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CBL Year 2 > Abdominal symptoms > Flashcards

Abdominal symptoms Flashcards

1
Q

What is gastroenteritis

A

Inflammation of the GI tract (stomach, small and large intestine)

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2
Q

Causes of gastroenteritis

A

Viral
bacterial
parasitic
non-infective

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3
Q

What does viral gastroenteritis typically present with

A

watery diarrhoea
cramping / abdominal pain
nausea and vomiting
sometimes low grade fever

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4
Q

how to prevent viral gastroenteritis

A

improved sanitation
behavioural change / infection control
vaccination (rotavirus)

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5
Q

Treatment for gastroenteritis

A

no specific treatment

need to make sure they are kept hydrated

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6
Q

How is diarrhoea defined

A

passage of three or more loose or liquid stools per day (or more frequent passage than normal)

frequent passing of normal stools is NOT diarrhoea

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7
Q

what is diarrhoea usually a symptom of

A

an infection of the intestinal tract

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8
Q

three clinical types of diarrhoea - define them

A

acute watery diarrhoea - lasts several hours or days, and includes cholera

acute blood diarrhoea - also called dysentery

persistent diarrhoea - lasts 14 days or more

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9
Q

4 most common causes of viral gastroenteritis

A

rotavirus - commonest cause pre-vaccine
calicivirus (norovirus and sapovirus)
Adenovirus
Astrovirus

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10
Q

fact about adenovirus (one of the viruses that cause gastroenteritis)

A

second most common cause of infantile diarrhoea in temperate climates

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11
Q

global epidemiology of viral gastroenteritis

A

considered benign but second leading cause of death in developing countries in children under 5
yet preventable and treatable

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12
Q

transmission of viral gastroenteritis

A

faecal - oral spread

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13
Q

natural defences of GI tract

A

lysozyme in saliva
gastric acid pH 2
mucus in GIT traps microbes
bile salts - duodenum, disrupt some cell surfaces
normal flora - modify environments with metabolites , nutrient competition, natural antibiotics
mucosal immunity - cell mediated immunity, and secretory IgA
Motility - vomiting and diarrhoea probably important in clearing pathogens

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14
Q

describe the transmission of viral gastroenteritis

A

infectivity high ( as few and 10 virions)
virus excretion high - up to 10 >8 virions/mL faeces
environmental survival good - no viral envelope, survives heating, drying, gastric acid secretions, and bile salts

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15
Q

general clinical features of viral gastroenteritis

A

dehydration causing hypotension, tachycardia and oliguria

distended abdomen - in some cases muscle guarding and hyperactive bowel sounds

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16
Q

Risk groups of viral gastroenteritis

A

Children - never been exposed before (no immunity), poor hygiene, high SA to volume ratio (susceptible to dehydration)

Elderly - frailty (low reserves), Co - morbidities

Immunosuppressed - suboptimal immune response and immune memory, prolonged shedding/infectivity

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17
Q

since rotavirus vaccination what causes the most cases of viral gastroenteritis in the UK and USA

A

norovirus

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18
Q

define incubation period

A

time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent.

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19
Q

incubation period of rotavirus

A

1-3 days

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20
Q

norovirus incubation period

A

10-50 hours

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21
Q

astrovirus incubation period

A

3-4 days

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22
Q

signs of severe dehyrdation

A

apathy/lethargy/unconscious/unable to drink easily

deep sunken eyes, no tears, parched mouth, cold/mottled appearance

tachycardia (bradycardia if extreme), weak pulse, deep breathing, prolonged capillary refill, skin recoil >2 secs, minimal urine output

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23
Q

pathogenesis if vomiting is main cause of fluid loss

A

metabolic alkalosis and hypercholeramia (elevated chloride ions)

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24
Q

pathogenesis if diarrhoea is main cause of fluid loss

A

acidosis more likely

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25
Q

how to diagnose viral gastroenteritis

A

stool enzyme immunoassays

molecular diagnosis - PCR of faeces or vomit (preferred type)

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26
Q

what is jaundice characterised by

A

elevated bilirubin in plasma causing yellowing of the skin or mucosa

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27
Q

unconjugated bilirubin

A

excess production cannot be cleared, e.g. haemolysis

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28
Q

what does high conjugated bilirubin mean

A

liver cell damaged

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29
Q

what is hepatitis

A

hepatocellular inflammation

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30
Q

causes of hepatitis

A 
infective
toxic
autoimmune
metabolic
obstructive
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31
Q

how is hepatitis A transmitted

A

through faecal oral transmission

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32
Q

how common is hepatitis A cases in the uk

A

rare

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33
Q

Hepatits A clinical features

A

spectrum from asymptomatic to acute liver failure
no chronic infection
jaundice incidence increases with age

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34
Q

Four clinical phases of hepatitis A - explained

A

Incubation/pre-clinical (range 15-50 days) - person is well but infectious for 2 weeks before illness upset

prodromal/pre-icteric (few days to 10 days) - flu like illness and loss of appetite

icteric phase - fever, jaundice (rarely pale stool and dark urine), liver enlargement and tenderness, anorexia, vomiting, fatigue, lasting 1-3 weeks

convalescence (recovering)

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35
Q

rare complications of a hepatitis A infection

A

fulminant hepatitis
cholestatis
relapsing hepatitis

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36
Q

pathogenesis of jaundice

A

probably due to immune mediated T lymphocyte destruction of hepatocytes

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37
Q

how to diagnose hepatitis A

A

clinical suspicion
biochemical features
epidemiological clues (age, risk groups, prior exposure, travel)
however need lab tests -antibody genome (RNA)

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38
Q

management of acute hepatitis A

A

dont need antivirals
check liver function, clotting and U&Es
if vomiting, dehydrated and altered consciousness then admit (bad signs)
transplant for acute liver failure

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39
Q

what do hepatitis B, D and C have in common

A

all bloodborne viral hepatitis agents

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40
Q

transmission of hepatitis B

A

typical blood borne virus so ..
sexually transmitted
mother to child
needle sharing - blood products

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41
Q

acute clinical features of hepatitis B

A

incubation period of 60-90 days
virtually all children and infants are asymptomatic with 50% adults being so too
ALT up to 2000 IU/L

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42
Q

relevance of hepatitis B surface antigen serology

A

abbreviation (HBsAg)

relevance - infected, acute or chronic

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43
Q

Acute management of hepatitis B

A

supportive
antivirals not usually given
check clotting, electrolytes; transplant for acute liver failure
counsel regarding transmission, screen for other blood borne viruses, STDs

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44
Q

management of chronic hepatitis B

A

assess need for antiviral therapy

most should be treated

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45
Q

Therapy of chronic hepatitis B

A

achieved by reducing HBV DNA levels - nucleoside antiviral drugs, immunomodulators

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46
Q

Hepatitis B prevention

A

avoid/reduce risk - safe sex, needle exchange, infection control
screening - blood products, high risk groups, pregnancy
treatment of chronic infections
Vaccine

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47
Q

describe hepatits C virus

A

Flavivirus, Hepacivirus
positive single stranded RNA
enveloped

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48
Q

what type of virus is hepatitis C

A

blood borne virus

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49
Q

Who has higher risk of severe fibrosis with hepatitis C

A 
increased alcohol intake
age >40yrs
HIV co - infection
Male
Chronic HBV  co-infection
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50
Q

management of hepatitis c

A

counsel on routes of transmission
avoid alcohol
vaccine against HAV and HBV
usually supportive - wait to see if it clears

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51
Q

what is considered change in bowel habit

A

depends on the patient
change in stool frequency
diarrhoea or constipation
Tenesmus - constant inclination to empty bowels
Bleeding
Steatorrhoea - excretion of abnormal amount of fat with faeces

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52
Q

what is tenesmus

A

constant inclination to empty bowels

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53
Q

what is steatorrhoea and what does it look like

A

excretion of abnormal amount of fat with faeces

looks pale and oily - can be especially foul smelling

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54
Q

common causes of altered bowel movement

A 
IBS
gastroenteritis 
medication
diet
coeliac disease
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55
Q

Less common but important causes of altered bowel movement

A

malignancy
IBD - inflammatory bowel disease
diverticular disease
bowel obstruction

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56
Q

difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)

A

IBS is a disorder of the GI tract whereas IBD is inflammation or destruction of the bowel wall, which can lead to sores and narrowing of the intestines

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57
Q

how can we investigate altered bowel habit

A 
bloods
endoscopy
capsule endoscopy
CT
MRI
US
Stool samples
nuclear medicine
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58
Q

blood tests to consider with altered bowel habits

A 
FBC
ferritin
CRP
LFTs
GLucose
thyroid function tests
calcium
lipase
TTG - tissue transglutaminase
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59
Q

what do stool samples look for

A

microscopy, culture and sensitivity (MC&S)
faecal calprotectin
helicobacter pylori stool antigen
faecal elastase

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60
Q

differentials for diarrhoea

A 
Drugs
infection
IBD
IBS
coeliac disease
malignancy
diverticultis
bile acid malabsorption
hyperthyroidism
diabetes mellitus
constipation (overflow)
ischaemic colitis
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61
Q

red flags in abdominal symptoms

A 
PR bleeding
weight loss 
family history colorectal cancer
nocturnal symptoms
abdominal mass
anaemia
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62
Q

difference between ulcerative colitis and crohn’s

A

UC is limited to the colon whereas crohn’s can occur anywhere between the mouth and the anus

in crohn’s there are healthy parts mixed with inflamed parts whereas UC will be inflamed areas together

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63
Q

causes of small bowel obstruction

A 
adhesions
hernia
malignancy
strictures
foreign bodies
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64
Q

causes of large bowel obstruction

A

primary malignancy
strictures
volvulus
luminal bodies

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65
Q

what is a volvulus

A

an obstruction caused by twisting of the stomach or intestine

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66
Q

what is paralytic ileus

A

muscle or nerve problem that stops peristalsis - not a physical blockage

common post-operatively

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67
Q

what is obstipation

A

severe constipation - i.e. no flatus either

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68
Q

3 things that cause obstipation

A

small bowel obstruction
paralytic ileus
large bowel obstruction

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69
Q

function of the large bowel

A

absorb salt and water
absorb short chain fatty acids
store faeces
expel faeces

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70
Q

rectosphinteric reflex

A

reflex characterized by a transient involuntary relaxation of the internal anal sphincter in response to distention of the rectum.

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71
Q

what is parenteral nutrition and when is it used

A

it is delivered into a large vein, bypassing the intestine and portal system

it is used if the absorptive function of the intestine is severely impaired

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72
Q

what is the main source of glucose for the brain

A

gluconeogenesis

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73
Q

what is refeeding syndrome

A

the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result from hormonal and metabolic changes and may cause serious clinical complications

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74
Q

when you start feeding a malnourished patient what need monitoring daily

A 
sodium
potassium
glucose
magnesium
phosphate 
urea
creatine
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75
Q

when you start feeding a malnourished patient what needs monitoring twice weekly

A

LFT (including clotting)

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76
Q

when you start feeding a malnourished patient what needs monitoring weekly

A

calcium
albumin
FBC
red cell indices

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77
Q

when you start feeding a malnourished patient what needs monitoring every 2-4 weeks

A

zinc
copper
folate
B12

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78
Q

When you start feeding a malnourished patient what needs monitoring every 3-6 months

A 
Vit D
Ferritin
iron
Mn
Se
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79
Q

Type 1 intestinal failure

A

acute onset, usually self-limiting

most often seen after abdominal surgery

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80
Q

type 2 intestinal failure

A

less common
acute onset
usually following catastrophic effect (e.g. intestinal ischaemia)

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81
Q

type 3 intestinal failure

A

chronic
patients are metabolically stable but IV support is required over months - years
may or may not be reversible

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82
Q

what does the proximal small intestine absorb (nutrients)

A 
fats
sugars
peptides and amino acids
iron
folate
calcium
water
electrolytes
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83
Q

what does the middle small intestine absorb (nutrients)

A 
sugars
peptides and amino acids
calcium
water 
electrolytes
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84
Q

what does the distal small intestine absorb (nutrients)

A

bile acids
vitamin B12
water electrolytes

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85
Q

what is short bowel syndrome

A

a condition in which your body is unable to absorb enough nutrients from the foods you eat because you don’t have enough small intestine

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86
Q

what causes short bowel syndrome

A 
post operative
mesenteric ischaemia
Chron's disease
trauma
neoplasia
radiation enteritis
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87
Q

management of short bowel syndrome

A

oral rehydration
parenteral nutrition
enteral nutrition
vitamin and mineral supplements

88
Q

how to prevent refeeding syndrome

A

can be prevented by electrolyte infusions and a slower refeeding regimen.

89
Q

What is TPN

A

total parenteral nutrition

90
Q

what dose of paracetamol would cause an overdose

A

> 10g or >200mg/kg

91
Q

why is paracetamol toxic in high doses

A

because its byproduct NAPQI combines with glutathione to produce a toxic compound

92
Q

what happens if a patient develops acute liver failure after paracetamol toxicity

A

it is fatal without a liver transplant

93
Q

treatment for paracetamol toxicity

A

N-acetylcysteine

94
Q

describe acute liver failure

A
  • onset of hepatic encephalopathy <8weeks from onset of liver dysfunction
  • no history of liver disease prior
  • subacute if 2-6 months from onset
95
Q

what is hepatic encephalopathy

A

a nervous system disorder brought on by severe liver disease . when the liver doesn’t work properly toxins build up in the blood
toxins then travel to the brain and affect brain function

patients with condition may seem confused

96
Q

Causes of acute liver failure

A 
paracetamol overdose
acute viral hepatitis
drug induced liver injury
autoimmune hepatitis
wilson's disease
97
Q

test for hepatitis B

A

hepatitis B surface antigen test (HBsAg)

98
Q

test for hepatitis C

A

hepatitis C antibody (HCV Ab)

99
Q

autoimmune hepatitis test

A 
smooth muscle antibody (anti-SMA)
immunoglobulin G (IgG)
100
Q

primary biliary cholangitis (PBC) test

A 
anti-mitochondrial antibody (AMA)
immunoglobulin M (IgM)
101
Q

primary sclerosing cholangitis (PSC) test

A

anti-nuclear cytoplasmic antibody (ANCA)

102
Q

alpha 1 antitrypsin deficiency test

A

alpha 1 antitrypsin

Alpha-1-Antitrypsin is an acute phase reactant. This means that it will be elevated in acute and chronic inflammatory conditions, infections, and with some cancers.

if they have a deficiency then… AAT is a protein that is made in the liver. It helps protect your lungs from damage and diseases, such as emphysema and chronic obstructive pulmonary disease (COPD).

103
Q

haemochromatosis test

A

ferritin (transferrin saturation)

104
Q

Wilson’s disease test

A

Caeruloplasmin

105
Q

what is cholangitis

A

inflammation of the bile duct system

106
Q

what is non alcoholic fatty liver disease associated with

A 
with metabolic syndrome:
type 2 diabetes
obesity
hypertension
hypertriglyceridaemia
107
Q

how to measure fibrosis

A

serum fibrosis scores
fibrosis markers or fibroscan
liver biopsu

108
Q

route of transmission for hep A

A

faecal - oral

109
Q

route of transmission for hep B

A

blood-borne
sexual
vertical

110
Q

route of transmission for hep C

A

blood-borne

111
Q

route of transmission for hep E

A

faecal - oral

112
Q

what hepatitis virus are there vaccines for

A

vaccines for hep A and B not for C and E

113
Q

what is haemachromatosis

A

a hereditary disorder in which iron salts are deposited in the tissues , leading to liver damage , diabetes mellitus, and bronze discolouration of the skin

114
Q

what is Wilson’s disease

A

is a rare inherited disorder that causes copper to accumulate in the liver, brain and other vital organs
most are diagnosed between 5-35

Symptoms
Fatigue, lack of appetite or abdominal pain.
jaundice
Golden-brown eye discoloration (Kayser-Fleischer rings)
oedema / ascites
Problems with speech, swallowing or physical coordination.
Uncontrolled movements or muscle stiffness.

115
Q

what is PBC

A

primary biliary cholangitis
disease that harms the livers ability to function
chronic condition
bile duct gets injured then inflamed and eventually permanently damaged

116
Q

what is PSC (what does it stand for and what is it actually?)

A

primary sclerosing cholangitis
chronic disease in which the bile ducts inside and outside the liver become inflamed and scarred and are eventually narrowed or blocked

117
Q

what is compensated cirrhosis

A

where the liver is coping with the damage and maintaining its important function

118
Q

what is decompensated cirrhosis

A

the liver is not able to perform all its functions adequately

119
Q

what is portal hypertension

A

elevated blood pressure in the portal venous system (portal vein is the main vein that runs to the liver)

120
Q

what is the most common cause of portal hypertension

A

cirrhosis (scarring) of the liver

121
Q

signs of portal hypertension

A 
ascites (fluid on the abdomen)
caput medusae (a cluster of swollen veins in your abdomen. )
splenomegaly
122
Q

what is referred pain

A

NOT radiating pain

pain felt in a part of the body that is not the source of the pain

123
Q

examples of referred pain

A 
brain freeze
MI
biliary colic
pancreatitis 
phantom limb pain
124
Q

what is colicky pain

A

pain characterised by either intermittent nature or variable/cyclical intensity

125
Q

examples of colicky pain

A

biliary colic
bowel obstruction
renal colic

126
Q

what is peritonitic pain

A

abdominal pain due to inflammation of the peritoneum

127
Q

describe visceral peritonitic pain

A

vague, poorly localised
dull ache
embryological origin

128
Q

describe somatic peritonitic pain

A

sharp

localised

129
Q

what could right upper quadrant pain refer to

A 
biliary colic
acute cholecystitis 
peptic ulcer (+/- perforation)
abscess
pancreatitis
pneumonia
130
Q

what could epigastrium pain refer to

A 
peptic ulcer
reflux oesophagitis
gastritis
AAA (abdominal aortic aneurysm)
pancreatitis
biliary colic
acute cholecystitis
131
Q

what could left upper quadrant pain refer to

A 
peptic ulcer
pancreatitis
splenic rupture (or cyst rupture)
abscess
pneumonia
132
Q

what could central (umbilical) pain refer to

A 
small bowel obstruction
appendicitis
mesenteric ischaemia 
AAA (abdominal aortic aneurysm)
IBS
133
Q

What could cause right iliac fossa pain

A 
appendicitis
mesenteric adenitis
Meckel's diverticulum
tubal/ovarian pathology (including ectopic)
IBD 
PID (pelvic inflammatory disease)
renal/ureteric colic
diverticulitis
134
Q

what could cause suprapubic pain

A 
diverticulitis 
IBD
large bowel obstruction
PID (pelvic inflammatory disease)
Ectopic pregnancy
retention of urine
135
Q

what could cause left iliac fossa pain

A 
diverticulitis
IBD
tubal/ovarian pathology (including ectopic)
PID (pelvic inflammatory disease)
renal/ureteric colic
136
Q

what is biliary colic

A

distention and contraction of a gall bladder against an obstructed cystic duct

137
Q

in the over 50s what is the most common diagnosis when they come in with abdominal symptoms

A

gallstones

138
Q

in the under 50s what is the most common diagnosis when they come in with abdominal symptoms

A

appendicitis

139
Q

describe gallstone disease

A

pain often right upper quadrant but can be epigastric
attack of biliary colic can last 30min to 4hrs
can recur every few hours
often follows a meal or in the evening

140
Q

describe cholecystitis - symptoms

A

constant, lasting days or hours
worse with moving including deep breaths
systemic sepsis and sudden cessation = think ischaemia
sudden generalised pain = think perforation

141
Q

describe pancreatitis

A

can be left upper quadrant for tail of pancreas
radiates to the back
fairly sudden onset, with gradual deterioration
constant

142
Q

investigations for query pancreatitis

A

amylase vs. lipase (serum vs. urine) (if they’re high can indicate pancreatitis)
bloods for grading
USS (gallstonees))
CT (diagnostic , prognostic, survellience)

143
Q

complications of pancreatitis

A 
pancreatic necrosis
acute fluid collections
pseudoaneurysm 
duodenal ileus
chronic pancreatitis
pseudo-cyst
144
Q

presentation of peptic ulcer disease (uncomplicated ulcer)

A

pain relating to eating (pre or post)
unaffected by movement or examination
“deep knawing pain” “burning pain”
often worse at night

145
Q

presentation of peptic ulcer disease (perforated ulcer)

A

4 quadrant peritonitis
localised peritonitis (RUQ usually)
right iliac fossa pain and peritonitis

146
Q

investigations for query peptic ulcer disease

A

endoscopy
consider H pylori
CT if concerned about perforation
CT angiogram if bleeding not arrested endoscopically

147
Q

Appendicits brief presentation

A

classic migratory pain
raised inflammatory markers
fever
localised peritonism in the right iliac fossa

148
Q

appendicitis signs

A 
McBurneys sign
Rovsing sign
Psoas stretch
Obturator sign
Starts at umbilicus and goes to right iliac fossa pain (this is because it is a midgut structure so pain originally presents in the umbilicus but as it gets worse it affects the more superficial nerves which causes right iliac fossa pain)
149
Q

what is McBurney’s sign

A

McBurney’s point is located two thirds the distance from the navel to the right anterior superior iliac spine, or the bony projection of the right hip bone. It is found at about 3.8–5.1 cm (1.5–2 inches) from the top of the hip bone towards the navel.

McBurney’s point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis.

150
Q

what is a perforated viscus also known as

A

intestinal or bowel obstruction

151
Q

What is GORD

A

gastro -oesophageal reflux disease

where acid from the stomach leaks up into the oesophagus

152
Q

what is pyelonephritis

A

type of urinary tract infection where one or both kidneys become infected

153
Q

what is a bowel infarction

A

also known as gangrenous bowel

it is an irreversible injury to the intestine resulting from insufficient blood flow

154
Q

causes of upper gastro - intestinal bleeding

A

varices
mallory-weiss tear
peptic ulcers
oesophagi-gastric malignancy

155
Q

what are varices

A

significantly dilated sub-mucosal veins in Gi tract

156
Q

what is a Mallory Weiss tear

A

typically small self-limiting slight superficial laceration to the oesophagus
occurs after severe and forceful, often multiple episodes of vomiting

157
Q

what is an ulcer

A

a breach of the continuity of the skin, epithelium or mucous membrane with disintegration and necrosis of epithelial tissue and often pus

158
Q

causes of peptic ulcers

A

helicobacter pylori
non steroidal anti inflammatory
physiological stress
diet (alcohol)

159
Q

presentation of gastric malignancy

A 
more generic:
anaemia
heart burn
naseau
weight loss
poor appetites
160
Q

What causes bleeding from the colon

A 
diverticular disease
IBD
large bowel malignancy
haemorrhoids
anal fissure
161
Q

what is diverticular disease

A

a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon

162
Q

Two conditions under umbrella term IBD

A

ulcerative colitis

crohns disease

163
Q

what is ulcerative colitis

A

a long term chronic condition where the colon and rectum become inflamed - it is limited to the colon and rectum

164
Q

what is crohns disease

A

inflammatory condition of any part of the GI tract and inflammation affects the full thickness of the bowel wall

165
Q

bleeding in ulcerative colitis

A

rarely torrential
often associated with diarrhoea with blood mixed in it
may lead to anaemia due to prolonged low level blood loss

166
Q

what are haemorrhoids

A

(also called piles)
vascular structures in the anal canal
in normal state - they are cushions that help with stool control
become a disease when swollen or inflamed

167
Q

what is an anal fissure

A

small tear in lining of anus

often caused by constipation

168
Q

define haematemesis

A

vomiting blood

169
Q

define meleana

A

black tarry stools as a result of upper GI bleeding

170
Q

what patients would you take a blood culture from

A

patients with:
fever
sepsis
or signs of a systemic infection

171
Q

how do you take a blood culture

A

aseptic non - touch technique
inoculate blood culture bottles before taking other bloods
fill in clinical details including travel history

172
Q

gram positive cocci in chains

A

enterococci

streptococci

173
Q

gram negative rods

A

aerobic - E coli, Klebisella, Enterobacter

anaerobic - bacteriodes,fusarium

174
Q

gram positive rods

A

anaerobic - lactobacillus , clostridium

175
Q

regimen 1 antibiotics for gram positive bacteria

Then regimen 2 and 3

A

1) amoxicillin
2) beta lactum plus beta lactamase inhibitor (for example Co-amoxiclav)
3) teicoplanin (for penicillin allergy)

176
Q

WHO definition of diarrhoea

A

passage of three or more loose or liquid stools per day

177
Q

salmonella species

A 
gram-negative 
flagellated 
7 subspecies
human infection usually faecal-oral
(consumption of contaminated poultry, eggs, and milk)
178
Q

what is enteric fever

A

also known as typhoid fever
common infectious disease in low and middle income countries
systemic illness characterized by fever, abdominal pain, and non-specific symptoms including nausea, vomiting, headache, and anorexia

179
Q

how to diagnose enteric fever

A

culture - blood, stool, bone marrow

serology

180
Q

management of enteric fever (typhoid fever)

A

antibiotics - amoxicillin, cotrimoxazole, ciprofloxacin, ceftriaxone
steroids
surgery if ileal perforation

181
Q

prevention of enteric fever

A

vaccination

182
Q 
(abdominal symptoms case)
24yr old female presents in ED with right lower quadrant pain 
3/7 dull pain
now more severe and sharp - slightly worse on urination
bowels open normally
no increased urinary frequency or dysuria
no fever
feeling unwell , bit faint
last menstrual period 7 weeks ago
some light bleeding in past 24 hrs
on examination:
clammy and in pain
P 88
BP 90/60
Tender right iliac fossa with guarding
pregnancy test positive
diagnosis?
A

ruptured ectopic pregnancy

183
Q

biggest risk factors for ectopic pregnancy

A

past infection -PID and chlamydia

also previous ectopic, smoking, infertility

184
Q

Management of ectopic pregnancy

A

if ruptured - management of shock and salpingectomy

unruptured - option of watch and wait, or medical management (methotrexate)

185
Q

what is pelvic inflammatory disease

A

infection of upper genital tract , including the womb, ovaries and connecting tubes

symptoms of pain in tummy, pain on urination and heavy painful periods

treatment with antibiotics

186
Q

shingles brief description

A

common 1:25
reactivation of latent herpes zoster virus
blister rash in dermatomal distribution
can be anywhere but abdomen/chest are most common
most common in elderly and immunocompromised
symptomatic management and antivirals

187
Q

red flags for urinary symptoms

A 
haematuria 
sudden incontinence
obstruction of urine flow , stream changes or retention
fever, riggers, nausea
loin pain
188
Q

3 sites for a urinary tract infection

A

urethra (urethritis): think STIs
Bladder (cystitis): lower UTI
kidney (pyelonephritis): upper UTI

189
Q

management of uncomplicated UTIs

A

symptomatic treatment of pain
ensure fluids
maybe antibiotics

190
Q

what is MSU

A

midstream specimen of urine

a sample of urine (wee) that is sent to a laboratory to be tested for evidence of infection.

191
Q

when is a MSU sent with a patient with a UTI

A

if they’re over 65 or if impaired renal function, abnormal urinary tract, or immunosuppresion

192
Q

when would you admit a patient with pyelonephritis

A

if unwell
pregnant
high risk
unable to take orals

193
Q

what is mesenteric adenitis

A

inflammation (swelling) of the lymph nodes in the abdomen (belly).

194
Q

What symptom means an urgent referral for an oesophago-gastro-duodenoscopy (OGD)

A

dysphagia

195
Q

presentation of oesophageal cancer

A 
progressive dysphagia
couhging
aspiration
hoarseness
weight loss
anorexia
anaemia
lymphadenopathy
196
Q

rule about gastric ulcer

A

its gastric cancer until proven otherwise

197
Q

what is Courvoisier sign

A

states that in a patient with painless jaundice and an enlarged gallbladder (or right upper quadrant mass), the cause is unlikely to be gallstones and therefore presumes the cause to be an obstructing pancreatic or biliary neoplasm (cancer) until proven otherwise

198
Q

different types of GI malignancy

A 
oesophageal
gastric
pancreatic
liver
colorectal
anal
199
Q

what test do you do if someone has altered bowel habits

A

colonoscopy

200
Q

presentation of gastric cancer

A 
epigastric pain
nausea
dysphagia
vomiting
epigastric mass
lymphadenopathy
virchows node
dermatomyotitis 
acanthosis nigricans
201
Q

investigations of gastric cancer

A

OGD

staging with: CT, PET-CT, laparoscopy

202
Q

presentation of pancreatic cancer

A 
epigastric pain
jaundice
anorexia
weight loos
abdominal mass
Courvoisier's sign
thrombophlebitis migrans
splenic vein thrombosis
203
Q

what is virchows node

A

is a lymph node and is a part of the lymphatic system. It is the thoracic duct end node. It receives afferent lymphatic drainage from the left head, neck, chest, abdomen, pelvis, and bilateral lower extremities, which eventually drains into the jugulo-subclavian venous junction via the thoracic duct

left supraclavicular lymph node

204
Q

what is thrombophlebitis migrans

A

an inflammatory reaction of the vein accompanied by a thrombus. It is characterized by the involvement of one vein group first, then improving and followed by the involvement of other vein groups

Thrombophlebitis is a phlebitis (inflammation of a vein) related to a thrombus (blood clot). When it occurs repeatedly in different locations, it is known as thrombophlebitis migrans (migratory thrombophlebitis).

205
Q

presentation of liver cancer

A 
anorexia
weight loss 
pain
ascites
jaundice
abdominal mass
hepatomegaly
206
Q

investigations for liver cancer

A 
USS
CT
ERCP 
needle biopsy
AFP

ERCP-Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope—a long, flexible, lighted tube.

AFP-An AFP tumor marker test is a blood test that measures the levels of AFP in adults. Protein made in liver when a baby is born. adults are supposed to have low levels

207
Q

Presentation of colorectal cancer

A 
iron deficiency anaemia
change in bowel habit
PR bleeding
tenesmus
weight loss
abdominal mass
PR mass
208
Q

what is tenesmus

A

the feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping. Food passes from the stomach into the small intestine.

209
Q

investigations for colorectal cancer

A

flexible sigmoidoscopy
colonoscopy
CT
CT colonography

210
Q

presentation of anal cancer

A 
pain
bleeding
mass
faecal incontinence
fistula
PR is painful/impossible
211
Q

what does functional abdominal pain mean

A

pain that is not caused by anatomical, biochemical, inflammatory or infectious abnormality

212
Q

NICE criteria for IBS

A

any of the following for at least 6 months:

  • abdominal pain or discomfort
  • bloating
  • change in bowel habit

plus at least two of:

  • symptoms made worse by eating
  • passage of mucous
  • abdominal bloating
  • altered passage (urgency, straining, incomplete evacuation)
213
Q

what diet is recommended for those with IBS

A

low FODMAP diet

214
Q

things to ask in bowel habit

A 
timing
consistency
colour
offensive smell
ease of flushing
blood
melaena (black, tarry stools)
215
Q

how many units is a typical glass of wine

A

2.3 units

CBL Year 2 (14 decks)

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