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Block 1 Year 3 > Week 10 > Flashcards

Week 10 Flashcards

(94 cards)

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1
Q

What is visceral pain ?

A

Pain originating from the organs

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2
Q

What is somatic pain ?

A

Pain originating from tissues like the skin, skeleton, muscles or tendons

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3
Q

What general issues can cause visceral pain ?

A
  • contraction
  • distention (stretch)
  • tension
  • ischaemia
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4
Q

Name the type of visceral pain associated with gall stones….

A

Biliary colic

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5
Q

What types of stimuli can trigger somatic pain ?

A

Activation of the pain receptors in tissues

  • temperature
  • force
  • vibration
  • swelling
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6
Q

Is visceral pain…
A) sharp and localised ?
B) dull and localised ?
C) dull and poorly localised ?

A

Dull and poorly localised

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7
Q

Where is visceral pain from the foregut structures felt ?

A

The epigastrium

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8
Q

Where is visceral pain from the midgut structures felt ?

A

The periumbilical region

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9
Q

Where is visceral pain from the hind gut structures felt ?

A

The hypogastric region

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10
Q

What does the term ‘distended abdomen’ mean ?

A

Abdomen that is greater in size than normal

(need to ask patient what normal is)

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11
Q

What does the term ‘tympanic abdomen’ mean ?

A

Distended abdomen (air), like a balloon

(similar to bloated)

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12
Q

What does the term ‘tender abdomen’ mean ?

A

Abdominal pain is present in response to touch/pressure

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13
Q

What does the term ‘soft abdomen’ mean ?

A

No peritonism (inflammation), even though pain might be present

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14
Q

What does the term ‘peritonitic’ mean ?

A

Inflammation of the peritoneum by a noxious substance

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15
Q

What does the term ‘rebound tenderness’ mean ?

A

Pain when releasing pressure from palpation

sign of peritonism

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16
Q

What does the term ‘guarding’ mean ?

A

Involuntary tensing of abdominal wall muscle on palpation

sign of local peritonism if in one quadrant only

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17
Q

What does the term ‘rigid abdomen’ mean ?

A

Involuntary guarding in all 4 quadrants

sign of general peritonitis

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18
Q

Which cell type in the stomach secretes hydrochloric acid ?

A

Parietal cells

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19
Q

Which cell type in the stomach secretes pepsinogen ?

A

Chief cells

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20
Q

Which cell type in the stomach secretes the hormone gastrin ?

A

G cells

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21
Q

Which cell type in the stomach secretes alkaline mucus to protect the stomach lining ?

A

Mucous cells

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22
Q

What are the functions of the exocrine pancreas ?

A

Secretion of digestive enzymes, water and ions into the duodenum

  • lipase hydrolyses triglycerides into monoglycerides and fatty acids
  • elastases break down elastin
  • chymotrypsinogen is converted into chymotrypsin that breaks down proteins into amino acids
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23
Q

In which part of the digestive tract is trypsinogen activated/converted into trypsin ?

A

Duodenum

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24
Q

What in the skeletal system could cause acute upper abdominal pain ?

A
  • lower rib fractures/issues
  • back pain can radiate forwards
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25
What in the **endocrine system** could cause acute upper abdominal pain ?
Diabetic ketoacidosis
26
What in the **nervous system** could cause acute upper abdominal pain ?
Back pain that gets referred forwards *depending on nerve involvement*
27
What in the **integumentary (skin) system** could cause acute upper abdominal pain ?
Skin rashes e.g shingles *you would expect to see this on examination*
28
What in the **obstetrics system** could cause acute upper abdominal pain ?
Pre-eclampsia, especially if associated with vomiting
29
What in the **digestive system** could cause acute upper abdominal pain ?
Stomach… - peptic ulcers - gastritis - perforation - cancer Duodenum …. - perforation Pancreas… - acute pancreatitis Gallbladder/biliary system… - biliary colic - acute cholecystitis Small bowel… - IBS
30
What in the **urinary system** could cause acute upper abdominal pain ?
Renal colic pain can radiate upwards *usually pain felt in loin/groin region*
31
What in the **haematological system** could cause acute upper abdominal pain ?
Rar Pain from splenomegaly causes by haematological malignancies - splint infarction - trauma to spleen
32
What in the **respiratory system** could cause acute upper abdominal pain ?
Acute lower lobe pneumonia
33
What in the **cardiovascular system** could cause acute upper abdominal pain ?
- ruptured abdominal aortic aneurysm - MI *(atypical presentation)*
34
What is ecchymosis ?
The medical term for **bruises**
35
What does Cullen’s sign look like ?
A bruise below the bellybutton *periumbilical ecchymosis*
36
What does Grey-Turner’s sign look like ?
Bruises in either flank
37
What is Murphy’s sign ?
Pain in RUQ from local peritonism from acute cholecystitis
38
What is Rovsing’s sign ?
Pain felt in right iliac fossa when the left side is palpated *sign of acute appendicitis*
39
What does Caput Medusae look like ?
Swollen veins (varices) in the abdomen around the belly button *occur with portal hypertension from liver cirrhosis*
40
What condition might present with Murphy’s sign ?
Acute cholecystitis
41
What condition might present with Rovsing’s sign ?
Acute appendicitis
42
What condition might present with Caput Medusae ?
Liver cirrhosis (Portal hypertension)
43
What can both Cullen’s sign and Grey-Turner’s sign indicate ?
Internal haemorrhage due to… - acute pancreatitis - splenic rupture - perforated peptic ulcer disease
44
What can acute pancreatitis cause/lead to ?
- systemic inflammatory response syndrome (SIRS) - renal failure *(acute kidney injury)* - respiratory failure *(acute respiratory distress syndrome)* - death in severe cases
45
What is the criteria for diagnosing acute pancreatitis ?
At least 2 of the following… - **abdominal pain** *(acute, persistent, epigastric pain radiating to the back)* - serum **lipase/amylase levels higher than 3x** upper limit of normal - **radiological evidence** of pancreatitis (CT/MR)
46
Which pancreatic cells release lipase and amylase ?
Acinar cells *in the inflamed pancreas*
47
Which is the more sensitive bio marker of acute pancreatitis… A) amylase ? B) lipase ?
Lipase
48
Which has the higher specificity as a bio marker for acute pancreatitis … A) amylase ? B) lipase ?
The have **the same** specificity of 99%
49
What does the *sensitivity* of a test/investigation mean ?
The true positive rate How many patients the test **correctly identifies as having** the disease/condition
50
What does the *specificity* of a test/investigation mean ?
The true negative rate How many patients the test **correctly identifies as not having** the disease/condition
51
Which test can detect acute pancreatitis up to 8-14 days post-onset… A) amylase ? B) lipase ?
Lipase
52
How many hours after onset of acute pancreatitis do A) amylase levels peak ? B) lipase levels peak ?
Amylase peaks between 12 and 72hrs after onset Lipase peaks at 24hrs after onset
53
How quickly can levels of A) amylase … B) lipase … Return to normal after onset of acute pancreatitis ?
A) amylase returns to normal **3 days** after onset B) lipase returns to normal **between 8 and 14 days** after onset
54
Which test is better overall for diagnosing acute pancreatitis… A) amylase ? B) lipase ?
Lipase
55
What are the 3 levels when assessing the severity of acute pancreatitis ?
- mild - moderate severe - severe
56
What classifies as **mild** acute pancreatitis ?
No organ failure or local/systemic complications
57
What classifies as **moderate severe** acute pancreatitis ?
- **transient organ failure** *(e.g AKI)* resolving within 48 hrs - may have a **local complication** *(e.g a peripancreatic collection)*
58
What classifies as **severe** acute pancreatitis ?
Persistent/multi organ failure
59
What are the 2 types of acute pancreatitis ?
- **interstitial oedematous** pancreatitis - **necrotising** pancreatitis
60
Which type of acute pancreatitis is more common … A) interstitial oedematous ? B) necrotising ?
Interstitial oedematous pancreatitis (90-95% of acute pancreatitis cases)
61
What happens in interstitial oedematous pancreatitis ?
Pancreatic parenchyma is inflamed/oedematous
62
What happens in necrotising pancreatitis ?
Necrosis of pancreatic parenchyma and/or peripancreatic tissue May become infected
63
What are the potential subtypes/complications associated with **interstitial oedematous** pancreatitis ?
- acute peripancreatic fluid collection (APFC) - pseudocyst
64
What are the potential subtypes/complications associated with **necrotising** pancreatitis ?
- acute necrotic collection (ANC) - walled off necrosis (WON)
65
What are the causes of acute pancreatitis?
**I**diopathic **G**allstones **E**thanol **T**rauma **S**teroid use **M**umps **A**utoimmune*/family Hx/genetics* **S**corpion sting **H**ypercalcaemia + hypertriglyceridaemia **E**ndoscopic retrograde cholangiopancreatography (ERCP) **D**rugs/medications
66
What investigations would you perform in the case of suspected acute pancreatitis ?
- Lipase/Amylase - U+Es - LFTs - Lactate - FBC - chest X-ray *(to rule out differentials e.g pneumonia or visceral perforation)*
67
What blood results would you expect to see in the case of acute pancreatitis ?
- **Lipase/amylase higher than 3x the upper limit of normal** - raised WCC - raised CRP - raised creatinine - raised urea *suggests AKI* - low albumin *normal LFTs and no jaundice rules out cholangitis*
68
What CXR results would you expect to see in the case of acute pancreatitis ?
Normal *air under diaphragm would suggest gastric/visceral perforation*
69
When would you perform a CT for a patient with suspected acute pancreatitis ?
**5-7 days after admission** *as this is when local complications would start to develop*
70
After bloods and CXR indicate acute pancreatitis, what is the next most appropriate investigation?
**Abdominal ultrasound (USS)** *to identify if gallstones are the cause* *a CT is indicated for a diagnosis if the bloods etc were unclear*
71
What would be the initial management of a patient with acute pancreatitis ?
- analgesics - antiemetics *(NG tube if vomiting)* - VTE prophylaxis - fluid balance (IV fluids and catheter)
72
When should an urgent upper GI endoscopy be ordered?
- patients with dysphasia *(swallowing issues)* Or - patients over 55 with weight loss and either upper abdo pain, reflux or dyspepsia
73
What does dyspepsia mean ?
Indigestion *feelings of burning, belching, bloating or barfing after eating*
74
What are the risk factors for GORD ?
- smoking - alcohol - stress - pregnancy - hiatus hernia - trigger foods - medications that reduce the tone of the LOS e.g NSAIDS and beta-blockers
75
What is the first line management for people with GORD, where cancer is not suspected ?
Proton-pump inhibitors e.g omeprazole, esomeprazole, lansoprazole… *Or upper GI endoscopy for patients who don’t respond to the meds*
76
Are there surgical options for GORD management ?
Yes, where meds and lifestyle management have failed Called a **Nissen fundoplication**
77
What is a Nissen fundoplication ?
A surgical management for GORD when other methods have failed Wrap the stomach fungus around the lower oesophagus to reinforce the LOS
78
What are the potential complications resulting from untreated GORD ?
- Barrett’s Oesophagus - oesophagitis - chronic cough - recurrent chest infections * due to gastric aspirate in the lungs* - benign stricture
79
What is oesophagitis ?
Inflammation in the lower oesophagus
80
How does unresolved GORD lead to a chronic cough ?
Stomach acid can reach the larynx at night when laid flat
81
What is the metaplastic change that occurs in Barrett’s Oesophagus?
Stratified squamous cells of oesophagus change to columnar cells like in the stomach **squamous —> columnar**
82
What factors would constitute surgery in the case of GORD ?
- unresolved by meds and lifestyle changes - desire to stop meds *e.g cos of side effects…* - presence of a hiatus hernia
83
What are the red flag symptoms (*ALARMS*) in patients presenting with dyspepsia ?
*Dyspepsia = indigestion* **A**naemia *(lethargy, breathlessness)* **L**oss of weight **A**norexia *(loss of appetite)* **R**ecent onset/progressive symptoms **M**allena and haematemesis *(black stool and red vomit)* **S**wallowing difficulty *(dysphagia)*
84
What age group are gastric cancers most commonly seen in ?
75+
85
What is the most common hydrological type of gastric cancer ?
**Adenocarcinoma** *less common: - squamous cell carcinoma - non-Hodgkin lymphoma - gastrointestinal stromal tumours (GIST) - neuroendocrine tumours (NETs)*
86
What are the main risk factors for gastric adenocarcinoma ?
- 75+ - male - H.pylori infection - FAP *(familial adenomatous polyposis)* - ethnicity *(black, Hispanic, Asian)* - smoking - alcohol - poor diet - obesity
87
What do the TNM stages refer to in the case of gastric adenocarcinoma?
T = how far the tumour has grown into the gastric wall N = lymph node spread M = metastatic spread
88
What does T2 stage indicate in gastric adenocarcinoma ?
T2 = invasion into muscularis propria
89
What does N2 stage indicate in gastric adenocarcinoma ?
Spread into 3-6 regional lymph nodes
90
What is the 5-year survival rate of… A) stage 3 gastric adenocarcinoma ? B) stage 4 gastric adenocarcinoma ?
Stage 3 = 25% Stage 4 <1%
91
What TNM grades classify stage 3 gastric adenocarcinoma ?
T2, N1-3, M0 Or T4a, N1-3, M0 *Stage 4 involves metastasis*
92
When does a cancer grading become stage 4 ?
When metastasis is involved
93
What is the investigation pathway required in cases of gastric adenocarcinoma ?
- upper GI endoscopy *(as per NICE guidelines)* - minimum of 6 biopsies during endoscopy - CT thorax, abdo + pelvis *(for initial staging)* - discussion at MDT - perioperative chemotherapy *(if tumour is resectable)*
94
What is the management for gastric adenocarcinoma ?

Block 1 Year 3 (7 decks)

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