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Flashcards in MedEd: GI Med/Surg Deck (31):
1

1. A 41 year old female presents with fever, RUQ pain and nausea. She has icteral sclera and is intensely shaking


A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

F. Cholangitis

Charcot's triad: Jaundice, RUQ pain, rigors

41 year old woman (Fat, female, fertile, fourty fair- gallstones)

Fever, nausea (differentiates it from biliary colic- inflammatory component)

Cholangitis: bile duct infection causing RUQ pain, jaundice and rigors

2

Continuous epigastric/RUQ pain
Local peritonism and raised WCC
Fever, N/V

Acute cholecystitis

Follows from stone or sludge impaction in the neck of the gall bladder
No jaundice (as CBD is not blocked- differentiates it from cholangitis)
May be Murphy's sign positive (inspiration and stop breathing- local peritonism)

3

RUQ pain, radiating to the back
Jaundice

Biliary colic

Symptomatic gallstones obstructing the cystic duct or CBD- jaundice
(Pain radiates to back due to diaphragm?)

4

RUQ pain, radiating to the back
Jaundice

Biliary colic

Symptomatic gallstones obstructing the cystic duct or CBD- jaundice
(Pain radiates to back due to diaphragm?)

5

2. A 65 year old man presents with severe, acute onset abdominal pain. BP: 90/60,
HR 150. Upon examination he has an expansile umbilical mass


A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

D. Ruptured AAA

severe, acute onset pain
Shock (hypotension and tachycardia)- so rupture
expansile umbilical mas
Increased risk of AAA >65 y.o.


Ruptured AAA
Intermittent/continuous abdominal pain
Radiates to back
Expansile abdominal mass
Shock

Screening programme for those >65, treat if >5.5cm across

6

3. A man presents with severe burns to 50% of his body. He is vomiting blood and is pyrexial


A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

J. Curling's Ulcer

burns (buzzword)
vomiting blood (GI bleed)
pyrexia (very unwell)

Curling's ulcer: acute peptic ulcer of gastrum/duodenum
Complication of severe burns (reduced plasma volume-->ischaemia and necrosis of gastric mucosa)

7

5. A man presents with central, burning abdominal pain which presents immediately after meals

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

H. Gastric ulcer

Central, burning pain (gastric source)
Post-prandial
Immediately after eating (so gastric- duodenal before meals (hungry) or at night)

8

Differences between Gastric and Duodenal ulcers

Gastric: immediately after meals, relieved by antacids, H. pylori

Duodenal: more common than gastric, epigastric pain before meals or at night (hungry), H. pylori

9

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

10

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

11

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

12

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

13

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

14

5. A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer
I. Duodenal Ulcer
J. Curling’s Ulcer
K. Zollinger-Ellison syndrome
L. Oesophageal Varices
M. Cholecystitis

I. Duodenal ulcer

Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)

15

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

16

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

17

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian torsion
D. Ruptured AAA
E. ureteric colic

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

18

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian torsion
D. Ruptured AAA
E. ureteric colic
F. cholangitis
G. splenic rupture

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

19

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian torsion
D. Ruptured AAA
E. ureteric colic
F. cholangitis
G. splenic rupture
H. gastric ulcer

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

20

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian torsion
D. Ruptured AAA
E. ureteric colic
F. cholangitis
G. splenic rupture
H. gastric ulcer


K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)

Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

21

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.




K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

22

Zollinger-Ellison syndrome:


Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

23

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

24

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
B. Ectopic pregnancy
C. Ovarian Torsion
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric Ulcer

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

25

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric ulcer
I. Duodenal ulcer

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

26

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric ulcer
I. Duodenal ulcer
K. Zollinger

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

27

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric ulcer
I. Duodenal ulcer
K. Zollinger-Ellison

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

28

6. A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.

A. Diverticulitis
D. Ruptured AAA
E. Ureteric colic
F. Cholangitis
G. Splenic rupture
H. Gastric ulcer
I. Duodenal ulcer
K. Zollinger-Ellison

K. Zollinger-Ellison syndrome

Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)


Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection

29

Zollinger-Ellison syndrome:


Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.

30

A 20 year old rugby player presents to A&E with severe LUQ pain after being tackled by ST George's scum at the UH semi-final.

G. Splenic rupture

31

A 20 year old rugby player presents to A&E with severe LUQ pain after being tackled by ST George's scum at the UH semi-final.

G. Splenic rupture