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Flashcards in Gastro Deck (259)
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1

A 35 year old woman complains of a cough for many months and is found to have TB. She is HIV positive and complains of painful swallowing. What is the likely cause? And why?

Oesophageal candidiasis
Immunocompromised patient
Causes odynophagia, dysphagia and substernal chest pain

2

What is a mallory Weiss tear? How do diagnose it?

Occur at gastro-oesophageal junction
Can be caused by repeated vomiting following alcohol consumption
Bleeding usually stops spontaneously within 2 days
Endoscopy needed for diagnosis

3

How does acute pancreatitis present?

Severe upper abdominal pain, can transmit to back and left shoulder blade
Eating or drinking might make it worse, particularly fatty foods
Nausea and vomiting
Diarrhoea
Fever

4

What is angiodysplasia?

Vascular lesion of GI tract, swollen fragile blood vessels which can result in blood loss from GI tract

5

What is an acute abdomen?

Condition of severe abdominal pain, usually requiring hospitalisation +/- emergency surgery
Caused by acute disease of or injury to the abdominal organs
History usually

6

What different pathological processes could be underlying an acute abdomen?

Inflammation
Infection
Distension
Perforation
Ischaemia
Neoplasm

7

What would be on your differential list for a patient with acute abdominal pain in the right hypochondrium?

Gall bladder: gallstones
Stomach: peptic ulcer, gastritis
Hepatic flexure colon: cancer
Lung: pneumonia

8

What would be on your differential list for a patient presenting with acute abdominal pain in their epigastric region?

Gall bladder: gallstones
Stomach: peptic ulcer, gastritis
Transverse colon: cancer
Pancreas: pancreatitis
Heart: MI

9

What would be on your differential list for a patient with acute abdominal pain in the left hypochondrium?

Spleen: rupture
Pancreas: pancreatitis
Stomach: peptic ulcer
Splenic flexure colon: cancer
Lung: pneumonia

10

What would be on your differential list for a patient with acute abdominal pain in the right lumbar region?

Ascending colon: cancer
Kidney: stone, hydronephrosis, UTI

11

What would be on your differential list for a patient with acute abdominal pain in the left lumbar region?

Descending colon: cancer
Kidney: stone, hydronephrosis, UTI

12

What would be on your differential list for a patient with acute abdominal pain in the umbilical region?

Small bowel: obstruction/ischaemia
Aorta: leaking AAA

13

What would be on your differential list for a patient with acute abdominal pain in the right iliac fossa?

Appendix: Appendicitis
Caecum: tumour, volvulus, closed loop obstruction
Terminal ileum: crohns, mekels
Ovaries/fallopian tube:ectopic, cyst, PID
Ureter: renal colic

14

What would be on your differential list for a patient with acute abdominal pain in the hypogastric region?

Uterus: fibroid, cancer
Bladder: UTI, stone
Sigmoid colon: diverticulitis

15

What would be on your differential list for a patient with acute abdominal pain in the left iliac fossa?

Sigmoid colon: diverticulitis, colitis, cancer
Ovaries/fallopian tube: ectopic, cyst, PID
Ureter: renal colic

16

What intestinal problems could cause an acute abdomen?

Acute appendicitis, mesenteric adenitis, Mekel’s diverticulitis, perforated peptic ulcer, gastroenteritis, diverticulitis, intestinal obstruction, strangulated hernia

17

What is mesenteric adenitis?

Abdominal lymphadenopathy which causes abdominal pain
Usually in children

18

What are potential hepatobiliary causes of an acute abdomen?

Biliary colic, cholecystitis, cholangitis, pancreatitis

19

What is cholecystitis?

Inflammation of gall bladder commonly due to blockage of the cystic duct with gallstones (Cholelithiasis) which causes a build up of bile and therefore increased pressure in the gallbladder

20

What is cholangitis?

Infection of the common bile duct commonly caused by infection secondary to a gallstone or tumour

21

What can be vascular causes for an acute abdomen?

Ruptured AAA, mesenteric ischaemia, ischaemic colitis

22

What are potential urological causes for an acute abdomen?

Renal colic, UTI, testicular torsion, urinary retention

23

What are potential gynaecological causes for an acute abdomen?

Ectopic pregnancy, ovarian cyst (rupture/haemorrhage/torsion), salpingitis, Mittelschmerz (ovulation pain)

24

What might be some medical causes for an acute abdomen?

Pneumonia, MI, DKA

25

What can cause right iliac fossa pain?

APPENDICITIS acronym
Appendix/ abscess
Pelvic inflammation
Period pain
Ectopic/ endometriosis
Neoplasm
Diverticulitis
Intussusseption (inversion of one portion of intestine within another)
Chrohn’s/ Cyst
IBD
Torsion
IBS
Stones

26

What can cause left iliac fossa pain?

SUPERCLOTS acronym
Sigmoid diverticular disease
Ureteric colic
Pelvic inflammation/ period pain
Ectopic/ endometriosis
Rectal abscess/haematoma
Colon cancer
Left lower pneumonia
Ovarian cyst
Torsion
Stones

27

What are important questions in a history for an acute abdomen?

Site and duration
Onset – sudden vs gradual
Character – colicky, sharp, dull, burning
Radiation – e.g. Into back or shoulder
Associated symptoms
Timing – constant, coming and going
Exacerbating and relieveing factors
Severity
Have you had a similar pain previously?
What do you think could be causing the pain?

28

What associated symptoms would you want to ask about in an acute abdomen history?

GI: bowels last opened, bowel habit (diarrhoea/constipation), PR bleeding/melaena, dyspeptic symptoms, vomiting
Urine: dysuria, heamaturia, urgency/frequency
Gynae: normal cycle, LMP, dysmenorrhoea/menorrhagia, discharge
Others: fever, appetite, weight loss, distention

29

What is Rovsing’s sign?

Sign of appendicitis: palpation of left lower quadrant of persons abdomen increases pain felt in the right lower quadrant

30

A 55 year old male undergoes an endoscopy after being referred by his GP with recurrent indigestion. Endoscopy reveals a small duodenal ulcer and H. pylori is demonstrated to be present. How would you treat this patient?

Omeprazole, metronidazole and clarithromycin: triple therapy for a week. Continue PPI after this