3-zolliinger ellison syndrome

pg 51-

zollinger ellison syndrome is characterised by the _________________ in ____________.

__________ releases excessive _______ → stimulates ___________ to release more _______ → causing __________.

features of ulcers → (2)

SX →

excessive HCL →

DX → (2)

presence of tumor(gastrinoma)…pancreas and duodenum

gastrinoma…gastrin…parietal cell of stomach…HCL…multiple ulcers

resistant to TX and abnormal localisation

abdominal pain, dyspepsia, weight loss, GI bleeding, chronic diarrhea

fasting gastrin test, secretin stimulation test

patient recently had full course h.pylori eradication. presents with burning retrosternal pain + endoscopy shows multiple ulcers in lower oesophagus, stomach and duodenum. investigation?

carbon 13 urea test

fasting gastrin test, secretin stimulation test

mesalazine drug class →

5-aminosalicylic acid (5-ASA)

perforated peptic ulcer

**upper GI endoscopy (primary diagnostics)

x-ray → free air under diaphragm

IV fluids, analgesic, AB, antiemetics → urgent surgery

hereditary haemochromatosis is autosomal _________.

it causes __________________ → ____________________

5 organs and its signs

triad : ________ + _________ + ___________

recessive

the increase in absorption of iron… ‘deposition’ in tissues

• liver → hepatomegaly, cirrhosis → hepatoma/cancer

• pancreas → DM

• skin → bronze skin (hyperpigmentation)

• joints → arthropathy

• heart → cardiomyopathy

hepatomegaly + DM + bronze skin

persistent dyspepsia + severe epigastric pain (night esp) + no DX or TX before. next step →

h.pylori serology test (initial step)

to diagnose → endoscopy

patient with hx of peptic ulcer is prone to get perforated peptic ulcer after surgery, why?

stress → high production of gastric acid

cholestatic hepatitis

→ ______ age, hx of use of _______________

SX → (6)

labs → (4)

old..co-amoziclav, amoxicillin, flucloxacillin

(drug induced hepatotoxicity)

dark urine, pruritus, fatigue, nausea, vomit, abd pain

high ALT, ALP, bilirubin and GGT

celiac disease

blistering rash on elbow →

shortening of the villi →

dermatitis hepetiformis

villous atrophy

pseudomembranous colitis is caused by

clostridium difficile

examples of AB that causes C. Difficile

manifestations

DX

TX

clindamycin | amoxicillin | ampicillin co-amoxiclav | broad spectrum cephalosporine | quinolones (eg ciprofloxacin)

hx of recent treatment with AB, diarrhea (maybe bloody), abd pain, fever, high WBCs and CRP

stool

1st line - vancomycin 2nd - metronidazole (ORAL)

mediastinitis can be caused by ____________ during the ________.

X-ray shows ___________.

Prominent symptoms is _________.

Types are ________(_______ area) and ________ (________ region radiates to ________).

TX → __________ + ___________

(normal BP excludes ___________)

(clear lung fields exclude ________ and _________)

oesophageal perforation… endoscopy

mediastinal widening

chest pain

anterior (subcostal)…posterior (epigastric…interscapular region)

AB + repairment of perforation

vascular injury…pneumothorax…aspiration pneumonia