Abdo pain

Question 1

Triad for acute mesenteric ischaemia

Answer 1

Gastrointestinal emptying (vomiting, diarrhoea)
Abdominal pain
Underlying cardiac disease  and CV risk factors (AF, T2DM, HTN)

Question 2

How to distinguish SIBO (Small intestinal bacterial overgrowth) and coeliacs

Answer 2

Both can present with symptoms of intermittent bouts of abdominal pain, bloating and loose stools

HOWEVER bloods will be different:
Coeliacs: low ferritin, B12 and folate
SIBO: bloods normal and folate might be elevated (bacteria produces this)

Question 3

Causes of high ferritin without iron overload

Answer 3

Inflammation (due to ferritin being an acute phase reactant)
Alcohol excess
Liver disease
Chronic kidney disease
Malignancy

Question 4

Causes of high ferritin with iron overload

Answer 4

Primary iron overload (hereditary haemochromatosis)

Secondary iron overload (e.g. following repeated transfusions)

Question 5

During infection ferritin is not a useful measure

Answer 5

May be falsely elevated during infection (an acute phase reactant)

Used transferrin, TIBC

Question 6

First line investigation for acute mesenteric ishaemia

Answer 6

Lactate

Question 7

Mackler’s triad for Booerhave syndrome

Answer 7

Vomiting
Thoracic pain
Subcutaneous emphysema (heard as crepitus in epigastric region)

Typically presents in middle aged men with a background of alcohol abuse.

Question 8

Mallory-Weiss syndrome

Answer 8

Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

Question 9

Plummer-Vinson syndrome

Answer 9

Dysphagia (secondary to oesophageal webs)
Glossitis (sore tongue)
Iron-deficiency anaemia
Cheilosis

Tx - Iron supplementation and dilatation of webs