Abdominal Conditions

Question 1

Name 3 upper abdominal inflammatory conditions.

Answer 1

Gall stone disease (cholecystitis, cholangitis). Pancreatitis. Peptic ulcer disease. Gastro-oesophageal reflux disease (GORD). Oesophagitis.

Question 2

Name 3 lower abdominal inflammatory conditions.

Answer 2

Appendicitis. Diverticular disease. Inflammatory bowel disease. Clostridioides (clostridium) difficile colitis. Radiation proctitis.

Question 3

What 5F’s summarise gall stone disease?

Answer 3

Fat. Fair. Female. Fertile. Forty.

Question 4

Name 3 complications of gall stone disease.

Answer 4

Biliary colic (sudden pain due to gallstone blocking cystic duct). Acute cholecystitis (infection). Obstructive jaundice. Ascending jaundice. Pancreatitis. Gallstone ileus.

Question 5

What are the 3 types of Acute cholecystitis.

Answer 5

Empyema (pus) of the gallbladder. Gangrene (loss of blood supply) of the gallbladder. Perforation (holes) of the gallbladder.

Question 6

When there is an interference of the blood supply for the gall bladder, it results in necrosis of the gall bladder known as…

Answer 6

Gangrene of the gallbladder.

Question 7

Why is there pain in gall stone disease?

Answer 7

Stone obstructs the cystic duct.

Question 8

What does the cystic duct do?

Answer 8

It transfers bile between the gallbladder and common and hepatic bile ducts.

Question 9

Why does pain subside when a patient with gallstone disease lies down?

Answer 9

Gallstone falls back down cystic duct.

Question 10

What’s the difference between cholangitis and cholecystitis?

Answer 10

Ascending cholangitis is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum . Cholecystitis is inflammation of the gallbladder.

Question 11

What is gallstone ileus?

Answer 11

When the gallstone enters the small bowel via the cholecysto-duodenal fistula - causes bowel obstruction.

Question 12

How do gall stones enter the small bowel?

Answer 12

Using the cholecysto-duodenal fistula.

Question 13

Give 2 treatments for gall stone disease.

Answer 13

Ultrasound scan. Magnetic resonance cholangiopancreatography (MRCP). ERCP - endoscope used to examine a patients pancreatic and bile ducts.

Question 14

What surgical procedure is used in gall bladder disease?

Answer 14

Laparascopic cholecystectomy (removal of gall bladder).

Question 15

Give 3 causes of acute pancreatitis.

Answer 15

Gallstones. Idiopathic. Ethanol. Trauma. Steroids. Mumps. Infection.

Question 16

Give 2 symptoms of acute pancreatitis.

Answer 16

Abdominal pain. Loss of appetite. Palpable, tender mass

Question 17

How is acute pancreatitis diagnosed?

Answer 17

CT scan - visualisation of inflammation, necrosis, abscess, pancreatic pseudocysts. Ultrasound - Gallstones. Lab results - elevated serum amylase, lipase, bilirubin

Question 18

Give 2 complications of acute pancreatitis.

Answer 18

Acute peripancreatic fluid collection. Pancreatic pseudocyst. Local complication of necrotizing pancreatitis. Severe manifestations e.g. Acute respiratory distress syndrome (ARDS).

Question 19

What is peptic ulcer disease?

Answer 19

It refers to both gastric and duodenal ulcers. ↑ acid secretion, ↓ protective mechanisms → mucosal damage → ulceration.

Question 20

Give 2 causal factors for peptic ulcer disease.

Answer 20

H. pylori infection (most common) -↑ gastric acid secretion, ↓ duodenal HCO3 secretion. NSAID - particularly low dose aspirin corticosteroids. Physiologic stress e.g. Cushing’s ulcer (intracranial hypertension), Curling ulcer (severe burns). Psychological stress. Hyperchlorydia. Smoking. Chronic obstructive pulmonary disease (COPD). Hypergastrinemia (Zollinger-Ellison syndrome).

Question 21

What bacteria is responsible for peptic ulcer disease?

Answer 21

Helicobacter pylori. Spiral ram-negative infection.

Question 22

What are proton-pump inhibitors?

Answer 22

Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production.

Question 23

Name 2 things used to treat peptic ulcers.

Answer 23

Surgery - for bleeding and complications. Proton-pump inhibitors e.g. metronidazole, meprazole, esomeprazole - reduce stomach acid production. Antibiotics e.g. clarithromycin, amoxicillin.

Question 24

Name 2 things used to diagnose peptic ulcers.

Answer 24

Abdominal CT scan. Barium abdominal radiography. Endoscopy.

Question 25

Give 2 complications of peptic ulcer disease.

Answer 25

Upper GI bleed. Repeated ulcers. Peptic ulcer perforation. Pyloric stenosis.

Question 26

What is gastro-oesophageal reflux disease (GORD)?

Answer 26

Prolonged content of gastric contents with lower oesophageal mucosa - stomach acid is able to pass back up oesophagus.

Question 27

Give 2 causes fo gastro-oesophageal reflux disease (GORD).

Answer 27

Smoking. Pregnancy. Large meals. Surgical treatment of achalasia (lower oesophageal sphincter fails to open during swallowing).

Question 28

Give 3 symptoms of gastro-oesophageal reflux disease (GORD).

Answer 28

Dyspepsia - burning feeling from stomach/lower chest. Acid brash - acid gets in your throat. Water brash - excessive salivation. Odynophagia - painful swallowing. Chest pain. Chronic cough.

Question 29

What happens in Barret's oesophagus?

Answer 29

Normal tissue lining the oesophagus -- the tube that carries food from the mouth to the stomach -- changes to tissue that resembles the lining of the intestine.

Question 30

Give 2 differential diagnoses of dyspepsia (indigestion).

Answer 30

Oesophagitis. Infection. Peptic ulcer. Gastrointestinal malignancy.

Question 31

What are 2 investigations for gastro-oesophageal reflux disease (GORD).

Answer 31

Full blood count - exclude anaemia. Endoscopy - assess for oesophagitis. Barium swallow.

Question 32

What is a barium swallow?

Answer 32

It's a test that may be used to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, bloodstained vomit, or unexplained weight loss. Barium sulfate is a metallic compound that shows up on X-rays and is used to help see abnormalities in the oesophagus and stomach.

Question 33

Name 2 ways that gastro-oesophageal reflux disease (GORD) can be managed.

Answer 33

Lifestyle - encourage weight loss. Drugs - antacids to relieve symptoms. Surgery e.g. nissen fundoplication (fundus of stomach wrapped around oesophagus to prevent reflux).

Question 34

Give 2 ways how appendicitis is prevented.

Answer 34

Central abdominal pain that migrates to right iliac fossa. Pain worse on movement, coughing. Nausea, vomiting and diarrhoea.

Question 35

Give 2 things you would find on examination for an appendicitis patient.

Answer 35

Guarding. Rebound tenderness (pain upon removal of pressure). Percussion tenderness.

Question 36

Give 2 causes of appendicitis.

Answer 36

Obstruction of lumen (e.g. foreign bodies, malignancy) blocks escape of mucosal secretions. Increased pressure causes engorgement (appendix swells with fluid) and inactivity.

Question 37

Give 3 ways to investigate appendicitis.

Answer 37

Urine dipstick. Pregnancy test. CT scan with contrast.

Question 38

How is appendicitis managed?

Answer 38

Laparoscopic appendicectomy - appendix removed through incision in the right lower abdominal wall.

Question 39

What is diverticular disease?

Answer 39

Sac-like protrusion of mucosa through the muscular colonic wall.

Question 40

Give 2 ways how diverticular disease.

Answer 40

Bloated. Constipation, diarrhoea. Tummy pain. Nausea.

Question 41

Give 2 complications of diverticular disease.

Answer 41

Development of a fistula (abnormal channel). Development of an abscess (pus caused by a bacterial infection). Intestinal obstruction (mechanical impairment causes blockage of bowel). Dysuria (pain on urination).

Question 42

How is diverticular disease treated?

Answer 42

Hartmann's procedure - surgical resection (cutting out) of rectosigmoid colon.

Question 43

What are the two types of inflammatory bowel disease?

Answer 43

Crohn's disease. Ulcerative colitis.

Question 44

What is the difference between Crohn's disease and Ulcerative colitis?

Answer 44

Crohn's disease - occurs anywhere between mouth and anus. Ulcerative colitis - limited to the inner lining of the colon.

Question 45

Give 2 ways of how ulcerative colitis is presented.

Answer 45

Diarrhoea. Blood in stools. Cramping. Weight loss.

Question 46

Give 2 ways of how Crohn's disease is presented.

Answer 46

Diarrhoea. Weight loss. Increase in the frequency and urgency. Cramping and abdominal pain. Malaise (feeding of discomfort).

Question 47

Name 2 ways of how inflammatory bowel disease is diagnosed.

Answer 47

Faecal calprotectin (protein biomarkers in faeces - determine inflammation). Stool culture. Bloods - FBC (anaemia) and C-reactive protein (rise).

Question 48

Name 2 ways inflammatory bowel disease is treated.

Answer 48

Immunosuppressants e.g. adalimumab, infliximab. Surgery.

Question 49

What surgery is carried out to treat inflammatory bowel disease?

Answer 49

Colectomy - surgical removal of part of the colon.

Question 50

Give 3 differentials of inflammatory bowel disease.

Answer 50

Diverticulitis (type of disease affecting the digestive tract). Irritable bowel syndrome. Laxative use. Colorectal carcinoma.

Question 51

What is Clostridiodes (Clostridium) difficile colitis?

Answer 51

Symptomatic infection due to spore forming bacteria.

Question 52

Name 3 symptoms associated with Clostridiodes (Clostridium) difficile colitis.

Answer 52

Diarrhoea. Fever. Loss of appetite. Feeling sick. Colonic perforation. Abdominal compartment syndrome - organ dysfunction by intrabdominal hypertension.

Question 53

What is procedure is used to treat Clostridiodes (Clostridium) difficile colitis?

Answer 53

Hartmann's procedure - total abdominal colectomy with end ileostomy.

Question 54

What is Radiation Proctitis?

Answer 54

Inflammation and damage to the lower parts of the colon after exposure to the x-rays.

Question 55

Name 2 acute symptoms of Radiation Proctitis.

Answer 55

Diarrhoea. Mucus discharge. Urgency.

Question 56

Name 2 chronic symptoms of Radiation Proctitis.

Answer 56

Bleeding more severe. Patients have obstructed defection - constipation, rectal bleeding, urgency, faecal incontinence.