Abdo Flashcards
liver disease - on examination
clubbing - esp primary biliary cirrhosis palmar erythema dupuytren's spider naevi gynaecomastia testicular atrophy
signs of liver cell failure
jaundice leuconychia bruising ascites encephalopathy
signs of portal HTN
varices
ascites
splenomegaly
caput medusae, with blood flow down the abdo below umbilicus
causes of ascites
cirrhosis - from portal HTN hypoalbuminaemia peritoneal mets heart failure hepatic vein thrombosis TB ovarian tumour
encephalopathy - presentation
flap
confusion + irritability
convulsions
coma
stoma examination - where are a colostomy and ileostomy usually situated?
colostomy - usually LIF
ileostomy - usually RIF
how can you tell if a stoma is a colostomy or ileostomy?
spout - ileostomy
flush - colostomy
what products are commonly produced in colostomy and ileostomy?
solid faeces - colostomy
liquid faeces - ileostomy
how can you differentiate a loop vs non-loop stoma?
one opening - non-loop
two - loop
what is an end-ileostomy? what are some indications?
when whole colon and rectum have been removed - panproctocolectomy
extensive UC
large bowel chron’s
familial polyposis coli
complications of stomas
Fluid loss
Odour
Ulceration of skin
Leakage
Stenosis
Herniation or prolapse
Ischaemia
Terminal ileum loss - failure to absorb bile salts + B12 - give B12 injections
Sexual + psychological problems - BIG ONE DON’T FORGET TO SAY
what is the role of a temporary loop stoma?
protecting (‘defunctioning’) a distal anastomosis
what is a temporary loop ileostomy?
used to protect a distal anastomosis
divert faeces
reduces risk of anastomotic leak
typ reversed after 6wk
eg may be used to protect a sigmoid colectomy or an anterior resection
2 key things to consider when examining stoma
site, spout and what comes out
“may i remove the bag”
causes of splenomegaly
haem malignancy:
myeloproliferative disease
CML + CLL
lymphoma
haem disorder:
hereditary spherocytosis
pernicious anaemia
infective:
glandular fever
malaria
other:
RA (felty’s)
portal HTN
