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Abdominal pain Flashcards

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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
What is Mirizzi syndrome?
Impaction of large stone in neck of gallbladder/cystic duct causing external compression of common bile duct
26
Types of cholangiocarcinoma?
Adenocarcinoma 90% | Squamous cell 10%
27
Wat is a klatskin tumour?
Cholangiocarcinoma at the confluence of the right and left hepatic ducts - 50-60%
28
Associations of PSC?
PSC + IBD (especially UC) is associated with cholangiocarcinoma and colorectal cancer
29
What is pancreatitis?
A disorder of the exocrine pancreas, and is associated with acinar cell injury with local and systemic inflammatory responses
30
Causes of pancreatitis?
``` Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidemia, hypercalcemia, hypothermia ERCP + emboli Drugs ```
31
Most common causes of pancreatitis?
Gallstones + ethanol
32
What is the Glasgow prognostic score?
``` 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 ```
33
Investigations for pancreatitis?
``` Amylase >3x than normal Lipase - better if not acute LFT's FBC MRCP CT Ultrasound ```
34
Complications of pancreatitis?
Pancreatitis necrosis Pseudcysts Cholecystitis Pancreatic abscess
35
Pancreatitis management?
``` Pain relief IV fluids Nil by mouth Ondansetron Electrolyte replacement Treat cause ```
36
Chronic pancreatitis?
Chronic inflammation of the pancreas causing irreversible damage
37
What is large duct chronic pancreatitis?
Dilation and dysfunction of ducts Diffuse pancreatic calcification Steatorrhoea
38
What is small duct chronic pancreatitis?
Imaging normal | Respond to replacement of enzymes
39
Symptoms of chronic pancreatitis?
``` Abdominal pain Nausea + vomiting Decreased appetite Exocrine dysfunction - malabsorption Endocrine function - diabetes mellitus ```
40
Right hypochondriac pain?
Pancreatitis Ulcer Gallstones Biliary colic
41
Epigastric pain?
``` Heartburn Pancreatitis Epigastric hernia Gallstones Ulcer ```
42
Left hypochondriac pain?
Pancreatitis | Ulcer
43
Left lumbar pain?
``` Kidney stones UTI Constipation Inflammatory bowel disease Diverticular disease ```
44
Umbilical pain?
``` Gastric ulcer Appendicitis (early) Aortic aneurysm Ruptured AA Pancreatitis IBD ```
45
Right lumbar pain?
Kidney stones UTI Constipation
46
Right iliac pain?
Appendicitis Ectopic pregnancy Ovarian torsion Inguinal/femoral hernia
47
Hypogastric pain?
UTI Appendicitis IBD Diverticular disease
48
Left iliac pain?
``` Diverticular disease IBD Ectopic pregnancy Ovarian torsion Inguinal/femoral hernia ```
49
General abdominal pain in female middle age?
Ovarian cancer - check CA 125
50
Other rare causes of abdominal pain?
``` MI Diabetic ketoacidosis Lower lobe pneumonia Sickle cell crisis Hypercalcemia Hereditary angio-oedema Ectopic pregnancy ```
51
Constant sharp pain, worse on movement or coughing?
Peritonitis
52
Shoulder tip pain?
Diaphragmatic irritation
53
Causes of right lower quadrant pain?
``` 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
What is appendicitis?
Inflammation of the appendix caused by obstruction of the lumen
55
Symptoms of appendicitis?
``` Abdo pain - central to RLQ Fever Nausea, vomiting Anorexia Tachycardia Constipation Rovsing's sign Psoas test Obturator test ```
56
What is rovsing's sign?
Pressure on LLQ elicits pain in RLQ
57
Psoas test?
Extension and abduction of hip eliciting pain
58
Obturator test?
Flex and internally rotate elicits pain
59
Complications of appendicitis?
``` Abscess Perforation Septicemia Peritonitis Mass formation ```
60
Treatment for appendicitis?
``` Oxygen Analgesia IV fluids Appendectomy Antibiotics ```
61
What is ileus?
Disruption of normal propulsive ability of the intestine due to the malfunction of peristalsis
62
Symptoms of peritonitis?
``` Abdominal pain Tachycardia Fever Anorexia Nausea Vomiting Rebound tenderness Bleeding ```
63
What are diverticulosis?
Mucosa and submucosal out-pouching through the muscular layer of the intestine
64
Risk factors for development of diverticula?
Poor fibre intake Low physical activity Obesity Excess alcohol consumption
65
What is diverticular disease?
Symptomatic diverticula
66
What is diverticulitis?
Inflammation of the diverticula
67
Symptoms of diverticulitis?
``` Abdominal pain Fever Blood PR Change in bowel habit Nausea + vomiting Anorexia ```
68
Treatment of diverticulitis?
``` Analgesia IV fluids Bulk-forming laxatives Antibiotics High fibre diet ```
69
Complications of diverticulitis?
``` Perforation Fistula Abscess Obstruction Haemorrhage ```
70
Common hernias?
``` Inguinal Femoral Hiatus Epigastric Umbilical Incisional ```
71
Rare hernias?
``` Spigelian Littre's Lumbar/dorsal Obturator canal Perineal Sciatic Sportsman's Traumatic ```
72
What is a spigelian hernia?
Through lines semilunaris muscle Localised pain worsened by straining or coughing Bulge in lower abdomen
73
What is a Littre's hernia?
Hernia sac contains Meckel's diverticulum
74
What is sportsman's hernia?
Debilitating Chronic groin pain Tear in external oblique resulting in occult hernia
75
Indirect inguinal hernia?
Through inguinal canal - both deep and superficial ring
76
Direct inguinal hernia?
Through Hesselbach triangle and out through superficial ring
77
Hesselbach triangle?
``` Inguinal ligament (inf) Inferior epigastric artery (lat) Rectus abdominis (med) ```
78
Incarcerated hernia?
Contents of sac becomes fixed within sac
79
Strangulated hernia?
Cut off blood supply to contents
80
Obstructed hernia?
Closed loop results in non-functioning tissue
81
Irreducible hernia?
Contents cannot be manipulate back into abdominal cavity
82
Indicators of pancreatitis severity?
``` 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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