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Abdo Flashcards

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1
Q

6Fs of abdominal distension

A 
Fat
Fluid
Faeces
Flatus
Foetus
Fucking big masses
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2
Q

R subcostal scar name and procedures

A

Kocher scar

Open cholecystectomy

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3
Q

Rooftop scar procedures

A

UGI surgery
Liver transplant
Pancreatic surgery e.g. whipples

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4
Q

Mercedes-benz scar procedures

A

Oesophagectomy

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5
Q

Midline laparotomy scar procedures

A
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6
Q

Lanz/Gridiron scar procedures

A

Appendicectomy

Lanz = horizontal
Gridiron = Oblique
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7
Q

Rutherford Morrison scar procedures

A

Renal transplant

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8
Q

Pfannenstiel scar procedures

A

C-section

Total Abdominal Hysterectomy

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9
Q

Causes of ascites

A

Transudative (SAAG >11)

  • Hypoalbuminaemia (liver disease)
  • Nephrotic syndrome
  • HF

Exudative (SAAG <11)

  • Infection e.g. SBP
  • Inflammation e.g. pancreatitis
  • Malignancy e.g. Ovarian cancer
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10
Q

Mx of ascites

A

Conservative
- Salt restriction

Medical

  • Spironolactone
  • SBP prophylaxis

Surgical

  • Ascitic drain (therapeutic paracentesis)
  • TIPSS
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11
Q

Causes of hepatomegaly

A

Infection

  • Hepatitis
  • CMV/EBV
  • Liver abcess

Infiltration

  • Amyloidosis
  • Sarcoidosis
  • Haemochromatosis

Blood

  • Lymphoma
  • Leukaemia

Biliary

  • PBC
  • PSC

Cancer

  • HCC
  • Hepatic adenoma

Congestion
- Budd Chiari syndrome

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12
Q

Extraintestinal features of IBD

A 
Aphthous ulcers
Pyoderma gangrenosum
Iritis (scleritis, episcleritis, anterior uveitis )
Erythema Nodosum
Sclerosing Cholangitis
Arthritis
C
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13
Q

Causes of massive splenomegaly

A

Malaria
CML
Myelofibrosis

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14
Q

Causes of splenomegaly

A

Infections

  • Bacterial e.g. TB, IE
  • Parasitic e.g. Malaria
  • Viral e.g. EBV

Haematological

  • Lymphoma
  • Leukaemia

Inflammatory/autoimmune disease

  • RA
  • Sarcoidosis
  • SLE

Liver

  • Portal hypertension
  • Cirrhosis
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15
Q

Signs of chronic stable liver disease

A

Hands

  • Leuconychia
  • Dupuytren’s contracture
  • Palmar erythema

Chest/abdomen

  • Spider naevi (>4)
  • Gynaecomastia
  • Caput medusae
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16
Q

Signs of decompensated liver disease

A

Jaundice
Ascites
Encephalopathy (asterixis, drowsiness, hyperventilation)

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17
Q

Causes of chronic liver disease/cirrhosis

A 
Alcoholic liver disease
Viral hepatitis
NAFLD
Autoimmune hepatitis
Haemochromatosis
Wilson's disease
A1-antitrypsin deficiency
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18
Q

Causes of portal hypertension

A

Liver cirrhosis
Portal vein thrombosis (Budd Chiari syndrome)
Schistosomiasis
Right Heart failure

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19
Q

Signs of portal hypertension

Study These Flashcards
A

Oesophageal varices
Caput medusae
Haemorrhoids
Splenomegaly

20
Q

Ix for chronic liver disease

Study These Flashcards
A 
FBC, U&E, LFTs
CRP
Lipid profile
Clotting
Liver screen (Hepatitis serology, antibodies (ASMA, Anti-LKM, AMA), Caeruloplasmin, AFP, Ferritin and transferrin)

USS abdo
Liver biopsy

21
Q

Mx of chronic liver disease

Study These Flashcards
A

Conservative

  • Alcohol abstinence
  • Nutrition input and vitamin supplements
  • Weight loss
  • Avoid hepatotoxic meds

Medical

  • Diuretics (if ascites present)
  • SBP prophylaxis (ciprofloxacin + propranolol)
  • Variceal prophylaxis

Surgery

  • TIPSS (for portal hypertension)
  • Liver transplant
22
Q

Spectrum of liver disease

Study These Flashcards
A

Fatty liver
Hepatitis
Cirrhosis: fibrotic change within the liver, leading to a loss of function and portal shunting

23
Q

Signs of renal disease/haemodialysis

Study These Flashcards
A

AV fistula
Tesio line insertion scar
Rutherford Morrison scar

24
Q

Causes of palpable kidney

Study These Flashcards
A

Renal cyst
Polycystic kidney disease
Renal tumour
Hydronephrosis

25
Ileostomy features
Normally RLQ Spouted Liquid faeces in stoma bag Can be end or loop (2 lumens)
26
Urostomy + ileal conduit
Indication: Post-cystectomy for bladder cancer Ileum is used to allow drainage of urine from ureters Appears similar to ileostomy but with urine in stoma bag
27
Colostomy features
Normally LLQ Flush to the skin Formed faeces in stoma bag
28
Ileostomy indications
End Ileostomy - Panproctocolectomy Loop ileostomy - Bowel rest after Anterior resection
29
Mx of acute alcohol withdrawal
Chlordiazepoxide (dependent on CIWA score) IV pabrinex and thiamine Measure glucose (but don't give as can precipitate Wernicke's)
30
How many spider naevi is abnormal? What are2 other causes?
>5 COCP Pregnancy
31
Mx of decompensated liver disease
Relieve symptoms: Lactulose Spironolactone Treat underlying cause definitively: TIPS
32
What is done in a TIPS procedure
Using a catheter and guidewire passed through the IVC and into the hepatic vein, a shunt is created directly between a branch of the hepatic portal vein and the hepatic vein, bypassing the liver
33
What is the Child Pugh score
Scoring system for determining mortality in patients with liver cirrhosis ``` Ascites Encephalopathy Bilirubin INR Albumin ```
34
When would you consider SBP prophylaxis for ascites?
After first ep of SBP After GI bleed If hypoalbuminaemic
35
RUQ pain differentials
``` Biliary colic Cholecystitis Acute hepatitis Basal pneumonia Pancreatitis ```
36
Epigastric pain differentials
``` Pancreatitis Biliary colic/cholecystitis Peptic ulcer disease Inferior MI Basal pneumonia ```
37
Generalised abdo pain differentials
Medical DKA Gastroenteritis Ischaemic colitis Surgical Peritonitis (SBP, perforation) Toxic megacolon/Bowel obstruction
38
Flank pain differentials
Nephrolithiasis (pyelonephritis) Renal cyst rupture ADPKD Renal cell carcinoma
39
Umbilical pain differentials
``` Appendicitis (early) AAA Pancreatitis Biliary colic Bowel obstruction ```
40
RIF pain differentials
Appendicitis Gynae (ovarian torsion, cyst rupture, ectopic pregnancy) Crohn's colitis Testicular torsion
41
LIF pain differentials
``` Diverticulitis UC Testicular torsion Gynae stuff UTI ```
42
``` RUQ pain (Biliary colic/Cholecystitis/Ascending cholangitis/Pancreatitis/hepatitis) - Basic obs, bloods (FBC, U+E, LFTs, Amylase, G+S, X-match), Imaging (US abdo, MRCP, ERCP) ``` Epigastric (Pancreatitis/Biliary Colic/Cholecystitis/ascending cholangitis/basal pneumonia/MI) - Basic obs, ECG, bloods (FBC, U+E, LFTs, Amylase, blood cultures, G+S, X-match), Imaging (US abdo), Generalised Abdo pain Basic Obs, stool culture, bloods (FBC, U+E, LFTs, Blood cultures, VBG, G+S, X-match), Ascitic tap ``` Flank pain (Renal colic/PKD/RCC) Basic obs, bloods (FBC, U+E, LFTs, G+S, X-match), urine dip + pregnancy test, Imaging (CT KUB, TVUSS) ``` ``` IF pain (Testicular torsion/Gynae stuff/Appendicitis/Diverticulitis/Renal colic/IBD) - Basic obs, bloods (FBC, U+E, LFTs), urine dip + pregnancy test, TVUSS/exploratory laparotomy ```
43
Diverticular disease Mx
Conservative - Diet (adequate fibre intake, good hydration) - Bulk-forming laxatives Diverticulitis PO co-amoxiclav if systemically unwell Diverticular abscess: IV abx and percutaneous drainage Peritonitis: Laparotomy for lavage and IV abx Surgery Resection with defunctioning stoma Hartmann's procedure
44
Peptic ulcer disease RFs
``` H. pylori Smoking NSAIDs Alcohol Burns (Curling ulcers) ```
45
Dysphagia systems Rx
``` Cough (esp. after eating) Chest pain Heartburn Vomiting Halitosis tiredness after eating FLAWS ```
46
Oesophageal cancer
Barium swallow/endoscopy + biopsy CT abdo pelvis Fitness for surgery tests Neoadjuvant chemotherapy to shrink tumour Oesophagectomy (pull some of stomach up into chest, can still eat afterwards but should be on liquid/soft food enteral feeds at least to start with) Endoscopic mucosal resection (most patients unsuitable for surgery)

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