DPD: Amir Sam Gastro Cases Flashcards Preview

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Flashcards in DPD: Amir Sam Gastro Cases Deck (46)
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1

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

Cancer (primary or secondary deposits)
Cirrhosis (early on)
Cardiac (congestive HF + constrictive pericarditis)
Infiltration (fatty, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases)

2

What are the 5 broad causes of liver disease?

Alcohol
AI
Drugs
Viral
Biliary disease

3

List 4 broad causes of splenomegaly

HTN (portal hypertension)
Haematological
Infection e.g. TB
Inflammation e.g. sarcoid

4

What 2 natures of pain occur in the abdomen?

Colicky: Obstruction
Constant: Inflammation

5

List 5 organs/ conditions causing epigastric pain

Stomach: Peptic ulcer, GORD
Pancreas: Acute pancreatitis
Heart: MI
Aorta: Ruptured AAA
Liver/ gall bladder: cholecystitis, hepatitis

6

What symptom characterises acute pancreatitis? What investigation would you perform? What would you expect to see?

Pain
Bloods- high amylase

7

List 4 characteristics of chronic pancreatitis. What would you expect to see in the bloods? What investigation is suggestive?

Pain
Weight loss
Loss of exocrine function
Loss of endocrine function
Normal amylase in blood
Stool sample: Low faecal elastase

8

List 5 organs/ conditions causing RUQ pain

Gall bladder: cholecystitis, cholangitis, gallstones
Liver: hepatitis, abscess
Lungs: basal pneumonia
Appendix: appendicitis
Kidney: Pyelonephritis

9

List 2 systems and causative conditions causing RIF pain

GI: Appendicitis, mesenteric adenitis, IBD, malignancy
O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy

10

List 2 organs/ conditions causing suprapubic pain

Cystitis
Urinary retention

11

List 2 systems and causative conditions causing LIF pain

GI: Diverticulitis, IBD, malignancy
O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy

12

List 4 causes of diffuse abdominal pain

Obstruction
Infection: Peritonitis, gastroenteritis
Inflammation: IBD
Ischaemia: mesenteric ischaemia

13

List 5 medical causes of diffuse abdominal pain

DKA
Addisons
Hypercalcaemia
Porphyria
Lead poisoning

14

What symptoms/ signs/ figures are consistent with spontaneous bacterial peritonitis?

Generalised abdominal pain
Ascites
WCC > 250 cell/mm3

15

What are the 5 causes of abdominal distension?

Fat
Flatus
Faeces
Fetus
Fluid

16

How do you assess for the presence of fluid in abdominal distension? Features of what else may be present?

Percuss for shifting dullness
Liver disease

17

What causes flatus? What is a risk factor for this? What symptoms may accompany flatus? How may you detect it?

Obstruction
Previous surgery (risk of adhesions)
N+V
Not opened bowel
Tinkling, high pitched BS on auscultation

18

What are the 2 types of fluid found in ascites? What causes the presence of each?

Transudate: Less protein. (Failures- liver, heart, kidney)
Exudate: More protein (Malignancy, infection, Budd-Chiari syndrome)

19

Name 2 causes of pre-hepatic jaundice

Haemolysis
Gilberts syndrome

20

Name a broad cause of hepatocellular jaundice. How is the conjugated BR excreted?

Hepatitis (Alcohol, AI, Viruses, Drugs)
Conjugated BR leaks out of hepatocytes + is excreted as dark urine

21

List 3 causes of post-hepatic jaundice. Describe the urine and stool.

Gallstones in CBD
Stricture
Ca of head of pancreas
Dark urine
Pale stool (low stercobilinogen)

22

Which cause of jaundice results in pale stool? How may you differentiate between the causes?

Obstructive/ post-hepatic
Pancreatic cancer= painless
Gallstones= painfull

23

What is trousseau's sign of malignancy?

Thrombophlebitis (inflammation of a vein due to a clot)

24

Which liver enzymes are most markedly raised in hepatic and obstructive jaundice?

Hepatic: AST + ALT
Obstructive: ALP + GGT

25

List 5 main causative organisms of infective colitis presenting with bloody diarrhoea. Think CHESS

Campylobacter
Haemorrhagic E.coli
Entamoeba histolytica
Salmonella
Shigella

26

Excluding infection what is the more likely cause of bloody diarrhoea in the young and old? In the young, what other features may suggest this?

Young: Inflammatory colitis (IBD)- episcleritis, erythema nodosum
Old: Ischaemic colitis, malignancy, diverticulitis

27

List 5 steps in management of an acute GI bleed

ABC
IV access
Fluids
G+S, X-match blood
OGD

28

What 2 drugs are important to administer in a variceal bleed?

Abx
Terlipressin (constricts splanchnic vessels)

29

What investigations are necessary in acute abdomen presentations?

FBC
U+Es
LFTs
CRP
Clotting
G+S, X match blood
Erect CXR
CT

30

Describe 6 management principles/ administrations in acute abdomen presentations

NBM
IV fluids
Analgesic
Anti-emetics
Antibiotics
Monitor vitals + UO