Abdo Flashcards
6Fs of abdominal distension
Fat Fluid Faeces Flatus Foetus Fucking big masses
R subcostal scar name and procedures
Kocher scar
Open cholecystectomy
Rooftop scar procedures
UGI surgery
Liver transplant
Pancreatic surgery e.g. whipples
Mercedes-benz scar procedures
Oesophagectomy
Midline laparotomy scar procedures
Lanz/Gridiron scar procedures
Appendicectomy
Lanz = horizontal Gridiron = Oblique
Rutherford Morrison scar procedures
Renal transplant
Pfannenstiel scar procedures
C-section
Total Abdominal Hysterectomy
Causes of ascites
Transudative (SAAG >11)
- Hypoalbuminaemia (liver disease)
- Nephrotic syndrome
- HF
Exudative (SAAG <11)
- Infection e.g. SBP
- Inflammation e.g. pancreatitis
- Malignancy e.g. Ovarian cancer
Mx of ascites
Conservative
- Salt restriction
Medical
- Spironolactone
- SBP prophylaxis
Surgical
- Ascitic drain (therapeutic paracentesis)
- TIPSS
Causes of hepatomegaly
Infection
- Hepatitis
- CMV/EBV
- Liver abcess
Infiltration
- Amyloidosis
- Sarcoidosis
- Haemochromatosis
Blood
- Lymphoma
- Leukaemia
Biliary
- PBC
- PSC
Cancer
- HCC
- Hepatic adenoma
Congestion
- Budd Chiari syndrome
Extraintestinal features of IBD
Aphthous ulcers Pyoderma gangrenosum Iritis (scleritis, episcleritis, anterior uveitis ) Erythema Nodosum Sclerosing Cholangitis Arthritis C
Causes of massive splenomegaly
Malaria
CML
Myelofibrosis
Causes of splenomegaly
Infections
- Bacterial e.g. TB, IE
- Parasitic e.g. Malaria
- Viral e.g. EBV
Haematological
- Lymphoma
- Leukaemia
Inflammatory/autoimmune disease
- RA
- Sarcoidosis
- SLE
Liver
- Portal hypertension
- Cirrhosis
Signs of chronic stable liver disease
Hands
- Leuconychia
- Dupuytren’s contracture
- Palmar erythema
Chest/abdomen
- Spider naevi (>4)
- Gynaecomastia
- Caput medusae
Signs of decompensated liver disease
Jaundice
Ascites
Encephalopathy (asterixis, drowsiness, hyperventilation)
Causes of chronic liver disease/cirrhosis
Alcoholic liver disease Viral hepatitis NAFLD Autoimmune hepatitis Haemochromatosis Wilson's disease A1-antitrypsin deficiency
Causes of portal hypertension
Liver cirrhosis
Portal vein thrombosis (Budd Chiari syndrome)
Schistosomiasis
Right Heart failure
Signs of portal hypertension
Oesophageal varices
Caput medusae
Haemorrhoids
Splenomegaly
Ix for chronic liver disease
FBC, U&E, LFTs CRP Lipid profile Clotting Liver screen (Hepatitis serology, antibodies (ASMA, Anti-LKM, AMA), Caeruloplasmin, AFP, Ferritin and transferrin)
USS abdo
Liver biopsy
Mx of chronic liver disease
Conservative
- Alcohol abstinence
- Nutrition input and vitamin supplements
- Weight loss
- Avoid hepatotoxic meds
Medical
- Diuretics (if ascites present)
- SBP prophylaxis (ciprofloxacin + propranolol)
- Variceal prophylaxis
Surgery
- TIPSS (for portal hypertension)
- Liver transplant
Spectrum of liver disease
Fatty liver
Hepatitis
Cirrhosis: fibrotic change within the liver, leading to a loss of function and portal shunting
Signs of renal disease/haemodialysis
AV fistula
Tesio line insertion scar
Rutherford Morrison scar
Causes of palpable kidney
Renal cyst
Polycystic kidney disease
Renal tumour
Hydronephrosis
Ileostomy features
Normally RLQ
Spouted
Liquid faeces in stoma bag
Can be end or loop (2 lumens)
Urostomy + ileal conduit
Indication: Post-cystectomy for bladder cancer
Ileum is used to allow drainage of urine from ureters
Appears similar to ileostomy but with urine in stoma bag
Colostomy features
Normally LLQ
Flush to the skin
Formed faeces in stoma bag
Ileostomy indications
End Ileostomy
- Panproctocolectomy
Loop ileostomy
- Bowel rest after Anterior resection
Mx of acute alcohol withdrawal
Chlordiazepoxide (dependent on CIWA score)
IV pabrinex and thiamine
Measure glucose (but don’t give as can precipitate Wernicke’s)
How many spider naevi is abnormal? What are2 other causes?
> 5
COCP
Pregnancy
Mx of decompensated liver disease
Relieve symptoms:
Lactulose
Spironolactone
Treat underlying cause definitively:
TIPS
What is done in a TIPS procedure
Using a catheter and guidewire passed through the IVC and into the hepatic vein, a shunt is created directly between a branch of the hepatic portal vein and the hepatic vein, bypassing the liver
What is the Child Pugh score
Scoring system for determining mortality in patients with liver cirrhosis
Ascites Encephalopathy Bilirubin INR Albumin
When would you consider SBP prophylaxis for ascites?
After first ep of SBP
After GI bleed
If hypoalbuminaemic
RUQ pain differentials
Biliary colic Cholecystitis Acute hepatitis Basal pneumonia Pancreatitis
Epigastric pain differentials
Pancreatitis Biliary colic/cholecystitis Peptic ulcer disease Inferior MI Basal pneumonia
Generalised abdo pain differentials
Medical
DKA
Gastroenteritis
Ischaemic colitis
Surgical
Peritonitis (SBP, perforation)
Toxic megacolon/Bowel obstruction
Flank pain differentials
Nephrolithiasis (pyelonephritis)
Renal cyst rupture
ADPKD
Renal cell carcinoma
Umbilical pain differentials
Appendicitis (early) AAA Pancreatitis Biliary colic Bowel obstruction
RIF pain differentials
Appendicitis
Gynae (ovarian torsion, cyst rupture, ectopic pregnancy)
Crohn’s colitis
Testicular torsion
LIF pain differentials
Diverticulitis UC Testicular torsion Gynae stuff UTI
RUQ pain (Biliary colic/Cholecystitis/Ascending cholangitis/Pancreatitis/hepatitis) - Basic obs, bloods (FBC, U+E, LFTs, Amylase, G+S, X-match), Imaging (US abdo, MRCP, ERCP)
Epigastric (Pancreatitis/Biliary Colic/Cholecystitis/ascending cholangitis/basal pneumonia/MI)
- Basic obs, ECG, bloods (FBC, U+E, LFTs, Amylase, blood cultures, G+S, X-match), Imaging (US abdo),
Generalised Abdo pain
Basic Obs, stool culture, bloods (FBC, U+E, LFTs, Blood cultures, VBG, G+S, X-match), Ascitic tap
Flank pain (Renal colic/PKD/RCC) Basic obs, bloods (FBC, U+E, LFTs, G+S, X-match), urine dip + pregnancy test, Imaging (CT KUB, TVUSS)
IF pain (Testicular torsion/Gynae stuff/Appendicitis/Diverticulitis/Renal colic/IBD) - Basic obs, bloods (FBC, U+E, LFTs), urine dip + pregnancy test, TVUSS/exploratory laparotomy
Diverticular disease Mx
Conservative
- Diet (adequate fibre intake, good hydration)
- Bulk-forming laxatives
Diverticulitis
PO co-amoxiclav if systemically unwell
Diverticular abscess: IV abx and percutaneous drainage
Peritonitis: Laparotomy for lavage and IV abx
Surgery
Resection with defunctioning stoma
Hartmann’s procedure
Peptic ulcer disease RFs
H. pylori Smoking NSAIDs Alcohol Burns (Curling ulcers)
Dysphagia systems Rx
Cough (esp. after eating) Chest pain Heartburn Vomiting Halitosis tiredness after eating FLAWS
Oesophageal cancer
Barium swallow/endoscopy + biopsy
CT abdo pelvis
Fitness for surgery tests
Neoadjuvant chemotherapy to shrink tumour
Oesophagectomy (pull some of stomach up into chest, can still eat afterwards but should be on liquid/soft food enteral feeds at least to start with)
Endoscopic mucosal resection (most patients unsuitable for surgery)
