Medschool Revision

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Malaria is a parasitic disease endemic to large areas of South and Central America, India and Africa. It is a protozoal infection that is transmitted by the female Anopheles mosquito vector.
There are four types of protazoa that infect humans, and all are from the genus Plasmodium.
Types of Malaria
Plasmodium falciparum
By far the worst form of malaria [...]

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. It commonly affects the lungs but can affect any part of the body with TB meninigitis being the most serious complication. It is increasingly becoming a problem in the western world after its levels declined throughout most of the 20th century mainly as a result of [...]

Hypothyroidism is very common and is easy to treat. Its onset is insideous and patients may not realise that they have any symptoms untill questioned. Others may present many months / years after the onset of symptoms.Hashimoto’s Thyroiditis
Causes
Chronic Autoimmune Thyroiditis (Hashimotos’s thyroiditis)
Iatrogenic
Secondary to:-

Radioactive Iodine Therapy
Thyroidectomy

Symptoms
Tiredness / Malaise / Somnolence
Weight Gain
Cold Intolerance
Goitre
Low Mood
Reduced Libido
Anorexia
Constipation
Hoarse voice
Signs
Useful to [...]

Jaundice is the yellow pigmentation of the skin, sclerae that becomes clinically apparent when serum bililirubin exceeds 35-50μmol/L.
Bilirubin Metabolism
Bilirubin is a breakdown product of erythrocyte degredation by the macrophages of the spleen. This produces unconjugated bilirubin which is not soluble in water. It is bound to albumin where it travels in the blood stream to [...]

Causes
Congenital
Dieulafoy’s lesions -Aneurysm of gastric vessels thought to be a developmental malformation as opposed to degenerative changes.
Neoplastic
Gastric Carcinoma - rare
Infective
Peptic Ulcers associated with H. pylori
Traumatic
Mallory-Weiss syndrome - bleeding caused by a tear in the mucosa at the junction of the stomach and oesophagus usually caused by severe vomiting, coughing or retching.
Vascular
Oesophageal Varicies - extremely dilated [...]

Gallstones
Mixed - 80%
Cholesterol and Calcium Bilirubinate

Imbalance between bile salts
Cholesterol supersaturation

Cholesterol (Pure) - 10%
Pigment Stones - 10%
Calcium Bilirubinate
Occurs in haemolitic patients / cirrhosis
History
Mostly asymptomatic
Biliary Colic
Caused by a temporary obstruction of the cystic duct or the common bile duct by a stone.

Right upper quadrant pain
May be associated with ingestion of fatty foods
Resolves after several hours
May radiate to [...]

Peptic ulcer disease are ulcers in or adjacent to acid producing tissue. These are Gastric Ulcers and Duodenal Ulcers. Duodenal ulcers usually occur in the proximal duodenum and are 4 times more common than Gastric Ulcers.
Aetiology
Mechanism is unclear but H.Pylori plays an important role as to NSAIDs and Asprin.
Clinical Features
Both

Dyspepsia
Relieved by antacids
Tenuous relationship with food

Associated [...]

Rare in UK, more common in Asia, notably Japan. Most commonly adenocarcinoma arising from the mucus secreting cells of the gastric crypts.
Aetiology
H. pylori - chronic gastritis & gastric cancer
Diets lacking in

Fresh fruit and vegetables
Vitamins A & C

Diets rich in

Salted food
Smoked food
Pickled food

Smoking
Alcohol
Pathology
Commonly adenocarcinoma arising from the mucus secreting cells of the gastric crypts.
50% in antrum
Macroscopically

Polypoid
Ulcerating
Fungating [...]

Functional Dyspepsia is a diagnosis of exclusion - Dyspepsia and ulcer-like symptoms where investigations fail to detect an ulcer.
History
Usually female with symptoms typically occurring in the morning.

Abdominal Pain
Nausea
Bloating

Irritable bowl syndrome often previously diagnosed.
Psychological features such as stress / anxiety
Examination
Tender in epigastrium
Weight loss can occur, but is rare.
Investigations
B-HCG - pregnancy
Endoscopy - exclude malignancy, especially in older [...]