DPD 3 - Abdo pain Flashcards Preview

Amir Sam DPD 2018 > DPD 3 - Abdo pain > Flashcards

Flashcards in DPD 3 - Abdo pain Deck (70)
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1

What are the signs of chronic liver disease seen in the hands? (A - J)

Asterixis (liver flap) - hepatic encephalopathy
Bruising
Clubbing
Dupuytren's contracture
Erythema (Palmar) - redness
Fetor
Gynaecomastia
Hair loss
Jaundice
Leuconychia - hypoalbuminaemia (decreased liver function)

2

What are the signs suggestive of abdominal disease seen on the arms, hands + neck?

AV fistulae - current or previous renal replacement therapy
Anaemia
Jaundice
Skin: excoriation marks or spider naevi
Oral examination: pigmentation, gum hypertrophy (on ciclosporine after renal transplant)
Lymphadenopathy

3

What are the signs suggestive of abdominal disease seen on the chest?

Gynaecomastia = benign proliferation of glandular tissue in a man
Hair loss
Excoriation marks
Spider naevi

4

What are the signs suggestive of abdominal disease seen on the abdomen?

Abdominal distension
Caput medusae = distended superficial abdominal veins; direction of flow in the veins below the umbilicus is towards the legs

5

Which surgical scar suggests biliary surgery?

Right subcostal (Kocher's incision)

6

Which surgical scar suggests liver transplant surgery?

Mercedes-Benz incision

7

Which surgical scar suggests a GI or major abdominal surgery?

Midline laparotomy incision

8

Which surgical scar suggests an appendicectomy?

McBurney's (Gridiron) incision
Lanz for cosmetic purposes (along the bikini line)

9

Which surgical scar suggests a renal transplant surgery?

J-shaped/'hockey stick' incision

10

Which surgical scar suggests a gynaecological surgery?

Pfannenstiel incision/low transverse

11

Which surgical scar suggests a hernia repair/vascular access surgery?

Inguinal incision

12

Which surgical scar suggests a nephrectomy?

Loin incision

13

What are the causes of hepatomegaly? (3 C's + infiltration)

1. Cancer - primary or secondary deposits
2. Cirrhosis (early, usually alcoholic - in late cirrhosis, the liver shrivels so actually becomes smaller)
3. Cardiac - CCF, constrictive pericarditis
4. Infiltration of the liver - infection, inflammation, malignancy e.g. fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis

14

What are the causes of splenomegaly? (2 H's, 2 I's)

1. Portal Hypertension - signs of chronic liver disease
2. Haematological - lymphoma, haemolytic anaemia, leukaemia
3. Infection - TB, infectious mononucleosis, malaria, schistomiasis
4. Inflammation - sarcoidosis

15

A 75 y/o man presents w/ epigastric pain + back pain. HR: 130 bpm. BP: 80/50 mmHg. What is the most likely diagnosis?
1. Peptic ulcer
2. Pancreatitis
3. Gastritis
4. GORD
5. Ruptured aortic aneurysm

Ruptured aortic aneurysm due to the hypotension + back pain

16

What are the 2 types of abdominal pain?

Constant = inflammation
Colicky = obstruction

17

What are the DDx for diffuse abdominal pain? (x 5)

1. Obstruction - pt may present w/ N+V and tinkling bowel sounds due to faecal impaction
2. Infection: peritonitis, gastroenteritis
3. Inflammation: IBD
4. Ischaemia: mesenteric ischaemia (post-prandial pain)
5. Medical: DKA (check glucose, bicarb, VBG - Tx: fluids, insulin, potassium); Addison's (fall in cortisol); Hypercalcaemia; porphyria (acute abdo pain + muscle weakness); lead poisoning

18

What are the DDx for epigastric pain? (x 5 broad categories)

1. Stomach: peptic ulcer (NSAID overuse --> inhibits COX1 --> decreases gastrin --> decreases GI barrier properties); GORD; Gastritis; malignancy
2. Pancreas: acute/chronic pancreatitis
3. Heart: MI
4. Aorta: ruptured aortic aneurysm
5. Liver/gallbladder: cholecystitis, hepatitis

19

What is the definitive Ix for acute and chronic pancreatitis?

Acute: serum amylase will be increased
Chronic: faecal elastase will be decreased; serum amylase may be normal

20

What is the presentation of acute pancreatitis?

Pain, increased serum amylase + alcohol Hx

21

What is the presentation of chronic pancreatitis?

Pain, weight loss
Loss of exocrine function - steatorrhoea (pale stool that is difficult to flush)
Loss of endocrine function - diabetes
Normal amylase
Decreased feacal elastase - stool sample for Ix

22

What are the DDx for RUQ pain? (x 6 broad categories)

1. Gallbladder: cholecystitis, cholangitis (infection of bile duct - jaundice, fever, rigor), gallstones
2. Liver: Hepatitis, abscess
3. Lungs: basal pneumonia
4. Appendix: appendicitis (esp. in pregnant women), retrocaecal appendix (going up and backwards + is inflamed)
5. Stomach, pancreas: peptic/duodenal ulcer, pancreatitis
6. Kidney: pyelonephritis (pain when tapping on renal angle)

23

What are the DDx for RIF pain? (x 2 broad categories)

1. GI: appendicitis, mesenteric adenitis, colitis (IBD), IBS, malignancy
2. Gynaecological: ovarian cyst rupture, twist, bleed; salpingitis (= inflammation of Fallopian tubes); ectopic pregnancy

24

What are the DDx for suprapubic pain? (x 3)

1. Cystitis
2. Urinary retention
3. UTI

25

What are the DDx for LIF pain? (x 2 broad categories)

1. GI: Diverticulitis (note how this is only more likely on LHS not RHS); colitis (IBD, ischaemic colitis); malignancy; faecal impaction
2. Gynaecological: ovarian cyst rupture, twist, bleed; ectopic pregnancy

26

Blockage of which artery causes ischaemia in the stomach/spleen/liver/gallbladder/duodenum?

Coeliac artery

27

Blockage of which artery causes bowel ischaemia in the small intestine + right colon?

Superior mesenteric artery

28

A pt comes in w/ severe abdominal pain + signs of shock. Abdo exam is normal. What is the most likely Dx? (dNTK)

Acute mesenteric ischaemia: this is classic triad of severe abdo pain, normal abdo exam + shock. Caused by obstruction of superior mesenteric artery

29

A pt comes in w/ poorly localised, colicky, post-prandial abdo pain; PR bleeding + weight loss. On abdo X-ray, a gassless abdomen is seen w/ thickening of bowel wall. What is the most likely diagnosis? (dNTK)

Chronic mesenteric ischaemia
Causes: low flow state e.g. HF, atherosclerotic disease. Obstruction of superior mesenteric artery

30

A 65 y/o man w/ an AAA repair 2 days ago presents w/ diffuse abdominal pain. HR: 120 bpm and RR: 30. What are his blood tests likely to show?
1. Normal lactate
2. High amylase
3. High bicarbonate
4. High sodium
5. High calcium

High amylase - this is a feature of ANY cause of acute abdo pain (not just pancreatitis)
Lactate will likely be high due to acidosis (high lactate indicates poor perfusion + ischaemia)
Bicarbonate likely to be low due to acidosis
Sodium won't usually be high, only observed in DI