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Abdomen Flashcards

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1
Q

What are the signs you are looking for in the hands?

A 
Asterixis 
Bruising  
Clubbing  
Dupuytren's Contracture  
Palmar Erythema  
Leuconychia 
Koilonychia
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2
Q

What are the signs you are looking for in the forearms?

A

AV fistulae

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3
Q

What are the signs you are looking for in the head and neck?

A

Anaemia
Jaundice
Skin: jaundice, scratch marks (excoriation marks) or spider naevi

Oral Examination:
Pigmentation
Gum hypertrophy

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4
Q

What are the signs you are looking for on the chest?

A

Gynaecomastia
Hair Loss
Excoriation Marks
Spider Naevi

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5
Q

Causes of hepatomegaly

A

Cancer (primary or secondary deposits)

Cirrhosis (later on in cirrhosis, the liver will shrink)

Cardiac:
Congestive cardiac failure
Constrictive pericarditis

Infiltration:
Fatty infiltration 
Haemochromatosis 
Amyloidosis 
Sarcoidosis
Lymphoproliferative disease
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6
Q

Summary of liver disease

A 
Alcohol  
Autoimmune  
Drugs  
Viruses  
Biliary Disease  
NOTE: these are the things to think about when you have any patient with jaundice, raised AST/ALT, raised BR
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7
Q

Causes of splenomegaly

A

Portal hypertension

Haematological:
E.g. haemolytic anaemia, lymphoma, leukaemia

Infection:
E.g. malaria, schistosomiasis, leishmaniasis, TB, infective endocarditis, infectious mononucleosis

Inflammation

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8
Q 
DDx of:
75 y/o man
Epigastric pain
HR: 130bpm
BP: 80/50mmHg
A

Ruptured AAA (pain radiating to back, tachycardiac, low BP)
Pancreatitis
Peptic Ulcer

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9
Q

What does constant abdominal pain usually indicate?

A

Inflammation

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10
Q

What does colicky abdominal pain usually indicate?

A

Obstruction

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11
Q

How does acute pancreatitis present? What is the main test to confirm?

A

Epigastric pain

HIGH amylase

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12
Q

How does chronic pancreatitis present? What is the main test to confirm?

A

Epigastric pain, weight loss
Loss of exocrine/endocrine function
NORMAL amylase
Faecal elastase (main test)

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13
Q

DDx of right upper quadrant pain

A

Gallbladder:
Gallstones
Cholecystitis
Cholangitis

Liver:
Hepatitis
Abscess

Above (Lungs)
Basal Pneumonia

Below (Appendix)
Appendicitis

Left (Stomach, Pancreas)
Peptic Ulcer Disease
Pancreatitis

Right (Kidney)
Pyelonephritis

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14
Q

DDx of right iliac fossa pain

A 
GI: 
APPENDICITIS 
Mesenteric adenitis  
Colitis (IBD) 
Malignancy

Gynaecological:
Ovarian cyst rupture, torsion or bleed
Ectopic pregnancy

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15
Q

DDx of suprapubic pain:

A

Cystitis

Urinary retention

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16
Q

DDx of left iliac fossa pain:

A

GI Causes:
DIVERTICULITIS
Colitis (IBD)
Malignancy

Gynaecological:
Ovarian cyst rupture, torsion, bleed
Ectopic pregnancy

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17
Q

DDx of diffuse abdominal pain

A

Obstruction

Infection:
Peritonitis
Gastroenteritis

Inflammation:
IBD

Ischaemia:
Mesenteric Ischaemia

Medical Causes: 
DKA 
Addison's Disease 
Hypercalcaemia 
Porphyria 
Lead poisoning
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18
Q

Which organs does the coeliac artery supply?

A 
Stomach
Spleen
Liver
Gallbladder
Duodenum
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19
Q

Which organs does the superior mesenteric artery supply?

A

Small intestine

Right colon

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20
Q

Which organs does the inferior mesenteric artery supply?

A

Left colon

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21
Q 
65 y/o man
AAA repair 2 days ago
Diffuse abdominal pain
HR: 120bpm
RR: 30

What will the blood test likely show?

A

Any cause of acute abdomen causes HIGH AMYLASE

Unlikely to have a normal amylase because he is tachycardic and tachypnoeic- indicates poor tissue perfusion and therefore some lactic acidosis

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22
Q 
55 y/o man
Excess ETOH use
Cirrhosis
Abdominal pain
Abdominal distension

O/E: Ascites, liver flap

How many neutrophils are you likely to see in spontaneous bacterial peritonitis?

A

Ascites neutrophils > 250 cells/mm3

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23
Q

Decompensated features of liver disease

A

Jaundice
Encephalopathy
Ascites

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24
Q

Causes of abdominal distension

A 
Fluid
Flatus
Fat
Faeces
Foetus
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25
Signs of ascites
Shifting dullness | Features of liver disease
26
Signs of obstruction
``` Nausea, vomiting Not opened bowel High pitched tinkling bowel sounds ?Previous surgery ?Tender irreducible femoral hernia in the groin ```
27
Causes of transudate in ascites
Cirrhosis Cardiac failure Nephrotic syndrome
28
Causes of exudate in ascites
Malignancy Infection (TB, pyogenic) Budd-Chiari syndrome
29
Causes of ascites with albumin gradient <11 g/L
``` Nephrotic Syndrome Tuberculosis Pancreatitis (acute and chronic) Cancer Peritonitis ```
30
Causes of ascites with albumin gradient >11 g/L
CARDIAC FAILURE (acute and chronic) CIRRHOSIS Portal Hypertension Constrictive Pericarditis (high albumin gradient, likely due to chronic liver disease)
31
Cause of pale stools
Low stercobilinogen
32
Pre-hepatic causes of jaundice
Haemolysis, defective conjugation
33
Hepatic causes of jaundice
Hepatitis
34
Post-hepatic causes of jaundice
CBD obstruction Stricture Cancer of the head of the pancreas
35
Causes of unconjugated hyperbilirubinaemia
Haemolysis | Gilbert's syndrome
36
What is hepatocellular jaundice?
Damage to liver cells, leakage of conjugated bilirubin from hepatocytes This is soluble and secreted in urine, giving dark urine
37
Causes of hepatitis
Alcohol Autoimmune Drugs Viruses
38
Difference in presentation with hepatitis vs obstruction
Both have dark urine | Obstruction also causes pale stools as no bilirubin reaches colon to be converted to stercobilinogen
39
``` DDx of: Painless jaundice Wt loss Dark urine Pale stool ```
Cancer of head of the pancreas
40
What markers rise in post-hepatic jaundice?
ALP | GGT
41
Which tumour marker is best associated with pancreatic cancer?
CA19-9
42
What is Trousseau Sign of Malignancy?
Episodes of vessel inflammation due to a blood clot which are recurrent or appearing in different locations over time Can be early sign of gastric cancer or pancreatic cancer
43
Main causes of bloody diarrhoea
Infection Inflammation Malignancy
44
Causes of infection in bloody diarrhoea
``` Campylobacter Haemorrhagic E. coli Entamoeba histolytica Salmonella Shigella ```
45
Which group of people is inflammatory colitis more common in?
Young people with extra-GI manifestations
46
Which group of people is ischaemic colitis more common in?
Elderly
47
What are the extra-GI manifestations of inflammatory bowel disease?
Eyes: episcleritis, scleritis, uveitis Skin: erythema nodosum, pyoderma gangrenosum
48
What is the lead pipe sign?
Seen on AXR Feature of inflammatory bowel disease Loss of haustral markings of colon
49
How does toxic megacolon appear on an AXR?
Colon diameter >6cm
50
Management of Acute GI bleed
``` ABC IV access Fluids Group and Save, cross-match blood OGD (find cause of bleed) Antibiotics (e.g. tazocin, ciprofloxacin) and terlipressin (causes splanchnic vasoconstriction) in addition for variceal bleeds ```
51
Management of Acute Abdomen
``` NBM Fluids Analgesic Anti-emetics Antibiotics Monitor vitals and urine output ```
52
Investigations for acute abdomen
FBC- look at WCC (if it is infective) U&Es- renal function and hydration status CRP- marker of infection and inflammation Clotting- to see if patient prone to bleeding in surgery Erect CXR- look for air under diaphragm
53
Investigations if patient presents with jaundice
FBC- check for various cause of jaundice LFTs- important if liver pathology suspected Abdominal USS- do after a fast, look for gallstones in distended, bile-filled gall bladder. Dilation of ducts shows some kind of obstruction
54
Investigations if patient presents with dysphagia and wt loss
OGD and biopsy
55
Investigations if patient presents with PR bleed and wt loss
Colonoscopy
56
What is Pabrinex?
Injection of water-soluble vitamins Given to patients with chronic liver disease Contains thiamine, prevents Wernicke's encephalopathy
57
Management plan for patient with ascites
``` Tap ascites, find WCC (to look for SBP) If infective -> antibiotics Diuretics to remove fluid Dietary sodium restriction Fluid restriction in patients with hyponatraemia Monitor weight daily Therapeutic paracentesis ```
58
Management of patient with encephalopathy
``` Lactulose- osmotic laxative Phosphate enemas Avoid sedation Treat infections Exclude GI bleed- alcoholic patients with chronic liver disease will have low urea, if it rises it could be due to digestion of blood cells ```
59
What are the features of an anastamotic leak?
Diffuse abdominal tenderness Guarding, rigidity Hypotensive/tachycardic
60
Features of a pelvic abscess
Pain, fever, sweats, mucus diarrhoea
61
Presentation and treatment of perianal abscess
Tender, red swelling Incision and drainage
62
Presentation and treatment of anal fissures
Rectal pain Stool coated with blood Advice regarding diet (fluid, fibre) GTN cream
63
Presentation of irritable bowel syndrome
Recurrent abdominal pain, bloating Improves with defecation Change in frequency/form of stool (can be diarrhoea or constipation) No PR bleed, anaemia, wt loss or nocturnal symptoms
64
Difference in presentation of irritable bowel syndrome and inflammatory bowel disease
IBS does not have nocturnal symptoms, IBD does
65
How to exclude coeliac disease
Measure tissue transglutaminase
66
Treatment of IBS
Diet and lifestyle modification Symptomatic treatment: Abdominal pain- antispasmodics Laxatives for constipation Anti-diarrhoeals

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