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96 Cards in this Set
- Front
- Back
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Energy requirements kcal/day for men and women
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2500
1800 |
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What is the equation to calculate PAL - Physical activity level
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PAL = Total expenditure/Basal Metabolic Rate
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How many amino acids are there and how many are essential
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20 total
9 essential |
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BMI =
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Wt (kg)/ Height squared
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Sx of Vit A def
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Xeropthalmia
Night blindness |
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Sx of Vit B1 def
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Thiamin
Beri-beri Wernicke-Korsakoff Syndrome |
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What Wernicke-Korsakoff Syndrome
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Acute Korsakoff psychosis leads to Wernicke's encephalopathy chronic.
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Sx of Vit B2 def
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Riboflavin
Glossitis Stomatitis |
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Sx of Vit B3 def
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Niacin
Pellagra (diarrhea, dermatitis, dementia, death) |
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Sx of Vit B12 def
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Cobalamin
Anaemia, dementia |
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Sx of Vit C def
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Absorbic Acid
Scurvy |
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Sx of Vit D def
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Rickets
Osteomalacia |
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Sx of Vit E def
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haemolytic anaemia
ataxia |
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Sx of Vit K def
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coagulopathy
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BMI for obese
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>30
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Mx of Obesity
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Cons - reduce intake (-600kcal/day) inc expenditure
Med - Orlistat Surg - Vertical banded gastroplasty, laproscopic banding, Roux-en-Y gastric bypass |
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Four phases of swallowing
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Voluntary tongue bolus propulsion
Upper Oesophageal sphincter relax Autonomic brain stem peristalsis Lower Oesophageal sphincter relaxes |
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what's the terminal part of the part of the stomach called and why's it important for stimulating acid release?
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the stomach antrum contains the antral G cells which release gastrin which stimulate H2 release
H2 and gastrin bind to parietal cells causing H+Cl- release |
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where's pepsinogen made
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chief cells
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where's IF made
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parietal cells along with H+
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how common are the hiatus hernias you know?
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Sliding 85%
Rolling (paraoesophagea) 10% Mixed 5% |
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top 5 sx to ellicit in GORD osler
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Hearburn (provoked by IAP, prone)
Waterbrash (>salivation 2' to acid) Hx Wt Gain Woken at night Odynophagia/dysphagia |
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Ix for GORD depending on age (3)
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young - empirical treatment
middle-old - endoscopy / 24hr ph monitoring (<4pH for >7% time) |
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Complications of GORD (3)
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Peptic ulceration of lower oesophagus
Benign stricture / fibrosis Barrett's Oesophagus - adenocarcinoma |
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Mx for GORD
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Cons - wt loss, pillows, small meals
Med - antacitds, alginates, H2 antag, PPI, prokinetic Surg - Nissen's Fundoplication |
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Some antacids are constipating some are laxatives, which are which
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Mg2+ are lax
Al3+ are constipating |
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What class is Gaviscon and MOA
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alginate
raft of protective foam |
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name an H2 antagonist
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Cimetidine (P450 inhibitor)
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Classify causes of dysphagia
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intraluminal
intramural extramural systemic |
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intraluminal causes of dysphagia (3)
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FB
Oesophagitis/Candidiasis Polypoid tumour |
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Intramural causes of dysphagia
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benign stricture
malignant stricture achalasia oesophageal web scleroderma |
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what is oesophageal web associated with and what does this mean
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plummer vinson syndrome
fe def anaemia squamous cell carc oesoph |
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extramural causes of dysphagia (5)
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pharyngeal pouch
rolling hiatus hernia bronchogenic ca thyroid mass thoracic aneurysm |
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systemic causes of dysphagia
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myasthenia gravis
ms motor neurone disease parkinson's psychological |
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Ix for dysphagia (3)
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endoscopy
ba swallow manometry |
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with oesophageal ca, what becomes difficult to swallow liquids or solids
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solids first
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prognosis for oesophageal cancer
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early mets to lung, liver, bone
<10% 5yr |
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Mx oesophageal ca (2+)
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surgical resection 1/3
2/3 get palliative stenting, dilatation with possible downgrading chemo/radio |
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is achalasia associated with squamous cell carcinoma
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yes 4% get it
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surgical op for achalasia
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Heller's procedure
similar to Ramstedt for pyloric stenosis in infants |
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causes of peptic ulcer disease (4+)
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h pylori (90% duod, 70%gastric)
nsaid (30%) smoking zollinger ellison coffee? |
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what is zollinger ellison and what is it associated with
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gastrinoma causing excess acid secretion - 60% malignant (part of MEN1) need venous gastrin levels and CT
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where can gastrinomas be (2+)
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duodenum
pancreas stomach ovary |
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which blood group slightly predisposed to ulcers
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group O - lewis antibodies
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how do prostaglandins protect from ulcers
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create barrier to acid by stimulating bicarbonate and mucus secretion
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how does h pylori survive in the stomach
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buffers pH with ammonia production from urea
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possible sites of peptic ulceration in order of commoness
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duodenum
stomach oesophagus meckel's (if gastric mucosa) jejenum (in zollinger ellison) |
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when do people get ulcer pain
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at night
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ix for suspected ulcer
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urea breath test
endoscopy c biopsy |
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regime for +ve urea breath test
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PPI (omeprazole)
Amox/clarith Met for 7 days |
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how do you protect mucosa of elderly who need an nsaid
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misoprostol
prostoglandin analogue |
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surgical mx of ulcer
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partial gastrectomy with bilroth I anastamoses (duo-remaining stomach)
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Causes of upper gi bleed in order of incidence (6)
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peptic ulcer (50)
NSAID/alcohol erosion (20) Mallory-Weiss (10) Oesoph Varices (5) Oesophagitis (5) Ca stomach, oesoph (3) |
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Causes of lower gi bleed (6)
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diverticular disease
angiodysplasia ischaemia meckel's ibd ca/polyp/fissure |
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assessment of severity of acute gi bleed
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rockall score
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mx of acute upper gi bleed
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thermocoagulation/laser/adrenaline/glue/endoclips
surgical underunning of vessel |
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risk factors for gastric ca (4+)
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h pylori
diet (salt/nitrates) smoking group A blood group pernicious anaemia (4) |
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skin features of gastric ca
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acanthosis nigricans
thrombophlebitis dermatomyositis |
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cell transormation in the small intestine
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membrane level epithelial cells migrate from crypts to villi tip, differentiating into goblet secretory and enterocyte absorption cells
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8 stages of fat absorption
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CCK release (follows FFA in duodenum)
Panc enzymes, constriction, oddi relax Triglyceride cleaved by lipase to FFA & monoglyc Bind to bile salts forming mixed micelles Transport into enterocyte Reesterified to triglycerides with cholesterol Chylomicrons exocytosed into lympatics Return to blood via thoracic duct |
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4 cardinal signs of obstruction
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Abdo pain
Distention Vomiting Absolute constipation |
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what is the allergic response to in coeliac disease
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gliaden fraction of wheat germ
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skin condition associated with coeliac disease
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Dermatitis herpetiformis
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Ix for coeliac disease (4)
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distal duodenal biopsy
endomysial iga antibodies tissue transglutimase bone densitometry |
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5 characteristic sx of ibs
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recurrent crampy abdo pain releived by defecation
pellety constipation/ low vol diarrhoea no blood no wt loss mucus occasionally |
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mx of spasms in ibs
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mebeverine
peppermint oil |
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mx diarrhoea ibs
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loperamide (opiod ag)
codeine colestyramine (bile acid sequestrant) - preventing their osmotic effects |
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mx constipated ibs
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roughage
ispaghula lactulose |
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what liver pathology associated with ibd
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primary sclerosing cholangitis
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antibodies in PSC
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80% pANCA
50% antinuclear/antismooth muscle |
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antibody in PBC
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antimitochondrial
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Mx of acute diverticulitis (4)
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7 day cef met
analgesia ng tube monitor for perf/obst for surgery |
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Causes of colon ca
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80% sporadic
10% HNPCC 1% FAP 1% IBD |
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Location of colon ca
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70% recto sigmoid
30% R side 20% transverse / descending |
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operation for within 2cm of anal verge
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AP resection with colostomy
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operation for rectal cancer
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anterior resection
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operation for a caecal cancer
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r hemicolectomy with ilocolic anastamosis
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operation for transverse cancer
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wide resection (both flexures)
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Talk me through Duke's classification
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A - confined mucosa (90)
B1 - incomplete muscularis propria (70) B2 - involve serosa (60) C1 - incomplete muscularis + lymph positive (30) C2 - involve serosa + lymph positive (30) D - Distant mets |
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Top 3 causes small bowel obstruction
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adhesions
hernias strictures |
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top 3 causes of large bowel obstruction
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ca
diverticulitis valvulus |
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Top 3 causes of bowel obstruction in children
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malrotation
intussusception hirschprung's |
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% of people's ileocaecal valves competent
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20%
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Haemorrhoids - where are the anal cushions
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3 - left lateral
7 - right posterior 11 right anterior o'clock positions |
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degrees of prolapse for haemorrhoids
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1st - never prolapse
2nd - spontaneous return 3rd - digital return 4th - cannot return |
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mx of haemorrhoids
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1/2nd degree - analgesia/soaks/diet
3/4th degree haemorrhoidectomy |
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CI's and Cx to starting Anti-TNF
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STOIC
Sepsis, TB/Hep serology, Optic Neuritis, Infusion reaction, Cancer? |
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Drug Mx of IBD
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GOAL : Induce and maintain remission
Steroid - rectal/oral/iv inducer 5ASA - oral/rectal - I&M AZA - Maint (steroid sparing) Cyclo- Induce IV severe - BM supression, nephrotoxic Anti TNF - criteria, iv infusion/sub cut |
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rare fatal cx of coeliac disease
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t cell lymphoma
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Severity score for IBD (6)
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Truelove & Witts
Stools >6 Blood Frequent Temp >37.5 Pulse >90 Hb <75% ESR >30 |
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smoking patient - associated with chron's or UC
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chron's
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which bile duct disease is associated with which form of IBD
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PSC with UC
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what is mesenteric adenitis
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inflammation of the mesenteric lymph nodes in the abdomen[1]. If it occurs in the right lower quadrant, it can be mistaken for acute appendicitis, often preceded by a sore throat
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hartman's you end up with ileostomy or colostomy
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colostomy
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indications for hartman's
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emergency op on
diverticulitis colon ca |
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3 commonest causes of biliary obstruction in uk
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gallstones
ca head of pancreas lymphadenopathy |
