-pugh
-Billirubin -Albumin -Prothrombin -Ascites -Encephalopathy |
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Wernike's is a deficiency of what?
What is it's triad Treatment? |
B1
opthalmoplegia, confusion, ataxia IV pabinex (watch for anaphylaxis, give before glucose) |
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Fatty liver (4)
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Alcohol
DM Obese Amiodarone |
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10-72 hours after admission, tachycardic, hypotensive patient with tremor, confusion fits and halucinations
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-Chlordiazepoxide (librium)
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dysphagic who has difficulty swallowing solids and liquid at onset....
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yes= motility disorder
No= Mechanical |
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Difficult to make a swallowing movement?
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Bulbar palsy
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Painful swallow?
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oesophagitis, CA, achalasia, oeophageal spasm
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Intermittant dysdphagia?
Progressive dysphagia? |
I= oesophageal spasm
>= Malig |
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Mechanical strictures
-malig(3) -benign (2) -extrinsic (5) -pharyngeal ? |
malig
----------- oesophageal ca Gastric Ca Pharengreal Ca Benign --------------- oesophageal web peptic stricture Extrinsic Pressure -------------------- -lung Ca -mediastinal lymph -Retrosternal Goitre -AA -Left atrium |
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Dyspepsia alarms signs
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A-nemia
L-oss of weight A-norexia R-ecent onset of progression M-elena / heamatemesis S-wallowing difficulty |
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pain before meals and at night, hx of h. plori, nsaids, aspirin, steroids
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Duodenal Ulcer
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Management of peptic ulcers
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-Lifestyle
-H. Pylori -PPI |
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7 risk factors of GORD
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-Smoking
-alcohol -hiatus hernia -preg -obesity -big meals -drugs (tricyclics, anticholinergics, nitrates) |
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Heartburn, water brash, odynophagia, noct. asthma
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Symps of GORD
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oesophagitis, ulcers, benign stricture, bareets, oesophag adeno, iron def anaemia
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GORD
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Lifestyle treatment for GORD
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lose weight
stop smoking raised head sleep small regular meals no hot drinks no alcohol no eating before bed |
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Pharma management for GORD
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Antacids (MG trisillicate)
Alignates (gaviscon) Oesophagitis= PPI Prokinetics (metoclopramide) |
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Surgery for GORD
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Nissan Fundiplication
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