Flashcards in Abdominal pain + GIT bleeding Deck (46):
1/3 of the way between the ASIS and the umbilicus
what does colicky pain mean?
waxes and wanes
how can the bowel be obstructed?
think intraluminal causes e.g. tumours, adhesions etc, mural causes and extraluminal causes e.g. compression
how can a patient's symptoms like vomiting indicate where the obstruction is?
Frequent vomiting and not a lot of pain can indicate foregut, more pain less vomiting = midgut, constipation and infrequent vomiting= hindgut
what does absent bowel sounds indicate?
bowel perforation or peritonitis
what does high pitched bowel sounds indicate?
what are we watching for when we do a gastro examination?
guarding, rebound, tenderness
Cholecystitis vs. biliary colic?
Biliary colic is when you have a gallstone lodged in the neck of the gallbladder or somewhere early on in the cystic duct. It is constant pain not colicky in nature. When you get inflammation of the gallbladder, you get cholecystitis. You get systemic features like fever as well. Cholecystitis may not always be due to a gallstone. RUQ pain in both
Choledocholithiasis vs ascending cholangitis?
choledocholithiasis is when you get a gallstone lodged in the bile duct/biliary system. You will also get obstructive jaundice along with the RUQ pain. Ascending cholangitis is the same thing with fever, hypotension and altered mental state--> REYNOLDS Pentad
What are the associated features of gallstones?
Female, fertile (ask about pregnancy), forty (age) and family history
ligament of----- defines upper and lower GIT bleeding?
ligament of Treitz (upper = UGIT bleeding; lower than the ligament of treitz = LGIT bleeding)
risk factors for bowel infarction?
• Smoking, atherosclerosis
• Ventricular aneurysms
which vessel is most involved in bowel obstruction?
what are the watershed zones in the bowel?
splenic flexure and the rectum. and so are classic sites for bowel ischaemia
what are the classic causes of SBO?
adhesions, hernias, crohn's
what generally causes diverticula forming in the GIT?
chronic constipation and increased intraluminal pressure can lead to mucosal herniations of the GIT --> diverticula formation
what is the difference between left and right sided diverticulitis?
Left sided diverticulitis affects the sigmoid colon and are often 'false diverticula'. Left sided diverticular disease is usually associated with Western countries and a sedentary lifestyle. Right sided diverticulitis affects the caecum and right side colon and is associated with Asian populations. Left is more common than right
what are some complications of diverticulosis?
-fistula, abscess formation
-Perforation and peritonitis
-scarring, strictures and bowel obstruction
what are some risk factors of diverticulitis?
• Low fibre diet
• Sedentary lifestyle
• Chronic constipation
when might you NOT get the classic story for diffuse epigastric pain --> localised McBurnie point pain for acute appendicitis?
when the appendix is retrocaecal.
what is a mallory weiss tear?
longitudinal tears (superficial oesophageal lacerations) down the length of the oesophagus, usually subsequent to severe vomiting following alcohol intoxication
what is the general history of presenting complaint do you have for a bowel infarction/ischaemia?
Severe acute abdominal pain, associated with nausea and vomiting, but non specific abdominal signs and examination.
what are some causes of bowel ischaemia?
• Compressed veins due to adhesions (venous obstruction)
• Global hypoperfusion
what is something you need to determine if you suspect that bowel infarction has occurred?
whether the patient has AF.
what do you think when a patient has abdominal pain that is worse with coughing?
sign of peritonism
what symptoms do you get when you have pancreatic insufficiency?
malabsorption (exocrine deficiency) and diabetes
what ix do you want to send off for ix of pancreatic insufficiency?
what is the ix for autoimmune pancreatitis?
other than pancreatitis, what other causes of elevated lipase?
mortality of infected pancreatic necrosis?
more than 80% death rate
Complications of pancreatitis
pesudocyst, necrosis,, perforation
is biliary colic pain colicky?
no, constant! but episodic
what is the normal Gall bladder wall thickness?
less than 4 mm
complications of cholelithiasis?
Distinguish local vs generalised peritonitis
Local- percussion tenderness
Guarding- voluntary or involuntary (use stethoscope to pretend to auscultate and apply a little bit of pressure)
Generalised- this is really bad. Cough peritonitis, get them to lift their head off the bed.
28 yr old F with supra pubic pain, voluntary guarding, no rebound tenderness, negative roving and mc burney tenderness. What ix do you order and why?
FBE, u and e
B-hcg looking for ectopic
Define upper GIT bleeds
bleeding that arises proximal to the ligament of Trietz
where is the ligament of trietz
flexure of the duodenum-jejunum
define mallory weiss tears
partial thickness submucosal linear tears in the oesophagus
how do we surgically manage bleeding peptic ulcer
inject adrenaline around the ulcer and then use surgical clips
management of mallory weiss tears?
PPI but usually self limiting
what does a dieulafoy lesion refer to?
what are the top 3 causes of lower GIT bleeds in young adults?
1. Merkel's diverticulum
what are the top causes of LGIT bleeding in older adults?
what are the 3 most common places in the gut for bowel ischaemic colitis?
and what are the most common causes of ischaemic colitis as these places? How do we manage them?
2. splenic flexure
3. sigmoid colon
Caecum- embolic cause
Splenic flexure- low blood flow through the area
Sigmoid colon- atherosclerosis/triple A repairs
We surgically manage those that have an embolic cause such as right sided ischaemic colitis. Low blood flow ischaemic colitis is conservatively managed.