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Abdominal pain Flashcards

1
Q

Causes of upper abdo pain?

A 
Gallstones
Kidney stones
Pyelonephritis
Shingles
Hepatitis
Hepatic abscess
Alcoholic liver disease
Hepatocellular carcinoma
Ulcer
Gastroenteritis
Indigestion
IBD
Pancreatitis
Aortic aneurysm
MI
Muscular or joint pain
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2
Q

What is cholangitis?

A

Infection of the biliary tree

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3
Q

Causes of cholangitis?

A

Stones
Biliary strictures
Infestation
Instrumentation

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4
Q

What is cholecystitis?

A

Inflammation of the gall bladder, caused by obstruction of the cystic duct

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5
Q

What are the types of gallstones?

A

Cholesterol stones
Black pigment stones
Brown stones

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6
Q

Risk factors for cholesterol stones?

A

Genetics
Diet - obesity, metabolic syndrome, sudden weight reduction
Age
Female sex hormones

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7
Q

What are black pigment stones? Risk factors?

A 
Polymerised calcium bilirubina
Age
Chronic haemolytic anaemia
Cirrhosis
Cystic fibrosis
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8
Q

What are brown pigment stones? Risk factors?

A

Unconjugated bilirubin and calcium salts of long-chain fatty acids
Bile duct strictures
Parasitic infestation

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9
Q

What are brown pigment stones? Risk factors?

A

Unconjugated bilirubin and calcium salts of long-chain fatty acids
Bile duct strictures
Parasitic infestation

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10
Q

Other symptoms of gallstone disease?

A 
Dyspepsia
Heartburn
Flactulence
Bloating
Nausea
Jaundice
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11
Q

Investigations for gallstone disease?

A 
FBC
LFTs
Lipase/amylase
Ultrasound
MRCP
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12
Q

Cholecystitis symptoms?

A 
Pain
Murphy's sign
Right shoulder pain
Anorexia
Nausea
Fever
Vomiting
Jaundice
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13
Q

What is Murphy’s sign?

A

Palpitation of right subcostal region = tender

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14
Q

What is charcot’s triad?

A

Jaundice + Fever + RUQ pain = ascending cholangitis

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15
Q

Other symptoms of cholangitis?

A

Clay stools
Pruritis
Hypotension
Confusion

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16
Q

What is primary biliary cholangitis?

A

Chronic disease of the small intrahepatic bile ducts causing progressive bile duct damage and eventually cirrhosis

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17
Q

What is cholangiocarcinoma?

A

Primary carcinoma arising from intrahepatic or extra hepatic biliary tree - 1.5% of all cancers

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18
Q

What is primary sclerosing cholangitis?

A

Chronic cholestatic disorder characterised by inflammation and fibrosis of the bile ducts, resulting in multifocal biliary strictures

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19
Q

Stage one of PSC?

A

Degeneration of epithelial lining

Inflammatory cell ductal and periportal infiltration

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20
Q

Stage two of PSC?

A

Fibrosis
Paucity of bile ductules
Periportal inflammatory cell infiltration
Piecemeal necrosis

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21
Q

Stage three of PSC?

A

Severe degenerative changes
Disappearance of bile ducts
Portal to portal fibrous septa

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22
Q

Stage four of PSC?

A

End-stage disease with secondary biliary cirrhosis

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23
Q

Difference between PBC and PSC?

A 
PBC 
- small interlobular ducts
- women more common
- autoimmune
PSC 
- all bile ducts
- men more common
- inflammatory
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24
Q

What is Caroli’s disease?

A

Rare congenital disorder of the intrahepatic bile ducts where the bile ducts become chronically dilated
Associated with autosomal recessive polycystic kidney disease

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25
Q

What is Mirizzi syndrome?

A

Impaction of large stone in neck of gallbladder/cystic duct causing external compression of common bile duct

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26
Q

Types of cholangiocarcinoma?

A

Adenocarcinoma 90%

Squamous cell 10%

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27
Q

Wat is a klatskin tumour?

A

Cholangiocarcinoma at the confluence of the right and left hepatic ducts - 50-60%

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28
Q

Associations of PSC?

A

PSC + IBD (especially UC) is associated with cholangiocarcinoma and colorectal cancer

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29
Q

What is pancreatitis?

A

A disorder of the exocrine pancreas, and is associated with acinar cell injury with local and systemic inflammatory responses

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30
Q

Causes of pancreatitis?

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidemia, hypercalcemia, hypothermia
ERCP + emboli
Drugs
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31
Q

Most common causes of pancreatitis?

A

Gallstones + ethanol

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32
Q

What is the Glasgow prognostic score?

A 
Severity of pancreatitis 
Age >55
WBC >15
Urea >16
Glucose >10
pO2 <8
Albumin <32
Calcium <2
LDH >600
ALT >200
3 or more = severe
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33
Q

Investigations for pancreatitis?

A 
Amylase >3x than normal
Lipase - better if not acute
LFT's
FBC
MRCP
CT
Ultrasound
34
Q

Complications of pancreatitis?

A

Pancreatitis necrosis
Pseudcysts
Cholecystitis
Pancreatic abscess

35
Q

Pancreatitis management?

A 
Pain relief
IV fluids
Nil by mouth
Ondansetron
Electrolyte replacement
Treat cause
36
Q

Chronic pancreatitis?

A

Chronic inflammation of the pancreas causing irreversible damage

37
Q

What is large duct chronic pancreatitis?

A

Dilation and dysfunction of ducts
Diffuse pancreatic calcification
Steatorrhoea

38
Q

What is small duct chronic pancreatitis?

A

Imaging normal

Respond to replacement of enzymes

39
Q

Symptoms of chronic pancreatitis?

A 
Abdominal pain
Nausea + vomiting
Decreased appetite
Exocrine dysfunction - malabsorption
Endocrine function - diabetes mellitus
40
Q

Right hypochondriac pain?

A

Pancreatitis
Ulcer
Gallstones
Biliary colic

41
Q

Epigastric pain?

A 
Heartburn
Pancreatitis
Epigastric hernia
Gallstones
Ulcer
42
Q

Left hypochondriac pain?

A

Pancreatitis

Ulcer

43
Q

Left lumbar pain?

A 
Kidney stones
UTI
Constipation
Inflammatory bowel disease
Diverticular disease
44
Q

Umbilical pain?

A 
Gastric ulcer
Appendicitis (early)
Aortic aneurysm
Ruptured AA
Pancreatitis
IBD
45
Q

Right lumbar pain?

A

Kidney stones
UTI
Constipation

46
Q

Right iliac pain?

A

Appendicitis
Ectopic pregnancy
Ovarian torsion
Inguinal/femoral hernia

47
Q

Hypogastric pain?

A

UTI
Appendicitis
IBD
Diverticular disease

48
Q

Left iliac pain?

A 
Diverticular disease
IBD
Ectopic pregnancy
Ovarian torsion
Inguinal/femoral hernia
49
Q

General abdominal pain in female middle age?

A

Ovarian cancer - check CA 125

50
Q

Other rare causes of abdominal pain?

A 
MI
Diabetic ketoacidosis
Lower lobe pneumonia
Sickle cell crisis
Hypercalcemia 
Hereditary angio-oedema
Ectopic pregnancy
51
Q

Constant sharp pain, worse on movement or coughing?

A

Peritonitis

52
Q

Shoulder tip pain?

A

Diaphragmatic irritation

53
Q

Causes of right lower quadrant pain?

A 
Appendicitis
Crohn's 
Diverticulitis
Meckel's diverticulum
Perforated peptic ulcer
Inguinal/femoral hernia
Malignancy
Mesenteric adenitis
UTI
Renal stones
Testicular/ovarian torsion
Ectopic pregnancy
54
Q

What is appendicitis?

A

Inflammation of the appendix caused by obstruction of the lumen

55
Q

Symptoms of appendicitis?

A 
Abdo pain - central to RLQ
Fever
Nausea, vomiting
Anorexia
Tachycardia
Constipation
Rovsing's sign
Psoas test
Obturator test
56
Q

What is rovsing’s sign?

A

Pressure on LLQ elicits pain in RLQ

57
Q

Psoas test?

A

Extension and abduction of hip eliciting pain

58
Q

Obturator test?

A

Flex and internally rotate elicits pain

59
Q

Complications of appendicitis?

A 
Abscess
Perforation
Septicemia
Peritonitis
Mass formation
60
Q

Treatment for appendicitis?

A 
Oxygen
Analgesia
IV fluids
Appendectomy
Antibiotics
61
Q

What is ileus?

A

Disruption of normal propulsive ability of the intestine due to the malfunction of peristalsis

62
Q

Symptoms of peritonitis?

A 
Abdominal pain
Tachycardia
Fever
Anorexia
Nausea
Vomiting
Rebound tenderness
Bleeding
63
Q

What are diverticulosis?

A

Mucosa and submucosal out-pouching through the muscular layer of the intestine

64
Q

Risk factors for development of diverticula?

A

Poor fibre intake
Low physical activity
Obesity
Excess alcohol consumption

65
Q

What is diverticular disease?

A

Symptomatic diverticula

66
Q

What is diverticulitis?

A

Inflammation of the diverticula

67
Q

Symptoms of diverticulitis?

A 
Abdominal pain
Fever
Blood PR
Change in bowel habit
Nausea + vomiting
Anorexia
68
Q

Treatment of diverticulitis?

A 
Analgesia
IV fluids
Bulk-forming laxatives
Antibiotics
High fibre diet
69
Q

Complications of diverticulitis?

A 
Perforation
Fistula
Abscess
Obstruction
Haemorrhage
70
Q

Common hernias?

A 
Inguinal
Femoral
Hiatus
Epigastric
Umbilical 
Incisional
71
Q

Rare hernias?

A 
Spigelian
Littre's
Lumbar/dorsal
Obturator canal
Perineal
Sciatic
Sportsman's
Traumatic
72
Q

What is a spigelian hernia?

A

Through lines semilunaris muscle
Localised pain worsened by straining or coughing
Bulge in lower abdomen

73
Q

What is a Littre’s hernia?

A

Hernia sac contains Meckel’s diverticulum

74
Q

What is sportsman’s hernia?

A

Debilitating
Chronic groin pain
Tear in external oblique resulting in occult hernia

75
Q

Indirect inguinal hernia?

A

Through inguinal canal - both deep and superficial ring

76
Q

Direct inguinal hernia?

A

Through Hesselbach triangle and out through superficial ring

77
Q

Hesselbach triangle?

A 
Inguinal ligament (inf)
Inferior epigastric artery (lat)
Rectus abdominis (med)
78
Q

Incarcerated hernia?

A

Contents of sac becomes fixed within sac

79
Q

Strangulated hernia?

A

Cut off blood supply to contents

80
Q

Obstructed hernia?

A

Closed loop results in non-functioning tissue

81
Q

Irreducible hernia?

A

Contents cannot be manipulate back into abdominal cavity

82
Q

Indicators of pancreatitis severity?

A 
PaO2< 7.9kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L

GI (9 decks)

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