61 Abdo pain, 62 - anorectal pain Flashcards
Sx of peptic ulcer disease
Dull, burning, upper abdominal pain which wakes the patient up at night and is relieved by eating.
Belching, weight loss, poor appetite.
Association with peptic ulcer and Ix for this
H. Pylori infection (Urea breath test or stool antigen test)
Mx of h pylori
7d amoxicillin 1g plus clarithromycin 500mg plus lansoprazole 30mg BD (triple therapy)
Mx of normal peptic ulcers
Stop NSAID / Smoking
lansoprazole 2/12
Sx of cholangitis?
Jaundice, fever and RUQ pain. Rigors.
Usually associated with gallstones
Mx of cholangitis
Iv fluids
ceftriaxone + metronidazole
Endoscopy may relive obstruction
Seen on bloods with cholangitis
raised CRP and LFTs
Reynold’s pentad of obstructive ascending cholangitis
Jaundice Fever Abdominal pain Shock Confusion
(bad)
Sx acute pancreatitis
upper abdo pain
fever
Nausea / vomit
Key Ix in acute pancreatitis
serum lipase / amylase
imaging for prognosis / cause
What is grey-turners sign
flank bruising in pancreatitis
Mx of acute pancreatitis
Iv fluids, oxygen, pain relief, Abx, nutrition
ERCP if gallstones present (this also warrants a cholecystectomy).
Causes of pancreatitis
I GET SMASHED
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hyperthermia/hypercalcaemia ERCP Drugs
chonic pancreatitis sx
Pain in the upper abdomen, nausea and vomiting, steatorrhea, weight loss,
Ix for chronic pancreatitis
LFTs
amylase - not normally raised
Abdo US - gallstones
Imaging for diagnosis
Mx of chronic pancreatitis
Treat with lifestyle advice: stop drinking and smoking.
Pain relief.
Need pancreatic enzyme supplementation, corticosteroids if autoimmune
Screen for DM, osteoporosis, refer to dietician,
Flank pain with fever and rigors
Renal colic (stones) check for UTI
Mx of colic
Treat pain, nausea and vomiting, push fluids.
Rfs for stones
dehydration, poor diet, obesity, avoid spinach, rhubarb, soy. Hypernatraemia,
When to admit for stones
shocked, poor pain control, pregnant, dehydration due to vomiting, AKI, sepsis, failed treatment.
Mx of stones
May pass spontaneously
Calcium channel blockers may facilitate this
Shock wave lithotripsy. Surgery if unsuitable.
Usual bacteria causing pyelonephritis
bowel commensals: E Coli, Klebsiella,
Sx of pyelonephritis
Fever, tachycardia, dysuria, rigors, nausea, vomiting
complications of pyelonephritis
hydronephrosis pus around kidney, shock, aki
Who gets admitted with pyelonephritis
dehydrated, feverish or shocked, pregnant, elderly, failed treatment.
Mx of pyelonephritis
ciprofloxacin 500mg BD 7d.
Prior to this, obtain urine specimen for CandS.
Treat pain and fever with paracetamol.
Maintain full hydration.
Usual cause of apendicitis
Calcified faeces blockage
Sx of apendicitis
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.
Associations with IBS
depression, CFS, fibromyaldia and anxiety.
Mx IBS
diet, stress relief, physical activity,
Sx of mesenteric ischemia
Abdo pain after eating, weight loss, vomiting after eating, diarrhoea, metabolic acidosis.
Rfs for mesenteric ischemia
AF, heart failure, renal failure, hypercoagulability,
Dx of mesenteric ischemia ? Mx?
angiography
stenting or thrombolysis (heparin and warfarin
What is intussusception ?
sx?
Bowel telescoping into itself.
Abdominal pain and cramping, nausea, vomiting (may be bilious) drawing up legs.
Red currant jelly stool.
Sausage shaped abdominal mass.
Usual age intussusception? pathology?
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.
Mx intussusception
Air enema confirms and reduces condition.
Can be further reduced with laproscopy.
What are haemorrhoids?
vascular structures in the anal canal which may become swollen or inflamed.
Sx haemorrhoids? rf?
bright red blood in stool
constipation
pregnancy
Mx of haemorrhoids
Increase fibre,
NSAIDs for pain.
Management usually conservative but can be ligated, which leaves a skin tag behind.
Sx of anal fissures ?
pain on deification
bright red blood on stool
Mx anal fissures
Lifestyle changes.
Simple analgesia.
Rectal GTN if not healing after 6 weeks.
Sx anal cancer
Rectal bleeding, itching and pain, lumps, mucus discharge, incontinence, sensation of incomplete emptying.
Key Ix in anal cancer
scope and biopsy
Mx of anal cancer
Chemo, radio and surgical resection, which may require the formation of a colostomy
What is a pilonidal abscess ? sx?
Cyst containing hair or skin debris near cleft of buttocks. Ingrown hair.
Very painful, pus.
Rfs for pilonidal abscess
sedentary life
obese
hirtuism
Sx of pilonidal abscess
surgical
