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PBLs > Week 15 - Abdomen > Flashcards

Week 15 - Abdomen Flashcards

1
Q

what are some causes of acute abdomen?

A

blood loss
obstructions
haematologic disorders
infection
perforation
toxins
blood flow blockage
endocrine and metabolic disorder

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2
Q

what is a mallory-weiss tear?

A

split in the inner layer of the oesophagus

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3
Q

what is cholecystitis?

A

inflammation of the gallbladder when a gallstone blocks bile from exiting

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4
Q

what are the most common causes of acute pancreatitis?

A

alcohol
gallstones

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5
Q

what is boerhaaves syndrome?

A

spontaneous rupture of the oesophagus that occurs during intense straining

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6
Q

what is buergers disease?

A

blood vessels in their legs, arms, feet and hands get inflamed, making it hard for blood to travel through.

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7
Q

what is uraemia?

A

buildup of toxins in the blood. Occurring when the kidneys stop filtering toxins out through urine

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8
Q

what is addisons disease?

A

adrenal glands don’t produce enough cortisol and aldosterone

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9
Q

what is acute intermittent porphyria?

A

porphyria is a deficiency in an enzyme that your body needs to make heme

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10
Q

what is the presentation of acute cholecystitis?

A

fever
guarding
positive Murphy’s sign (abrupt stopping of inspiration when the palpating hand meets the inflamed gallbladder descending with the liver from behind the subcostal margin on the right side -
but not on the left side).
Increased WBC and CRP.

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11
Q

what investigations are done when you suspect acute cholecystitis?

A

ultrasound of gallbladder and biliary ducts

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12
Q

what is murphys sign? when is it positive?

A

abrupt stopping of inspiration when the palpating hand meets the inflamed gallbladder descending with the liver from behind the subcostal margin on the right side -
but not on the left side

acute cholecystitis

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13
Q

what is cholangitis?

A

infection of the biliary tree

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14
Q

what is the presentation of cholangitis?

A

triad of:
- fevers
- right upper quadrant pain
- jaundice

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15
Q

what does a triad of: fevers, RUQ pain and jaundice suggest?

A

cholangitis

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16
Q

what is the presentation of a duodenal ulcer?

A

epigastric pain, dull or burning discomfort, typically relieved by food, nocturnal pain.

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17
Q

what type of ulcer has pain that is relieved by eating food?

A

duodenal ulcer

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18
Q

how is a duodenal ulcer investigated?

A

OGD, barium meal and pH study (Helicobacter pylori often present in mucosa or by serology).

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19
Q

what is the presentation of gallstone colic (with no acute inflammation or infection)?

A

jaundice
biliary colic
pain in epigastrium or RUQ radiating to right lower scapula.
No fever or increased WBC.

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20
Q

what is suggested by: jaundice, biliary colic, pain in epigastrium or RUQ radiating to right lower scapula. No fever or increased WBC?

A

gallstone colic (with no acute inflammation/infection)

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21
Q

what is the presentation of gastric carcinoma?

A

marked anorexia
fullness
pain
Troisier’s sign (a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa).

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22
Q

what is troisiers sign? what is it positive in?

A

a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa

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23
Q

what is suggested by these symptoms: marked anorexia, fullness, pain, Troisier’s sign (a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa)?

A

gastric carcinoma

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24
Q

how do you investigate gallstone colic?

A

ultrasound of gallbladder and biliary ducts

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25
what is the presentation of a gastric ulcer?
epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain.
26
what is suggested by these symptoms: epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain?
gastric ulcer
27
which type of ulcer is exacerbated by eating food?
gastric ulcer
28
what is the presentation of gastritis?
epigastric pain, dull or burning discomfort, nocturnal pain.
29
what investigations are done in suspected gastric ulcer?
OGD, barium meal and pH study
30
what is suggested by these symptoms; epigastric pain, dull or burning discomfort, nocturnal pain?
gastritis
31
what investigations are done in gastritis?
OGD, barium meal and pH study.
32
what is the presentation of a hiatus hernia?
heartburn, worsens with stooping or lying, relieved by antacids.
33
what is suggested by these symptoms: heartburn, worsens with stooping or lying, relieved by antacids?
hiatus hernia
34
what investigations are done in a hiatus hernia?
OGD, barium meal
35
what is the presentation of oesophagitis?
retrosternal pain, heartburn.
36
what is suggested by these symptoms: retrosternal pain, heartburn?
oesophagitis
37
how is oesophagitis investigated?
OGD
38
what is the presentation of pancreatitis?
pain radiating straight through to the back, better on sitting up or leaning forward.
39
how is pancreatitis investigated?
increased serum amylase, CT pancreas.
40
what are the differentials for pain in the RUQ?
cholecystitis pyelonephritis ureteric colic hepatitis pneumonia
41
what are the differentials for LUQ pain?
gastric ulcer pyelonephritis ureteric colic pneumonia
42
what are the differentials for RLQ pain?
appendicitis ureteric colic inguinal hernia IBD UTI gynaecological testicular torsion
43
what are the differentials for LLQ pain?
diverticulitis ureteric colic inguinal hernia IBD UTI gynaecological testicular torsion
44
what region is the gallbladder found?
right hypochondrial
45
where in the peritoneam does the gallbladder lie?
intraperitoneal
46
what is the function of the gallbladder?
concentrate and store bile which is produced by the liver
47
what is bile released in response to?
cholecystokinin
48
what are the 3 parts of the gallbladder?
Fundus – the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line. Body – the largest part of the gallbladder. It lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum. Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree. The neck contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis.
49
what duct leaves the gallbladder carrying bile?
cystic
50
what duct is formed by the joining of the cystic and common hepatic ducts?
common bile duct
51
What ducts join to form the common bile duct?
cystic common hepatic
52
what ducts join to form the hepatopancreatic ampulla?
common bile pancreatic
53
what regulates the major duodenal papilla?
sphincter of oddi
54
what are the 5 parts of the pancreas?
ucinate process head neck body tail
55
which is the only part of the pancreas that is intraperitoneal?
tail
56
what vessels travels under the neck of the pancreas?
superior mesinteric vessels
57
what arteries supply the pancreas?
pancreatic branches of the splenic artery
58
what is the venous drainage of the pancreas?
Venous drainage of the head of the pancreas is into the superior mesenteric branches of the hepatic portal vein. The pancreatic veins draining the rest of the pancreas do so via the splenic vein.
59
what pneumonic gives the causes of pancreatitis?
I GET SMASHED · Idiopathic · Gallstones · Ethanol (alcohol consumption) · Trauma · Steroids · Mumps · Autoimmune · Scorpion sting · Hyperlipidaemia · ERCP Drugs (furosemide, thiazide diuretics and azathioprine)
60
what factors indicate severe pancreatitis?
· Severe epigastric pain radiating through to the back · Associated vomiting · Abdominal tenderness Systemically unwell (low-grade fever, tachycardia)
61
what score is used to assess the severity of pancreatitis? list out the points
glasgow score PANCREAS pao2 <8 age >55 neutrophils >15 calcium <2 uRea >16 enzymes (LDH>600, AST/ALT>200) alnumin <32 sugar >10 0 - 1 mild 2 moderate >3 severe
62
what is the management of pancreatitis?
· Initial resuscitation (ABCDE approach) · IV fluids · Nil by mouth · Analgesia · Careful monitoring · Treatment of gallstones in gallstone pancreatitis (ERCP/cholecystectomy) · Abx - if infection present Treatment of complications (endoscopic or percutaneous drainage of large collections)
63
what are the complications of pancreatitis?
· Necrosis of the pancreas · Infection in a necrotic area · Abscess formation · Acute peripancreatic fluid collections · Pseudocysts - can develop 4 weeks after acute pancreatitis Chronic pancreatitis
64
what are the 2 types of gallstones?
* Cholesterol stones are made of hardened cholesterol and comprise 80% of all gallstones. Pigment stones are small dark stones made of bilirubin - pigment stones can be subdivided into brown and black pigment stones.
65
what are the risk factors for gallstones?
Risk Factors are the 5 Fs * Fat * Female * Forty * Fertile Family History
66
what is obstructed in cholecystitis?
opening of cystic duct by a stone
67
what is obstructed in cholangitis?
common bile duct .: no bile can travel at all
68
what factors can make a patient higher risk for surgery?
obesity = harder to safely administer anaesthesia age = anaesthesia side effects smoking sleep apnoea diabetes = stress of surgery increases blood sugar, fasting may lead to hypoglycaemia
69
what factors make anaesthesia riskier?
* Allergies to anaesthesia or a history of adverse reactions to anaesthesia * Diabetes * Heart disease (angina, valve disease, heart failure, or a previous heart attack) * High BP * Kidney problems * Lung conditions (asthma and COPD) * Stroke Seizures
70
what are common adverse effects of general anaesthesia?
N+V sore throat shock bleeding wound infection DVT/PE lung problems urinary retention
71
what are some significant risks of general anaesthesia?
* Accidental awareness (waking during the anaesthetic) * Aspiration * Dental injury, mainly when the laryngoscope is used for intubation * Anaphylaxis * Cardiovascular events (e.g., myocardial infarction, stroke and arrhythmias) * Malignant hyperthermia (rare) * Death
72
what is malignant hyperthermia?
Increased body temperature (hyperthermia) Increased carbon dioxide production Tachycardia Muscle rigidity Acidosis Hyperkalaemia hypermetabolic response to anaesthesia
73
how is malignant hyperthermia treated?
dantrolene interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.
74
how do you perform a nutritional assessment?
ABCDE Anthropemetry = measurements for different components of the body Biochemistry = blood tests Clinical = symptoms theyre feeling and comorbidities Diet = energy, fluid and dietary requirements Environment = social and physical factors
75
what is rapid sequence induction/intubation?
used to gain control over the airway as quickly and safely as possible where a patient is intubated in an emergency scenario and detailed pre-planning is not possible. It is also used in non-emergency situations where the airway needs to be secured quickly to avoid aspiration, such as in patients with gastro-oesophageal reflux or pregnancy.
76
what is the triad of general anaesthesia?
hypnosis = used to make the patient unconscious. They can be either given intravenously or by inhalation. muscle relaxation = block the neuromuscular junction from working. Acetylcholine (the neurotransmitter) is released by the axon but is blocked from stimulating a response from the muscle. Muscle relaxants are given to relax and paralyse the muscles. This makes intubation and surgery easier. analgesia
77
what are the options for IV and inhaled hypnotic agents in general anaesthesia?
Intravenous options for a general anaesthetic include: * Propofol (the most commonly used) * Ketamine * Thiopental sodium (less common) * Etomidate (rarely used) Inhaled options for a general anaesthetic include: * Sevoflurane (the most commonly used) * Desflurane (less favourable as bad for the environment) * Isoflurane (very rarely used) * Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)
78
what are the 2 categories of muscle relaxants used in general anaesthesia?
* Depolarising (e.g., suxamethonium) Non-depolarising (e.g., rocuronium and atracurium)
79
what types of nutritional support techniques are there?
1. Food fortification- adding nutrients to food 2. Total enteral tube feeding- NG tube 3. Parenteral nutrition- Delivery of nutrition into the blood stream
80
what are the indications for food fortification?
1. intake of nutrient is below desirable level 2. food is still consumed in quantities that will make a significant contribution to diet
81
what are the indications for total enteral tube feeding?
patient who cannot tolerate adequate oral intake to meet metabolic demand
82
what are the indications for pareteral nutrition?
patients that have condition that impairs food intake, nutrient digestion or absorbtion e.g. short bowel syndorme, GI fistula, bowel obstruction, acute pancreatitis
83
when is GGT commonly raised?
after drinking alcohol
84
what do investigations show in pre-hepatic jaundice?
LFTs normal bilirubin high
85
what are some types of prehepatic jaundice?
gilberts syndrome haemolytic anaemia
86
what do investigations show in hepatic jaundice?
ALT and AST high released from breakdown of liver cells
87
what are some causes of hepatic jaundice?
viral hepatitis EBV CMV autoimmune drug toxicity alcohol hereditary diseases
88
what do investigations show in post hepatic jaundice?
GGT and ALP raised obstructive jaudice
89
what are some causes of post hepatic jaundice?
gall stones anything obstructing the biliary tree e.g cancers, pancreatic cancer biliary sclerosis
90
how do you assess for alcohol withdrawal?
CAGE questionairre CIWA score to assess for symptoms
91
what type of bacteria is h.pylori?
gram -ve rod shaped
92
what is the treatment for h.pylori?
2 antibiotics and a PPI
93
what drug is used in refeeding syndrome?
pabrinex
94
what is the first line therapy for ulcerative colitis?
IV hydrocortisone
95
what are some risk factors for GORD?
alcohol poor diet stress obesity
96
what factors require urgent upper GI investigation?
malena coffee ground vomit dysphagia weight loss >55
97
what are the treatments for GORD?
PPI antacids H2 antagonist lifestyle advice
98
what are some complications for GORD?
barrets oesophagus oesophageal adenocarcinoma strictures aspiration
99
what investigations should be done in a paracetemol overdose?
paracetemol levels LFTS (would increase transaminases - hepatic jaundice) renal function abg clotting factors albumin glucose
100
what is the initial treatment for a paracetamol overdose?
activated charcoal

PBLs (19 decks)

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