61 Abdo pain, 62 - anorectal pain

Question 1

Sx of peptic ulcer disease

Answer 1

Dull, burning, upper abdominal pain which wakes the patient up at night and is relieved by eating.

Belching, weight loss, poor appetite.

Question 2

Association with peptic ulcer and Ix for this

Answer 2

H. Pylori infection (Urea breath test or stool antigen test)

Question 3

Mx of h pylori

Answer 3

7d amoxicillin 1g plus clarithromycin 500mg plus lansoprazole 30mg BD (triple therapy)

Question 4

Mx of normal peptic ulcers

Answer 4

Stop NSAID / Smoking

lansoprazole 2/12

Question 5

Sx of cholangitis?

Answer 5

Jaundice, fever and RUQ pain. Rigors.

Usually associated with gallstones

Question 6

Mx of cholangitis

Answer 6

Iv fluids
ceftriaxone + metronidazole

Endoscopy may relive obstruction

Question 7

Seen on bloods with cholangitis

Answer 7

raised CRP and LFTs

Question 8

Reynold’s pentad of obstructive ascending cholangitis

Answer 8

Jaundice
Fever
Abdominal pain
Shock
Confusion

(bad)

Question 9

Sx acute pancreatitis

Answer 9

upper abdo pain
fever
Nausea / vomit

Question 10

Key Ix in acute pancreatitis

Answer 10

serum lipase / amylase

imaging for prognosis / cause

Question 11

What is grey-turners sign

Answer 11

flank bruising in pancreatitis

Question 12

Mx of acute pancreatitis

Answer 12

Iv fluids, oxygen, pain relief, Abx, nutrition

ERCP if gallstones present (this also warrants a cholecystectomy).

Question 13

Causes of pancreatitis

Answer 13

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hyperthermia/hypercalcaemia
ERCP
Drugs

Question 14

chonic pancreatitis sx

Answer 14

Pain in the upper abdomen, nausea and vomiting, steatorrhea, weight loss,

Question 15

Ix for chronic pancreatitis

Answer 15

LFTs
amylase - not normally raised
Abdo US - gallstones

Imaging for diagnosis

Question 16

Mx of chronic pancreatitis

Answer 16

Treat with lifestyle advice: stop drinking and smoking.

Pain relief.
Need pancreatic enzyme supplementation, corticosteroids if autoimmune

Screen for DM, osteoporosis, refer to dietician,

Question 17

Flank pain with fever and rigors

Answer 17

Renal colic (stones) 
check for UTI

Question 18

Mx of colic

Answer 18

Treat pain, nausea and vomiting, push fluids.

Question 19

Rfs for stones

Answer 19

dehydration, poor diet, obesity, avoid spinach, rhubarb, soy. Hypernatraemia,

Question 20

When to admit for stones

Answer 20

shocked, poor pain control, pregnant, dehydration due to vomiting, AKI, sepsis, failed treatment.

Question 21

Mx of stones

Answer 21

May pass spontaneously
Calcium channel blockers may facilitate this

Shock wave lithotripsy. Surgery if unsuitable.

Question 22

Usual bacteria causing pyelonephritis

Answer 22

bowel commensals: E Coli, Klebsiella,

Question 23

Sx of pyelonephritis

Answer 23

Fever, tachycardia, dysuria, rigors, nausea, vomiting

Question 24

complications of pyelonephritis

Answer 24

hydronephrosis pus around kidney, shock, aki

Question 25

Who gets admitted with pyelonephritis

Answer 25

dehydrated, feverish or shocked, pregnant, elderly, failed treatment.

Question 26

Mx of pyelonephritis

Answer 26

ciprofloxacin 500mg BD 7d. Prior to this, obtain urine specimen for CandS. Treat pain and fever with paracetamol. Maintain full hydration.

Question 27

Usual cause of apendicitis

Answer 27

Calcified faeces blockage

Question 28

Sx of apendicitis

Answer 28

Generalised abdo pain, nausea, vomiting, decreased appetite, pain localises to RLQ when the head of the appendix presses on the peritoneum (McBurney’s point): rebound tenderness.

Question 29

Associations with IBS

Answer 29

depression, CFS, fibromyaldia and anxiety.

Question 30

Mx IBS

Answer 30

diet, stress relief, physical activity,

Question 31

Sx of mesenteric ischemia

Answer 31

Abdo pain after eating, weight loss, vomiting after eating, diarrhoea, metabolic acidosis.

Question 32

Rfs for mesenteric ischemia

Answer 32

AF, heart failure, renal failure, hypercoagulability,

Question 33

Dx of mesenteric ischemia ? Mx?

Answer 33

angiography stenting or thrombolysis (heparin and warfarin

Question 34

What is intussusception ? | sx?

Answer 34

Bowel telescoping into itself. Abdominal pain and cramping, nausea, vomiting (may be bilious) drawing up legs. Red currant jelly stool. Sausage shaped abdominal mass.

Question 35

Usual age intussusception? pathology?

Answer 35

First two years of life. Infection with rotavirus. Telescoping is normal at that age. Peyer’s patches (gut lymph tissue) expands and traps the segment of bowel much like a hernia.

Question 36

Mx intussusception

Answer 36

Air enema confirms and reduces condition. Can be further reduced with laproscopy.

Question 37

What are haemorrhoids?

Answer 37

vascular structures in the anal canal which may become swollen or inflamed.

Question 38

Sx haemorrhoids? rf?

Answer 38

bright red blood in stool constipation pregnancy

Question 39

Mx of haemorrhoids

Answer 39

Increase fibre, NSAIDs for pain. Management usually conservative but can be ligated, which leaves a skin tag behind.

Question 40

Sx of anal fissures ?

Answer 40

pain on deification | bright red blood on stool

Question 41

Mx anal fissures

Answer 41

Lifestyle changes. Simple analgesia. Rectal GTN if not healing after 6 weeks.

Question 42

Sx anal cancer

Answer 42

Rectal bleeding, itching and pain, lumps, mucus discharge, incontinence, sensation of incomplete emptying.

Question 43

Key Ix in anal cancer

Answer 43

scope and biopsy

Question 44

Mx of anal cancer

Answer 44

Chemo, radio and surgical resection, which may require the formation of a colostomy

Question 45

What is a pilonidal abscess ? sx?

Answer 45

Cyst containing hair or skin debris near cleft of buttocks. Ingrown hair. Very painful, pus.

Question 46

Rfs for pilonidal abscess

Answer 46

sedentary life obese hirtuism

Question 47

Sx of pilonidal abscess

Answer 47

surgical