Abdo Flashcards
Give some differentials to vomiting
V - I - gastroenteritis A M - uraemia, hyppercalcaemia, DKA I - N - D - anti-biotics, chemo, digoxin, leveodopa, opiates
CNS - raised ICP, vestibular problems, migraine
Psych + alcohol excess
Pregnancy
Reflex - MI/Biliary colic
SMO differentials
Adhesions Hernia Crohns Intessusception Obstruction due to extrinsic cancer
How do you manage bowel obstruction?
Drip and suck
- IV fluids with electrolyte monitoring/correction
- NG tube to reduce the V
- Contact surgeons
A 40yr old man comes in with 10kg weight loss
What are your differentials?
Malabsorption - coeliacs, chrons/UC, intolerances
Psych - anorexia nervosa/bulimia
Endocrine - hyperthyroidism, addisons, DM
Neoplasm - malignancy
Alcoholic liver disease
What is achalasia?
It is oesphageal peristalsis with failure of LOS relaxation which leads to impaired oesophageal emptying
How can you treat achalasia?
SM relaxation - nifedipine CCB, nitrates or botox injections
Surgical - endoscopic balloon dilation
Systemic sclerosis is another cause of dysphagia
What abs would you test for?
Anti-centomere
Anti-topoisomerase (SCL 70)
Anti-nuclear abs
What are the RF for peptic ulcers?
H.pylori
Smoking
Drugs - NSAIDs, steroids, SSRIS
Stress
How do you test for H.pylori?
1) Urea breath test
2) Stool antigen (stop ppi 1 wk before)
3) Serum IgG levels
Causes of constipation?
Idiopathic + immobility Intestinal obstruction Colonic diseases Painful anal diseases Drugs - opioids, iron, codeine, TCAs, Metabolic - hypothyroidism, hypercalcaemia Depression
What are the causes of non-acute diarrhoea in a returning traveller?
Giardiasis (Rx metronidazole) Cryptosporidiosis Amoebiasisi Tropical sprue Schistosomiasis
Define Crohns disease
What might you see on a biopsy of Crohn’s disease?
Crohn’s disease = transmural non-caseasting granuloma inflammation from mouth to anus
Rose thorn ulcers
Cobble stoning
Skip lesions
What are the complications of Crohn’s?
POMFAN Perforations Oral ulcer/obstruction Malabsorption Fissures Anal skintags/abscess Neoplasms
What tests can you do if you suspect IBD?
Blds: FBC, U&E, LFTs, Fe, B12, folate albumin
Cultures + microscopy
Stool Faecal calprotectin
Imaging: ileocolonoscopy + biopsy
