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PACES > Abdo > Flashcards

Abdo Flashcards

1
Q

6Fs of abdominal distension

A 
Fat
Fluid
Faeces
Flatus
Foetus
Fucking big masses
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2
Q

R subcostal scar name and procedures

A

Kocher scar

Open cholecystectomy

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3
Q

Rooftop scar procedures

A

UGI surgery
Liver transplant
Pancreatic surgery e.g. whipples

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4
Q

Mercedes-benz scar procedures

A

Oesophagectomy

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5
Q

Midline laparotomy scar procedures

A
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6
Q

Lanz/Gridiron scar procedures

A

Appendicectomy

Lanz = horizontal
Gridiron = Oblique
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7
Q

Rutherford Morrison scar procedures

A

Renal transplant

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8
Q

Pfannenstiel scar procedures

A

C-section

Total Abdominal Hysterectomy

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9
Q

Causes of ascites

A

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
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10
Q

Mx of ascites

A

Conservative
- Salt restriction

Medical

  • Spironolactone
  • SBP prophylaxis

Surgical

  • Ascitic drain (therapeutic paracentesis)
  • TIPSS
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11
Q

Causes of hepatomegaly

A

Infection

  • Hepatitis
  • CMV/EBV
  • Liver abcess

Infiltration

  • Amyloidosis
  • Sarcoidosis
  • Haemochromatosis

Blood

  • Lymphoma
  • Leukaemia

Biliary

  • PBC
  • PSC

Cancer

  • HCC
  • Hepatic adenoma

Congestion
- Budd Chiari syndrome

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12
Q

Extraintestinal features of IBD

A 
Aphthous ulcers
Pyoderma gangrenosum
Iritis (scleritis, episcleritis, anterior uveitis )
Erythema Nodosum
Sclerosing Cholangitis
Arthritis
C
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13
Q

Causes of massive splenomegaly

A

Malaria
CML
Myelofibrosis

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14
Q

Causes of splenomegaly

A

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
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15
Q

Signs of chronic stable liver disease

A

Hands

  • Leuconychia
  • Dupuytren’s contracture
  • Palmar erythema

Chest/abdomen

  • Spider naevi (>4)
  • Gynaecomastia
  • Caput medusae
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16
Q

Signs of decompensated liver disease

A

Jaundice
Ascites
Encephalopathy (asterixis, drowsiness, hyperventilation)

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17
Q

Causes of chronic liver disease/cirrhosis

A 
Alcoholic liver disease
Viral hepatitis
NAFLD
Autoimmune hepatitis
Haemochromatosis
Wilson's disease
A1-antitrypsin deficiency
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18
Q

Causes of portal hypertension

A

Liver cirrhosis
Portal vein thrombosis (Budd Chiari syndrome)
Schistosomiasis
Right Heart failure

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19
Q

Signs of portal hypertension

A

Oesophageal varices
Caput medusae
Haemorrhoids
Splenomegaly

20
Q

Ix for chronic liver disease

A 
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

21
Q

Mx of chronic liver disease

A

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
22
Q

Spectrum of liver disease

A

Fatty liver
Hepatitis
Cirrhosis: fibrotic change within the liver, leading to a loss of function and portal shunting

23
Q

Signs of renal disease/haemodialysis

A

AV fistula
Tesio line insertion scar
Rutherford Morrison scar

24
Q

Causes of palpable kidney

A

Renal cyst
Polycystic kidney disease
Renal tumour
Hydronephrosis

25
Q

Ileostomy features

A

Normally RLQ
Spouted
Liquid faeces in stoma bag
Can be end or loop (2 lumens)

26
Q

Urostomy + ileal conduit

A

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

27
Q

Colostomy features

A

Normally LLQ
Flush to the skin
Formed faeces in stoma bag

28
Q

Ileostomy indications

A

End Ileostomy
- Panproctocolectomy

Loop ileostomy
- Bowel rest after Anterior resection

29
Q

Mx of acute alcohol withdrawal

A

Chlordiazepoxide (dependent on CIWA score)
IV pabrinex and thiamine
Measure glucose (but don’t give as can precipitate Wernicke’s)

30
Q

How many spider naevi is abnormal? What are2 other causes?

A

> 5

COCP
Pregnancy

31
Q

Mx of decompensated liver disease

A

Relieve symptoms:
Lactulose
Spironolactone

Treat underlying cause definitively:
TIPS

32
Q

What is done in a TIPS procedure

A

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

33
Q

What is the Child Pugh score

A

Scoring system for determining mortality in patients with liver cirrhosis

Ascites
Encephalopathy
Bilirubin
INR
Albumin
34
Q

When would you consider SBP prophylaxis for ascites?

A

After first ep of SBP
After GI bleed
If hypoalbuminaemic

35
Q

RUQ pain differentials

A 
Biliary colic
Cholecystitis
Acute hepatitis
Basal pneumonia
Pancreatitis
36
Q

Epigastric pain differentials

A 
Pancreatitis 
Biliary colic/cholecystitis
Peptic ulcer disease
Inferior MI
Basal pneumonia
37
Q

Generalised abdo pain differentials

A

Medical
DKA
Gastroenteritis
Ischaemic colitis

Surgical
Peritonitis (SBP, perforation)
Toxic megacolon/Bowel obstruction

38
Q

Flank pain differentials

A

Nephrolithiasis (pyelonephritis)
Renal cyst rupture
ADPKD
Renal cell carcinoma

39
Q

Umbilical pain differentials

A 
Appendicitis (early)
AAA
Pancreatitis
Biliary colic
Bowel obstruction
40
Q

RIF pain differentials

A

Appendicitis
Gynae (ovarian torsion, cyst rupture, ectopic pregnancy)
Crohn’s colitis
Testicular torsion

41
Q

LIF pain differentials

A 
Diverticulitis
UC
Testicular torsion
Gynae stuff
UTI
42
Q
A 
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
43
Q

Diverticular disease Mx

A

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

44
Q

Peptic ulcer disease RFs

A 
H. pylori
Smoking 
NSAIDs
Alcohol 
Burns (Curling ulcers)
45
Q

Dysphagia systems Rx

A 
Cough (esp. after eating)
Chest pain
Heartburn
Vomiting
Halitosis
tiredness after eating 
FLAWS
46
Q

Oesophageal cancer

A

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)

PACES (13 decks)

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