Medical Causes of Acute Abdomen Flashcards
Major dyspepsia causes?
Severe oesophagitis PUD Oesophageal cancer Gastric cancer Barrett's oesophagus H. Pylori
How may PUD present?
Epigastric pain - worse after eating, back radiation with antacid relief
Can by asymptomatic
Asymptomatic to massive GI bleed crisis
Diagnosed through endoscopy
Causes of gastric or duodenal ulceration?
H Pylori
NSAIDs
Gastric cancer
Zollinger ellison
Rarely crohn’s, sarcoidosis, TB
Two major patterns of H pylori gastritis?
Antrum-predominant - increased acid output with gastric metaplasia, chronic inflammation and duodenal ulcers
Pan-gastritis - reduce acid output with gastric ulcers and cancers. Adenocarcinoma and MALT lymphomas
How to check for H pyrlori?
Can do a breath test, often now we do antigen tests.
Treatment of PUD
Stop NSAIDs, eradicate H pylori
Check healing 6-8 weeks with endoscopy
Breath for HP
If no resolve - others e.g. zollinger
Mechanisms of diarrhoea?
Secretory e.g. cholera
Osmotic e.g. malabsorption, drugs, hypolactasia
Exudative e.g. IBD/severe infections
Abnormal motility e.g. IBS, drugs, prior surgery
Mixed
NB Overflow
Dysentery?
Diarrhoea with blood, often with fever, pain and vomiting.
Most commonly shigella, salmonella, e.coli etc.
What can c.diff cause at its worst?
Pseudomembranous colitis.
Must take oral ABx.
FMT can work
How do we document malabsorption?
Stool sample for fat globules 3 day faecal fat estimation FBC - B12, folate, Fe, ferritin Clotting - PT time and vit K Albumin and other LFTs
Main malabsorption causes?
Pancreatitis or panc cancer Coeliac's Crohn's Infective Bacterial overgrowth
How to test for malabsorption causes?
Faecal elastase
CT scanning/ERCP
Trial of therapies
tTG (tissue transglutaminase), anti-endomysial Ab for coeliac’s, need biopsies for diagnosis
Lactulose breath test for bacterial overgrowth, not common
Small bowel MRI for crohn’s or diverticulosis
IBD Investigations
Stool cultures to exclude infection
Inflammatory markers
Rectal biopsies
Acute severe colitis immediate treatment (before toxic megacolon)
AXR for dilatation Call surgeons Fluid, IV hydrocortison and ABx Consider biologic 3-4 days Colectomy 5-7 days Or they die
