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Block 1 Year 3 > Week 10 > Flashcards

Week 10 Flashcards

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
Q

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

A

Diabetic ketoacidosis

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26
Q

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

A

Back pain that gets referred forwards depending on nerve involvement

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27
Q

What in the integumentary (skin) system could cause acute upper abdominal pain ?

A

Skin rashes e.g shingles

you would expect to see this on examination

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28
Q

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

A

Pre-eclampsia, especially if associated with vomiting

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29
Q

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

A

Stomach…
- peptic ulcers
- gastritis
- perforation
- cancer

Duodenum ….
- perforation

Pancreas…
- acute pancreatitis

Gallbladder/biliary system…
- biliary colic
- acute cholecystitis

Small bowel…
- IBS

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30
Q

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

A

Renal colic pain can radiate upwards

usually pain felt in loin/groin region

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31
Q

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

A

Rar

Pain from splenomegaly causes by haematological malignancies

  • splint infarction
  • trauma to spleen
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32
Q

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

A

Acute lower lobe pneumonia

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33
Q

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

A
  • ruptured abdominal aortic aneurysm
  • MI (atypical presentation)
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34
Q

What is ecchymosis ?

A

The medical term for bruises

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35
Q

What does Cullen’s sign look like ?

A

A bruise below the bellybutton

periumbilical ecchymosis

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36
Q

What does Grey-Turner’s sign look like ?

A

Bruises in either flank

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37
Q

What is Murphy’s sign ?

A

Pain in RUQ from local peritonism from acute cholecystitis

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38
Q

What is Rovsing’s sign ?

A

Pain felt in right iliac fossa when the left side is palpated

sign of acute appendicitis

39
Q

What does Caput Medusae look like ?

A

Swollen veins (varices) in the abdomen around the belly button

occur with portal hypertension from liver cirrhosis

40
Q

What condition might present with Murphy’s sign ?

A

Acute cholecystitis

41
Q

What condition might present with Rovsing’s sign ?

A

Acute appendicitis

42
Q

What condition might present with Caput Medusae ?

A

Liver cirrhosis

(Portal hypertension)

43
Q

What can both Cullen’s sign and Grey-Turner’s sign indicate ?

A

Internal haemorrhage due to…
- acute pancreatitis
- splenic rupture
- perforated peptic ulcer disease

44
Q

What can acute pancreatitis cause/lead to ?

A
  • systemic inflammatory response syndrome (SIRS)
  • renal failure (acute kidney injury)
  • respiratory failure (acute respiratory distress syndrome)
  • death in severe cases
45
Q

What is the criteria for diagnosing acute pancreatitis ?

A

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
Q

Which pancreatic cells release lipase and amylase ?

A

Acinar cells in the inflamed pancreas

47
Q

Which is the more sensitive bio marker of acute pancreatitis…
A) amylase ?
B) lipase ?

A

Lipase

48
Q

Which has the higher specificity as a bio marker for acute pancreatitis …
A) amylase ?
B) lipase ?

A

The have the same specificity of 99%

49
Q

What does the sensitivity of a test/investigation mean ?

A

The true positive rate

How many patients the test correctly identifies as having the disease/condition

50
Q

What does the specificity of a test/investigation mean ?

A

The true negative rate

How many patients the test correctly identifies as not having the disease/condition

51
Q

Which test can detect acute pancreatitis up to 8-14 days post-onset…
A) amylase ?
B) lipase ?

A

Lipase

52
Q

How many hours after onset of acute pancreatitis do
A) amylase levels peak ?
B) lipase levels peak ?

A

Amylase peaks between 12 and 72hrs after onset

Lipase peaks at 24hrs after onset

53
Q

How quickly can levels of
A) amylase …
B) lipase …
Return to normal after onset of acute pancreatitis ?

A

A) amylase returns to normal 3 days after onset

B) lipase returns to normal between 8 and 14 days after onset

54
Q

Which test is better overall for diagnosing acute pancreatitis…
A) amylase ?
B) lipase ?

A

Lipase

55
Q

What are the 3 levels when assessing the severity of acute pancreatitis ?

A
  • mild
  • moderate severe
  • severe
56
Q

What classifies as mild acute pancreatitis ?

A

No organ failure or local/systemic complications

57
Q

What classifies as moderate severe acute pancreatitis ?

A
  • transient organ failure (e.g AKI) resolving within 48 hrs
  • may have a local complication (e.g a peripancreatic collection)
58
Q

What classifies as severe acute pancreatitis ?

A

Persistent/multi organ failure

59
Q

What are the 2 types of acute pancreatitis ?

A
  • interstitial oedematous pancreatitis
  • necrotising pancreatitis
60
Q

Which type of acute pancreatitis is more common …
A) interstitial oedematous ?
B) necrotising ?

A

Interstitial oedematous pancreatitis

(90-95% of acute pancreatitis cases)

61
Q

What happens in interstitial oedematous pancreatitis ?

A

Pancreatic parenchyma is inflamed/oedematous

62
Q

What happens in necrotising pancreatitis ?

A

Necrosis of pancreatic parenchyma and/or peripancreatic tissue

May become infected

63
Q

What are the potential subtypes/complications associated with interstitial oedematous pancreatitis ?

A
  • acute peripancreatic fluid collection (APFC)
  • pseudocyst
64
Q

What are the potential subtypes/complications associated with necrotising pancreatitis ?

A
  • acute necrotic collection (ANC)
  • walled off necrosis (WON)
65
Q

What are the causes of acute pancreatitis?

A

Idiopathic

Gallstones
Ethanol
Trauma

Steroid use
Mumps
Autoimmune/family Hx/genetics
Scorpion sting
Hypercalcaemia + hypertriglyceridaemia
Endoscopic retrograde cholangiopancreatography (ERCP)
Drugs/medications

66
Q

What investigations would you perform in the case of suspected acute pancreatitis ?

A
  • Lipase/Amylase
  • U+Es
  • LFTs
  • Lactate
  • FBC
  • chest X-ray (to rule out differentials e.g pneumonia or visceral perforation)
67
Q

What blood results would you expect to see in the case of acute pancreatitis ?

A
  • 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
Q

What CXR results would you expect to see in the case of acute pancreatitis ?

A

Normal

air under diaphragm would suggest gastric/visceral perforation

69
Q

When would you perform a CT for a patient with suspected acute pancreatitis ?

A

5-7 days after admission as this is when local complications would start to develop

70
Q

After bloods and CXR indicate acute pancreatitis, what is the next most appropriate investigation?

A

Abdominal ultrasound (USS) to identify if gallstones are the cause

a CT is indicated for a diagnosis if the bloods etc were unclear

71
Q

What would be the initial management of a patient with acute pancreatitis ?

A
  • analgesics
  • antiemetics (NG tube if vomiting)
  • VTE prophylaxis
  • fluid balance (IV fluids and catheter)
72
Q

When should an urgent upper GI endoscopy be ordered?

A
  • patients with dysphasia (swallowing issues)

Or

  • patients over 55 with weight loss and either upper abdo pain, reflux or dyspepsia
73
Q

What does dyspepsia mean ?

A

Indigestion

feelings of burning, belching, bloating or barfing after eating

74
Q

What are the risk factors for GORD ?

A
  • smoking
  • alcohol
  • stress
  • pregnancy
  • hiatus hernia
  • trigger foods
  • medications that reduce the tone of the LOS e.g NSAIDS and beta-blockers
75
Q

What is the first line management for people with GORD, where cancer is not suspected ?

A

Proton-pump inhibitors e.g omeprazole, esomeprazole, lansoprazole…

Or upper GI endoscopy for patients who don’t respond to the meds

76
Q

Are there surgical options for GORD management ?

A

Yes, where meds and lifestyle management have failed

Called a Nissen fundoplication

77
Q

What is a Nissen fundoplication ?

A

A surgical management for GORD when other methods have failed

Wrap the stomach fungus around the lower oesophagus to reinforce the LOS

78
Q

What are the potential complications resulting from untreated GORD ?

A
  • Barrett’s Oesophagus
  • oesophagitis
  • chronic cough
  • recurrent chest infections * due to gastric aspirate in the lungs*
  • benign stricture
79
Q

What is oesophagitis ?

A

Inflammation in the lower oesophagus

80
Q

How does unresolved GORD lead to a chronic cough ?

A

Stomach acid can reach the larynx at night when laid flat

81
Q

What is the metaplastic change that occurs in Barrett’s Oesophagus?

A

Stratified squamous cells of oesophagus change to columnar cells like in the stomach

squamous —> columnar

82
Q

What factors would constitute surgery in the case of GORD ?

A
  • unresolved by meds and lifestyle changes
  • desire to stop meds e.g cos of side effects…
  • presence of a hiatus hernia
83
Q

What are the red flag symptoms (ALARMS) in patients presenting with dyspepsia ?

A

Dyspepsia = indigestion

Anaemia (lethargy, breathlessness)
Loss of weight
Anorexia (loss of appetite)
Recent onset/progressive symptoms
Mallena and haematemesis (black stool and red vomit)
Swallowing difficulty (dysphagia)

84
Q

What age group are gastric cancers most commonly seen in ?

A

75+

85
Q

What is the most common hydrological type of gastric cancer ?

A

Adenocarcinoma

less common:
- squamous cell carcinoma
- non-Hodgkin lymphoma
- gastrointestinal stromal tumours (GIST)
- neuroendocrine tumours (NETs)

86
Q

What are the main risk factors for gastric adenocarcinoma ?

A
  • 75+
  • male
  • H.pylori infection
  • FAP (familial adenomatous polyposis)
  • ethnicity (black, Hispanic, Asian)
  • smoking
  • alcohol
  • poor diet
  • obesity
87
Q

What do the TNM stages refer to in the case of gastric adenocarcinoma?

A

T = how far the tumour has grown into the gastric wall

N = lymph node spread

M = metastatic spread

88
Q

What does T2 stage indicate in gastric adenocarcinoma ?

A

T2 = invasion into muscularis propria

89
Q

What does N2 stage indicate in gastric adenocarcinoma ?

A

Spread into 3-6 regional lymph nodes

90
Q

What is the 5-year survival rate of…
A) stage 3 gastric adenocarcinoma ?
B) stage 4 gastric adenocarcinoma ?

A

Stage 3 = 25%
Stage 4 <1%

91
Q

What TNM grades classify stage 3 gastric adenocarcinoma ?

A

T2, N1-3, M0

Or

T4a, N1-3, M0

Stage 4 involves metastasis

92
Q

When does a cancer grading become stage 4 ?

A

When metastasis is involved

93
Q

What is the investigation pathway required in cases of gastric adenocarcinoma ?

A
  • 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
Q

What is the management for gastric adenocarcinoma ?

A

Block 1 Year 3 (7 decks)

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