59 - Abdominal distention, 60 abdo mass Flashcards by Hamish Reed-Embleton

Causes of abdo distention

Fat
Flatus
Foetus
Faeces
Fluid
Fibroids
Fatal (tumours)

How well did you know this?

Not at all

Perfectly

What are ascites? Cause?

Fluid accumulation in peritoneal cavity.

liver cirrhosis, metastates, heart failure, TB, Meig’s,

How well did you know this?

Not at all

Perfectly

Ix of ascities?

USS
FBC
LFTs
ascitic tap

How well did you know this?

Not at all

Perfectly

Mx of ascites?

manage cause
diuretics
paracentesis - but risk of infection

How well did you know this?

Not at all

Perfectly

What is meigs ?

Triad
benign ovarian tumor ascites
pleural effusion that resolves after resection of the tumor.

Usually Ovarian fibromas

How well did you know this?

Not at all

Perfectly

Sx / signs of hepatomegaly

Can feel it

May also cause jaundice, bruising, lethargy, weight loss, poor appetite

How well did you know this?

Not at all

Perfectly

Causes of hepatomegaly

Infection: mono, hepatitis, abscess, malaria, amoboeasis,

Biliary: PBC, PSC
(Primary sclerosing cholangitis
Primary biliary cholangitis)

Metabolic: haemochromatosis, Wilson’s, glycogen storage diseases

Congenital: haemolytic anemia, sick cell

Neoplastic

Other: alcoholism, sarcoid, drugs,

How well did you know this?

Not at all

Perfectly

Causes of splenomegaly

haemolytic anaemia, leukemia, lymphomas, portal hypertension, haemoglobinopathies, AIDS, infections,.

How well did you know this?

Not at all

Perfectly

Mx if hyperspenic

splenectomy

How well did you know this?

Not at all

Perfectly

Causes of bowel obstruction

mechanical obstruction, adhesions (from previous surgery), hernias, volvulus, tumours, endometriosis, IBD, ischaemic bowel

How well did you know this?

Not at all

Perfectly

Sx / signs of bowel obsturction

Abdominal pain, vomiting, bloating, tinkly bowel sounds.

First sign is lack of flatus, then lack of stool.

How well did you know this?

Not at all

Perfectly

How does bowel obstruction progress

toxic megacolon or faecal vomiting.

How well did you know this?

Not at all

Perfectly

Ix / Mx of obstruction

Give iv fluids and pain medication.

USS, CXR and CT.

Needs urgent surgery.

DO NOT give laxatives.

How well did you know this?

Not at all

Perfectly

Causes of volvulus

Malrotattion, Hirschsprung, pregnancy, adhesions,

Obvs needs urgent surgery

How well did you know this?

Not at all

Perfectly

PKD can be AD / AR. Signs?

Mass

hypertension, headaches, abdominal pain, haematuria, polyuria leading to renal failure.

How well did you know this?

Not at all

Perfectly

Gene in PKD

PKD1-3 leads to faulty polycystin-1 and 2 which leads to cillial defects.

How well did you know this?

Not at all

Perfectly

Severe PKD mx

dialysis / transplant

How well did you know this?

Not at all

Perfectly

Bowel mass DDx …name 4

obstruction, intussusception, volvulus, pyloric stensosis, cholecystitis, hernias, hepatomegaly, tumour, aneurysm, abcesses, diverticulitis, IBD,

How well did you know this?

Not at all

Perfectly

What is pyloric stenosis? usual age?

Narrowing of the connection between the stomach and the duodenum (pylorus)

Usually occurs in the first few months of life. Occurs more in boys.

How well did you know this?

Not at all

Perfectly

Signs of pyloric stenosis

Projectile non-bilious vomiting.

olive shaped mass in epigastrium.

How well did you know this?

Not at all

Perfectly

Seen on Ix of pyloric stenosis

Capillary blood gas shows a metabolic (hypochloraemic, hypokalaemic) alkalosis due to repeated vomiting. This is diagnostic.

Surgeons usually want an ultrasound.

How well did you know this?

Not at all

Perfectly

Mx pyloric stenosis

pyloromyotomy

How well did you know this?

Not at all

Perfectly

What is cholecystitis ?

Sx ?

Gallbladder inflammation.

Right upper abdominal pain, nausea, vomiting, fever,

How well did you know this?

Not at all

Perfectly

Usual cause of cholecystitis

bile duct blockage

can be vasculitic

How well did you know this?

Not at all

Perfectly

Complication of cholecytitis

gallbladder rupture -> empyema

Mx of cholecystitis

cholecytectomy pain control Stones can be removed by ERCP

what is ERCP

Endoscopic retrograde cholangiopancreatography endoscope into bile duct

Gallstones called? Usual Mx

Cholelithiasis. | Most are silent and do not require treatment.

Sx of symptomatic gallstones

Cramping colicky pain in the upper right abdomen. Hepatomegaly, fever, jaundice, dark urine and vomiting

Rfs for gallstones

fat, fair, forty, pregnant, family history, diabetes, liver disease

What are gallstones made from ?

cholesterol / bilirubin

What is the stupid law of courvoisier?

painless jaundice and enlarged gallbladder, the cause is unlikely to be gallstones.

Mx of gallstones

Shock wave lithotripsy

Usual Ca in pancreas ? | Sx? prognosis?

Usually adenocarcinoma. Disease usually silent. Jaundice, weight loss, back pain, loss of appetite. May secrete Poor prognosis due to the fact that even non-specific signs indicate advanced disease.

What do people with pancreatic cancer tend to get? mets go where?

DVTs liver

What is urinary retention

Inability to completely empty the bladder. Can become incredibly painful.

Causes of urinary retention

BPH, neuropathy, constipation, infection, drugs, tumour, iatrogenic, prostatitis, phimosis

Complications of urinary retention?

Stones, infection, rupture

Dx of urinary retention

bladder US

Mx if prostatic cause of urinary retention

foley catheter / prostatic stent

Bladder ca which cells?

urothelium (transitional cell)

Rfs of bladder ca

rubber and polycyclic aromatic hydrocarbons, smoking, genetics, schistosomiasis,

Signs of bladder ca

Haematuria (may be microscopic), dysuria, polyuria, urge,

When does bladder ca have a poor prognosis

when muscle wall is invaded

Ix / Mx bladder ca

Cystoscopy and biopsy US / CT / MRI Treat with resection surgery, BCG immunotherapy, chemotherapy

What is diverticulitis?

Arising from diverticulosis: outpouching of large bowel wall ->infection

Sx diverticulitis

Sudden onset lower abdominal pain, fever, nausea, vomiting, constipation, blood in the stool.

rfs diverticulitis

smoking, diabetes, NSAIDs, low dietary fibre

DDx diverticulitis

IBS, IBD, malignancy,

Complications of diverticulitis

Sepsis | bleeds, abscess, perforation, adhesions, fistulas and faecal impaction.

2 key Ix in diverticulitis

CT and colonscopy.

Mx of most diverticulitis

conservative

Skip leisions found in which IBD

crohns

sx of crohns

Abdo pain, loose bloody stools (nature of which decided by section of bowel involved), fever, weight loss. Anaemia, rash, fatigue, aphthous ulcers, sausage like abdominal mass.

Associations with crohns

primary sclerosing choelycistitis | enteropathic arthiritis

Mx of crohns

Oral pred + methotrexate to maintain remission. Good evidence for Abx. Surgical resection rarely works.

2 main complications of crohns

bowel ca | abscesses

Sx of UC

Abdo pain, loose bloody stools, weight loss, anaemia,

Major complications of UC

High risk bowel ca megacolon enteopathic arthritis

Key Ix in IBD

Colonoscopy and biopsy

Mx of UC

Mesalazine. Prednisolone. Resection may be necessary.

Crohns vs UC

``` Crohn’s disease Porridge steatorrhea Weight loss, fistulae, fever Skip lesions (‘cobblestone’) Worsened by smoking Full thickness inflammation Granulomas Crypt lesions ``` ``` UC Mucus-like with blood Tenesmus Continuous inflammation Improved by smoking Peripheral layer involvement No granulomas on histology No crypt lesions ```

Complications of ovarian cysts

May produce torsion if they twist. Bloating, lower abdo pain. Can rupture also: vomiting and pain.

Sx of PCOS

Ammenorrhea, heavy periods, obesity, hirsuitism, acne, pain, infertility.

Dx of PCOS

Must have two out of 3: high androgens, anovulation, cysts on ultrasound.

Rfs of PCOS

obesity, lack of exercise, family history,

PCOS associations

T2DM, obesity, OSA, heart disease, endometrial cancer.

How to help fertility issues in PCOS

lose weight metformin and clomifene

When does ovarian Ca usually happen? Sx?

post-menopause. Symptoms are non-specific: bloating, pelvic pain.

2 key Ix for ovarian Ca

CA-125 | US

What are fibroids? Sx?

Leiomyoma: benign smooth muscle tumours. Rarely malignant. Painful heavy periods, but can be silent. Dyspareunia. Can push on bladder: urinary frequency and pain. Bloating and discomfort.

Rfs for fibroids

``` obesity FHx PCOS HTN nulliparity ```

Mx fibroids

Mild pain relief in mild disease. Iron supplements may be needed. Intrauterine system shrinks and manages small disease. Hysterectomy in severe disease.

When do fibroids often naturally regress

menopause

Complications of fibroids

torsion compress other things miscarriage

What is endometriosis? key sx ?

Endometrial tissue present outside of the uterus (ovaries, tubes, bladder, peritoneum, lung). Dyspareunia, infertility, cyclical pain

Complications of endometriosis

lowered fertility adhesions ca

What must you consider in any woman of reproductive age with abdo pain ?

ectopic

Rfs for ectopic

IUD and coil increase incidence. PID, chlamydia, smoking, infertility treatment, previous ectopic,

Major complication of ectopic

rupture

Dx of ectopic

HCG urine dip and ultrasound.

Mx ectopic

methotrexate | surgery

Rfs for hernias

Post-op, congenital, coughing, straining, weight lifting, pregnancy, connective tissue disease are all risks.

59 - Abdominal distention, 60 abdo mass Flashcards

(83 cards)