PJS
autosomal dominant condition
->mutations in the STK11 (LKB1) gene on chromosome 19.
- multiple hamartomatous polyps throughout the gastrointestinal tract, most commonly in the small intestine, stomach, and colon
- complications such as intussusception, GI bleeding, and obstruction
- mucocutaneous hyperpigmentation, which manifests as dark pigmented spots on the lips, oral mucosa, fingers, and toes.
when do we get pneumococcal vaccine in splenectomy?
What other vaccines
2 weeks after operation and then every 5 years.
ne dose of Hib/MenC and MenB. Then after one month, the patient should receive a second dose of MenB.
How to assess exocrine function of pancreas
Lundh meal is a combination of skimmed milk powder mixed with corn oil and dextrose used to assess exocrine pancreatic function. Following administration, serum lipase measurements can provide a good indicator of exocrine pancreatic status.
RFs of breast cancer
increasing age
inherited mutations in BRCA1/BRCA2 genes
family history of breast or early ovarian cancer
exposure to ionising radiation before the age of 30
first pregnancy after the age of 35
early menarche
late menopause
alcohol consumption
postmenopausal obesity
prolonged use of HRT.
Types of breast cancer
Phyllodes
DCIS
Phyllodes - stromal cells - adipose tissue, tissue surrounding ducts.
DCIS-> most common form of non-invasive breast cancer, in which abnormal cells are found and are limited to the ductal lining, without invasion through the basement membrane into the surrounding stroma.
Lobular cancer -> cellular changes in the acini or the terminal ductules of the breast lobules also known as glandular cells, without stromal invasion. can be bilateral
Fibroadenoma
histology type
epithelial and stromal cells
common outer upper quadrant
what increases the risk of developing breast cysts
Oral contraceptives/HRT
what maybe associated with duodenal perforation
Replacement of the duodenal epithelium with foveolar gastric epithelium is seen in duodenal ulceration and is related to hyperacidity.
Gastric cancer
adenocarcinomas.
Risk factors include hypochlorhydia, diet, gastric polyps and H.pylori infection.
Diagnosed using endoscopy with biopsy and staged with endoscopic ultrasound and computed tomography (CT) scan.
What is linitis plistica
Gastric linitis plastica is a diffuse type of cancer. Malignant cells invade throughout the stomach, resulting in the thickening and rigidity of the stomach wall. Most of the patients present late. Endoscopically the stomach looks thick with reduced distensibility. Biopsy reveals invasion of all the layers of the stomach in a diffuse pattern. Malignant cells look like a signet ring. Prognosis is poor and treatment may include radical surgery or palliative chemotherapy.
Colorectal grading
A – Limited to mucosa
B1 – Into muscularis propria but not penetrating it. No nodes
B2 – Penetrating muscularis propria. No nodes
C1 – Metastasis to one to four regional lymph nodes
C2 – Metastasis to more than four lymph nodes
D – Distant metastases.
RFs for anal fistula
diabetic patients
immunocompromised patients
people receiving anal sex
patients with inflammatory bowel disease, or diverticulitis.
anal fissures class
acute – present for less than six weeks
chronic – present for six weeks or longer
primary – no clear underlying cause
secondary – caused by an underlying constipation, inflammatory bowel disease, sexually transmitted infection (STI) or colorectal cancer.
What is gallstone ileus?
when a gallstone enters small bowel via a fistula
can heavy drinking alter periods
yes
as liver metabolises oestrogen and in alcoholics liver damaged therfore alters menstrual periods
causes of HCC
hepc then b, cirrhosis - alcoholism, PBC, PSC
what is zollinger ellison syndrome
endocrine disorder
gastrin-secreting tumours that may cause symptoms of peptic ulcer disease, gastro-oesophageal reflux disease and chronic pancreatic disorders
It causes multiple and recurrent peptic ulcers in the distal duodenum and proximal jejunum.
How does curlings occur happen
happens in severe burns
severe depletion of the plasma volume results in ischaemia and cell necrosis of the mucosa is known as a Curling’s ulcer. It is therefore important that all severe burn patients are managed with proton pump inhibitors to reduce the incidence of this.
stomach and duodenum
most common benign liver tumor
other type
haemangioma
hepatic adenoma ass background of elevated levels of oestrogen for example from the combined oral contraceptive pill.
coeliac disease
T-cell-mediated autoimmune disease affecting the small bowel caused by gluten intolerance.
-> symptoms including steatorrhoea (due to an inability to absorb fats as evidenced in this case by offensive stools that are difficult to flush away), abdominal pain and bloating.
Ix -> It can be diagnosed by a jejunal biopsy, which classically shows subtotal villous atrophy and crypt hyperplasia.
The management involves a gluten-free diet, which can relieve symptoms -> type of hypersensitivity reaction
Ulcerative colitis Histology features
inflammatory infiltrate, goblet-cell depletion, glandular distortion, mucosal ulcers and crypt abscesses.
Pseudopolyps
What is Gilbert syndrome
- Autosomal-recessive cause of mild unconjugated hyperbilirubinaemia
- defective conjugation within the liver.
- Normally mild jaundice develops when affected patients develop concomitant infections, are fasting or have other physiological stressors.
Hyperbilirubinaemia is unconjugated it will not be present in the urine.
BPH Mx how it works
Finasteride is an alpha-reductase inhibitor, which blocks the conversion of testosterone to dihydrotestosterone and reduces the size of the hyperplastic glands. A 6-month trial of treatment is required and symptoms may be reduced or delayed or even avoid surgery. Alpha-adrenergic blockers can be used to relax bladder neck muscle fibres and fibres in the prostate gland, and take effect within a week.
what do we use to predict mortaility in pancreatitis
rnasons
