Abdominal Flashcards
(227 cards)
1
Q
GORD
A
Reflux of gastric contents causing mucosal damage and weakened muscles
2
Q
Prevalence of GORD
A
15% in adults
Common in infancy but will resolve in 12-18 months
3
Q
Lifestyle risk factors of GORD
A
Obesity, smoking, alcohol, coffee, fatty food
4
Q
Symptoms of GORD
A
Heartburn Acid regurgitation, unpleasant taste in back of throat Dysphagia Oesophagitis Ulceration Bloating and Belching Bad breath Waterbrash/ Acidbrash (excess salivation) Association with asthma.
5
Q
Differential Diagnosis of GORD
A
Oesophagitis, Infection, Duodenal ulcer, gastric ulcers, Heart pain
6
Q
Investigations of GORD
A
- Upper GI endoscopy: if oescophagitis or Barrett’s syndrome present the GORD confirmed
- Intraluminal monitoring: 24 hour pH monitoring
7
Q
Management of GORD: Lifestyle choices
A
- Encourage weight loss, smoking cessation, raise bed head, small regular meals
- Avoid alcohol, eating before bed
8
Q
Drugs to avoid in GORD
A
- those that slow motility: nitrates, anticholinergics, TCA
- Those that damage mucosa: NSAIDS, bisphosphonates
9
Q
Drugs to treat GORD
A
- Alginate containing antacids e.g. gaviscon
- H2-receptor anatgonist (reduced acid production by cells) e.g. cimetidine
- PPI e.g. omeprazole, lansoprazole
- Prokinetic agents e.g. metocloperamide
10
Q
Surgery for GORD
A
Laparoscopic Nissen Fundoplication (LNF) - surgery tightening the ring of muscle at the bottom of the oesophagus to stop acid leaking from stomach
11
Q
Complications of GORD
A
Ulcers, Peptic stricture, Barrett’s oesophagus, Oesophagitis
12
Q
Side effects of H2 receptor antagonists
A
Diarrhoea, headaches, rash and tiredness
13
Q
Pathology of Barrett’s oesophagus
A
Squamous mucosa replaced by columnar mucosa
14
Q
Peptic Ulcer
A
Breach in the mucosal lining of the stomach or duodenum
15
Q
Where are gastric and duodenal ulcers most common?
A
Gastric ulcer- lesser curvature of the stomach
Duodenal ulcer- duodenal ampulla
16
Q
Define Dyspepsia
A
Indigestion with pain or discomfort in the upper abdomen
17
Q
Prevalence of DU and GU
A
Du affects 10-15% of adults and are 4x more common than GU
18
Q
Who is affected in Peptic Ulcers
A
Common in elderly, common in females, prevalent in developing countries due to high H. Pylori infection rates
19
Q
Zollinger-Ellison Syndrome
A
Disease in which tumours cause the stomach to produce too much acid, resulting in peptic ulcers.
20
Q
What causes Zollinger-Ellison Syndrome
A
Gastronima, a tumour that secretes a hormone called gastrin stimulating release of gastric acid
21
Q
Causes and risk factors of Peptic Ulcers
A
H.pylori NSAIDs, steroids, SSRIs Smoking Stress Delayed gastric emptying in GU Increased gastric emptying in PU
22
Q
Which blood group is most at risk of duodenal ulcers?
A
O
23
Q
what percentage of DU and GU does H.pylori cause?
A
95% of DU
80% of GU
24
Q
Symptoms of peptic ulcers
A
Epigastric pain, N&V, bloating, weight loss, burping, reflux, back pain (suggest posterior ulcer)
25
What mnemonic is used for the Peptic ulcer symptoms
ALARM
- Anaemia
- Loss of Weight
- Anorexia
- Recent onset/ Progressive symptoms
- Meleana/ haematemesis
26
where does dark, tarry stools suggest bleeding comes from?
Bleeding in the upper part of GI tract. Blood is darker as it has been digested through the tract.
27
Differential diagnosis of Peptic Ulcer
Gastritis, GORD, pancreatitis, cholecystitis (gallstones) hepatitis, IBD, AAA, MI
28
Cholecystitis
Inflammation of the gallbladder due to blockage by gallstones
29
Cholangitis
Inflammation of the bile duct caused by bacteria ascending from the junction with the duodenum
30
Investigations for peptic ulcer
- FBC blood test
- H. Pylori testing
- Urea Breath Test
- Stool antigen test
- Serology to detect IgG antibodies
- Rapid urease test (CLO)
- Endoscopy
31
Rapid Urease Test (aka Campylobacter-like organism test)
Fast test for diagnosing H.Pylori. If present, H.Pylori secretes urease which converts urea to ammonia
32
Management for Peptic Ulcers
Smoking cessation, decrease alcohol intake, reduce stress, stop NSAIDs
33
Recurrence rate of H. pylori after eradication
10-20%
34
What does H. Pylori Eradication Triple Therapy Involve?
2 Antibiotics and 1 PPI
35
Antibiotics against H.Pylori in Triple Therapy
Amoxicillin, Clarithromycin, Metronidazole
36
PPI used in Triple Therapy
Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole
37
Complications of Peptic Ulcers
Haemorrhage
Perforation of Ulcer
Malignancy
Gastric outflow obstruction
38
Perforated Viscus
Loss of gastrointestinal wall integrity with subsequent leakage of enteric contents.
39
Commonest cause of Acute Upper GI bleeds
Peptic Ulcers (gastric and duodenal) and Oesopha-gastric varices
40
Mallory-Weiss syndrome
Bleeding from a tear in the lining of the oesophagus due to prolonged vomiting and increased intra-abdominal pressure
41
Risk Factors to Acute Upper GI bleeds
Alcohol abuse, chronic liver disease, NSAID
42
Symptoms for Actue Upper GI bleeds
Haematemesis, Malaena, PR bleeding, Nausea
43
Signs/ Examination of Acute Upper GI bleeds
Cold, clammy, capillary refill <2, hypotensive, tachycardic
44
What is the Rockall Score?
A scoring system used to identify patients at risk of adverse outcome following acute upper GI bleed. Criteria uses increasing age, co-morbidity, shock and endoscopic finding.
45
What is the Glasgow-Blatchford bleeding Score?
The GBS helps identify which patients with UGIB can be safely discharged from the emergency room.
46
Managing UGIB
1. Blood volume: transfuse red cells
2. Endoscopy
3. Drug therapy: PPI- Omeprazole, prokinetics- erythromycin
4. Surgery if persistent
47
Budd–Chiari syndrome
Occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites, and liver enlargement.
48
Acute lower GI bleeds
Occurring from the colon, rectum or anus. Presenting as hematochezia or meleana.
49
Hematochezia
Bright red blood, clots or burgundy stools. Suggest bleeding from lower GI
50
Meleana
Dark sticky stools cwith digested blood. Suggest bleeding from upper GI
51
Causes of LGIB
Diverticulitis, Ischaemic colitis, Crohns, Haemorrhoids, Anal fissure
52
Investigations for LGIB
1. Proctoscopy
2. Flexible sigmoidoscopy or colonoscooy
3. Angiography
53
Proctoscopy
Uses a proctoscope to examine the anal cavity, rectum, or sigmoid colon.
54
Inflammatory Bowel Disease
Inflammatory, idiopathic, autoimmune conditions of the colon and GI tract
55
Main IBD
UC and Crohns• Collagenous colitis, lymphocytic collitis, ischaemic collitis, diversion collitis and Behçet’s syndrome
56
Behcet's syndrome
Causes blood vessels to be inflammed throughout the body. Symptoms include mouth sores, eye inflammation, skin rashes and genital sores
57
Location of UC and Crohn's
UC affects the large intestines
| Crohns affects any part of tract from the mouth to the anus
58
Prevalence of UC and Crohn's
UC: 2/1000 in UK
CD: 1/1000 in UK
59
Who is affected by UC and Crohn's
15-40 y.o
Affects males and females equally
Affected by race and ethnic origin
UC more common in non-smokers. CD more common in smokers.
60
Crohn's disease
Skip lesions, deep ulcers, cobblestone appearance, granulomas, Transmural, strictures common, Crypst abscesses uncommon, Goblet cells present
61
Ulcerative Collitis
Rectum always involved, Continuous, mucosa is inflamed, superficial, no granulomas, stictures uncommon, Crypt abscesses common, goblet cells depressed
62
Symptoms for IBD
diarrhoea with blood in UC, steatorrhoea in CD, abdominal pain, malaise, lethargy, anorexia, weight loss, aphthous ulcers, tenesmus, urgency, N&V in CD
63
Tenesmus
Continuous inclination to open the bowels
64
Canker sore or Apthous ulcers
Small lesions that develop in your mouth or on gums. Unlike cold sores, they are not found on the lips and not contagious.
65
Proctitis
UC affecting the colon only
66
Pancolitis
UC affecting the whole colon
67
Erythema Nodosum
Swollen fat under the skin causing red bumps and patches
68
Pyoderma gangrenosum
Large painful ulcers on the skin mainly legs. Autoimmune disease associated with UC and CD
69
Differentials for IBD
IBS, Infective colitis, Coeliac Disease, Diverticulitis
70
Investigations for IBD
- Bloods: FBC, b12, folate, ESR, CRP, blood culture
- Stools
- Abdo X-ray
- Barium enema
- Colonoscopy
- Rectal biopsy
- MRI
- Staging
71
Crohn's Disease Activity Index (CDAI)
Tool used to quantify the symptoms of patients with Crohn's disease. Helps to identify response or remission of disease
72
Trulove and Witts' Severity Index
Measures the severity of UC. Classified as mild, moderate or severe
73
Treatment of Crohns
1. Stop Smoking
2. Glucocorticoids- Prednisolone
3. Infliximab
4. Surgery- panproctocolectomy and end-ileostomy
74
Treatment of UC
1. Aminosalicylate - mesalazine
2. Azathioprine for moderate to severe
3. Surgery
75
Complications of IBD
Strictures, fistulae, perforation, haemorrhage, colorectal cancer, toxic megacolon, anaemia, osteoporosis due to steroid therapy
76
Irritable bowel Syndrome and the different types
A functional bowel disorder.
- IBS-D (Diarrhoea predominated)
- IBS-C (Constipation)
- IBS-A (Alternating stool pattern)
- IBS- PI (Post-infective)
77
How common is IBS
- Affects 1 in 5 people
- Most common functional gastrointestinal disorder (FGID)
- Females 2x more likely than men
- Teens to 40s
78
Cause of IBS
Unknown. Result of the disruption in communication between the brain and gut
79
Risk Factors for IBS
Depression, hypochondriac, being female
80
Symptoms for IBS
Pain and cramping, diarrhoea, constipation, changes in bowel movements, bloating, tenesmus
81
Differentials for IBS
IBD, Coeliac Disease, Gastroenteritis, Colorectal carcinoma
82
Manning Criteria
Helps in diagnosis of IBS. Minimum of 2.
1. Relief of abdominal pain with defecation
2. Bloating or abdominal distention
3. Looser stool with the onset of abdominal pain
4. Feeling of incomplete evacuation of stool
5. More frequent bowel movements with the onset of pain
6. Passage of mucus from the rectum
83
Rome II Criteria
Used to diagnose functional bowel disorder. For IBS, at least 12 weeks preceding the abdominal discomfort with 2 of the 3 features:
1. Relieved with defecation
2. Change in frequency of stool
3. Change in appearance of stool
84
Treating IBS
1. Avoid food that trigger symptoms
2. Adjust fibre in diet
3. Exercise regularly
4. Reduce stress levels
85
Antidiarrhoeal drugs for bowel frequency
Loperamide, codeine, co-phenotrope
86
Smooth muscle relaxants for pain
Mebeverine, hydrochloride, dicycloverine, hydrochloride, peppermint oil
87
Infective Gastroenteritis
Infection of the stomach and GI tract due to bacterial or viral infection, causing vomiting and diarrhoea.
88
Risk factor for Infective Gastroenteritis
Young children and older Aldults
Travellers to developing countries
Homosexual men
89
Causes of Infective Gastroenteritis
- Viral causes common in children
- Bacterial causes common in adults
- Parasitic: protozoa esp giardia lambia, entamoeba histolytica, cryptosporidium
90
Mechanisms of Infective Gastroenteritis
- Mucosal adherence
- Mucosal invasion where bacteria penetrates lining
- Toxin Production: Enterotoxins and cytotoxins
91
Organisms that cause Infective Gastroenteritis
Bacillus cereus, Staph. aureus, C. perfringens, C. botulinum, C. diff, Norovirus, Salmonella spp., E.coli, Shigella Sonnei, Campylobacter, Cryptosporidium, V. Cholera, Rotavirus, ETEC
92
Risk factors for Infective Gastroenteritis
Poor personal hygiene, lack of sanitation, immunocompromised, achlorydia, uncooked food, insufficient reheating
93
Symptoms of Infective Gastroenteritis
Diarrhoea, Vomiting, Abdominal pain, fever, fatigue, headache, muscle pain
94
Differentials for Infective gastroenteritis
IBD, IBS, Coeliac Disease, Colorectal Cancer, UTI, Chest infections, Malaria
95
Investigations for Infective Gastroenteritis
Stool Culture
Urea and Electrolytes
Clostridium difficile toxin
Blood Culture
96
Treatment for Infective gastroenteritis
1. Oral Rehydration Solution
2. Antibiotics
3. Antiemetics and Antidiarrhoeals
97
Antiemetics
Drug to treat nausea and vomiting. Used to treat motion sickness and the side effects of opiods
98
Antiemetics
Prochlorperazine
99
Antidiarrhoeals
Codeine, Loperamide
100
Antibiotic for Shigella, Campylobacter and Salmonella
Ciprofloxacin????
101
Antibiotic for Cholera
Tetracycline
102
Complications of Infective Gastroenteritis
Dehydration, IBS, Haemolytic Uraemic Syndrome
103
Glasgow-Blatchford Score
Helps identify patients for whom outpatient care is suitable
104
Treating suspected variceal bleeding
Give a splachnic vasoconstrictor such as terlipressin or octreotide intravenously with abx such as quinolone, cephalosporin or piperacillin-tazobactam.
105
Acute Pancreatitis
Acute inflammation of the pancrease releasing exocrine enzymes that cause autodigestion of the organ.
106
Where is acute pancreatitis most common
Scandinavia and USA
107
Causes of pancreatitis
I GET SMASHED
| Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion Stings, Hyperlipidaemia, ERCP, Drugs
108
Symptoms of Acute pancreatitis
Epigastric pain, radiates to back,jaundice, shock, ileus, rigid abdomen, tenderness, Cullen's sign or Grey Turner's, tachycardia, fever,
109
Ileus
A painful obstruction of the ileum
110
Differentials for pancreatitis
`AAA
111
Investigations for pancreatitis
Bloods: Raised Serum amylase and urinary amylase, Serum Lipase, CRP
Chest Xray, Abdominal Ultrasound, Contrast-enhanced spiral CT, MRCP, ERCP
112
What criteria is used for pancreatitis within 48 hours?
Modified Glasgow criteria for pancreatitis caused by gallstones and alcohol.
113
What criteria is used to test for alcohol-induced pancreatitis after 48hrs.
Ranson's Criteria
114
Glasgow criteria Score for pancreatitis (PANCREAS)
A score > 3 =Acute Severe Pancreatitis. A score < 3 = Acute Mild Pancreatitis
```
PaO2 < 8kPa
Age > 55yo
Neutrophils
Calcium < 2mmol/l
Renal Function: Urea > 16mmol
Enzymes: AST/ALT > 200iu/L
Albumin <32g/l
Sugar: glucose >10mmol/L
```
115
APACHE II Score
Acute Physiologic Assessment and Chronic Health Evaluation. Used to predict ICU mortality
Sensitive even within first 24hrs of presentation
116
Management of patients with Acute Pancreatitis (VACCINES)
```
Vital Signs monitoring
Analgesia/ Abx
Catheter- Calcium gluconate
Cimetidine (H2 receptor)
IV access and fluids
NBM or Nutrition
Empty gastric contents
Surgery if required
```
117
Complications of Pancreatitis (PAIN)
Peripancreatic fluid collections
Abscesses
Infection
Necrosis
118
Chronic pancreatitis
Long-standing inflammation leading to irreversible damage
119
Who does chronic pancreatitis affect
Male:female 4:1
| Median age 51 y
120
Causes of chronic pancreatitis
- Obstruction of bicarbonate excretion leading to activation of pancreatic enzymes causing tissue necrosis and fibrosis
- Alcohol causes proteins to precipitate in the ductular structure leading to dilatation and fibrosis
- Tropical chronic pancreatitis
- Hereditary chronic pancreatitis
- Autoimmune chronic pancreatitis
- Cystic fibrosis
- Tumours
121
Symptoms of chronic pancreatitis
Upper abdominal pain, weight loss, Diarrhoea, anorexia, bloating, Steatorrhoea, jaundice
122
Differential for chronic pancreatitis
Pancreatic malignancy
123
Investigations for chronic pancreatitis
if known alcohol abuse: Serum amylase and lipase, faecal elastase, transabdo USS. contrast-enhanced spiral CT
124
Management of chronic pancreatitis
```
Alcohol abstinence
Low fat diet due to inability to digest
Give Creon
Give fat-soluble ADEK
Analgesia
Diabetes
Surgery for unremitting pain, narcotic abuse, or decreased weight
```
125
Complications of chronic pancreatitis
```
Pancreatic pseudocyst
Diabetes
Biliary obstruction
Local arterial aneurysm
Pancreatic carcinoma
Intra/retroperitoneal cyst rupture
```
126
Kwashiorkor
Type of malnutrition involving swelling. Adequate energy but insufficient protein intake. Oedema and hepatomegaly.
127
Marasmus
Type of malnutrition involving thinness and wasting. Inadequate energy and protein intake.
128
Iron deficiency
Leads to microcytic anaemia, due to poor diet or elevated needs
129
Iodine deficiency
Leads to goitre/hypothyroidism
130
Vitamin A deficiency
fat-soluble vitamin, xerophthalmia (dryness of the conjunctiva), cause of blindness
131
Zinc deficiency
leads to acrodermatitis or Gianotti-Crosti syndrome causing itchy red blisters
132
Vitamin C deficiency
leads to scurvy, anemia, spontaneous bleeding, pain in the limbs, anorexia, cachexia, gingivitis, halitosis
133
Vitamin D deficiency
leads to osteoporosis and osteomalacia, fat-soluble vitamin
134
Vitamin E deficiency
Leads to neurological deficit and haemolysis, fat soluble vitamin
135
Vitamin K deficiency
Leeds to bleeding disorders, fat-soluble vitamin
136
Vitamin B1/ Thiamine deficiency
causes Beri-beri, heart failure with oedema
137
Wet Beri-beri
Affects cardiovascular system, causing SOB, increased heart rate and swelling
138
Dry Beri-beri
Affects nervous system causing difficulty walking , numbness in hands and feet, confusion, pain and vomiting
139
Coeliac Disease
Inflammatory response in the small intestines caused by gluten preventing absorption . Gluten is found in wheat, barley and rye.
140
Signs and Symptoms of Coeliac Disease
Diarrhoea, abdominal pain, bloating and flatulence, constipation, fatigue, weight loss, dermatitis herpetiformis (itchy rash), ataxia
141
Diagnosing Coeliac Disease
Blood test, antibody testing followed by a biopsy
142
Gallstones
A crystalline mass formed by g the gallbladder made from bile pigments, cholesterol and calcium salts.
143
Cholelithiasis
The formation of gall stones
144
Who does gall stones affect
'Fair, fat, fertile, female and forty'
145
2 types of gallstones
Cholesterol gallstones: 80% cholesterol by weight, light yellow, dark green or brown
Pigment Stones: small and dark, made of bilirubin and calcium salts,Black pigment stones common in haemolytic conditions, brown pigment stones common in biliary infection
146
Risk factors for gallstones
Increasing age, femaile, family history, obesity, weight loss, diabetes, oral contraception, smoking, parity
147
Signs and Symptoms for cholecystitis and cholangitis
Epigadtric/ RUQ pain, Pain radiates to back , jaundice, reffered to right shoulder pain, nausea and vomiting, jaundice, feer due to peritonitis
148
Murphy's Sign
Patient supine, ask pt to breathe in, place fingers in RUQ, inflamed gallbladder impinges on fingers causing pain on patient - Positive Murphy's sign
149
Investigations for gallstones
```
Bloods: raised CRP
Liver Function Tests
Ultrasound
Abdominal X-ray
MRCP
ERCP
```
150
MRCP
Magnetic Resonance Cholangiopancreatography. An MRI that produces images of the hepatobiliary and pancreatic systems using radiowaves.
151
ERCP
Endoscopic Retrograde Cholanio-Pancreatography is a procedure that examines the pancreatic and bile ducts. Tube placed through mouth and through to bile ducts. Can cause stone extraction, stent insertion or biopsy.
152
Complications for Gallstones
Obstructive jaundice, cholangitis, gallstone ileus, pancreatitis, empyema, pancreatitis, Mirizzi's syndrome
153
Mirizzi's Syndrome
Common hepatic duct obstruction caused by extrinsic compression a stone in the cystic duct or infundibulum of gallbladder, presenting with jaundice.
154
Antibiotics for cholangitis
Cefuroxime and metronidazxole
155
Acute Hepatitis
Inflammation of the liver caused by infection, medications, toxins and autoimmune disorders.
156
Hepatitis A
- RNA Virus
- Most common acute viral hepatitis
- Faecal-oral spread or shellfish
- Humans are only reservoir
- Picornavirus
157
Hepatitis B
- DNA Virus
- Hepadnavirus
- Reverse transcriptase activity
- Transmission via infectious blood
158
Hepatitis C
- RNA Virus
- Flavivirus
- Transmission via infectious blood
159
Hepatitis D
- Incomplete RNA virus, requires HepB virus for activation
160
Hepatitis E
- RNA Virus
| - Spread via faecal-oral route
161
Non-viral Infections that cause Hepatitis
Toxoplasma Gondii
Leptospira icterohaemorrhagiae
Coxiella burnetii (Q fever)
162
Viral Infections that cause Hepatitis
Viral A, B (D), C, E
Epstein- Barr Virus
Cytomegalovirus
Yellow Fever Virus
163
Drugs that cause Hepatitis
Paracetamol
164
Poisons that cause Hepatitis
Amanita Phalloides (mushrooms)
Aflatoxin
Carbon Tetrachloride
165
Other causes of Hepatitis
Pregnancy, circulatory insufficiency, Wilson's Disease
166
Risk Factors for Hepatitis
IVDU, alcohol abuse, poor hygiene, contaminated water, travel, bleeding disorders, MSM, Pregnancy and breastfeeding, needlestick injury
167
Symptoms of Hepatitis
Flu-like symptoms: feer, malaise, anorexia, nausea, RUQ pain, arthralgia, jaundice, dark urine, pale stools, hepatosplenomegaly, adenopathy
168
Differentials for Hepatitis
Biliary colic, pancreatitis, cholecystitis
169
Investigations for Hepatitis A
- LFTs: increased AST/ALT, and bilirubin
- FBC: prolonged PT
- Antibodies
170
Hepatitis A treatment
- Mainly supportive
- Avoid alcohol
- Immunisation
171
Hepatitis B treatment
- Avoid sex, alcohol
| - Immunisation
172
Hepatitis C treatment
- Weekly Peginterferon injection
| - Daily ribavirin
173
Hepatitis D treatment
- Peginterferon alpha
| - Liver transplantation
174
Hepatitis E treatment
- People will usually get better without treatment
| - Acetaminophen/Paracetamol against vomiting should not be given
175
Antiviral drugs for Hepatitis
Ribavirin, Boceprevir, Tolaprevir, Entecavir, Tenofovir, Lamivudine, Adefovir, Telbivudine
176
Complications of Hepatitis
Chronic hepatitis, Cirrhosis, Chronic liver disease, hepatocellular carcinoma
177
Acute appendicitis
Sudden inflammation of the appendix and is a surgical emergency
178
Who does acute appendicitis affect
Mainly 10-20yo
179
Causes of Acute appendicitis
Lumen of appendix becomes obstructed with faecolith and gut organisms invade appendix wall. The appendix becomes filled with mucous and swells. Pressure increases in the lumen, vessels become occluded causing ischaemia. Bacteria can leak out forming pus.
180
Symptoms of Acute appendicitis
Abdominal pain, loss of appetite, Nausea and vomiting, swollen belly, fever,
181
Signs of Acute Appendicitis
General abdominal tenderness,
182
McBurney's Sign
Deep tenderness at McBurney's point signifies acute appendicitis, tachycardia, furred tongue, coughing hurts, shallow breaths
183
Mcburney's point
Fount one-third of the distance from the anterior superior iliac spine to the umbilicus
184
Aaron's sign
Referred pain felt in the epigastrium upon continuous firm pressure over McBurney's point.
185
Psoas sign/ Cope sign
Pain on extending hip if retrocaecal appendix
186
Rosving's sign
When palpation of the left lower quadrant increases the pain felt in the right lower quadrant
187
Alvarado score
Scoring system used to diagnose appendicitis.
- Abdo pain migrating to right iliac fossa
- Anorexia
- N or V
- Tenderness in right iliac fossa
- Rebound tenderness
- Fever of 37.3
- Leukocytosis > 10,000
- Neutrophilia > 70%
188
Investigations for appendicitis
- Bloods: Increased WCC, ESR, CRP
- USS
- CT
189
Treating appendicitis
Appendicectomy and antibiotics
190
Complications of appendicitis
Perforation, appendix abcess, appendix mass (when an inflamed appendix becomes covered with omentum)
191
Small and large bowel obstruction
A mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion.
192
Causes of a bowel obstruction
Adhesions, constipation, tumours, hernias, volvulus, diverticular stricture, foreign body, gallstone ileus, Crohn's stricture, instussusception, TB
193
Paralytic ileus
Obstruction of the intestine due to paralysis of the intestinal muscles
194
Causes of an ileus
abdo surgery, pancreatitis, spinal injury, hypokalaemia, hyponatraemia, uraemia
195
Ogilvie's Syndrome
aka Acute colonic pseudo-obstruction (ACPO) is a massive colonic distention in the absence of mechanical obstruction
196
Symptoms of a bowel obstruction
Nausea, vomiting, anorexia, colic, constipation, no flatus, abdominal distention
197
Signs of a bowel obstruction
Distention, tenderness, resonant to percussion, active tinkiling bowel sounds, absent sounds
198
Differentials for bowel obstruction
Gastroenteritis- diarrhoea, flatus
| Gut perforation
199
Investigations for bowel obstruction
Abdo x-ray, water-soluble (gastrografin) enema, CT, colonoscopy
200
Treatment for bowel obstruction
Small bowel obstruction can be treated with fluids, analgesia, correction of electrolyte imbalance
Large bowel obstruction or strangulation require stenting or surgery
Flexible sigmoidoscopy for sigmoid volvulus
201
Complications for bowel obstruction
Perforation and bowel ischameia can lead o peritonitis and septicaemia
Flu and electrolyte imbalance can lead to AKI
202
Hernias
The protrusion of a viscus through a defect of the wall of its containing cavity into an abnormal position
203
4 classifications of hernias
Irreducible, Incarceration, Obstructed, Strangulated
204
Irreducible hernia
part of a bowel that cannot be pushed back into the right place
205
Incarcerated hernia
Contents of hernia sac are stuck inside by adhesions
206
Obstructed hernia
when GI contents cannot pass though
207
Strangulate hernia
If ischaemia occurs and is a surgical emergency
208
Most common hernia
Inguinal hernia
209
Who is commonly affected by inguinal hernias
Mainly males
210
Who is commonly affected by femoral hernias
Female, pregnant, increasing age
211
Indirect inguinal hernias
Passes though the deep inguinal ring and through the superficial inguinal ring. Can strangulate
212
Direct inguinal hernias
hernia pushes directly forward through the posterior wall of the inguinal canal into a defect. Rarely strangulate.
213
Contents of inguinal canal
Round ligament, spermatic cord and ilioinguinal nerve
214
Borders of the inguinal canal
- Anterior wall: aponeurosis of the external oblique
- Posterior wall: transversalis fascia.
- Roof: transversalis fascia, internal oblique, and transversus abdominis.
- Floor: inguinal ligament
215
Borders of the femoral canal
- Anteriorly: inguinal ligament
- Medially: lacunar ligament.
- Laterally: femoral vein
- Posteriorly: Pectineus
216
Risk factors for hernias
- Increased intra-abdominal pressure
| - Weakness of the abdominal muscles: Chronic cough, Constipation, Heavy lifting, Advanced age, Obesity
217
Risk factors for hernias
Increased intra-abdominal pressure, Weakness of the abdominal muscles: Chronic cough, Constipation, Heavy lifting, Advanced age Obesity
218
Borders of the femoral triangle
- Superiorly: inguinal ligament
- Medially: adductor longus muscle
- Laterally: sartorious muscle
219
Symptoms of hernia
Pain particularly when coughing or stooping, change in bowel habit, constipation, burning sensation in the groin, scrotal swelling
220
Differentials for hernia
Inguinal hernia, femoral canal lipoma or lymph node, saphena varix, femoral artery aneurysm, athletic pubalgia, hydrocele, varicocoele, undescended testes
221
Saphena varix
Dilatation at the top of the long saphenous vein due to valvular incompetence. Saphena varix will disappear when lying flat, have palpable thrill when coughing, and varicose veins can be found elsewhere.
222
Athletic Pubalgia
Condition of the pubic joint affecting athletes following a small tear in rectus sheath through which impingement of abdominal wall musculature can occur
223
Investigations or hernia
Abdominal USS
224
Management of inguinal hernias
- Lichtenstein repair: mesh inserted to reinforce abdominal wall
- Laparoscopic repair for recurrences or bilateral hernias
225
Management of femoral hernias
- All femoral hernias should be repaired due to risk of strangulation.
- Herniotomy = ligation and excision of the sac
- Herniorrhapy = repair of hernia defecit
226
Charcot's Triad
Signs of cholangitis: RUQ pain, fever and jaundice
227
Renold's Triad
Signs suggesting the diagnosis obstructive ascending cholangitis: right upper quadrant pain, jaundice, and fever with shock (low blood pressure, tachycardia) and an altered mental status.
