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125 Cards in this Set

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Investigations for Pancreatitis
Simple: Urinalysis, b HCG
Heme: FBC, U/E's LFT's CRP, Amylase (urinary Amylase) ABG's w/ Lactate, Calcium, Magnesium, Glucose,
Radiological: Erect Chest, Biliary Tree USS, MRCP
Specialist Test: CT Scan after 72 horus
Management:
ABC's DEFG (oxygen therapy, vigorous IV due to third spacing) and DEFG
1. NBM w/ NG suction
2. Analgesia
3. Replace electrolyte loss (Ca/Mg)
4. Antibiotics if severe
5. Consider ERCP if persistent jaundice
6. entral feeding via NasoJejunal Tube
7. begin oral foods as soon as pain/appetite returns
8. ICU may be waranted if 3 + on glasgow score
Pancreatitis Treatment
Management:
ABC's DEFG (oxygen therapy, vigorous IV due to third spacing) and DEFG
1. NBM w/ NG suction
2. Analgesia
3. Replace electrolyte loss (Ca/Mg)
4. Antibiotics if severe
5. Consider ERCP if persistent jaundice
6. entral feeding via NasoJejunal Tube
7. begin oral foods as soon as pain/appetite returns
8. ICU may be waranted if 3 + on glasgow score
9. Manage lifestyle factors: MDT input if alcohol abuse suspected.
Investigation of Gall Bladder Disease
Simple Bedside: Urinalysis/B-HCG, ECG
Heme: FBC, U/E's, LFT's, U/E's, CRP, Amylase, ABG's/Blood Culture (if unwell),
Radiological: Ultrasound scan is first line (pericholocystic fluid, wall thickening and sonographic murphy's sign), CT with contrast in non-specific abdominal pain
Specialist nature investigations: MRCP or ERCP (if suspected common bile duct obstruction +/- extraction/sphincterotomy)
Treatment of Gall Bladder Disease
1. Treat with ABC approach first
1. NBM
2. IVT
3. Analgesia
4. Anti-emetics
5. DVT prophylaxis
6. Antibiotics (cefuroxime/met)
7. Emergent ERCP if common bile duct obstruction
8. Cholecystectomy ideally within 72 hours or at 6 weeks.
9. Manage Lifestyle Factors --> Loose weight
Investigation of Renal Colic
1. Simple Bedside: Urinalysis, B-HCG, ECG, urine microscopy, Culture and Sensitivity and stone analysis
Heme: FBC, U/E's, LFT's, CRP, Amylase, ABG's/Blood Culture if Susp. Pyelonephritis
Radiological: KUB xray, CT KUB, Intravenous urogram (standing column, delayed emptying, dilated ureter and renal pelvis, radio-opaque stone).
Specialist Investigations: Cystoscopy if bladder stone, for recurrent stone formers: Calcium, Phosphate, Uric Acid, Parathyroid if hypercalcemia.
Also 24 hour urine for: Calcium, phosphate, uric acid, oxalate, magnesium and citrate
Treatment of Renal Colic
1. ABC DEFG approach
1. Analgesia (diclofenec suppositories 50 mg (max 150 TDS), IV Morphine/Paracetamol)
2. Anti-emetics- cyclizine 50mg tds
3. IVT/DVT prophylaxis if necessary
4. Depending on the size, location and consistency of stone
5. Acute Setting: Cystoscopy with Stent placement if no drainage. Or percutaneous Nephrostomy.
6. Alpha Blocker: Tamsulosin 400 micrograms
6. Elective treatment: If less than 5 mm Tamsulosin and conservative management, if less than 2.5 cm Extracoporeal shockwave lithotripsy. Percutaneous Nephrotomy if larger than 2.5 cm in kidney, if ESWL fails then uretoscopy with extraction.
7. Manage Lifestyle Factors: Adequate fluid intake, avoid dehydration, reduce animal protein, avoid high dose vitamin c.
Medications:Thiazides for hypercalcemia, allopurinol for hyperuricouria, potassium citrate for hypocitriuria
Causes of Hematuria
Systemic: Fever, coagulopathy, exercise, sickle cell

Renal: Trauma, Renal Cell Carcinoma, urothelial cancer, pyelonephritis, nephrocalcinosis, nephrolithiasis, TB

Glomerular: Interstitial Nephritis, Glomerulonephritis: Wegners, Goodpasture’s, IgA nephropathy, Post-streptococcol Glomerulonephritis

Lower Urinary Tract: Bladder Ca, Interstitial cystitis, UTI, polyps, Prostatitis, BPH, urethral stricture, urethritis

Pseudohematuria: PV bleed, hemolysis, myoglobinuria, beets, drugs (e.g. rifampicin)
Investigation of Hematuria
Simple Bedside Tests: Urinalysis, Urine Microscopy, Urine Culture and Sensitivities, Urine Cytology

Heme tests: FBC (anemia, leukocytosis), Clotting, U/E's, CRP, p-anca, anti-nuclear antibodies, anti-dsDNA, anti-steptolysin-O tests, quantaferon gold,

Radiological Tests: Renal/Bladder Ultrasound Scan

Specialist Investigations: Cystoscopy, Intravenous Pyelorogram/CT for upper tract imaging, renal biopsy
Treatment of Hematuria
ABC approach (treat cause)
1. Bladder irrigation w/ normal saline to remove clots
2. continous bladder irrigation with large 22 Fr. Catheter to prevent clot
3. If refractory instillation of Silver Nitrate 1%
4. If still refractory interventional radiography
Treatment of Acute Pyelonephritis
ABC approach: If severe pain and systemically septic consider CT for pyonephrosis
1. IV antibiotics (Cipro is first line)
2. IVT/DVT prophylaxis
3. Analgesia
4. Investigate for cause (diabetes, stones etc)
5. discharge advice re: fluid intact hygeine seeking earlier help
Treatment of anything cancer/social causes
1. MDT dumbass with support groups etc.
Acute Ascending Cholangitis: what is Charcot's Triad
1. Fever/rigours
2. RUQ pain
3. Jaundice
Investigation of Cholangitis
1. Simple Bedside: Urinalysis (may show bilrubinuria, B-HCG

Heme: FBC, U//E's, LFT's, CRP, Amylase, ABG's, Blood Culture, Group and Save

Radiological: USS, ERCP (therapeutic and diagnostic)
Treatment of Cholangitis
ABC approach
1. IVT/DVT prophylaxis
2. IV ABx (cef/met)
3. Analgesia
4. Anti-emetics
5. ERCP with drainage
6. percutaneous transhepatic biliary drainage
7. Consider maintenance therapy for recurrent cholangitis with TMP-SMX or a flouroquinolone
Types of Renal Calculi
1. Calcium (radioopaque, Thiazides,potassium citrate, allopurinol if hyperoxaluria)
2. Uric Acid (ECSWL not effective, alkanalize the urine)
3. Pyruvate (mag ammonium phosphate due to urea splitting organisms)
4. Cysteine (hypercystenuria AR defect resulting in COLA urine (cysteine, ornithine, lysine, argenine), ECSWL not effective, aggressive stone disease in children, give penacillamine/captopril)
Bladder outflow obstruction Investigations
1. Simple Bedside: DRE, urinalysis, microscopy, culture and sensitivity, cytology if malig susp
2. Heme: FBC, U/E's, CRP, PSA
3. Radiological: Bladder USS and post void Scan, Renal USS for hydronephrosis
4. Specialist Investigations: Urodynamics, cystoscopy, Ultrasound guided rectal biopsy
Causes of BOO:
Urethral: Urethral Stricture, Phimosis, Paraphimosis, urethral neoplasm, urethral stone, blood clot

Bladder Neck: BPH, Prostate Ca, Prostatitis, constipation, pelvic tumor

Bladder: Bladder Ca, Bladder polyp, stone

Neurological: Spinal cord trauma, Multiple sclerosis, spinal cord lesion, stroke, pelvic sugery

Pharmacologic: anticholinergics, narcotics
Treatment of BPH:
Medical Therapy
1. Alpha Blockers: Tamsulosin 400mcg
2. Finesteride 5 mg

Surgical Therapy
1.transurethral resection of prostate
minimally invasive therapies like cryotherapy etc.
prostatectomy
3. intermittent catheterization by patient, suprapubic catheter in extreme cases.

Lifestyle Factors:
Decrease fluids in the evening to avoid nocturia, avoid Tea/Coffee/Alcohol anything with Tannins in it
Treatment of Bladder outflow obstruction
Complications
ABC approach
1. Catheter and drain bladder and leave indwelling until drained
2. If chronic intermittent or suprapubic catheterization

Complications:
1. Atonic Bladder
2. Post catheterization diuresis (monitor and replace fluid and electrolytes accordingly.
Causes of urethral stricture/Treatment
1. Congenital
2. Traumatic (instrumentation (most common) catheterization, trauma)
3. Infection (UTI's, urethritis due to STI)

Treat:
1. Dilatation
2. Internal Urethrotomy
3. Open surgical reduction
Peptic Ulcer Disease/Perforated Peptic Ulcer Disease Investigation
Simple Investigations: Urinalysis, B HCG, BG
Heme: FBC, U/E's, LFT's CRP, Group and Save/Cross Match, ABG's Amylase
Radiological: Upper GI series may show ulcer
Specialist investigations: Needs OGD
Management of Lower GI blood loss.
ABC's First!!!!!

Keep NBM!

If massive (large amounts of blood, hemodynamicaly compramised or loosing blood between stool)

1. ABC management --> High Flow Oxygen, Two large bore cannula's fluid rescucitation, NG suction to assess upper GI
--> Once stabalised consult Lower GI surgeons
and emergent colonoscopy
If rapid Bleeding --> Angiography with embolization
Bloods: FBC, U/E's, Clotting and cross match 4 units

If not massive:
2. Simple Bedside: None
Heme: FBC, U/E's, Clotting, cross match 4 units
Radiological: techtinium radiolabled RBC scan (can detect less than .1 ml/hr
Special Tests: Angiography,
Management of Upper GI hemorrhage: Suspected Bleeding Ulcer
ABC's
--> High Flow Oxygen, Place two large bore I.V. cannula's, fluid resucitation w/ blood products if necessary.
--> Bloods: FBC, U/E's, Clotting,LFT's cross match 4-6 units
--> NG tube placement + Aspiration to confirm source
--> NBM
--> 80 mg IV PPI + 8 mg/hour
Once stable consult Upper GI/Gastroenterology
--> Endoscopy 1. active bleeding vessel then clips/thermocoagulation + epinephrine, consider clot removal
2. flat not actively bleeding lesion --> start PPI's


Once settled: clear fluids post 6 hours, test for H-pylori, if rebleeds then do endoscopy
Lifestyle Factors: Decrease alcohol, stop offending drugs (NSAIDS), decrease spicy foods.
Upper GI Bleeding w/ Esophageal Varacies Management
ABC's
- Oxygen if possible, Two Large bore IV cannula's with colloid, correct clotting deficiencies with Fresh Frozen Plasma, fresh blood and Vit K
-Bloods: FBC's, U/E's, Clotting, LFT's, Cross Match 6 Units,
--> NBM
--> Give IV Octretide
--> Endoscopy with sclerotherapy/vessel ligation

Long Term Management:
-->MDT with alcohol support services
-->referral to gastroenerologist
--> Betablocker therapy
---> Nitrates therapy
--> Prophylactic band ligation of varicies
--> Transhepatic Portosystemic Shunting
--> Liver Transplant
Acute Appendicitis Investigations
Simple Bedside: Urinalysis, B-HCG, BM
Heme: FBC, U/E's, LFT's, CRP, Amylase, ABG's, Blood Culture if Unwell
Radiological: None, clinical diagnosis. If unsure or pregnancy, consider Pelvic USS.
Special: Laproscopic investigation
Acute Appendicitis Treatment
ABC Approach!
1. NBM/DVT prophylaxis
2. IVT
3. Analgesia
4. Antiemetics
5. I.V. Abx post surgery
6. Laproscopic appendectomy
7. If unsure and patient stable watchful waiting can avoid unnecessary appendectomy
Differential Diagnosis for Right Iliac Fossa Pain in a Female
GI Causes
1. Appendicitis
2. Terminal Ileitis (chron's, yersinia etc)
3. Gastroenteritis
4. Mesenteric Adenitis
5. Small bowel obstruction/Large Bowel Obstruction

Urinary
1. Urinary Tract Infection
2. Renal Colic
3. Pyelonephritis

Gyne Causes
1. Ectopic Pregnancy
2. Cyst Accident
3. Ovarian Torsion
4. Pelvic Inflammatory Disease
5. Acute Salpingitis
6. Endometriosis

Medical Causes
1. DKA
2. Sickle Cell
3. Mesenteric Adenitis
Differential for Right Upper Quandrant Pain
Hepatobiliary
1. Biliary Disease (cholangitis, choledocholithiasis, ascending cholangitis)
2. Pancreatitis
3. Hepatitis

GI
1. PUD
2. Acute Gastritis (erosive/hemorrhagic i.e. NSAIDS/Asprin)
3. Gastroenteritis
4. SBO/LBO
5. Appendicitis

Renal
1. Renal Colic
2. Pyelonephritis

Gyne
1. Ectopic
2. PID (Fitz-Hugh's Curtis Syndrome)

Medical
1. Myocardial Infarction
2. Lower Lobe Pneumonia
3. Diabetic Ketoacidosis
4. Prophyria
Epigastric Pain
DO NOT FORGET AAA
GI
1. PUD (+/- perforation)
2. Acute Gastritis
3. Gastroenteritis
4. Pancreatitis
Left Upper Quandrant
GI
1. PUD
2. Gastritis
3. Pancreatitis

Splenic
1. Splenic Infarction
2. Splenic Injury
Umbilical Pain
DO NOT FORGET AAA
GI Causues
1. Early Appendicits
2. Small Bowel Obstruction/Large Bowel Obstruction
3. Gastroenteritis
4. IBD
4. Mesenteric Ischemia
5. Irritable Bowel Syndrome
6. Mesenteric Adenitis

Renal Causes
1. Cystitis

Gyne
-Ectopic

Medical
1. DKA
2. Sickle Cell
3. Prophyria
Left Lower Quadrant Pain
GI
1. Diverticulitis
2. Gastroenteritis
3. SB0/LBO

Renal
1. Ureteric Colic
2. Cystitis
3. Pyelonephritis

Gyne
1. Ectopic
2. PID
3. Cyst Accident
4. Acute Salpingitis
5. Ovarian Torsion
6. Endometriosis
Supra-Pubic Pain
1. Cystitis
2. Endometritis
3. Gyne Cancers
3. Urinary Retention
Causes of Small Bowel Obstruction
1. Adhesions
2. Hernias
3. Tumours (intrinsic i.e. cecum, extrinsic)
4. Strictures (e.g. IBD)
5. IBD
5. Intussception
6. Volvulus
7. Bezoars
8. Gallstone Ileus
Pseudoobstruction/Paralytic Ileus do to inflamation (pancreatitis/peritonitis)
Causes of Large Bowel Obstruction
1. Neoplasm
2. Diverticulitis
3.Volvulus
4. IBD
5. Fecal Impaction
6. Strictures
7. Surgical
Investigation of Diverticulitis
Simple: Urinalysis, bHCG, BG
Heme: FBC, U/E's, LFTs, CRP, Amylase, ABG's/Blood cultures
Radiological: Erect Chest Xray, CT with contrast
Specialist Investigations: None
Management of Diverticulitis
ABC's management
1. NBM/DVT prophylaxis
2. IVT
3. Analgesia
4. Anti-emetics
5. Antibiotics (cefuroxime/Mentronidazole)
6..Percutaneous drainage of any abcesses > 3cm
7. If reccurrent attacks/doesn't resolve in 48 hours/complications consider sigmoidectomy
8. Lifestyle advice: increase fibre, stay hydrated.
Complications of Diverticulitis
1. Perforoation
2. Abcess formation
3. Fistula formation (colovesicle in men, pneumaturia. Colovaginal, colocutaneous in women)
4. Stricture
Investigation of Peripheral Arterial Disease
Simple Bedside: ABPI, Blood glucose, doppler flow studies
Heme: Lipid Profile
Specialist TestsExercise ABPI
Radiography: MR angiography/CT angiography
Treatment of Peripheral Arterial Disease
Medical: Asprin, Statins, Pentoxyphylline (xanthine derivitive, improves blood flow by reducing viscosity and improving RBC deformability)
Cilostazol (Type 3 Phosphodiesterase inhibitor, inhibits platlete aggregation)

Surgical: Stent, endarterectomy, bypass graft

Lifestyle: 1. Stop Smoking
2. low cholesterol diet
3. manage diabetes accordingly
4. exercise daily, walking may be the single best thing to improve intermittent claudication
Treatment of Acute Limb Threatning Vaso-occlusion
ABC management
1. Immediate Heperinization with 5000 I/U
2. Maintain PTT above 60 seconds
3. Consult with vascular surgeon
4. Embolectomy/Stenting
Complictions post revascularization?
1. Compartment syndrome due to revasculrization
2. Renal Failure and multiorgan failure due to toxic metabolites for muscle breakdown
Causes of a post op fever:
1. Days 0-2
2. Days 3-5
3. Days 6+
1.
- Atelectasis most common cause in first day.
-early wound infection
-aspiration pneumonia
-addisonian crisis, transfusion reaction
2. Day 3
-infection more likely
-UTI, Pneumonia, Wound infection
-I.V. site infection/thrombophlebitis
3. Days 5+
-DVT/PE (DAYS 7-10 MOST LIKELY)
-Anastomotic leakage
-Abdominal Abcess
-Drug Fever
-Cholecystitis
-Parotidis
Wound Complications
1. Dehiscence
2. Evisceration
3. Hematoma
4. Seroma
5. Infection
Types of Esophageal Hernias
1. Sliding (most common 90%)
- can cause GERD symptoms
2. Paraesophageal
Investigation and treatment of esophageal hernias
1. Investigate --> barium swallow, 24 hour pH monitoring, endoscopy w/ biopsy
2. Treat
Lifestyle: Smaller/less fat meals, decrease alcohol/smoking, weight loss, elevate head of bed, no food before bed
Medical: H2/PPI
Surgical: Fundoplication if severe
Esophageal rupture treatment
1. NBM
2. Antibiotics
3. Fluid rescus
4. Surgery
Presentation of Esophageal cancer
VWBAD
- also tracheoesophageal fistula
Complications of Gastric ulcers
1. Perforation (sudden pain, rigid abdomen, ileus)
2. Hemorrhage
3. Posterior Erosion to Pancrease (elevated amylase)
4. GASTRIC OUTLET OBSTRUCTION
Gastric Carcinoma
adenocarcinoma
Difference Between Small bowel obstruction and paralytic ileus
1. Small bowel obstruction:
-vomiting early on (may be billous), pain is diffuse and crampy (constant if strangulation/perforation), distension if distal, may have visable peristalsis, BS may be hyperactive, characteristic xray changes (no gas in rectum/dilated SB loops/Air fluid levels)
2. Paralytic Ileus
-has nausea/vomiting, pain is minimal or absent, may have distension, bowel sounds are decreased/absent, characteristic xray (gas throughout/no air-fluid levels
Large Bowel Obstruction
1. Cramping Pain
2. Abdo Distension
3. No vomiting if ileocelcal valve is competent
4. vomiting late.
5. Obstipation
6. Characteristic xray (enlarged Large bowel (look for haustra), picture frame appearence, kidney bean sign in volvulus).
Treatment of Small bowel obstruction:
ABC management
IM FINE
I.V. large bore canula's,
Monitors: HR, BP, SATS, ECG
F: Foleys Catheter
Investigations: Bloods, Xray
N-Nill by mouth/NG tube to decompress
E-xrays
Manage medically if partial/history of pelvic/abdo surgery as likely to resolve
- if not resolving in 72 hours then theatre
-medical management in cases of IBD with steroids
Large Bowel Obstruction Treatment
ABC's I'M FINE (IVT, Monitors, Foley catheter, Investigations, NBM/NG tube, Xrays/CT
-open loop (invompetent IC valve, safe), close loop (competent IC valve, can rupture)
-surgical correction with diverting colostomy
What is an acute abdomen plus metabolic acidosis?
Intestinal ischemia until proven otherwise
Radiological appearence of intestinal ischemia
1. Air in portal vein
2. pneumotosis intestinalis
CT with contrast: Thickened wall/ SMA/IMA thrombus
CT angiography is the gold standard
Treatment of intestinal ischemia
1. ABC's IM FINE, Abx
2. Vascular intervention (embolectomy, stenting)
3. Resection of necrotic bowel.
Risk Factors for Cholelithiasis:
Cholesterol Stones
1. Fat (obesity),
2. Female,
Fertile. (multiparity, OCP, Forty (afe),
3. impaired emptying (starvation, Diabetes, TPN),
4. Rapid Weight loss (cholesterol mobilization)

Pigment Stones
1. Hemolysis (e.g. spherocytosis)
2. Cirrhosis
3. Bile duct stasis (infection, strictures)
What does a calcified gallbladder increase your risk of?
Cancer
Complications of gall stones
1. Acute Cholangitis
2. Pancreatitis
3. cholcystenteric fistula w/ gallstone ileus
Symptoms of Acute Cholecystitis
1. severe constant pain that can last hours to days, RUQ, nausea/vomiting, Boas Sign (scapular pain), Low grade fever, palpable tender gall bladder.
Bloods: Mildly elevated liver enzymes, mild leukocytosis
Complication of Acute Cholecystitis
1.Gangrene Perforation
2. Empyema
3. Cholecystenteric fistula
What is the difference in biliary colic vs. Acute Cholecystits treatment?
Biliary Colic requires no Abx just analgesia and appropriate IVT
Acute Cholecystis requires antibiotics
what is Acute Cholangitis?
Bile duct obstruction leading to stasis, bacterial overgrowth and suppuration and biliary/systemic sepsis
What are the features of Acute Cholangitis?
Charcot's triad: Fever, RUQ pain, Jaundice
May be septic as well.
Investigations for Acute Cholangitis?
Simple: Urinalysis, BHCG, OBS (ECG, SATS, BP, HR, RR)
Heme: FBC, U/E's, LFT's, U/E's, CRP, Amylase, Blood Cultures, ABG's
Radiological: Erect Chest xray, Abdo USS (intra/extrahepatic dilatation), CT w/ contrast
Treatment of ascending cholangitis
ABC's IM FINE (I.V.T., Monitoring, Foley Catheter, Investigations, NBM, NG suction, Xrays)
-Analgesia/Antiemetics
-NBM/NG suction
-Antibiotics
-ERCP w/ drainage/sphincterotomy
-Percutaneous transhepatic drainage
Bacteria in cholangitis
K- Klebsiella
E - Ecoli
E - Enterobacter, Enterococcus
P - Proteus
S - Serratia
What are the featuers of Gall bladder cancer
1. Adenocarcinoma
2. Vague RUQ pain w/ a hx of gall stones
3. Jaundice
4. Weight loss, anorexia
5. palpable gall bladder
Risk factors for Cholangiocarcinoma
1. age 50-70
2. gallstones
3. ulcerative colitis
4. PSC
5. Choledochal cyst
6. Liver Fluke
Investigations for Bile duct cancer
Simple: None
Heme: FBC's, U/E's, LFT's
Radiological: USS, ERCP, CT scan, Chest xray, Bone scan
Complications of acute pancreatitis
1. Abcess/Necrosis
2. Pseudocyst
3. Hemarrhage of splenic vessels
4. Diabetes
5. ARDS/Multiorgan failure
6. Ascities
7. DIC
8. Hypocalcemia
what level is the umbilicus at?
What level are the renal vessels at?
1. L3/l4 (bifurcation of the aorta)
2. L1
What are the two most common locations for the appendix?
1. Retrocecal appendix (65%)
2. Pelvic Appendix (30%)
When should you institute empiric therapy for PID?
Woman who presents with risk factors, lower abdominal pain and has no identifiable factors for pain.
On examination one of the following
1. cervical motion tenderness
2. adenexal tenderness
3. Uterine tenderness
What is therapy for PID?
1. Ceftriaxone Abx 500 mg IM
1. Doxycycline 100 mg BD 14 days
2. Metronidazole 400 mg BD 14 days
AAA triad
1. severe sharp pain to back
2. hyoptension
3. pulsatile mass
AAA size criteria
diameter of > 3.0cm (Normal diameter is about 2 cm)
- if above 3 cm monitor with abd USS every 6 months
Risk of rupturing AAA
1. > 5.5 cm, 5.0 in marfans, 4 cm in women
2. .4 cm/year
Investigations for AAA
CROSS MATCH 6units!
CAUSES OF AAA
1. 90% of are infrarenal and cause by degenerative changes often attributed to atherosclerosis
RISK factors for AAA
1. SMOKING
2. White men over 70
3. PVD, IHD, CVD
4. HTN/Hypercholesterolemia
Complications of AAA
1. Rupture
2. Fistula (aortocaval --> Heart failure, tachycardia etc)
3. Emboli (eg blue toe syndrome)
4. Thrombus
Treatment of AAA
Medical: Monitor 6 monthly if under 4 cm
-reduce risk factors via lifestyle interventions--> STOP SMOKING IS PARAMOUNT!!!!!!
Surgical Intervention: Endoluminal stenting, aortic graft
Presenting Complain for head a neck cancers.
1. Trismus (inability to open mouth completely)
2. Globus Sensation
3. Odynophagia
3. HOARSENESS
4. Dysphagia
5. Pain
6. Referred pain
7 Wt Loss
8. Facial nerve/cranial nerve palsies
9. Hemoptysis
Major Risk Factors for Head and Neck Cancers
1. SMOKING
2. ALCOCHOL
3. Laryngopharyngeal reflux
4. HPV infection
5 Betel Nut Chewing
6. History of HEAD AND NECK CANCER --> Field cancerization.
What is the most common type of ENT cancer?
How common is it?
Squamous cell cancer
6th most common malignancy
Cause of cancer deaths?
1. Lung
2. Colon
3. Breast/Prostate
4. Pancreatic
Histology of Pancreatic cancer
1. Adenocarcinoma (2/3 are in head)
2 80% are ductal, remainder are islet cell
Risk factors for pancreatitic cancer
1. Smoking
2. Obeisity
3. Chronic Pancreatitis
4. Diabetes
5. Cirrhosis
Most common metastasis for pancreatic cancers
1. Local invasion/spread
2. Local lymphnodes
3. liver
4. Late spread to lungs, peritoneum and distant nodes
Presenting signs and symptoms of pancreatic cancer
1. 75% present with weight loss.
2. Obstructive Jaundice
3. Deep seated abdominal pain
4. 25 % present with Back pain
5. Hepatosplenomegaly
6. Sudden onset diabetes
7. Pain is relieved by leaning forward/worsened by lying down/night
6. Palpable mass suggests surgical incurability
7. Palpable gall bladder w/ jaundice = malignant obstruction of common bile duct.
Imaging for presenting with weightloss.
Do chest abdo CT contrast along with FBC etc.
If jaundiced what else should you ask about?
Itching!
What does migratory thrombophlebitis indicate?
cancer of the body of the pancreas
What is Whipple procedure?
Pancreaticoduodectomy
Causes of Hematuria
Trauma: Renal/Bladder/Catheter insertion
Inflammation: Proctitis, BPH, UTI, STI, Pyelonephritis, renal TB, interstitial cystitis, urethral stricture
Tumour: BPH, Prostate Cancer, urothelial cancer, renal cell cancer
Stone: Renal Stone
Investigations of Hematuria
Simple: urinalysis (could be pseudohematuria), urine C/S, microscopy and cytology
Bloods: FBC, U/E's, CRP
Radiological: For stones
Specialist Investigations: cystocopy with Retrograde pyelorogram (shows filling defect), CT/IVP
What to do if results for hematuria workup are negative?
1. Repeat BP, Urinalysis and cytology at 6, 12, 24 and 36 months
Causes of Urinary Retention
1. BOO
-Bladder: Tumour, Stone, Clot, FB, constipation (pushes bladder forward)
-Prostate: BPH, Tumor, Prostatitis
Urethra: Stricture, Tumor, phimosis, paraphimosis

2. Pharmacologic/Neuologic
-anticholinergics
-antihypertensives
-spinal cord injury
Female Urogyne Questions
1. Frequency, Urgency (do you make it all the time, do you have accidents), Nocturia, stress incontinence, (sneezing/laughing/getting up), dysuria, hematuria, have the feeling of something coming down/heaviness,
Complications of bladder outlet obstruction
1. damage to bladder.
2. Post Obstruction Diuresis (>3L in one day or 200 mls in 2 consecutive hours.
Usually self limiting may need replacement of electrolytes, do bloods every 6 hours.
When is urgent intervention needed in kidney stones?
1. Bilateral stones
2. Solitary Kidney
3. Acute Renal Failure
4. Intractable Pain
What kidney stones are radiolucent on xray and need CT scanning?
uric acid
What is stenting used for? When is it Used?
1. Allow for obstructed kidney to flow before more definitive treatment
2. stones 1.5-2.5 cm
Cancers associated with HNPCC
1. Colorectal
2. small bowel,
3. stomach
4. hepatobiliary tract
5. ovarian/endometrial
6. Renal Pelvis Ureter
Cancers Associated with FAP (APC GENE)
1. Colorectal
2. Small bowel
3. Bile Duct
4. PANCREAS
5. THYROID
6. ADRENAL
7 CONGENITAL HYPERTROPHYOF THE RETINAL PIGMENT EPITHELIUM
Symptoms of Right sided Colon Cancers
1. Unexplained anemia
2. Occult Blood
3. Right sided abdo patient
4. Dyspepsia
5. Weight Loss
Symptoms of Left sided Colon Cancer
1. Obstructive Symptoms
2. Change in bowel habit Constipation/Diarrhea ( COULD BE DIARRHEA IN ELDERLY)
3. Frank BLOOD/MUCOUS
4. Weight Loss
Symptoms of Rectal Cancer
1. Tenasmus
2. Bleeding
3. Change in Bowel Habit (DIARRHEA OR CONSTIPATION)
4. Weight Loss
What is the prognosis of CRC according to stage?
T1 (submucousa) = >90%
T2 (muscularis propria) = 85%
T3 (subserosa) 70-80%
T4 (penetrates visceral peritoneum) = 70%
Any Nodes = 40%
Any Mets = 5%
What is the difference between fibroadenoma and fibrocystic changes?
1. Fibroadenoma is a benign neoplasm that is round, rubbery and movable, it is a cyst and is solitary in nature.
2. Fibrocystic changes or focal nodulocystic changes that are often bilateral, are painful premenstrually and vary with the cycle. They often have brown/green/yellow discharge. Often appear in upper outer quadrant.
What is the overall five year survival rate for colorectal cancer?
63-64 %
What is the overall five year survival rate for Breast cancer
88 % (women) 79% (men)
What is the overall five year survival rate for Prostate Cancer?
96%
Whati s the five year survival rate for Pancreatic cancer?
6%
What is the 5 year survival rate for esophageal cancer?
13%
What is the prognosis based on Staging for Breast Cancer?
Stage 1 (<2cm) = 94%
Stage 2a (<2cm + node positive) = 85%
Stage 2b (2-5cm node +, or >5cm node -) = 70%
Stage 3a (any size, fixed nodes) = 52%
Stage 3b (Skin/Chest Wall Invasion) = 48%
Stage 3c (any size, IPSILATERAL + AXILLARY NODE +) = 33%
Stage 4 = Mets = 18%
Risk Factors for breast cancer?
1. Gender
2. Age
3. Family History
4. Previous Breast Ca
5. Inc. Breast density
6. Mulliparity, Early Menarche, Late menopause)
7. Radiation Exposure
8 5+ yrs of HRT
What are unfavorable features?
1 less than 2cm
2. ER negative
3. Her 2 positive
4. inflammatory cancer
Types of Breast Cancer?
1. Ductal Ca in Situ (80% non palpable detected on mammography, lumpectomy/radiation)
2. Lobular Carcinoma insitu (not a preecursor lesion)
3. Invasive ductal carcinoma --> 80%
4. Loular Carcinoma --> 15 %
5. Paget's Disease --> 1-3 %
6. Inflammatory Ca --> 1 - 4%
Where do breast cancers metastasize to?
1. Bone
2. Lung
3. Pleura
4. Liver
5. Brain
What blood type is a risk for Gastric Cancer?
1. Type A blood
What are the red flags for epigastric discomfort?
V: Vomiting
W: Wt. Loss
B: Blood (melena/hematemesis/anemia)
A: Abdominal Mass/Anorexia
D: Dysphagia
Prognosis by stage in Gastric Cancer?
Stage 1 (mucosa/submucosa) = 70%
Stage 2 (muscularis propria) = 30%
Stage 3 (regional nodes) = 10%
Stage 4 (distant mets) = 0%