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what acid-base abnormality do you get in pyloric stenosis?
hypochloraemic hypokalaemic metabolic alkalosis
what is octreotide and 3 uses
- Somatostatin analogue (inhibits GH release)
- 1. Variceal bleeding
- 2. Acromegaly
- 3. Carcinoid tumours: blocks release of tumour mediators and counters peripheral effects
which type of rectal tumours is managed by AP resection?
abdomino-perineal resection for low rectal tumours
what kind of resection is done for a high rectal tumour?
what is the management of ascites?
- ascitic tap: urgent MC&S (SBP)
- dietary sodium restriction, fluid restriction
- bed rest
- spironolactone, add frusemide if it doesn't work
what is the management of refractory ascites…what do you have to remember?
- total paracentesis (therapeutic)
- infusion of albumin or colloid with it (otherwise ascites will come back)
what is the differential for left lower quadrant pain?
- sigmoid diverticulitis
- sigmoid cancer
- ruptured ectopic pregnancy
- perforated colon
- UC, Crohns
- period pain
- tubo-ovarian abscess
- rénal or ureteric colic
name 5 other differentials that come in right but not left lower quadrant pain
- perforated caecum
- meckel's diverticulum
- psoas abscess
- mesenteric adenitis
in elderly, what are the 2 main causes of significant rectal bleeding and how to differentiate?
- barium enema: abnormal in diverticulae but would look normal angiodysplasia
- diagnose angio: colonoscopy
what are the symptoms of scurvy? where is vitamin C absorbed?
- vitamin C: proximal ileum
- bleeding from gums, hair follicles, into joints
- loose teeth
if you have vitamin B3 (nicotinamide) deficiency, what is disease and symptoms?
what happens in B6 deficiency? and which drug can cause this?
- pyridoxine deficiency: polyneuropathy
- caused by isoniazid
what are 3 features of B12 deficiency?
- macrocytic anaemia
- neuropathy (subacute combined degen of spinal cord)
what is the triad of subacute combined degeneration of the spinal cord?
- (mix UMN and LMN)
- 1. extensor plantars (UMN)
- 2. absent knee jerks (LMN)
- 3. absent ankle jerks (LMN)
how may subacute combined degeneration of the spinal cord present?
- falls at night due to ataxia and reduced vision
- note STT in tact
in alcoholics, they commonly have low glucose, what else must be checked before giving glucose?
- thiamine level as wernicke's can be precipitated by glucose administrated to a thiamine-deficient patient.
- so make sure thiamine is given BEFORE glucose
what is the inheritance of peutz-jeghers syndrome?
what is the risk of peutz-jeghers transforming to malignancy?
what are the 3 main categories for splenomegaly?
- haematological malignancies: lymphoma…
- infections: malaria EBV
which infection has to be considered a differential for coeliac?
- get watery diarrhoea and villous atrophy
what is the differential for right upper quadrant pain?
- acute cholecystitis
- duodenal ulcer
- congestive hepatomegaly
- R base pneumonia
what is the differential for left upper quadrant pain?
- ruptured spleen
- perforated colon
- gastric ulcer
- aortic aneurysm
- L basal pneumonia
what is the differential for bilateral leg oedema?
- increased venous pressure: right heart failure
- low oncotic pressure: low albumin: cirrhosis, renal failure, protein losing enteropathy
- venous insufficiency: acute e.g. sitting too long; chronic: haemosiderin, itchy, eczema, ulcers
- drugs: nifedipine (vasodilators
- pelvic mass, pregnancy
what is the differential for unilateral leg oedema?
- compartment syndrome
- necrotising fasciitis
- bone or muscle tumours
- impaired mobility: trauma, arthritis, bakers cyst
which drugs can cause acute pancreatitis?
which artery supplies the transverse colon and what is it a branch of?
- middle colic artery
- branch of superior mesenteric artery
what is the AXR sign of Crohn's?
what can you see on AXR of UC?
finely granular appearance e.g. of TC and absence of hausfrau
what is a sentinel loop on xray? give e.g.
- indicates localised ileus from nearby inflammation
- e.g. in acute pancreatitis see a sentinel loop in left hypochondrium
- acute appendicitis
- in acute appendicitis see in RIF
- in acute cholecystitis see in RUQ
what is status epilepticus?
- seizures lasting > 30 mins
- or repeated seizures without intervening consciousness
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