Gall bladder: - Cholecystitis - Cholangitis - Gallstones Liver: - Hepatitis - Abscess Above - basal pneumonia Below - appendicits Left (stomach and pancreas) -pancreatitis, peptic ulcer Pyelonephritis (right, kidne)

Abdo exam - AS Flashcards by Thivyaa Gangatharan

Summarise the main five causes of the liver disease?

Alcohol
Autoimmune
Drugs
Viral
Biliary disease

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Give some causes of hepatomegaly (three Cs plus I)

Cancer
Cirrhosis
Cardiac - congestive cardiac failure or constrictive pericarditis

Infiltration
- Fatty infiltration

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Infiltrative causes of hepatomegaly

Fatty infiltration
Haemochromatosis 
Amyloidosis
Sarcoidosis
Lymphoproliferative disease

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Four broad causes of splenomegaly

Portal hypertension
Haematological causes
Infection
Inflammation

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Infective causes of splenomegaly

Malaria
TB
Infective endocarditis

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Inflammatory causes of splenomegaly

Sarcoid

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Back pain + severe abdo pain

More likely: AAA

Could also be: Pancreatitis

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Constant abdo pain suggests

Inflammation

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Colicky abdo pain suggests

Obstruction

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Epigastric pain causes according to organ and associated questions to ask

Stomach - Peptic ulcer - NSAID use?
GORD - better with antacids
Gastritis (retrosternal, ETOH)
Malignancy

Pancreas
Acute Pancreatitis (history of gallstones, high amylase)

Think around the pain:
Above: MI
Below: AAA
Right: Cholecystitis
Hepatitis

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Two most common cause of epigastric pain

Peptic ulcer

Pancreatitis

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Differentiate between acute vs chronic pancreatitis

Acute - painful with high amylase

Chronic - pain with weight loss, loss of exocrine and endocrine function, NORMAL AMYLASE but ELASTASE detected in stool

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RUQ pain

Gall bladder:

Cholecystitis
Cholangitis
Gallstones

Liver:

Hepatitis
Abscess

Above - basal pneumonia
Below - appendicits
Left (stomach and pancreas)
-pancreatitis, peptic ulcer

Pyelonephritis
(right, kidne)

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Appendicitis can present with RUQ in which group of patients?

Pregnant women

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RIF pain by system

GI 
Appendicitis
Mesenteric adenitis
Colitis (IBD)
Malignancy

Gyanecological:
Ovarian cyst rupture, twister, bleed
Ectopic pregnancy

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Suprapubic

Cystitis

Urinary retention

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LIF causes

GI:
Diverticulitis
Colitis (IBD)
Malignancy

Gynaecological:
Ovarian cyst rupture, twist, bleed
Ectopic

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Causes of generalised abdo pain

Obstruction 
Infection - peritonitis, gastroenteritis 
Inflammation - IBD
Ischaemia - mestenteric 
Medical causes

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Give medical causes of generalised abdo pain

DKA
Addison's
Hypercalcemia
Porphyria
Lead poisoning

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What might you see with someone who has addisons and why?

Hyperpigmentation
due to increased ACTH and alpha MSH production in response to unresponsive adrenals (they can’t produce cortisol or aldosterone)

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Name some mesenteric arteries

Celiac artery
Superior mesenteric artery
Inferior mesenteric artery

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Which organs are supplied by the celiac arteries?

Stomach, spleen, liver, gall bladder

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After ischaemia, talk about bloods

Lactate would go up
so you’d be acidotic, so bicarbonate would not be up
Amylase is up in other causes of acute abdomen

What marker is consistent with spontaneous bacterial peritonitis (SPB)?

Ascites with neutrophil count over 250 cells/mm

Bicarb - high in respiratory acidosis to compensate for CO2 but not high as it can't compensate lactic acidosis

Fluid in abdo suggests

Ascites

Flatus suggests

``` Obstruction with: n and V Constipation High pitched, tinkling BS Previous surgery Tender irreducible femoral hernia in groin ```

Classification of ascites

Transudate (without protein) | Exudate

Causes of prehepatic jaundice

Haemolysis | Defective conjugation

Hepatic causes of jaundice

Hepatitis

Causes of transudate ascites

Cirrhosis Cardiac failure Nephrotic syndrome

Causes of exudate ascites

Malignancy Infection Budd-chiari syndrome

What is Budd-chiari syndrome

Clot in hepatic vein - hepatic vein thrombosis ?? Portal vein thrombosis

What turns urobilinogen into the next product?

Bacteria - stercobilinogen hence colour of stool

Which enzyme is involved in conjugation

Glucuronyl transferase

Causes of hepatitis

Alcohol Autoimmune Drugs Viruses

Give causes of obstruction of the common bile duct which can result in post-hepatic jaundice?

Gallstones in CBD Stricture Cancer of head of pancreas

What causes pale stool?

Low stercobilinogen

Painless jaundice is caused by

Pancreatic cancer

What is a sign associated with pancreatic cancer?

Throbophlebitis Erythema nodosum (on signs)

Obstructivee jaundice raised markers

ALP and GGT

Hepatitic jaundice raised markers

AST

Marker of pancreatitic cancer

CA19 9

Hepatocellular carcinoma marker ?? (double checK)

Alfa-fetoprotein

Bloody diarhhoea causes

``` Infective colitis Inflammatory colitis Ischamic colitis Diverticulits malignancy ```

What would you suspect in elderly patients with bloody diarrhoea

Ischaemic colitis

What would you suspect in elderly patients with bloody diarrhoea

Ischaemic colitis

What would you suspect in young people with with bloody diarrhoea

Inflammatory colitis

Give some causes of infective colitis

``` Campylobacter Haemorrhagic E.Coli Entamoeba histolytica Salmonella Shigella ```

Thick haustral folds is called

Thumbprinting sign

Another sign with inflammatory / infective colitis

lead piping sign

What do you call 'lots of poo'

Faecal loading

Managment of acute GI bleed

ABC IV access Fluids G

Management of acute abdo pain

``` Nill by mouth IV fluids Analgesics Analgesics Consider antiemetics ANtibotics Moniror vials Investigations ```

What would you give if smeone had vacriceal bleed?

Antibiotics | Terlipressin

Why terlipressin?

Vasoconstriction of splanchnic vessels