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Abdo Flashcards

1
Q

Smoking helps with which IBD

A

UC

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2
Q

No bowel sounds

A

Peritonitis
SBP
GI perforation

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3
Q

SBP organisms

A

E. coli
Klebsiella
Strep

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4
Q

In what can you get portal HTN

A

SBP due to worsening cirrhosis of the liver

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5
Q

Ix signs in GI perforation

A

Pneumoperitoneum
Riglers sign
Loss of lover dullness

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6
Q

What electrolyte abnormality can you get in acute pancreatitis

A

Hypocalcaemia

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7
Q

Severity score for acute pancreatitis

A

Modified Glasgow coma scale

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8
Q

Rosvigs sign and when do you get it

A

LIF palpation causes RIF pain

Acute appendicitis

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9
Q

Causes of obstruction

A
  • outside of bowel: volvulus, adhesions, hernias
  • within the bowel wall: tumor or Crohns
  • inside the lumen: gall stone Ileus
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10
Q

Bowel obstruction management

A

Drip and suck

Surgery

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11
Q

Caecal volvulus

Sigmoid volvulus

A

Fetal LIF

Coffee bean in RIF

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12
Q

Mesenteric Ischemia triad

A

1 acute severe abdo pain

  1. Normal abdo exam
  2. Hypovolemic shock
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13
Q

Gasless abdomen on X-RAY
When?
What else would you find?

A

Acute mesenteric Ichemia

Increased WCC and metabolic acidosis

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14
Q

Ischemic colitis can lead to what?

A

Gangrenous colitis

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15
Q

IX for Ischemic colitis

A

Colonoscopy and biopsy

Barium enema = thumb printing

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16
Q

Chronic mesenteric Ischemia triad

A

Colicky post prandial pain
Weight loss
Upper abdominal bruits

PMH. Vascular disease

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17
Q

In acute pancreatitis what suggests the cause is alcohol?

A

Increased lipase

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18
Q

Rectal bleeding

Painful, mixed with stool

A

Colitis

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19
Q

Rectal bleeding
Painless
Streaked with blood

A

Rectal tumor

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20
Q

Rectal bleeding
painless
Mixed with stool

A

Colitis or colon tumor

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21
Q

Rectal bleeding
Painful
On the paper

A

Anal fissure

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22
Q

Rectal bleeding

Painless on paper

A

Haemorrhoids

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23
Q

Rectal bleeding
Painless
Blood in the pan

A

Haemorrhoids
Colitis
Diverticular disease

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24
Q

Rectal bleeding
Painful
Blood in the pain

A

Colitis

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25
Q

Rectal bleeding
Painful
Streaked with stool

A

Anal tumor

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26
Q

Symptoms after what time?

  • campylobacter
  • salmonella
A
  • campylobacter: 1-5 days post ingestion

- salmonella: -12-72hrs post ingestion

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27
Q

What is Budd Chiari syndrome?

Triad.

A

Hepatic vein outflow obstruction

  1. Abdominal pain
  2. Hepatomegaly
  3. Ascities
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28
Q

P ANCA positive

A

UC

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29
Q

Cobblestone and rose thorn appearance

A

Crohns on barium follow through

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30
Q

Angular stomatitis and dermatitis herpetiformis presents in what?
What Ix do you want to do?

A

Coeliac

TTG and AntiEMA

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31
Q

UC severity index

A

Truelove and Witts

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32
Q

Maintaining remission in UC and Crohns

A

UC: 1. 5ASA - mesalazine
2. +/- mercaptopurine or azathioprine

Crohns:
Monotherapy eg mercaptopurine or azathioprine

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33
Q

Crohns treatment

A

(C for Crohns and then As)

  • stop smoking
    1. Corticosteroids
    2. 5ASA
    3. Azathioprine or mercaptopurine
    4. Anti TNF
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34
Q

UC treatment for inducing remission

A

Mild/moderate.

  1. Topical or oral 5ASA
  2. +/- oral beclamethasone
    • 6wks of prednisolone oral
  4. ++ 6 wks of tarcolimus oral

Severe
IV steroids and fluids
IV cyclosporin and/or surgery

35
Q

Hep B Px

A

Flu like symptoms
Rash
Lymphadenopathy

36
Q

Which hepatitis is not independent

A

Hep D needs hep B to act

37
Q

Tx for chronic Hep B infection

A

Peginterferon alpha +/- tonofovir

38
Q 
Primary sclerosing cholangitis 
1. What is it?
2. Ix
3. Associated with what? 
4 AMA?
A

Primary sclerosing cholangitis
1. What is it? Non malignant, non bacterial inflammation resulting in fibrosis and strictures
2. Ix: MRCP/ERCP and biopsy –> beading of billary tree
3. Associated with what? UC, HIV and retroperitoneal
fibrosis.
4 AMA? Negative

Primary sclerosing cholangitis is a risk factor for developing cholangiocarcinoma (affects at least 10%).

39
Q 
Primary Billary Cirrhosis 
1. What is it?
2. Ix
3. Associated with what? 
4 AMA?
A

Primary Billary Cirrhosis
1. What is it? AI condition resulting in cholestasis, cirrhosis, portal HTN
2. Ix. Increased IgM, TSH, cholesterol
Definitive diagnosis is made by liver biopsy
3. Associated with what? Thyroid disease, systemic sclerosis and RhA, Srojens
4 AMA? Positive

40
Q

Allgrove syndrome is associated with what?

A

Achalasia

41
Q

Dysphasia for fluids and solids at the same time
What is this condition a RF for?
What Ix?

A

Achalasia
Aspiration pneumonia
CXR and barium swallow showing bird beak

42
Q

Psoas sign

A

When lying on left side and extending hip you get pain

In appendicitis

43
Q

Copes sign

A

Appendicitis

Pain in flexion and internal rotation of right hip. If appendix in close rotation to obturator interning

44
Q

McBurneys sign

A

RLQ tenderness

45
Q

Autoimmune hepatitis is characterised by what?

A
  1. Circulating autoantibodies with increased serum globulin
  2. Inflammatory changes on liver histology
  3. Favourable response to immunosuppressive treatment
46
Q

Management of coeliac disease

  1. Long term
  2. Coeliac crises
A
  1. Gluten free diet, calcium, iron and vit D supplementation
  2. Crises:
    - rehydration and correction if electrolyte abnormalities
    - adjunct: corticosteroids
47
Q

Complications of coeliac disease

A

Osteoporosis
Dermatitis herpetiformis
Malignancy
Recurrent pancreatitis

48
Q

Charcots triad.

Reynolds Pentad

A
  1. Jaundice
  2. Fever/rigors
  3. RUQ pain
  4. CNS signs/confusion
  5. Low bp
49
Q

Nocturnal asthma

A

GORD

Hence can get wheeze on chest examination in GORD

50
Q

Mallory Weiss Risk Factors

A
  • chronic cough
  • recurrent vomittung
  • hiatus hernia
  • alcohol use heavy
  • retching during endoscopy
51
Q

IgM antibodies suggest what

A

Hepatitis A

52
Q

What might a hiatus hernia present with?

A

Heartburn
Flatulence
Symptomatic gastroesophageal reflux
Difficulty swallowing

53
Q

What are hiatus hernias associated with?

A

Barrett’s Oesophagus

Oesophageal adenocarcinoma

54
Q

If suspect infectious abdo pathology ask about these 3 things

A

Travel / contaminated water
Contact with individuals with similar symptoms
Immunocompromised or recent ABx treatment

55
Q

pANCA positive

A

UC

56
Q

What can mark the severity of UC

A

Fecal calprotectin

57
Q

Ileus OE

A

No pain and absent bowel sounds

58
Q

IBS irritable bowel syndrome diagnosis is based on

A

Rome criteria

59
Q

Liver failure is defined by

A

Jaundice
Encephalopathy
Coagulopathy

60
Q

Defining liver failure

A

Hyper acute: jaundice with encephalopathy within 7 days
Acute: 1-4 wks
Subacute: 5-26 wks

61
Q

Tx of liver failure

A
  1. Resuscitation
  2. Treat the cause!
  3. Manage and prevent complications eg prophylactic Abx
62
Q

Anti mitochondrial antibodies

A

Primary biliary cirrhosis - typically middle aged women. Accidental finding due to raised alkaline phosphatase

63
Q

Wilson’s disease symptoms

A

Liver disease in children’s: hepatitis, jaundice, easy bruising, variceal bleed
CNS signs in adults: tremor, dysarthria, dysphasia
Mood: depression or mania
Decreased memory, quick to anger

64
Q

Wilsons on examination

A 
Disdiadochokinesis
Hepatosplenomegaly 
Jaundice 
Kayser fleicher rings 
Sunflower cataract (copper in lens seen with slit lamp)
65
Q

Wilsons investigations

A

Decreased serum caeruloplasmin

66
Q

Serum markers of liver cell damage

A
  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Alkaline phosphatase (ALP)
  • Gamma glutamyl transferase (GGT)
67
Q

Serum markers of liver function

A

Albumin
Pro-thrombin time
Bilirubin

68
Q

When is GGT raised

A

Elevated in chronic alcohol use (will also have raised AST:ALT)

Also raised in bile duct disease and hepatic metastasis (raised ALP)

69
Q

Sources of ALP

A

bone, s intestine, kidney and placenta

70
Q

ALP is elevated in

A

Liver isoenzyme markedly elevated if obstructive jaundice or bile duct damage

Less elevated in viral hepatitis or alcoholic liver disease i.e. hepatocyte damage

71
Q

Causes of low albumin

A

Low production (chronic liver disease, malnutrition)
Loss (gut, kidney)
Sepsis (“3rd spacing”)

72
Q

Alpha-fetoprotein

A

HCC

Raised in pregnancy and testicular cancer

73
Q

Hepatitis B serology:

HBsAg

A

Vaccine contains this

or suggests Acute OR Chronic Infection

74
Q

Hepatitis B serology:

HBsAb

A

produced if

  • immunized
  • had previous exposure to Hep B
75
Q

Hepatitis B serology:

HbcAb

A

not present if have been immunized before

-usually the second thing to increase post acute infection (4weeks)

76
Q

Hepatitis B serology:

HBeAg

A

indicates high level of infection

E for EXTREME

77
Q

Hepatitis B serology:

IgM anti-HBc

A

Acute infection

78
Q

Hepatitis B serology:

Total Anti-HBc

A

Previous / Ongoing infection

79
Q

Side effects of alendronate

A

oesophagitis, oesophageal erosions, oesophageal ulcers and oesophageal strictures

To avoid this, the exposure of alendronate to the oesophagus should be minimised.
First, alendronate should be avoided in disorders that delay oesophageal emptying (e.g. strictures) and used cautiously in patients with dysphagia or
reflux.
Secondly, it should be taken upright so that gravity reduces transit time and reflux.
Thirdly, by taking at least half an hour before any food,
the chances of any alendronate refluxing into the oesophagus are reduced further.
Fourthly, taking with lots of water should wash the alendronate through the oesophagus as swiftly as possible.

80
Q

Courvoisier’s law

A

Courvoisier’s law suggests that in the presence of jaundice an enlarged gallbladder is not due to gallstones, as a gallbladder with stones is chronically fibrosed
and therefore incapable of enlargement.

81
Q

Cholangiocarcinoma is an adenocarcinoma of the biliary tree and is associated with…

A

ulcerative colitis
primary sclerosing cholangitis
and to a lesser extent Crohn disease.

82
Q

Haemochromatosis is an autosomal recessive disorder of increased dietary absorption of iron. Most cases affect Irish males over 40 years of age.

A

There is systemic iron deposition, for example in the liver (cirrhosis), pancreas (diabetes), heart (cardiac failure) and skin (tanned appearance).

The diagnosis is confirmed by liver biopsy, which shows iron deposition with liver fibrosis and cirrhosis. Treatment is by weekly venesection.

83
Q

Infectious mononucleosis (glandular fever) is a self-limiting illness caused by Epstein–Barr virus. It is most common in teenagers and young adults, and presents with malaise, fevers, sore throat and lymphadenopathy. Hepatosplenomegaly may be found on examination.

A

Treatment is symptomatic. Remember that ampicillin and amoxicillin must not be given to anyone suspected of having infectious mononucleosis as they can precipitate a widespread rash.

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