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Core Conditions Y3 > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Risk factors for GORD?

A

Smoking, alcohol, hiatus hernia, pregnancy, obesity, nitrates, tricyclic antidepressants, acidic/fatty foods

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2
Q

Typical patient with GORD?

A

Obese man, retrosternal burning pain, worse on lying flat and after meals

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3
Q

Three major symptoms of GORD?

A
  1. Heart burn after eating/when lying, relieved by antacids
  2. Odynophagia
  3. Retrosternal burning
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4
Q

Two minor symptoms of GORD?

A
  1. Nocturnal cough

2. Morning hoarseness

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5
Q

Two investigations for GORD?

A
  1. Endoscopy

2. 24hr pH monitoring

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6
Q

Conservative treatment of GORD?

A

Reduce weight, cut down smoking, change diet

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7
Q

Four medical treatments of GORD?

A

Antacids
H2 receptor antagonists (ranitidine)
PPIs (omeprazole)
Prokinetics (metoclopramide)

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8
Q

Five complications of GORD?

A 
Oesophagitis
Oesophageal stricture
Barrett's
Ulceration
Anaemia
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9
Q

Which sex is more likely to get peptic ulcer?

A

Men 2x more likely

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10
Q

Risk factors for peptic ulcer?

A 
H. pylori (MOST COMMON)
NSAIDs
Smoking
Stress
Steroids
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11
Q

Typical patient with peptic ulcer?

A

Middle aged man, long-term epigastric pain, presents with melaena

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12
Q

Five symptoms of peptic ulcer?

A 
Epigastric pain (worse at night/after food, relieved by antacids)
Nausea/vomiting
Haematemesis/melaena
Weight loss
Anaemia
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13
Q

Investigations for peptic ulcer?

A

H pylori screen (rapid urease/urea breath test)

Endoscopy

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14
Q

Conservative treatment of peptic ulcer?

A

Stop smoking/NSAIDS

Avoid foods that cause symptoms

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15
Q

Two treatments for peptic ulcer?

A 
Acid suppression (PPIs, H2 receptor antagonists)
H pylori triple therapy
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16
Q

Five complications of peptic ulcer?

A 
Malignancy
Haemorrhage (15-20%)
Perforation
Pyloric stenosis
Anaemia
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17
Q

Who gets UC?

A

Age 15-30 yrs, more common in women and caucasians

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18
Q

Features of UC?

A 
Insidious onset
Diarrhoea with blood
Distension
Malaise, anorexia
Severe colitis
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19
Q

Blood test changes in UC?

A

Low Hb

Raised CRP

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20
Q

Other investigations of UC?

A

Stool culture
Abdominal XR
Abdominal USS
Endoscopy with biopsy

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21
Q

Medical treatment of UC?

A

Mild: prednisolone, aminosalicylate
Severe: IV hydration, hydrocortisone, immunosuppression
Remission: Aminosalicylates, immunosuppression

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22
Q

Surgical treatment of UC?

A

Colectomy with ileostomy

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23
Q

Four complications of UC?

A

Perforation
Bleeding
Toxic megacolon
Colon cancer (30% after 35yrs)

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24
Q

Pathologic features of UC?

A

Continuous lesions
Ulcers
Goblet cell destruction
Crypt abscesses

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25
Q

Pathologic features of Crohn’s?

A

Skip lesions
Transmural inflammation
Fistulas

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26
Q

Risk factors for Crohn’s?

A

Smoking

High sugar, low fibre diet

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27
Q

Features of Crohn’s?

A

Diarrhoea (often non-bloody)
Abdo pain (RIF)
Weight loss, fever, malaise, anorexia
Mouth ulcers/perianal features

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28
Q

Blood test changes in Crohn’s?

A

Low Hb, raised platelets
Raised CRP
Low albumin

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29
Q

Other investigations for Crohn’s?

A

Abdominal XR
Small bowel MRI
Endoscopy

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30
Q

Conservative treatment of Crohn’s?

A

Stop smoking

Diet change

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31
Q

Medical treatment of Crohn’s?

A

Mild: Prednisolone, aminosalicylates
Severe: IV hydration, hydrocortisone
Remission: Aminosalicylates, methotrexate, metronidazole (infection), Anti-TNF

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32
Q

Surgical treatment of Crohn’s?

A

Resect as little bowel as possible as it is not curative

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33
Q

Five complications of Crohn’s?

A 
Malabsorption
Small bowel obstruction
Strictures
Abscesses
Fistulae
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34
Q

Clinical features of infective gastroenteritis?

A

Diarrhoea +/- vomiting
Dysentery
Systemic symptoms

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35
Q

Investigations for gastroenteritis?

A

Raised WBC and CRP

Stool culture/sigmoidoscopy (if symptoms persist)

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36
Q

Treatment of gastroenteritis?

A

Rehydration
Antiemetics
Antibiotics (if systemic illness)
AVOID ANTIDIARRHEALS

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37
Q

Clinical features of ascites?

A

Abdominal distension
Shifting dullness on percussion
Fluid thrill

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38
Q

Investigations for ascites?

A 
Aspirate colour (straw coloured = normal)
Abdominal USS/CT
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39
Q

Conservative treatment of ascites?

A

Treat cause

Reduce Na+ intake and fluid restriction

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40
Q

Medical treatment of ascites?

A

Diuretics (spironolactone, furosemide)

Paracentesis

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41
Q

Three complications of ascites?

A

Spontaneous bacterial peritonitis
Hyponatraemia
Pleural effusion (resp distress)

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42
Q

Four risk factors for acute hepatitis?

A

Recent new medication
Recent foreign travel
Unprotected sex
IVDU

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43
Q

Typical patient with acute hepatitis?

A

Young girl, impulsively took many tablets two days ago, history of depression, presenting with nausea and epigastric pain

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44
Q

Features of acute hepatitis?

A

Jaundice
Abdominal pain
Rarely hepatic encephalopathy

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45
Q

Five important blood tests for acute hepatitis?

A 
INR
LFTs
U&Es
FBC
ABG (pH, lactate, ammonia)
46
Q

Treatment of acute hepatitis?

A

Treat underlying cause
Fluid resuscitation
Vitamin supplements (Vit K, thiamine)
Low threshold for antibiotics

47
Q

Three complications of acute hepatitis?

A

Multi organ failure
Sepsis
Cerebral oedema

48
Q

Three most common causes of chronic liver failure?

A

NAFLD
AFLD
Autoimmune

49
Q

Typical patient with chronic liver failure?

A

Middle aged, presents with fever, malaise and profound jaundice

50
Q

Clinical features of chronic liver failure?

A

Jaundice, fatigue, anorexia
Autoimmune: rash, arthritis
Alcoholic: parotid enlargement, neuropathy
NAFLD: diabetes, high cholesterol

51
Q

Investigations for chronic liver failure?

A

Bloods: deranged LFTs
Imaging: USS/CT
Other: biopsy

52
Q

Treatment of chronic liver failure?

A 
Treat underlying cause
Nutritional support (alcoholic)
Immunosuppression (autoimmune)
53
Q

What are the four Fs of gallstones?

A

Fat
Forty
Female
Fair (skinned)

54
Q

Typical patient for gallstones?

A

40 year old overweight caucasian lady, RUQ pain especially after fatty food

55
Q

Features of gallstones?

A

80% asymptomatic
Nausea, vomiting
+ve Murphy’s sign
Biliary colic

56
Q

Gold standard investigation for gallstones?

A

USS

57
Q

Treatment of gallstones?

A

Symptomatic until stone passes

Laparoscopic cholescystectomy

58
Q

Three main complications of gallstones?

A

Cholecystitis
Cholangitis
Bile duct blockage (pancreatitis)

59
Q

Typical patient with appendicitis?

A

25 year old student, one day history of fever and severe pain centrally and in RIF, guarding and tenderness in RIF

60
Q

Symptoms of appendicitis?

A

Vomiting
Anorexia
Intense pain

61
Q

Signs of appendicitis?

A

Guarding in RIF

Rebond tenderness

62
Q

What do blood tests show in appendicitis?

A

Raised WBC and CRP

63
Q

Treatment of appendicitis?

A

Appendectomy

IV fluids and metronidazole if severe

64
Q

Typical patient presenting with small bowel obstruction?

A

Colicky abdominal pain with bile-stained vomit and abdo distension

65
Q

Symptoms of small bowel obstruction?

A

Severe colicky spasms in central abdomen

Vomiting/constipation

66
Q

Signs of small bowel obstruction?

A

Abdominal distension

Tinkling bowel sounds

67
Q

Investigations in suspected small bowel obstruction?

A

Rectal exam
Bloods (lactate raised)
Plain abdo XR

68
Q

Treatment of small bowel obstruction?

A

NG tube to remove bowel secretions
Ischaemia: emergency surgery
Hernia: herniotomy/manual release

69
Q

Typical patient with large bowel obstruction?

A

Elderly patient presenting with abdo distension and absolute constipation

70
Q

Symptoms of large bowel obstruction?

A

Complete constipation

Colicky spasmodic pain - more severe and constant than in small bowel obstruction

71
Q

Signs of large bowel obstruction?

A

Distension

Anaemia

72
Q

Investigations of large bowel obstruction?

A

Rectal exam
Bloods (lactate raised)
Plain abdo XR
Sigmoidoscopy

73
Q

Treatment of large bowel obstruction?

A

Ischaemia: emergency surgery
Stenting
Less urgent obstructions: water soluble enema

74
Q

Typical patient with acute pancreatitis?

A

60 year old man, severe upper abdo pain, came on suddenly, radiates to back with vomiting, also jaundiced

75
Q

Symptoms of acute pancreatitis?

A

Sudden upper abdo pain radiating to back
Pain relieved on sitting forwards
Nausea/vomiting

76
Q

Signs of acute pancreatitis?

A

Jaundice
Cullen’s sign: periumbilical bruising
Grey Turner’s sign: flank bruising
Epigastric tenderness

77
Q

Blood test results in acute pancreatitis?

A 
Raised pancreatic enzymes
Highly raised amylase
Raised lipase
Raised WBC, CRP
Raised AST (gallstones)
78
Q

Treatment for acute pancreatitis?

A

Symptomatic until cause is treated
Gallstone removal
Pancreatic abscess surgery

79
Q

Typical age of chronic pancreatitis presentation?

A

50s

80
Q

Features of chronic pancreatitis?

A

Epigastric pain relieved on sitting forwards
Jaundice
Bloating
Malabsorption (steatorrhoea, weight loss, anorexia)

81
Q

Investigations for chronic pancreatitis?

A

Stool: Low faecal elastase
Imaging: AXR shows clacification

82
Q

Conservative treatment for chronic pancreatitis?

A

Alcohol cessation

Low fat diet

83
Q

Medical treatment of chronic pancreatitis?

A

H2 receptor blocker (ranitidine)
Pancreatic supplements
Analgesia, lipase, fat soluble vitamins

84
Q

Typical patient with oesophageal cancer?

A

65 year old man, two month history of progressive dysphagia and weight loss

85
Q

Symptoms of oesophageal cancer?

A

Progressive dysphagia
Odynophagia
Significant weight loss
Haematemesis, hoarseness, vomiting, cough

86
Q

SIgns of oesophageal cancer?

A

Anaemia
Anorexia
Ascites
Lymphadenopathy

87
Q

Investigations for oesophageal cancer?

A

Endoscopy

Staging CT/endopic USS

88
Q

Treatment of oesophageal cancer?

A

Resection
Chemotherapy
Radiotherapy

89
Q

Typical patient with gastric cancer?

A

50 year old man presents with weight loss and haematemesis

90
Q

Symptoms of gastric cancer?

A

Nausea/vomiting
Weight loss
Bowel changes
Abdo pain +/- haemorrhage

91
Q

Signs of gastric cancer?

A

Palpable epigastric mass (50%)
Virchow’s node (30%)
Acanthosis nigrans

92
Q

Investigations for gastric cancer?

A

Gastroscopy with biopsy

Staging CT/endoscopy

93
Q

Treatment of gastric cancer?

A

Surgery
Chemotherapy
Radiotherapy
PPIs to reduce bleeding in ulcerating tumours

94
Q

Typical patient with a femoral hernia?

A

Elderly female, tender groin swelling

95
Q

Clinical features of femoral hernia?

A

Mass in upper medial thigh
Tenderness
Colicky abdo pain

96
Q

Investigation of femoral hernia?

A

Ask the patient to stand and cough and watch direction of movement?

97
Q

Treatment of a femoral hernia?

A

Surgical repair

98
Q

Two real differences between femoral and inguinal hernias?

A

Inguinal = M>F

Location (inguinal is more superior and medial)

99
Q

What is the classification criteria for colorectal carcinoma?

A

Dukes

100
Q

Typical patient with colorectal cancer?

A

Elderly patient, weight loss and change in bowel habits

101
Q

Symptoms of colorectal cancer?

A

Bowel habit change
Blood in stool
Weight loss
Pain

102
Q

Investigations of colorectal cancer?

A

Colonoscopy with biopsy

Staging CT

103
Q

Treatment of colorectal carcinoma?

A

Chemotherapy
Radiotherapy
Surgery

104
Q

Most common cause of upper GI bleed?

A

Gastric ulcer

105
Q

Symptoms of acute GI bleed?

A

Haematemesis
Melaena
Symptoms of blood loss (syncope, anaemia)

106
Q

Investigations for acute GI bleed?

A

Bloods (high urea +normal creatinine)

Endoscopy if haemodynamically stable

107
Q

Score used for prognosis of acute GI bleed?

A

Rockall Score

108
Q

Management of acute GI bleed?

A

Small: Lifestyle advice (avoid alcohol, NSAIDs, etc.)
Large: ABCDE approach

109
Q

What ages and sex are most likely to present with coeliac?

A

Females

Infants and ages 30-40 yrs

110
Q

Features of coeliac disease?

A 
Diarrhoea (50%)
Foul smelling stool
Weight loss
Abdo pain
Distension
Mouth ulcers
111
Q

Investigations for coeliac disease?

A

Auto-antibody tests

Endoscopy with biopsy

112
Q

Treatment of coeliac disease?

A

Gluten free diet

Vitamin supplements

Core Conditions Y3 (2 decks)

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