Abdo Flashcards
1
Q
Smoking helps with which IBD
A
UC
2
Q
No bowel sounds
A
Peritonitis
SBP
GI perforation
3
Q
SBP organisms
A
E. coli
Klebsiella
Strep
4
Q
In what can you get portal HTN
A
SBP due to worsening cirrhosis of the liver
5
Q
Ix signs in GI perforation
A
Pneumoperitoneum
Riglers sign
Loss of lover dullness
6
Q
What electrolyte abnormality can you get in acute pancreatitis
A
Hypocalcaemia
7
Q
Severity score for acute pancreatitis
A
Modified Glasgow coma scale
8
Q
Rosvigs sign and when do you get it
A
LIF palpation causes RIF pain
Acute appendicitis
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
10
Q
Bowel obstruction management
A
Drip and suck
Surgery
11
Q
Caecal volvulus
Sigmoid volvulus
A
Fetal LIF
Coffee bean in RIF
12
Q
Mesenteric Ischemia triad
A
1 acute severe abdo pain
- Normal abdo exam
- Hypovolemic shock
13
Q
Gasless abdomen on X-RAY
When?
What else would you find?
A
Acute mesenteric Ichemia
Increased WCC and metabolic acidosis
14
Q
Ischemic colitis can lead to what?
A
Gangrenous colitis
15
Q
IX for Ischemic colitis
A
Colonoscopy and biopsy
Barium enema = thumb printing
16
Q
Chronic mesenteric Ischemia triad
A
Colicky post prandial pain
Weight loss
Upper abdominal bruits
PMH. Vascular disease
17
Q
In acute pancreatitis what suggests the cause is alcohol?
A
Increased lipase
18
Q
Rectal bleeding
Painful, mixed with stool
A
Colitis
19
Q
Rectal bleeding
Painless
Streaked with blood
A
Rectal tumor
20
Q
Rectal bleeding
painless
Mixed with stool
A
Colitis or colon tumor
21
Q
Rectal bleeding
Painful
On the paper
A
Anal fissure
22
Q
Rectal bleeding
Painless on paper
A
Haemorrhoids
23
Q
Rectal bleeding
Painless
Blood in the pan
A
Haemorrhoids
Colitis
Diverticular disease
24
Q
Rectal bleeding
Painful
Blood in the pain
A
Colitis
25
Rectal bleeding
Painful
Streaked with stool
Anal tumor
26
Symptoms after what time?
- campylobacter
- salmonella
- campylobacter: 1-5 days post ingestion
| - salmonella: -12-72hrs post ingestion
27
What is Budd Chiari syndrome?
| Triad.
Hepatic vein outflow obstruction
1. Abdominal pain
2. Hepatomegaly
3. Ascities
28
P ANCA positive
UC
29
Cobblestone and rose thorn appearance
Crohns on barium follow through
30
Angular stomatitis and dermatitis herpetiformis presents in what?
What Ix do you want to do?
Coeliac
| TTG and AntiEMA
31
UC severity index
Truelove and Witts
32
Maintaining remission in UC and Crohns
UC: 1. 5ASA - mesalazine
2. +/- mercaptopurine or azathioprine
Crohns:
Monotherapy eg mercaptopurine or azathioprine
33
Crohns treatment
(C for Crohns and then As)
- stop smoking
1. Corticosteroids
2. 5ASA
3. Azathioprine or mercaptopurine
4. Anti TNF
34
UC treatment for inducing remission
Mild/moderate.
1. Topical or oral 5ASA
2. +/- oral beclamethasone
3. + 6wks of prednisolone oral
4. ++ 6 wks of tarcolimus oral
Severe
IV steroids and fluids
IV cyclosporin and/or surgery
35
Hep B Px
Flu like symptoms
Rash
Lymphadenopathy
36
Which hepatitis is not independent
Hep D needs hep B to act
37
Tx for chronic Hep B infection
Peginterferon alpha +/- tonofovir
38
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Primary sclerosing cholangitis
1. What is it?
2. Ix
3. Associated with what?
4 AMA?
```
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
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Primary Billary Cirrhosis
1. What is it?
2. Ix
3. Associated with what?
4 AMA?
```
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
Allgrove syndrome is associated with what?
Achalasia
41
Dysphasia for fluids and solids at the same time
What is this condition a RF for?
What Ix?
Achalasia
Aspiration pneumonia
CXR and barium swallow showing bird beak
42
Psoas sign
When lying on left side and extending hip you get pain
| In appendicitis
43
Copes sign
Appendicitis
| Pain in flexion and internal rotation of right hip. If appendix in close rotation to obturator interning
44
McBurneys sign
RLQ tenderness
45
Autoimmune hepatitis is characterised by what?
1. Circulating autoantibodies with increased serum globulin
2. Inflammatory changes on liver histology
3. Favourable response to immunosuppressive treatment
46
Management of coeliac disease
1. Long term
2. Coeliac crises
1. Gluten free diet, calcium, iron and vit D supplementation
2. Crises:
- rehydration and correction if electrolyte abnormalities
- adjunct: corticosteroids
47
Complications of coeliac disease
Osteoporosis
Dermatitis herpetiformis
Malignancy
Recurrent pancreatitis
48
Charcots triad.
| Reynolds Pentad
1. Jaundice
2. Fever/rigors
3. RUQ pain
4. CNS signs/confusion
5. Low bp
49
Nocturnal asthma
GORD
| Hence can get wheeze on chest examination in GORD
50
Mallory Weiss Risk Factors
- chronic cough
- recurrent vomittung
- hiatus hernia
- alcohol use heavy
- retching during endoscopy
51
IgM antibodies suggest what
Hepatitis A
52
What might a hiatus hernia present with?
Heartburn
Flatulence
Symptomatic gastroesophageal reflux
Difficulty swallowing
53
What are hiatus hernias associated with?
Barrett's Oesophagus
| Oesophageal adenocarcinoma
54
If suspect infectious abdo pathology ask about these 3 things
Travel / contaminated water
Contact with individuals with similar symptoms
Immunocompromised or recent ABx treatment
55
pANCA positive
UC
56
What can mark the severity of UC
Fecal calprotectin
57
Ileus OE
No pain and absent bowel sounds
58
IBS irritable bowel syndrome diagnosis is based on
Rome criteria
59
Liver failure is defined by
Jaundice
Encephalopathy
Coagulopathy
60
Defining liver failure
Hyper acute: jaundice with encephalopathy within 7 days
Acute: 1-4 wks
Subacute: 5-26 wks
61
Tx of liver failure
1. Resuscitation
2. Treat the cause!
3. Manage and prevent complications eg prophylactic Abx
62
Anti mitochondrial antibodies
Primary biliary cirrhosis - typically middle aged women. Accidental finding due to raised alkaline phosphatase
63
Wilson's disease symptoms
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
Wilsons on examination
```
Disdiadochokinesis
Hepatosplenomegaly
Jaundice
Kayser fleicher rings
Sunflower cataract (copper in lens seen with slit lamp)
```
65
Wilsons investigations
Decreased serum caeruloplasmin
66
Serum markers of liver cell damage
- Alanine transaminase (ALT)
- Aspartate transaminase (AST)
- Alkaline phosphatase (ALP)
- Gamma glutamyl transferase (GGT)
67
Serum markers of liver function
Albumin
Pro-thrombin time
Bilirubin
68
When is GGT raised
Elevated in chronic alcohol use (will also have raised AST:ALT)
Also raised in bile duct disease and hepatic metastasis (raised ALP)
69
Sources of ALP
bone, s intestine, kidney and placenta
70
ALP is elevated in
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
Causes of low albumin
Low production (chronic liver disease, malnutrition)
Loss (gut, kidney)
Sepsis (“3rd spacing”)
72
Alpha-fetoprotein
HCC
| Raised in pregnancy and testicular cancer
73
Hepatitis B serology:
| HBsAg
Vaccine contains this
| or suggests Acute OR Chronic Infection
74
Hepatitis B serology:
| HBsAb
produced if
- immunized
- had previous exposure to Hep B
75
Hepatitis B serology:
| HbcAb
not present if have been immunized before
| -usually the second thing to increase post acute infection (4weeks)
76
Hepatitis B serology:
| HBeAg
indicates high level of infection
| E for EXTREME
77
Hepatitis B serology:
| IgM anti-HBc
Acute infection
78
Hepatitis B serology:
| Total Anti-HBc
Previous / Ongoing infection
79
Side effects of alendronate
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
Courvoisier’s law
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
Cholangiocarcinoma is an adenocarcinoma of the biliary tree and is associated with...
ulcerative colitis
primary sclerosing cholangitis
and to a lesser extent Crohn disease.
82
Haemochromatosis is an autosomal recessive disorder of increased dietary absorption of iron. Most cases affect Irish males over 40 years of age.
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
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.
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.
