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Sheff 91 core clinical problems > 61 Abdo pain, 62 - anorectal pain > Flashcards

61 Abdo pain, 62 - anorectal pain Flashcards

1
Q

Sx of peptic ulcer disease

A

Dull, burning, upper abdominal pain which wakes the patient up at night and is relieved by eating.

Belching, weight loss, poor appetite.

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2
Q

Association with peptic ulcer and Ix for this

A

H. Pylori infection (Urea breath test or stool antigen test)

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3
Q

Mx of h pylori

A

7d amoxicillin 1g plus clarithromycin 500mg plus lansoprazole 30mg BD (triple therapy)

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4
Q

Mx of normal peptic ulcers

A

Stop NSAID / Smoking

lansoprazole 2/12

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5
Q

Sx of cholangitis?

A

Jaundice, fever and RUQ pain. Rigors.

Usually associated with gallstones

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6
Q

Mx of cholangitis

A

Iv fluids
ceftriaxone + metronidazole

Endoscopy may relive obstruction

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7
Q

Seen on bloods with cholangitis

A

raised CRP and LFTs

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8
Q

Reynold’s pentad of obstructive ascending cholangitis

A 
Jaundice
Fever
Abdominal pain
Shock
Confusion

(bad)

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9
Q

Sx acute pancreatitis

A

upper abdo pain
fever
Nausea / vomit

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10
Q

Key Ix in acute pancreatitis

A

serum lipase / amylase

imaging for prognosis / cause

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11
Q

What is grey-turners sign

A

flank bruising in pancreatitis

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12
Q

Mx of acute pancreatitis

A

Iv fluids, oxygen, pain relief, Abx, nutrition

ERCP if gallstones present (this also warrants a cholecystectomy).

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13
Q

Causes of pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hyperthermia/hypercalcaemia
ERCP
Drugs
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14
Q

chonic pancreatitis sx

A

Pain in the upper abdomen, nausea and vomiting, steatorrhea, weight loss,

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15
Q

Ix for chronic pancreatitis

A

LFTs
amylase - not normally raised
Abdo US - gallstones

Imaging for diagnosis

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16
Q

Mx of chronic pancreatitis

A

Treat with lifestyle advice: stop drinking and smoking.

Pain relief.
Need pancreatic enzyme supplementation, corticosteroids if autoimmune

Screen for DM, osteoporosis, refer to dietician,

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17
Q

Flank pain with fever and rigors

A 
Renal colic (stones) 
check for UTI
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18
Q

Mx of colic

A

Treat pain, nausea and vomiting, push fluids.

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19
Q

Rfs for stones

A

dehydration, poor diet, obesity, avoid spinach, rhubarb, soy. Hypernatraemia,

20
Q

When to admit for stones

A

shocked, poor pain control, pregnant, dehydration due to vomiting, AKI, sepsis, failed treatment.

21
Q

Mx of stones

A

May pass spontaneously
Calcium channel blockers may facilitate this

Shock wave lithotripsy. Surgery if unsuitable.

22
Q

Usual bacteria causing pyelonephritis

A

bowel commensals: E Coli, Klebsiella,

23
Q

Sx of pyelonephritis

A

Fever, tachycardia, dysuria, rigors, nausea, vomiting

24
Q

complications of pyelonephritis

A

hydronephrosis pus around kidney, shock, aki

25
Q

Who gets admitted with pyelonephritis

A

dehydrated, feverish or shocked, pregnant, elderly, failed treatment.

26
Q

Mx of pyelonephritis

A

ciprofloxacin 500mg BD 7d.

Prior to this, obtain urine specimen for CandS.

Treat pain and fever with paracetamol.

Maintain full hydration.

27
Q

Usual cause of apendicitis

A

Calcified faeces blockage

28
Q

Sx of apendicitis

A

Generalised abdo pain, nausea, vomiting, decreased appetite, pain localises to RLQ when the head of the appendix presses on the peritoneum (McBurney’s point): rebound tenderness.

29
Q

Associations with IBS

A

depression, CFS, fibromyaldia and anxiety.

30
Q

Mx IBS

A

diet, stress relief, physical activity,

31
Q

Sx of mesenteric ischemia

A

Abdo pain after eating, weight loss, vomiting after eating, diarrhoea, metabolic acidosis.

32
Q

Rfs for mesenteric ischemia

A

AF, heart failure, renal failure, hypercoagulability,

33
Q

Dx of mesenteric ischemia ? Mx?

A

angiography

stenting or thrombolysis (heparin and warfarin

34
Q

What is intussusception ?

sx?

A

Bowel telescoping into itself.

Abdominal pain and cramping, nausea, vomiting (may be bilious) drawing up legs.
Red currant jelly stool.
Sausage shaped abdominal mass.

35
Q

Usual age intussusception? pathology?

A

First two years of life. Infection with rotavirus. Telescoping is normal at that age. Peyer’s patches (gut lymph tissue) expands and traps the segment of bowel much like a hernia.

36
Q

Mx intussusception

A

Air enema confirms and reduces condition.

Can be further reduced with laproscopy.

37
Q

What are haemorrhoids?

A

vascular structures in the anal canal which may become swollen or inflamed.

38
Q

Sx haemorrhoids? rf?

A

bright red blood in stool

constipation
pregnancy

39
Q

Mx of haemorrhoids

A

Increase fibre,
NSAIDs for pain.

Management usually conservative but can be ligated, which leaves a skin tag behind.

40
Q

Sx of anal fissures ?

A

pain on deification

bright red blood on stool

41
Q

Mx anal fissures

A

Lifestyle changes.
Simple analgesia.
Rectal GTN if not healing after 6 weeks.

42
Q

Sx anal cancer

A

Rectal bleeding, itching and pain, lumps, mucus discharge, incontinence, sensation of incomplete emptying.

43
Q

Key Ix in anal cancer

A

scope and biopsy

44
Q

Mx of anal cancer

A

Chemo, radio and surgical resection, which may require the formation of a colostomy

45
Q

What is a pilonidal abscess ? sx?

A

Cyst containing hair or skin debris near cleft of buttocks. Ingrown hair.

Very painful, pus.

46
Q

Rfs for pilonidal abscess

A

sedentary life
obese
hirtuism

47
Q

Sx of pilonidal abscess

A

surgical

Sheff 91 core clinical problems (51 decks)

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