interactive cases iii Flashcards
(50 cards)
1
Q
What signs do you look for in the hands for an abdo exam?
A
A sterixis (liver flap) B ruising C lubbing D upuytren's contracture E rythema (palmar) ... L euconychia
2
Q
What is caput medusae indicative of?
A
Portal hypertension
3
Q
Possible ddx of hepatomegaly
A
C ancer - primary/secondary C irrhosis - early on, usually alcoholic C ardiac - congestive heart failure - constrictive pericarditis Infiltration - fatty, haemochromatsis, amylodosis, sarcoidosis, hypoproliferative diseases
4
Q
Main causes of liver disease
A
Alcohol Autoimmune Drugs Viral Biliary disease
5
Q
Possible ddx of splenomegaly
A
H - portae hypertension
H - haematological
I - infection
I - inflammation
6
Q
What do you need to distinguish regarding abdo pain?
A
Nature - constant (inflammation) or colicky (obstruction) Location - 9 regions - general pain - medical cause?
7
Q
Possible ddx of epigastric pain
A
Stomach - peptic ulcer (NSAID use) - GORD (better with antiacids) - gastritis (retrosternal, ETOH) - malignancy Pancreas - acute pancreatitis (gallstones, high amylase) Heart (above) - MI Aorta (below) - ruptured aortic anuerysm Liver/gallbladder (right) - cholecystitis - hepatitis
8
Q
Differentiate between acute and chronic pancreatitis
A
Acute - high amylase - pain Chronic - pain w/ wt loss - normal amylase - loss of endocrine and exocrine function (malabsorption hence wt loss) - faecal elastase decreased
9
Q
Possible ddx of RUQ pain
A
Gallbladder - cholecystitis - cholangitis - gallstones Liver - hepatitis - abscess Lungs (above) - basal pneumonia Appendix (below) - appendicitis Stomach, pancreas (left) - peptic ulcer, pancreatitis Kidney (right) - pyelonephritis
10
Q
Possible ddx of RIF pain
A
GI - appendicitis - mesenteric adenitis - colitis (IBD) - malignancy Gynaecological - ovarian cyst rupture/twist/bleed - ectopic pregnancy
11
Q
Possible ddx of suprapubic pain
A
Cystitis
Urinary retention
12
Q
Possible ddx of LIF Pain
A
GI - diverticulitis - colitis (IBD) - malignancy Gynaecological - ovarian cyst rupture/twist/bleed - ectopic pregnancy
13
Q
Possible ddx of diffuse/generalised pain
A
Obstruction Infection (peritonitis, gastroenteritis) Inflammation (IBD) Ischaemia (mesenteric ischaemia) Medical causes
14
Q
What are medical causes of abdo pain?
A
DKA Addison's Hypercalcaemia Porphyria Lead poisoning
15
Q
Name the arteries of the GI blood supply
A
Coeliac
Superior mesenteric artery
Inferior mesenteric artery
Iliac
16
Q
What does the coeliac artery supply?
A
Stomach, spleen, liver, gallbladder, duodenum
17
Q
What does the SMA supply?
A
Small intestine, right colon
18
Q
What does the IMA supply?
A
Left colon
19
Q
What does the iliac artery supply?
A
Rectum
20
Q
What reading would you expect from amylase when pt has abdo pain?
A
High amylase
21
Q
What does an ascites neutrophil count greater/equal to 250 cells/mm3 indicate?
A
Evidence of spontaenous bacterial peritonitis
22
Q
What causes abdo distention?
A
Fluid (ascites) Flatus (obstruction) Fat Faeces Foetus Foreign body (mass)
23
Q
Features of ascites
A
Shifting dullness
Signs of liver disease
24
Q
Features of obstruction
A
Nausea + vomiting Not opened bowels High pitched, tinkling bowel sounds ?previous surgeries (adhesions) ?tender, irreducible femoral hernia in groin
25
Possible causes of transudate ascites
(transudate = albumin levels not high)
Cirrhosis
Cardiac failure
Nephrotic syndrome
26
Possible causes of exudate ascites
```
(exudate = albumin levels high)
Malignancy
- abdo, pelvic, peritoneal mesothelioma
Infection
- TB, pyogenic
Budd-Chiari syndrome (hepatic vein thrombosis)
Portal vein thrombosis
```
27
What causes pale stool?
Low stercobilinogen
28
Pre-hepatic causes of jaundice
Haemolysis
Defective conjugation
Gilbert's syndrome (decreased glucuonidation)
=> unconjugated bilirubin present
29
Hepatic causes of jaundice
Hepatitis
- alcohol, autoimmune, drugs, viral
=> conjugated bilirubin present
30
Post-hepatic causes of jaundice
CBD obstruction
- gallstones in CBD
- stricture
- Ca of head of pancreas
=> conjugated bilirubin present
31
Which types of jaundice may also have dark urine and/or pale stool?
Hepatic => dark urine
| Post-hepatic => dark urine and pale stool
32
Which proteins are high in pancreatic cancer?
ALP and alpha-fetoprotein
33
Possible ddx of bloody diarrhoea
Infective colitis
Inflammatory colitis (young, extra-GI manifestations)
Ischaemic colitis (elderly, high lactate)
Diverticulitis, malignancy
34
Which bacteria commonly cause infective colitis?
```
C ampylobacter
H aemorrhagic E Coli
E ntamoeba histolytica
S almonella
S higella
```
35
What would you see in an abdo X-ray for the following conditions:
a) inflammation,
b) toxic megacolon,
c) overflow, spurios diarrhoea?
a) thickening of bowel wall, thumb print
b) dilated loops of large bowel
c) faecal loading
36
How would you manage an acute GI bleed?
```
ABCDE
IV access
Fluids
G&S, X-match blood
OGD
```
37
Which drugs are used to treat variceal bleeds?
Antibiotics (evidence of reduced mortality)
| Terlipressin (splanchnic vasoconstrictor)
38
Which ix would you take for an acute abdo presentation?
Bloods: FBC, U&E, LFTs, CRP, clotting, G&S, X-match
Erect CXR
CT
39
What mx would you do for an acute abdo presentation?
```
NBM
Fluids
Analgesic
Anti-emetics
Antibiotics
Monitor fluids and urine output
```
40
What specific ix would you do for the following PCs:
a) jaundice
b) dysphagia, wt loss
c) PR bleed, wt loss?
a) Bloods (FBC, LFTs, CRP) and abdo USS (after fast as gallstones better visualised)
b) OGD + biopsy
c) Colonoscopy
41
How is ascites managed?
Diuretics (spironolactone and/or furosemide)
Dietary Na+ restriction
Fluid restriction in pt w/hyponatraemia
Monitor wt daily
Therapeutic paracentesis (with IV human albumin)
42
What is SAAG?
Serum albumin ascites gradient:
| serum albumin - ascites albumin
43
What are ddx when SAAG > 11g/L?
Cirrhosis
Cardiac failure
Budd-Chiari syndrome
44
What are ddx when SAAG < 11g/L?
TB
Cancer
Nephrotic syndrome
45
What causes SAAG to increase?
Portal hypertension -> increase in hydrostatic pressure -> more fluid leaves circulatory system -> enter peritoneal space causing ascites -> albumin too large molecule to pass membrane -> serum albumin concentrated
tl;dr more water in peritoneal space, more albumin in vasculature
46
How do you manage encephalopathy?
```
Lactulose
Phosphate enemas
Avoid sedation
Treat infections
Exclude GI bleeds
```
47
What are complications of post-op care?
```
Wound infection
- erythematous
- discharge
Anastomotic leak
- diffuse abdo tenderness
- guarding, rigidity
- hypotensive/tachycardic
Pelvic abcess
- pain, fever, sweats, mucus diarrhoea
```
48
Compare two perianal diseases pc and mx
```
Perianal abcess
- tender, red swelling
- incision + drainage
Anal fissure
- rectal pain (defecation)
- stool coated w/blood
- GTN cream
- advice re diet (fluids, fibre)
```
49
What is a typical hx of IBS?
```
Recurrent abdo pain, bloating
Improves w/defecation
Change in freq./form of stool
No PR bleed, anaemia, wt loss or nocturnal sx
Exclude coeliac
```
50
How is IBS managed?
```
Diet + lifestyle modification
Symptomatic rx
- abdo pain: anti-spasmodics
- laxatives for constipation
- anti-diarrhoeals
```
