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General practice 2023 > Murtagh - Abdominal pain > Flashcards

Murtagh - Abdominal pain Flashcards

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1
Q

inflammatory causes of acute abdomen

A

inflammatory bowel disease
appendicitis
cholecystitis
hepatitis
pancreatitis
salpingitis (Fallopian tubes)
diverticulitis

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2
Q

causes of acute abdomen caused by perforation

A

perforated duodenal ulcer
perforated gastric ulcer
faecal peritonitis
biliary peritonitis
appendicitis

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3
Q

obstructive causes of acute abdomen

A

biliary colic
acute small bowel obstruction
acute large bowel obstruction
ureteric colic
acute urinary retention
intestinal infarction

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4
Q

heamorragic causes of acute abdomen

A

ruptured ectopic pregnancy
ruptured spleen or liver (haemoperitoneum)
ruptured ovarian cyst
ruptured abdominal aortic aneurysm

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5
Q

causes of acute abdomen related to torsion (ischaemia)

A

sigmoid volvolus
torsion ovarian cyst
torsion of testes

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6
Q

what is the most likely cause of severe colicky midline umbilical abdominal pain with distension and vomiting

A

SBO

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7
Q

what is the most likely cause of midline lower abdominal pain with distention and vomiting

A

large bowel obstruction

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8
Q

name something that must be considered in an elderly patient presenting with severe abdominal pain with a background of arteriosclerotic disease or AF, or following MI

A

mesenteric artery occlusion

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9
Q

‘probability diagnosis’ for acute abdominal pain

A

acute gastroenteritis
acute appendicitis
mittelschmerz/dysmenorrhea
irritable bowel syndrome
biliary colic/renal colic

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10
Q

serious cardiovascular disorders ‘not to be missed’ for acute abdomen presentation

A

myocardial infarction
ruptured AAA
dissecting aneurysm aorta
mesenteric artery occlusion/ischaemia

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11
Q

severe infections ‘not to be missed’ in acute abdomen presentations

A

acute salpingitis
peritonitis/spontaneous bacterial peritonitis
ascending cholangitis
intra-abdominal abscess

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12
Q

other ‘serious disorders not to be missed’ for acute abdomen

A

pancreatitis
ectopic pregnancy
small bowell obstruction/strangulated hernia
sigmoid volvolus
perforated viscus
neoplasia (large or small bowel obtstruction)

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13
Q

pitfalls often missed in acute abdomen

A

acute appendicitis
myofascial tear
pulmonary causes - pneumonia or pulmonary embolism
faecal impaction (elderly)
herpes zoster

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14
Q

rare causes of acute abdomen

A

porphyria
lead poisoning
henoch-schonlein purpura
haemochromatosis
haemoglobinuria
Addison disease

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15
Q

seven masquerades checklist for acute abdomen

A

depression
diabetes (ketoacidosis)
drugs (especially narcotics)
anaemia (sickle cell)
endocrine disorder (thyroid storm, Addison)
spinal dysfunction
UTI (including urosepsis)

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16
Q

for acute abdomen - is the patient trying to tell me something?

A

consider munchausen syndrome, sexual dysfunction and abdominal stress

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17
Q

probability diagnosis of chronic abdomen

A

irritable bowel syndrome
diverticular disease
mittelschmerz/dysmenorrhea
peptic ulcer/gastritis

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18
Q

serious disorders not to be missed in chronic abdomen

A

cardiovascular - mesenteric artery ischaemia or AAA
neoplasia
- bowel/stomach cancer
- pancreatic cancer
- ovarian tumours
severe infections
- hepatitis
- recurrent PID

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19
Q

pitfalls often missed for chronic abdomen

A

adhesions
appendicitis
food allergies
lactase deficiency
constipation/faecal impaction
chronic pancreatitis
crohns disease
endometriosis
diverticulitis

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20
Q

rare causes of chronic abdomen

A

tropical infections eg. hydatids, melioidoses, malaria, strongyloides
uraemia
lead poisoning
porphyria
sickle cell anaemia
hypercalcaemia
Addisons disease

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21
Q

seven masquerades checklist for chronic abdomen

A

depression
drugs
andocrine disorder (Addisons disease)
spinal dysfunction
UTI

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22
Q

for chronic abdomen - is the patient trying to tell me something?

A

consider hypochondriasis, anxiety, sexual dysfunction, munchausen syndrome

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23
Q

misdiagnosis of ectopic pregnancy may cause

A

rapid hypovolaemic shock

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24
Q

misdiagnosis of ruptured AAA may cause

A

rapid hypovolaemic shock

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25
misdiagnosis of gangrenous appendix may cause
peritonitis/pelvic abscess
26
misdiagnosis of perforated ulcer may lead to
peritonitis
27
misdiagnosis of obstructed bowel may lead to
gangrene
28
what is a common cause of acute abdomen in children
mesenteric adenitis
29
red flags to ask about in history taking for the acute abdominal pain patient
collapse on the toilet lightheadedness ischameic heart disease progressive vomiting pain, distention menstural abnormalities malignancy lack of flatus
30
signs to look out for in the acute abdomen presenting patient
pallor and sweating hypotension atrial fibrillation or tachycardia fever prostration rebound tenderness and guarding decreased urine output
31
early appendicitis presents typically as
centraal abdominal pain that shifts to the right iliac fossa some 4-6 hours later can cause diarrhoea with abdominal pain, especially if a pelvic appendix
32
in what populations might appendicitis present atypically
elderly, in children, pregnancy and in those taking steroids
33
disaccharidase deficiencies
eg. lactase deficiency associated with cramping and abdominal pain, which may be severe follows hours after the ingestion of milk and is accompanied by the passage of watery stool
34
how might herpes zoster present
in the elderly patient with unilateral abdominal pain in the dermatomal distribution
35
causes of abdominal pain, frequency and dysuria other than UTI
cause could also be diverticulitis, pelvic appendicitis, salpingitis or a ruptured ectopic pregnancy
36
drugs to consider as a cause of abdominal pain
alcohol antibiotics aspirin corticosteroids cytotoxic agents tricyclic antidepressants iron preparations nicotine NSAIDs/COX-2 inhibitors sodium valproate phenytoin
37
for a patient with AF you should consider
mesenteric artery obstruction
38
for a patient with tachycardia you should consider
sepsis and volume depletion
39
for a patient with taahypnoea you should consider
sepsis, pneumonia, acidosis
40
for a patient with pallor and shock you should consider
acute blood loss
41
for a patient with absent bowel sounds you should consider
diffuse sepsis, ileum, mechanical obstruction (advanced)
42
for distension, you should consider
six Fs fat, fluid, flatus, faeces, fetus, frightening growths
43
for hypertympany, you should consider
indicates mechanical obstruction
44
haemoglobin may identify
anaemia with chronic blood loss eg. peptic ulcer, cancer, oesophagitis
45
blood film may indicate
abnormal red blood cells with sickle cell disease
46
WCC may indicate
leucocytosis with appendicitis acute pancreatitis mesenteric adenitis cholecystitis (especially with empyema) pyelonephritis
47
ESR indicates
raised with cancer, crohns disease, abscess, but non-specific test
48
CRP may indicate
preferable to ESR use in diagnosing and monitoring infection, inflammation eg. pancreatic
49
liver function tests may indicate
hepatobiliary disorder
50
serum amylase and/or lipase may indicate
if raised to greater than three times the normal upper level then pancreatitis is most likely also raised partially with most intra-abdominal disasters (e.g. ruptured ectopic pregnancy, perforated peptic ulcers, ruptured empyema of gall bladder, ruptured aortic aneurysm)
51
faecal elastase may indicate
chronic pancreatitis
52
pregnancy tests may indicate
for susppected ectopic urina and serum bHCG
53
blood in urine sample may indicate
ureteric colic (stone or blood clot), urinary infection
54
white cells in urine sample may indicate
urinary infection, appendicitis (bladder irritation)
55
bile pigments in urine sample may indicate
gall bladder disease
56
porphobilinogen in the urine sample may indicate
porphyria (add ehrlich aldehyde agent)
57
ketones in the urine sample may indicate
diabetic ketoacidosis
58
air in the urine sample is called
pneumaturia
59
pneumaturia may indicate
fistula (eg. diverticulitis, other pelvic abscess, pelvic cancer)
60
faecal blood may indicate
mesenteric artery occlusion, intussusception (recurrant jelly), colon cancer, diverticulitis, crowns disease and ulcerative colitis
61
what might you look for on an x-ray abdomen
- kidney/ureteric stones (70% opaque) - biliary stones (10-30% opaque) - air in the biliary tree - calcified aortic aneurysm - marked distension sigmoid - sigmoid volvolus - distended bowel with fluid level: bowel obstruction - enlarged caecum with large bowel obstruction - blurred right psoas shadow: appendicitis - coffee bean sign: volvulus - a sentinel loop of gas in left upper quadrant (LUQ): acute pancreatitis
62
a distended bowel with fluid level on x-ray indicates
bowel obstruction
63
a blurred high psoas shadow on x-ray indicates
appendicitis
64
a coffee bean sign on x-ray indicates
volvolus
65
a sentinel loop of gas in the upper left quadrant indicates
acute appendicitis
66
what are you looking for on a chest x-ray
perforated ulcer
67
an ultrasound is most useful for
hepatobiliary system, kidneys and female pelvis
68
what should you look for on an ultrasounds
gallstones ectopic pregnancy pancreatic pseudocyst aneurysm aorta/dissecting aneurysm hepatic metastases and abdominal tumours thickened appendix parabolic collection
69
an ultrasound might be affected by
gas shadows
70
a CT scan is good for
gives good survey of abdominal organs including masses and fluid collection
71
what are you looking for on CT scan
pancreatitis (acute and chronic) undiagnosed peritoneal inflammation (best) trauma diverticulitis leaking aortic aneurysm retroperitoneal pathology appendicitis (especially with oral contrast)
72
ERCP might show
bile duct obstruction and pancreatic disease
73
a contrast enhanced x-ray might be useful for
e.g. gastrograffin meal diagnosis of bowel leakage
74
HIDA or DIDA nuclear sign is used for
diagnosis of acute cholecystitis this is useful when US is unhelpful
75
other investigations for abdominal presentations
IVP barium enema MRI ECG endoscopy upper GI sigmoidoscopy and colonoscopy
76
what does this stuff look like on plain x-ray?
77
early severe vomiting indicates
severe obstruction of the GIT
78
what is colicky pain
rhythmic pain with regular spasms of recurring pain building to a climax and then fading
79
what is true colic?
true colic is ureteric colic biliary colic and kidney colic are not 'true colics'
80
epigastric pain usually arises from
usually arises from the disorders of the embryologic foregut eg. oesophagus, stomach and duodenum, hepatobiliary structures, pancreas and spleen
81
if the pain moves from the epigrastrium to the right
gall bladder and liver
82
if the pain moves from the peigastrium to the left
spleen
83
periumbilical pain usually arises from
usually arises from disorders of the embryologic midgut
84
supreppubic pain usually arises from
disorders of the embryologic hindgut
85
pain from visceral mechanoreceptors
triggered by intestinal distention or tension on mesentery or blood vessels diffuse and poorly localised pain
86
pain from parietal peritoneal nociceptors
triggered by mechanical, thermal and chemical stimuli pain is experienced directly at the site of insult

General practice 2023 (49 decks)

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