Abdo exam - AS Flashcards
Summarise the main five causes of the liver disease?
Alcohol Autoimmune Drugs Viral Biliary disease
Give some causes of hepatomegaly (three Cs plus I)
Cancer
Cirrhosis
Cardiac - congestive cardiac failure or constrictive pericarditis
Infiltration
- Fatty infiltration
Infiltrative causes of hepatomegaly
Fatty infiltration Haemochromatosis Amyloidosis Sarcoidosis Lymphoproliferative disease
Four broad causes of splenomegaly
Portal hypertension
Haematological causes
Infection
Inflammation
Infective causes of splenomegaly
Malaria
TB
Infective endocarditis
Inflammatory causes of splenomegaly
Sarcoid
Back pain + severe abdo pain
More likely: AAA
Could also be: Pancreatitis
Constant abdo pain suggests
Inflammation
Colicky abdo pain suggests
Obstruction
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
Two most common cause of epigastric pain
Peptic ulcer
Pancreatitis
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
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)
Appendicitis can present with RUQ in which group of patients?
Pregnant women
RIF pain by system
GI Appendicitis Mesenteric adenitis Colitis (IBD) Malignancy
Gyanecological:
Ovarian cyst rupture, twister, bleed
Ectopic pregnancy
Suprapubic
Cystitis
Urinary retention
LIF causes
GI:
Diverticulitis
Colitis (IBD)
Malignancy
Gynaecological:
Ovarian cyst rupture, twist, bleed
Ectopic
Causes of generalised abdo pain
Obstruction Infection - peritonitis, gastroenteritis Inflammation - IBD Ischaemia - mestenteric Medical causes
Give medical causes of generalised abdo pain
DKA Addison's Hypercalcemia Porphyria Lead poisoning
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)
Name some mesenteric arteries
Celiac artery
Superior mesenteric artery
Inferior mesenteric artery
Which organs are supplied by the celiac arteries?
Stomach, spleen, liver, gall bladder
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
IS
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
