Flashcards in Interactive cases - Abdo Deck (61)
What do you look for in the general inspection of an abdo exam?
- jaundice or pallor
- conjunctival pallor
what do you look for in the hands?
- Dupuytren's contracture
- Erythema (pallor): janeway lesions, osler's nodes
- Leukonychia: hypoalbuminaemia
what do you look for in the forearms?
- AV fistulae
- current/previous renal replacement therapy
what do you look for in the head and neck?
- skin markings (jaundice, excoriation marks, spider naevi)
- oral exam: pigmentation, gum hypertrophy (cyclosporine causes this after renal replacement)
what do you look for in the chest inspection?
- spider naevi
- hair loss
- pectus excavatum
- excoriation marks
what do you percuss for?
- shifting dullness, bladder
what are the causes of hepatomegaly?
- Cardiac (CCF, constrictive pericarditis)
- Infiltration (fatty, haemochromatosis, amyloidosis, sarcoidosis)
what are causes of liver disease?
- biliary disease
what are the causes of splenomegaly?
H, H , I, I
- portal Hypertension (chronic liver disease)
what are the symptoms of a perforated AAA?
- epigastric pain radiating to back
- reduced BP
- reflex tachy
what are the differentials for epigastric pain originating in the stomach?
- peptic ulcer (NSAID use?)
- gastritis (retrosternal pain, ETOH use)
what are the differentials for epigastric pain originating in the acute pancreatitis?
look for gallstone history and high amylase
- Acute: pain, high amylase (>1000)
- Chronic: pain, weight loss, loss of exocrine (diabetes), and endocrine (malabsorption) function, normal amylase, faecal elastase (low)
what is superior to epigastrium that can cause epigastric pain?
what is inferior to epigastrium that can cause epigastric pain?
what isright-lateral to epigastrium that can cause epigastric pain?
What are RUQ pain differentials?
- Gall bladder: cholecystitis, cholangitis, gallstones
- Liver: hepatitis, abscess
what is superior to RUQ that can cause RUQ pain?
what is inferior to RUQ that can cause RUQ pain?
appendicitis e.g. in pregnancy
what is left lateral to RUQ that can cause RUQ pain?
peptic ulcer, pancreatitis
`what is right lateral to RUQ that can cause RUQ pain?
what is RIF pain differentials?
- GI tract: appendicitis, mesenteric adenitis (esp in children following resp infection), colitis, malignancy
- Gynaecological: ovarian cyst rupture, twist, bleed, ectopic pregnancy
- Mittelschmerz: mid pain from follicle rupture
what are LIF pain differentials?
- GIT: diverticulitis, colitis, malignancy, sigmoid volvulus
- gynaecological: ovarian cyst rupture, twist, rupture, ectopic pregnancy, Mittelschmerz
What are the suprapubic pain differentials?
- urinary retention
- testicular torsion
what are diffuse pain differentials (surgical)?
- infection (peritonitis, gastroenteritis)
- inflammation (IBD)
- ischaemia (mesenteric ischaemia)
what are diffuse pain differentials (medical)?
- DKA (hypercalcaemia)
- Addison's (lead poisoning)
what test do you have to do in any case of acute abdomen?
always get HIGH AMYLASE
what is the definition of SBP?
ascites neutrophil >250 cells/mm3
what do you check for if there is fluid causing abdominal distension?
- check for shifting dullness
- check for features of liver disease which may be causing the ascites
what do you check for if there is flatus causing abdominal distension?
- nausea/ vomiting
- high pitched tinkling or absent bowel sounds
- previous surgeries (adhesions?)