Abdo Flashcards
intermittent dysphagia of both solids and liquids
achalasia
RUQ pain, inflam, palpable mass, R shoulder pain, murphys signs
acute cholecyctitis
epig pain radiating to back, relieved by sitting forward, worse on movement, cullens + grey-turners
acute panc
RUQ pain, heamatemesis, melaena, dupuytren contracture, palmar erythema, spider naevi, gynocomastia
alco hep
tearing pain on defacation, blood on wiping
anal fissure
central abdo pain which later localises to RLQ, roving sign, dec bowel sounds, fever
appendicitis
fever, anorexia, hepatomeg, jaundice, circulating autoantibodies
AI hep
distention, jaundice, haematemisis, melaena, leukonychia, palmar erythema, asterisks, icterus, clubbing, loss of sexual hair, periph oedema
cirrhosis
diarrhoea, abdo discomfort, osteoporosis, dermatitis herpetiformis, Fe def anaemia
coeliac
chronic diarrhoea, RLQ pain, blood in stools, fever, fatugue
crohns
colicky, worsting abdo pain, feel hot and cold, guarding, tenderness, western diet, obese, >50, polymorphonuclear leukocytosis
diverticular disease
sudden RUQ pain, constant, may radiate to shoulder
biliary colic
charcots triad - RUQ tenderness, fever, jaundice
cholangitis
palpable epig mass, virchows node, sister mary joseph node (above umbilicus)
gastric cancer
epigastric pain, N&V, no suspicious features of malig,fever, emesis
gastritis
painless rectal bleeding esp on wiping
haemorrhoids
sudden onset diffuse abdo pain, signs of shock ,
intestinal ischaemia
diffuse pain, constipation/obstipation, tinkling bowel sounds
intestinal obstruction
severe vomiting then blood streaked vomit, chest pain
mallory-wells tear
progressive dysphagia from solids to liquids, FLAWS, burning chest pain
oesophageal cancer
painless jaundice with palpable abdo mass, FLAWS
panc cancer
pain on eating, anorexia
gastric ulcer
pain relieved by eating, wake at night, obesity
duodenal ulcer
coffee ground vomit + melena, background of H.pylori/NSAID use
ruptured peptic ulcer
rectal bleeding, back pain (sacroilitis), red eyes (epscleritis), erythema nodosum, inc freq and severity of diarrhoea, erythema nodosum
Ulcerative collitis
fever, jaundice, raised AST/ALT,
viral hep
upturned U on abdo xray
sigmoid volvulus
abdo xray - absence of normal caecum in RIF
caecal volvulus
CLD (jaundice, easy bruising), tremor, early onset Parkinson’s, keyser fletcher rings
wilsons disease
achalasia inv
endoscopy, barium swallow, oesophageal manometry
achalasia management
balloon dilation
comp of achalasia
asp pneumonia, SC oesophageal carcinoma, GORD
what causes porcelain gallbladder
=thickened wall with air in
caused by ischaeia + inf with gas producing org
causes of acute panc
I GET SMASHED
idiopathic, gallstones, ethanol, trauma, steroids, mumps, AI, scorpion bites, Hypercalcaemia, ERCP, drugs
common comp of acute panc
panc psuedocysts = fullness in epic 2-3 weeks after
panc carcinoma
CA19-9 tumour marker
panc carcinoma
marker for panc insuff
faecal elastase
Tx for panc insufficiency
oral enz rep
comp of ERCP
perforation, asp pneumonia, haemorrhage, acute panc, ascending cholangitis
what is the management for alcohol hep
alco management - omazepan, diazepam pabrinex (IV thiamine) IV vit correct electrolyte/glucose abn oral lactulose (vs encephalopathy) diuretics steroid therapy
Tx for AI hep
corticosteroids + immunosupp
comp of corticosteroids
osteoporosis, DM, HTN, cateracts
changes in barrets oesophagus
sq to columnar
management of barrels O
PPI + radiofreq ablation/resection
main complications of cirrhosis
portal HTN (-> varices + haemorrhoids) hepatorenal syndro
genetic RF for colorectal cancer
FAP, HNPCC
left vs right side colorectal cancer
L - presents earlier w/ PR bleed, tenesmus, mass on DRE -> obs
R- presents later -> anaemia
what can mimic crohns
TB/Yersinia
inflam in CD
patchy inflam extending through all layers
, can affect anywhere in GIT but esp ileum/ascending colon
management of CD
busonide, 5ASA, corticosteroids
where are diverticulitis most common
95% = sigmoid
FBC findings in diverticular disease
polymorphonuclear leukocytosis
Imaging for gallstones
USS - 90% are cholesterol - radiopaque
courvoiseirs law
painless jaundice w/ palpable gallbladder is not gallstones
fatigue, bronze skin, diabetes, hepatomeg, arteritis, inc serum iron
haemochromatosis
femoral hernia
below ing lig, below and lat to pubic tubercles, often strangulated
Inguinal hernia
above ing lig, above and med to pubic tubercle
Direct hernia,
through abdo wall, med to inf epic a.
indirect hernia
through ing canal, lat to inf epig a.
AFP tumour marker
hepatocellular carcinoma
cause of pseudomembranous collitis
c dif
bloating, fever, shock, colon dilation
toxic megacolon
what is rigler’s sign
air on both sides of intestinal wall - pneumoperitoneum
how to tell difference between large and small bowel on CXR
small = valve comitantes
main causes of liver cysts
E. coli, klebsiella, strep milleri
why would liver biopsy be contra ind
major comp = bleeding
contra if extensive ascites of INR >2.5
management of oesophageal varices
ABCDE
terlipressin - dec portal HTN
endoscopy + band ligation
NSAIDS and PUD
NSAIDS inhib COX1 -> dec prostaglandin synth and inc gastric damage so in risk PUD
management of H. pylori + PUD
PPI + 2 antibiotics
management of H. pylori neg PUD
PPI (-prazole) or H2 antag (-tidine)
inflam in UC
continuous inflam of colonic mucosal layer extending proximally in a release/remitting course
genetic RF associated with UC
HLA-B27
stool findings in UC
neg cultures, inc calprotein
management of UC
IV hydrocortisone
mesalazine (5ASA) - maintains remission and dec cancer risk
if unresponsive - ifliximab (TNF alpha suppressor)
HBV vs HCV prognosis
HBV - most adults clear
HCV - most adults become chronic carriers
HBV serology
HbsAg - active inf
HbeAg - infective
anti-HbS - immune
anti-Hbc - caught in past
HEP A - transmission, RF
face-oral (contamination water + shellfish), poor hygiene
Hep B transmission, RF
bodily fluids, health workers in africa, likely chronic in kids
Hep c transmission, RF
blood products, injecting drugs, most adults become carriers
Hep D transmission, RF
bodily fluids, co-inf with hep B
Hep E transmission, RF
face-oral, immunocomp,
volvulus asso with malig
sigmoid = no asso caecal = high asso with large bowl malig
inv for wilsons
dec serum caereuloplasmin, inc urinary copper
zollinger-ellison syndrome
neuroendocrine tumour in panc producing gastrin -> 90% get PUD
inc fasting serum gastrin
