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Amir Sam Lectures > Lecture 2 - Abdo > Flashcards

Lecture 2 - Abdo Flashcards

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1
Q

What does it mean when a patient has a Right subcostal scar?

A

Possible history of biliary surgery.

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2
Q

What does it mean when a patient has a Mercedes-Benz Scar?

A

Possible history of Liver Transplant.

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3
Q

What does it mean when a patient has a midline laparotomy incision?

A

Possible history of GI/Any major Abdo surgery.

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4
Q

What does it mean when a patient has a McBurney’s Scar?

A

Possible history of appendicectomy.

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5
Q

What does it mean when a patient has a J shaped/hockey stick incision?

A

Possible history of Renal Transplant.

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6
Q

What does it mean when a patient has a ‘Low Transverse’ Scar?

A

Possible history of gynaecological surgery.

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7
Q

What does it mean when a patient has an Inguinal Scar?

A

Possible history of hernia repair/vascular access.

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8
Q

What does it mean when a patient has a Loin scar?

A

Possible history of nephrectomy.

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9
Q

What are the main causes of Hepatomegaly?

A

Cancer (Primary or Secondary)

Cirrhosis (early, usually alcoholic)

Cardiac:

  • Congestive Heart failure
  • Constrictive Pericarditis

Could also be Infiltrative, due to: fatty infiltration, haemochromatosis, amyloidosos, sarcoidosis or lymphoproliferative disease.

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10
Q

What are the main causes of Liver Disease and abnormal LFTs?

A

Alcohol

Autoimmue

Drugs

Viruses

Biliary

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11
Q

What are the causes of Splenomegaly?

A

Portal Hypertension

Haematological

Infection

Inflammation

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12
Q

What would be the most likely diagnosis if a 75yo M presents with:

Epigastric pain that radiates to the back

Tachycardia

Hypotension

?

A

Ruptured Aortic Aneurysm

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13
Q

How can Abdominal pain be classified?

A

Nature:

  • Constant (Inflammation)
  • Colicky (Obstruction)

Location

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14
Q

Name a medical cause of acute abdominal pain.

A

Addisonian Crisis

DKA

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15
Q

What would be your Ddx if a patient presents with epigastric pain?

A

Stomach:

  • Peptic Ulcer (?NSAIDs)
  • Gord (Response to antacids)
  • Gastritis (retrosternal, ?ETOH use)
  • Malignancy

Pancreas

-Acute Pancreatitis (?Gallstones, high amylase)

Hepatobilliary

  • Cholecystitis
  • Hepatitis

Other

  • AAA
  • MI
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16
Q

How does Acute Pancreatitis present?

A

Epigastric pain

High Amylase

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17
Q

How does Chronic Pancreatitis present?

A

Pain

Weight Loss

Loss of exocrine (malabsorption) & endocrine function (diabetes)

Normal Amylase, High Faecal Elastase

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18
Q

What would your Ddx be if a patient presents with RUQ pain?

A

Gall Bladder:

  • Cholecystitis
  • Cholangitis
  • Gallstones

Liver:

  • Hepatitis
  • Abscess

Other:

  • Basal Pneumonia
  • Appendicitis
  • Peptic Ulcer
  • Pancreatitis
  • Pyelonephritis
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19
Q

What would be your Ddx if a patient presented with RIF pain?

A

GI:

  • Appendicitis
  • Mesenteric Adenitis
  • Colitis (IBD)
  • Malignancy

Gynae:

  • Ovarian Cyst
  • Ectopic pregnancy
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20
Q

What would be your Ddx if a patient presented with acute suprapubic pain?

A

Cystitis

Urinary retention

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21
Q

What would be your Ddx if a patient presented with LIF pain?

A

GI:

  • Diverticulitis
  • Colitis
  • Malignancy

Gynae:

  • Ovarian Cyst
  • Ectopic Pregnancy
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22
Q

What would be your Ddx if a patient presented with diffuse abdominal pain?

A

Obstruction

Infection: Peritonitis, Gastroenteritis

Inflammation: IBD

Ischaemia: Mesenteric Ischaemia

Medical:

  • DKA
  • Addison’s
  • Hypercalcaemia
  • Porphyria
  • Lead Poisoning
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23
Q

Which artery supplies the Left Colon?

A

Inferior Mesenteric Artery

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24
Q

Which artery supplies the small intestine and right colon?

A

Superior Mesenteric Artery

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25
Which artery supplies the Stomach, Spleen, Liver and Gallbladder?
Coeliac Artery
26
What blood abnormality is likely to be present in a patient presenting with acute, diffuse abdominal pain post-surgery?
High Amylase is likely to be present in all patients who present with abdominal pain. The level will be distinctively higher in those presenting with Acute Pancreatitis.
27
How is Spontaneous Bacterial Peritonitis defined?
Ascites Neutrophiles \>250 cells/mm3
28
How would you classify the causes of Abdominal Distension?
**_Fluid:_** Ascites (presents with shifting dullness and commonly features of liver disease.) **_Flatus:_** Due to obstruction Also: **F**at, **F**aeces, **F**etus, **F**ucking huge tumour
29
How does Bowel Obstruction present?
- Distension - Nausea, vomiting - Lack of bowel movements - High-pitched 'tinkling' Bowel Sounds. - ?Hx of abdo surgery (adhesions) - ?Tender irreducible femoral hernia in the groin
30
What are the main causes of Ascites?
Cirrhosis Cardiac Failure Nephrotic Syndrome Malignancy Infection (eg. TB, pyogenic) Budd-Chiari Syndrome (Hepatic Vein Thrombosis), portal vein thrombosis.
31
What makes faeces brown?
Stercobilinogen
32
How is jaundice classified?
**_Pre-hepatic:_** - Haemolysis - Defective Conjugation (Gilbert's) **_Hepatic:_** -Hepatitis **_Post-Hepatic:_** -CBD Obstruction
33
Which enzyme is defective in Gilbert's Syndrome?
Glucuronyltransferase
34
Which symptoms are typically present in a patient with Pre-hepatic Jaundice?
Just yellowing of the skin.
35
Which symptoms will a patient with hepatic jaundice typically present with?
Yellowing of the skin Dark Urine (leakage of conjugated bilirubin from hepatocytes)
36
Which symptoms will a patient with post-hepatic jaundice typically present with?
Yellow skin Dark urine Pale stools
37
What can cause post-hepatic jaundice?
Gallstones CBD Stricture Carcinoma in the head of the pancreas
38
Which blood tests are likely to be elevated in a patient presenting with: Painless Jaundice Weight Loss Dark Urine Pale Stools ?
ALP CA19-9
39
What are the main causes of Bloody Diarrhoea?
Infective Colitis Inflammatory Colitis (Patients will be younger and present with extra-GI manifestations) Ischaemic Colitis (Typically Elderly) Diverticulitis Malignancy
40
Which organisms most commonly cause Infective Colitis?
CHESS **C**ampylobacter **H**aemorrhagic E.Coli **E**ntamoeba histolytica **S**almonella **S**higella
41
How would you investigate a patient with bloody diarrhoea?
Stool Test, for infective causes Colonoscopy, for inflammatory causes **CT** & AXR, for ischaemia. Lactate & CK, for ischaemia.
42
What does this AXR show?
Thickening of the bowel wall, most likely due to inflammatory causes.
43
What does this AXR show?
'Lead Pipe Colon' Featureless colon typical of chronic UC
44
What is shown in this AXR?
Megacolon (Toxic, if the patient is acutely unwell)
45
What does this AXR show in a patient who presents with diarrhoea?
Faecal Overload. The Diarrhoea is Overflow Diarrhoea, which requires laxatives to treat.
46
How would you manage an Acute GI Bleed (non-variceal)?
ABC IV Access Fluids - 0.9% NaCl G&S X-match blood OGD
47
How would you manage an Acute Variceal Bleed?
Same as normal Acute GI Bleed + Antibiotics +Terlipressin
48
Which investigations would you order for a patient presenting with an Acute Abdomen?
FBC, U&Es, LFTs, CRP, Clotting Profile, G&S, X-Match Erect CXR CT
49
What would be the first line management for a patient being investigated for an Acute Abdomen?
Nil-by-Mouth Fluids Analgesic Anti-emetics Antibiotics Monitor vitals & urine output
50
How would you investigate a jaundiced patient?
Bloods: FBC, LFTs, CRP Abdominal USS (after fasting)
51
How would you investigate a patient presenting with Dysphagia & Weight Loss?
OGD & Biopsy
52
How would you investigate a patient presenting with PR bleed & Weight Loss?
Colonoscopy
53
What would be your next investigation in a patient with deranged LFTs?
**_Abdominal Ultrasound_**
54
How would you manage a patient with Ascites?
Diuretics (Spironolactone +- furosemide) Dietary Na restriction Fluid restriction in patients with hyponatraemia Daily weight monitoring Therapeutic Paracentesis (with IV human albumin)
55
How should you classify Ascites?
Serum Ascites Albumin Gradient (**SAAG**) **S**erum Albumin - **A**scites Albumin \>11g/L = Cirrhosis, Cardiac Failure \<11g/L = TB, Cancer, Nephrotic Syndrome
56
How would you manage a patient with Hepatic Encepalopathy?
**Lactulose** (Increased Bowel movements helps flush toxins out, compensating for Liver Failure) **Phosphate Enemas** Avoid Sedation (eg. benzodiazepines) Treat infections Exclude GI bleeds (Bleeding provides toxin-producing bacteria with a plentiful supply of proteins to feast on)
57
How would you identify an infected wound post-op?
The wound would be: - Erythematous - Would be secreting discharge
58
How would you identify an Anastomotic Leak post-op?
Diffuse Abdominal Tenderness Guarding, rigidity of the abdomen ?Hypotensive & Tachycardic.
59
How would you identify a Pelvic Abscess post-op (commonly post-appendicectomy)?
Pain Fever Sweats Mucous Diarrhoea
60
How would you identify and treat a Perianal Abscess?
Tender red swelling around the back passage. Treat with incision & drainage.
61
How would you identify an Anal Fissure?
Patient presents with rectal pain on defaecation. The stool would be coated in blood.
62
How would you manage a patient with an Anal Fissure?
Give lifestyle advice RE. Diet (Adequate fluid intake, high fibre) GTN cream
63
How would you identify a case of IBS?
Diagnosis of exclusion. Bloating tends to improve with defecation. **No Red Flag symptoms:** **-**No PR Bleed, Anaemia, Weight loss, or **Nocturnal Symptoms** -Must exclude Coeliac
64
How would you treat a patient with IBS?
**_Diet & lifestyle Advice_** **_Symptomatic treatment:_** Abdominal Pain - Antispasmodics Constipation - Laxatives Diarrhoea - Anti-Diarrhoeals

Amir Sam Lectures (6 decks)

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