Abdominal pain + GIT bleeding Flashcards Preview

Core conditions Olivia MD > Abdominal pain + GIT bleeding > Flashcards

Flashcards in Abdominal pain + GIT bleeding Deck (46):
1

McBurnie's point?

1/3 of the way between the ASIS and the umbilicus

2

what does colicky pain mean?

waxes and wanes

3

how can the bowel be obstructed?

think intraluminal causes e.g. tumours, adhesions etc, mural causes and extraluminal causes e.g. compression

4

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

5

what does absent bowel sounds indicate?

bowel perforation or peritonitis

6

what does high pitched bowel sounds indicate?

obstruction

7

what are we watching for when we do a gastro examination?

guarding, rebound, tenderness

8

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

9

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

10

What are the associated features of gallstones?

Female, fertile (ask about pregnancy), forty (age) and family history

11

ligament of----- defines upper and lower GIT bleeding?

ligament of Treitz (upper = UGIT bleeding; lower than the ligament of treitz = LGIT bleeding)

12

risk factors for bowel infarction?

• Smoking, atherosclerosis
• Ventricular aneurysms
• AF
• Coagulopathies
• Cancer
Vasculitis

13

which vessel is most involved in bowel obstruction?

SMA

14

what are the watershed zones in the bowel?

splenic flexure and the rectum. and so are classic sites for bowel ischaemia

15

what are the classic causes of SBO?

adhesions, hernias, crohn's

16

what generally causes diverticula forming in the GIT?

chronic constipation and increased intraluminal pressure can lead to mucosal herniations of the GIT --> diverticula formation

17

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

18

what are some complications of diverticulosis?

-fistula, abscess formation
-Perforation and peritonitis
-scarring, strictures and bowel obstruction

19

what are some risk factors of diverticulitis?

Risk factors
• Low fibre diet
• Elderly
• Sedentary lifestyle
• Chronic constipation
and Obesity

20

when might you NOT get the classic story for diffuse epigastric pain --> localised McBurnie point pain for acute appendicitis?

when the appendix is retrocaecal.

21

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

22

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.

23

what are some causes of bowel ischaemia?

• Compressed veins due to adhesions (venous obstruction)
• Embolus
• Global hypoperfusion

24

what is something you need to determine if you suspect that bowel infarction has occurred?

whether the patient has AF.

25

what do you think when a patient has abdominal pain that is worse with coughing?

sign of peritonism

26

what symptoms do you get when you have pancreatic insufficiency?

malabsorption (exocrine deficiency) and diabetes

27

what ix do you want to send off for ix of pancreatic insufficiency?

faecal elastase

28

what is the ix for autoimmune pancreatitis?

iGG 4

29

other than pancreatitis, what other causes of elevated lipase?

gastritis
renal failure
pregnancy
renal colic

30

mortality of infected pancreatic necrosis?

more than 80% death rate

31

Complications of pancreatitis

pesudocyst, necrosis,, perforation

32

is biliary colic pain colicky?

no, constant! but episodic

33

what is the normal Gall bladder wall thickness?

less than 4 mm

34

complications of cholelithiasis?

• INFECTION
• EMPYEMA
• PANCREATITIS
MUCOCOELE

35

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)
Rebound tenderness


Generalised- this is really bad. Cough peritonitis, get them to lift their head off the bed.

36

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
U/s transvaginal

37

Define upper GIT bleeds

bleeding that arises proximal to the ligament of Trietz

38

where is the ligament of trietz

flexure of the duodenum-jejunum

39

define mallory weiss tears

partial thickness submucosal linear tears in the oesophagus

40

how do we surgically manage bleeding peptic ulcer

inject adrenaline around the ulcer and then use surgical clips

41

management of mallory weiss tears?

PPI but usually self limiting

42

what does a dieulafoy lesion refer to?

AV malformations

43

what are the top 3 causes of lower GIT bleeds in young adults?

1. Merkel's diverticulum
2. IBD
3. polyps

44

what are the top causes of LGIT bleeding in older adults?

Diverticular disease
IBD
Angiodysplasias
Neoplasms

45

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?

1. caecum
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.

46

What is the role of the iliocaecal valve?

to prevent reflux of the large bowel into the small bowel