how would you differentiate acute cholecystitis from biliary colic?
AC has fever, sometimes rigors, SEVERE RUQ pain, positive murphys sign
note if jaundice then must urgent US check GS in CBD as risk cholangitis
An 83-year-old man presents following a collapse. He is not tachycardic but has a postural drop in blood pressure. He has mild epigastric discomfort. You note he has a history of arthritis and hypertension. diagnosis?
bleeding peptic ulcer
arthritis so on NSAID so bleed - hypovol - postural drop BP
why not tachycardic? as on a blockers for HTN
what is the differential diagnosis for acute appendicitis?
PID or period (Mittelschmerz - painful ovulation in middle of cycle)
pancreatitis, perf peptic ulcer
IBD - crohns
name 4 conditions or RF predispose to oesophageal cancer and why?
plummer vinson: IDA and oes web causing dysphagia its premalignant
achalasia: prolonged stasis contributes to mucosal changes
reflux oesophagitis: Barrett's oesophagus
what are the complications of diverticular disease and how do they present?
haemorrhage: profuse bright red rectal bleed, NOT precipitated by defaecation
fistula due to per and abscess of inflamed diverticulum
bladder fistula: pneumaturia - air in urine
what are pseudopolps and which disease are they a feature of?
areas of inflamed oedematous and swollen mucosa NEXT to the ulcerated areas of colon
name 3 conditions that cause fistula in ano?
Crohn's disease - confirm by biopsy
leukaemia patients have inc risk anorectal disorders esp. fissure in ano and fistula in ano
what is the incidence of gastric adenocarcinoma like worldwide?
generally marked decrease in incidence (due to treating H pylori?)
but increase at GOJ (Barrett's?)
common in Japan
what are the associations for gastric adenocarcinoma?
blood group A
lower social class
name 3 pathological types of gastric adenocarcinoma:
linitis plastic (leather bottle)
n.b. if confined to mucosa and submucosa then its 'early'
what are the symptoms of gastric adenocarcinoma?
dyspepsia (above 50y and longer than 1 month)
what are the signs of gastric adenocarcinoma?
Virchow's node: large left supraclav node (trosier's sign)
hepatomegaly - mets
spread of gastric adenocarcinoma?
transcoelomic to ovaries = Krukenberg tumour
investigations for gastric adenocarcinoma?
1. gastroscopy and multiple biopsies around ulcer edge
NB malignant ulcers may appear to heal on drug treatment
2. staging: EUS, CT, MRI
treatment of gastric adenocarcinoma?
if tumour in distal 2/3: partial gastrectomy
proximal tumour: total gastrectomy
chemo:epirubicin, cisplatin, 5-FU
palliative: for obstruction, pain or haemorrhage
what are the early complications of stomas?
haemorrhage at stoma site
dermatitis: effects of contents of stoma or due to contact dermatitis from allergy to adhesive appliance
high output: fluid and electrolyte loss esp. ileostomy
obstruction due to adhesions
stoma ischaemia - change in colour to black
what are the late complications of stomas?
prolapse of stoma
renal calculi: high ileostomy losses - met acid and low urine volume
cholesterol GS: if loss of TI - interrupt enterohepatic circ of bile salts
which part of the bowel does diverticular disease commonly affect?
what is the treatment for acute diverticular disease?
analgesia - avoid morphine as it increases muscle spasm
surgery rarely needed acutely
bleeding normally stops spontaneously and doesn't need treatment
what are the complications of gastric surgery?
which type of GS are associated with bacteria in the bile?