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71 Cards in this Set
- Front
- Back
which blood test indicates liver synthetic ability over a long-period of time (ie CLD), long half-life
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albumin
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what does an isolated rise in GGT indicate
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alcohol
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what cause must you consider in all abnormal LFTs
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drugs
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what blood tests specific for:
- wilson's disease - haemochromatosis - a1-antitrypsin def |
- W: Cu & caeruloplasmin
- ferratin / trandferrin - a1-antitrypsin |
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what blood tests specific for:
- autoimmune hep - PBC - PSC |
autoimmune hep: ANA, SMA, LKM-1
PBC: AMA (M2), IgM PSC: ANA, SMA |
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important q's to ask in hx
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stool & urine colour
SH:travel, transfusions, tattoos - occupation, unprotected sex, alcohol, smoker DH: OTC (inc paracetamol), herbal, illegal, supplements, steroids FH PMH: DM, hyperlipidaemia, interventions (ERCP), mumps, scorpion, |
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what to look for on GENERAL (inspection) on examination (GI)
(i.e. not hands and stuff) |
nutrition (BMI), scars, distension (local/general), deformities, distended veins (caput medusa, JVP), masses, pulsations (AAA)
feverish, pallor, anaemia/jaundice. |
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signs of liver disease on examination
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spider naevi, palmar erythema, gynaecomastia
liver FLAP clubbing leukonykia (hypoalbuminaemia) jaundice/ anaemia low/ high BMI ascites/ caput medua hepatosplenomegaly ENCEPHALOPATHY |
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what to look for on the hands in GI examination
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clubbing /koilonykia
leukonykia nicotine stain palmar erythema liver flap pulse |
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what's first line therapy for variceal/ upper GI bleeding
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ABC & resuscitate (IVI)!!
ENDOSCOPY: - sclerotherapy - banding - glue CT- during active bleed |
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what element used to treat angiodysplasia of the oesophagus via endoscopy
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ARGON
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ways of treating oesophageal strictures
- benign - malignant |
DILATATION (balloon eg for achalasia)
STENT (malignancy) |
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what procudure used to remove intralumenal objects (eg gallstones)
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ERCP- SPHINCTEROMETRY
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first line Ix for cholecystitis
2nd line |
★USS★- ?dilated BD?
stones- ERCP no dilated BD--> MRCP |
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tests/ Ixs for pancreatitis
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↑amylase
USS- exclude GS, assess obstruction/ complications (eg pseudocyst) ★CT★ |
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Ixs for suspected perforation
(general/ localised peritonism, systemic fever, shock, infection) |
★CXR★- subdiaphragmatic air
CT- source, gas/fluid |
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first line Ix for appendicitis
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★USS★- more useful in children, exclude other causes
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Ixs for diverticulitis (inflammation of diverticulosis)
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★PR EXAM★
inflam markers: WCC, CRP AXR Ba enema sigmoidoscopy/colonoscopy ★CT★ |
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first line Ix for distended abdomen
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★AXR★
- ?small or large bowel - ?gas or fluid - ?volvulus/ ileus USS- fluid CT- cause |
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ALARM symptoms for dyspepsia
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dysphagia
GI blood loss (anaemia, haematemesis) persistent vomitin wt loss mass |
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Ixs for dysphagia with alarm symptoms (3)
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★H.pylori★ C-urea breath test
★ensoscopy★ +/- biopsy Ba swallow |
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Ixs for change in bowel habit
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★PR exam★
ba enema ★sigmoid-/ colon-soscopy★ AXR CT ?Chron's- white-cell scan |
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Ixs for jaundice
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BLOODS- FBC, U&Es, LFTs, CRP, virology, immunology, auto-abs
★USS★ - ?bile ducts dilated= post-hepatic - ? mets -? cirrhosis - ?ascites ?biopsy MRCP +/- ERCP CT |
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what mneumonic used to think of differentials
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VINDICATE
Vascular Infection Neoplasm Drugs Inflammatory Congenital Auto-immune Trauma Endocrine |
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what organs/ structures likely to cause epigastric pain
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heart, oesophagus, stomach, duodenum, GB, bile ducts, liver, pancreas
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organs/ structures likely to cause RUQ pain
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liver, GB, bile ducts, duodenum, PNEUMONIA!
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organs/ structures likely to cause LUQ pain
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pancreas, stomach, splenic flexure (abscess, infarct), spleen, stomach, PNEUMONIA!
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organs/ structures likely to cause central abdo pain
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early appendicitis, pancreas, bowel, transverse colon
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organs/ structures likely to cause RLQ
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appendicitis, Chron's, colonic ca, ascending colon, (r.ovary & fillopian tube)
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organs/ structures likely to cause LLQ pain
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diverticulitis, colorectal / sigmoid ca (descending colon), colitis (likely ischaemic), ovary
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apart from GI causes, what other systems must you consider in a pt presenting with abdominal pain
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GU, repro
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baseline tests & initial management of pt with an acute abdomen
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O2, IV fluids, Abx's if infection (eg peritonitis)
analgesia +/- anti-emetic BLOODS: FBC, U&Es, LFTs, amylase, CRP, ABG, cross-match ?transfusion urine ECG, CXR, AXR, USS |
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what do skin changes (bruising/ darkening) indicate
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intra-peritoneal haemorrhage
acute haemorrhaginc pancreatitis |
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S&Ss og mesenteric ischaemia
- acute - chronic |
AF with;
1) ACUTE SEVERE abdominal pain - constant, central/RIF hypovolaemia: low BP, high HR 2) SEVERE colicky post-prandial pain, PR bleeding, wt loss COLONIC ischaemia- left sided pain, BLOODy D |
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Ix & results for mesenteric ischaemia
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↑WCC, ↑Hb (due to plasma loss), ↑lactate
METABOLIC ACIDOSIS ↓HCO3- AXR/ Ba enem- no gas, "thumb-printing" (submucosal swelling) CT ★ANGIOOGRAPHY★ |
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causes of mesenteric ischaemia (4)
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★AF!★
vasculitis trauma strangulation of hernia/ volvulus |
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&Ss bowel obstruction
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anorexia, nausea, VOMITING (bile-stained) - relief
COLICKY abdo pain (contsant in colon) DISTENTION constipation |
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examination findings in bowel obstruction
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high-pitched tinkling BS
distention w/o shifting dullness visible PERISTALSIS tenderness |
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differentiate bowel obstruction from a strangulation
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strangulation- more SHARP CONSTANT, localised, ?fever ? high WCC
obstruction- CENTRAL COLICKY |
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Ixs for bowel obstruction
findings |
AXR: DISTENTION of gas PROXIMAL to obstruction
- SMALL b.: plicae (pic) - LARGE b.: haustra ?ba enema |
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management/ treatment of bowel obstruction:
- incomplete - complete and strangulation |
INCOMPLETE: conservative
- IV fluids, NG tube + NBM, replace electrolytes COMP+STRANG: emergency surgery!!! |
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causes of bowel obstruction (BATH VIPS)
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BOLUS- food, faeceas, gallstone (impacted ileus)
Adhesions (congenital, iatrogenic) TUMOUR Hernias- strangulated Volvulus INTUSSUSCEPTION Pseudo-obstruction Strictures (chron's diverticulosis) |
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causes of bowel distention
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5F;s:
Fat Fluid Faeces Food Feotus |
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ddx of rectal bleeding (7)
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anal fissure
perianal haematoma colorectal polys/ ca diverticular disease proctitis (inflam anal canal + rectum)/ gastroenteritis IBD haemorrhoids |
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S&Ss haemorrhoids (piles)
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★PAINLESS★
FRESH blood PR perianal itching ★CONSTIPATION/ straining!!!!!★ anaemia (sometimes: mucus) |
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what are piles (haemorrhoids)
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displaced & protuding rectal/ anal CAPILLARIES
- gravity, increased anal tone, straining prone to rupture & bleed (NB: not varicose veins) |
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Ixs for haemorrhoids
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★PR exam★- only prolapsing piles visible, internal piles NOT PALPABLE!!!!!
proctoscopy sigmoidoscopy |
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management of haemorrhoids
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high fibre diet
topical SCLEROSANTS band LIGATION 4th deg: haemorrhoidectomy |
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rectal prolapse can be:
1) partial 2) complete - presentation S&Ss |
incontinence
protruding mass blood & mucus PR poor anal tone |
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presentation S&Ss of anal fissure
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fresh BLOOD
PAINFUL on defaecation constipation (holding back from pain) ITCH mucosal TAG |
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3 mananagement options for anal fissure
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increase dietary FIBRE
GTN ointment lateral sphincterotomy |
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presentation S&Ss of anal FISTULA
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BLOOD
MUCUS chron's TB Ca opening distal from site of anus |
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causes of an abdominal mass
(don't thing just GI...also repro & GU) mneumonic: A CHEMICAL |
AAA
Chron's inflam Hernia Enlarged organ Malignancy Intussusception Cyst/ abscess Appendicitis Lymphadenopathy |
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physical examination of a mass
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shape, size
fluctuating (respiration/ palpation) rashes/ lesions/ colour pulsations character: smooth/ craggy, hard, soft tender percuss: gas, solid, liquid (shifting) BS? bruits (AAA) |
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3 cardiac/ vascular complications post-op
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haemorrhage
MI DVT/ PE |
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3 GI complications post op
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ileus
anastomotic dehiscence (pic) adhesions |
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what's an ileus (complication post-op)
presentation (S&Ss) |
painful obstruction of ileum/ small intesting
PARALYSIS of motility ABSENT BS & peristalsis VOMITIN distention dehydration (need electrolytes correcting) |
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presentation S&Ss (helpful hx) in suspecting adhesions
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bowel OBSTRUCTION
vomiting, distention, constipation, abdo pain (colicky) "tinkling" BS/ absent prev abdo surgery |
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cause of hernias
main type |
natural opening/ weak/ defect in muscle wall area
stretching, surgery, increased abdominal pressure INGUINAL |
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what does an irreducible hernia indicate
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obstructed (bowel contents cannot move through)
or strangulated (blood supply compromised) - risk gangrene if arterial supply compromised |
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what type of people at risk of femoral hernias
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old, thin FEMALES (x10 more common than M)
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what structure lies anterior and lateral to femoral canal
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anterior: inguinal lig
lateral: femoral vein |
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relation to inguinal canal:
- floor -roof - anterior - posterior - medially |
FLOOR: inguinal lig
ROOF: transversalis fascia & internal oblique ANT: external oblique anponeurosis POST: transversalis MEDIAL: conjoint tendon |
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differentiate an indirect & direct inguinal heria
- anatomically - clinically |
INDIRECT; lateral to inf epigastric vessels, through inguinal canal --> scrotum
DIRECT: medial to inf epi vessels, directly through wall. REAPPEARS with cough test |
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what point is 1/2 way between pubic tubercle and ASIS
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DEEP inguinal ring
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which type of inguinal hernia better controlled with digital pressure
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indirect hernia
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what layer does the processus vaginalis take from the soma wall, what does it subsequently become
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from the parietal peritoneum
descends ahead of the testis into the scrotum becomes the tunica vaginalis |
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in the male, what layers of the abdominal wall does the testis descend through, which does it take into the scrotum
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parietal peritoneum--> tunica vaginalis (doesn't surround testis, lies in FRONT)
transversalis fascia --> internal spermatic fascia transversus abdominus (not taken) internal oblique--> CREMASTER muscle external oblique APONSEUROSIS --> external spermatic fascia |
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what structure if formed by joining of internal oblique and transversus abdominus, connecting these muscles to the pubic tubercle. Lateral to the inguinal canal
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conjoint tendon
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which layer of the abdominal wall does the cremaster muscle come from
which nerve is it supplied by |
INTERNAL oblique
genitofemoral nerve |
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what structures past through the inguinal canal in the MALE
which are within the spermatic cord? |
SPERMATIC CORD:
- Vas deferens - testicular artery - pampiniform plexus - genitofemoral nerve (lymphatics & autonomic nerves) ILIOINGUINAL nerve- outwith cord |