Abdo pain Flashcards by Alice Hanton

Features of GORD

burning central chest pain relieved by antacids and worse on lying down or after a meal.

Dry cough

Increased salivation

How well did you know this?

Not at all

Perfectly

GORD Rx

Antacids, PPI, H2 antagonist

How well did you know this?

Not at all

Perfectly

Criteria for endoscopy in GORD

Dysphagia

> /=55 and alarm sx (dysphagia, wt loss, haematemesis)

> /=55 and resistant to Rx.

How well did you know this?

Not at all

Perfectly

Pancreatitis features

Epigastric pain radiating to back, relieved by sitting forwards

Vomiting

Jaundice

Shock

Ileus

Rigid abdomen ± local or generalised tenderness

Tachycardic

Fever

Cullen’s sign (peri umbilical bruising) or grey turner’s (flank bruising, develops after a few days)

How well did you know this?

Not at all

Perfectly

Pancreatitis causes

Gallstones (35%)

Ethanol (35%)

Trauma (1.5%)

Steroids

Mumps

Autoimmune

Scorpion

Hyperlipidaemia/hypothermia/hypercalcaemia

ERCP (5%), emboli

Drugs

Pregnancy

Idiopathic

Cancer (neoplasia)

How well did you know this?

Not at all

Perfectly

When will amylase be raised in pancreatitis? What is defined as raised?

First 24-48hrs

> 1000u/ml or 3x normal

How well did you know this?

Not at all

Perfectly

What else can amylase be raised in?

Renal failure

Cholecystitis

Mesenteric infarct

GI perforation

How well did you know this?

Not at all

Perfectly

What is a more specific marker than amylase for pancreatitis?

Lipase is more sensitive and specific

How well did you know this?

Not at all

Perfectly

How can CRP predict severe pancreatitis?

> 150 36hrs post admission

How well did you know this?

Not at all

Perfectly

Investigations for pancreatitis

LFTs, FBC, U&Es, Amylase, glucose, ca2+, coagulation screen

CRP

ABG

AXR

Erect CXR

US if gallstones and raised AST

ERCP if LFTs worsen

How well did you know this?

Not at all

Perfectly

What might an AXR show in pancreatitis?

Decreased psoas shadow (fluid)

Sentinel loop of proximal jejunum due to ileus

How well did you know this?

Not at all

Perfectly

Why do you get an erect CXR in pancreatitis?

Excludes e.g. perf

How well did you know this?

Not at all

Perfectly

Why do you CT in pancreatitis?

Severity and complications e.g. necrotising pancreatitis and oedema

How well did you know this?

Not at all

Perfectly

What score can you use for pancreatitis severity?

Modified Glasgow Score (3 or more on admission and on subsequent tests within 48hrs = ICU/HDU)

How well did you know this?

Not at all

Perfectly

Management pancreatitis?

O2 if necessary

Insert NG tube (or can have oral feeding if no nausea/vom/abdo pain)

IV fluids

Catheter to monitor fluid status

Analgesia ± anti-emitic

ERCP and remove gallstones if necessary

?ABx if associated infection

May need ICU management if other organs affected

How well did you know this?

Not at all

Perfectly

How do you monitor pancreatitis?

Repeat CT

How well did you know this?

Not at all

Perfectly

Features of peptic ulcer

Epigastric pain related to hunger/food/time of day

Fullness after meals

Heartburn

Tender epigastrium

(±dizziness, fainting if bleeding)

How well did you know this?

Not at all

Perfectly

Red flags with peptic ulcer

ALARMS

Anaemia

wt Loss

Anorexia

Recent onset or progressive sx

Melaena/haematemesis

Swallowing difficulty

How well did you know this?

Not at all

Perfectly

What are the two scoring systems used for GI bleeds?

Glasgow Blatchford score and Rockall score

How well did you know this?

Not at all

Perfectly

What is the Blatchford score for in GI bleed

To calculate how severe the bleed is and so how quickly they’ll need endoscopy

How well did you know this?

Not at all

Perfectly

What is the Rockall score for in GI bleed?

Future risk of re-bleed/mortality (it has a pre and post endoscopy section)

How well did you know this?

Not at all

Perfectly

Other causes of GI bleeding?

Mallory-weiss tear

Oesoph varices

Gastritis

Oesophagitis

Duodenitis

Malignancy

How well did you know this?

Not at all

Perfectly

What is it important to establish in acute GI bleed?

Are they shocked?

How well did you know this?

Not at all

Perfectly

What should your ABCDE management be in GI bleed

Oxygen as they are acutely unwell

2lg bore cannulas in MCF- take bloods (FBC, U&Es, LFT, VBG, clotting, crossmatch 4-6u)

Fluid bolus if shocked, or O neg if necessary if fluid isn’t getting it under control. If the fluid works a bit then you have time to get a full cross match.

ECG

ABG

How well did you know this?

Not at all

Perfectly

What useful things do you get on a VBG?

pH and lactate (sepsis) Hb (quicker than FBC) glucose (good in DKA) Potassium (hyperkalaemia)

What is the significance of rebleeding GI bleed?

40% mortality

Food ____ gastric ulcer, ____ duodenal ulcer

Worsens gastric Relieves duodenal

When would you transfuse in GI bleed?

Hb <70

What are the five gall bladder stone issues?

1. cholelithiasis 2. biliary colic 3. cholecystitis 4. choledocholithiasis 5. cholangitis

What is cholelithiasis?

Harmless stones in GB

what is biliary colic?

after a fatty meal, pain <6h and apyrexial

What is cholecystitis?

Inflammed GB- biliary colic that won't go away- RUQ pain >6h + pyrexia

What is choledocholithiasis?

gallstones in CBD. LFT derangement, pain, apyrexial

What can choledocholithiasis lead to?

Pancreatitis or cholangitis

What is cholangitis?

infected or inflamed biliary tree secondary to impacted stone or stricture. Charcot's triad - RUQ, fever, jaundice May become Reynold's Pentad (+ hypoperfusion and decreased consciousness) = shock

Management biliary colic

Analgesia Rehydrate Elective lap-chole. (potential complication of waiting could be pancreatitis)

Presentation of acute cholecystitis

Epigastric/RUQ pain radiating to right shoulder Vomiting Fever May have RUQ mass Murphy's sign (inhale when palpate the GB having breathed out)

Investigations for acute cholecystitis?

FBC, U+E, glucose, amylase, LFT CXR ECG (pain could be atypical MI presentation) USS (shows thickened GB containing stones, fluid, dilated CBD)

Management acute cholecystitis or cholangitis

Analgesia NBM IV fluids Antibiotics (e.g. coamox) Refer to surgeons for lap-chole

Aneurysm is dilatation of ?%

>50% original

What is a pseudoaneurysm

Blood in adventitia, communication with lumen. Often following trauma

What tissue disorders can cause AAA

Marfans, Ehlers danlos

Is there screening for AAA?

Yes men age 65 USS

Risk of rupture <5.5cm

<1%/yr

Risk of rupture >6cm?

25%/yr

When is rupture more likely

Smoker Woman FHx HTN

When do you get elective surgery for AAA?

>5.5cm Expanding >1cm/year Symptoms

Investigations to do with AAA

ECG FBC, cross match 10-40u 2LB cannulae

Management AAA

Straight to theatre. Inform vascular surgeons, anaesthetist and theatre Give blood if shocked but keep systolic BP <100

What is Rovsing's sign

Appendicitis- pain in RIF when LIF is palpated

What is psoas sign?

Pain on extending hip in retrocaecal appendix

What is cope sign?

Pain on flexion and internal rotation of hip of appendix near obturator internus

What would be raised in blood tests appendicitis

Neutrophils and CRP

If unsure of appendicitis diagnosis what imaging has high diagnostic accuracy?

What is a closed loop bowel obstruction?

2 points e.g. sigmoid volvulus, risk perf

Peritonism, sharp, constant localised pain with fever and raised WCC suggests what type of bowel obs?

Strangulated

Most common cause of small bowel obstruction?

Adhesions 75%

Bowel obs investigations

FBC, U+E, amylase AXR erect CXR Could do CT for cause

Can you colonoscopy in bowel obs?

NO might perf

Management bowel obs

Drip and suck Analgesia Definitive depends but could be conservative, surgery, endoscopic decompression (closed lool) or stent (malignancy)

Where are 95% diverticuli?

Sigmoid colon

Should you colonoscopy in diverticulitis?

No may perf

Investigations diverticulitis

CT diagnose AXR perf FBC (WCC raised) CRP

Rx diverticulitis

If mild then home- could do no solids ± Abx Could admit for: Analgesia NBM Fluids IV Abx

How is the pain in renal colic?

Severe unilat abdo pain in loin radiating to testicle/labia/tip of penis. Constant underlying pain with excruciating spasms. ±N+V, haematuria

Investigations in renal colic

Urine dip and MSU (haematuria usually. See if concurrent infection) U+E, Creatanine, glucose, calcium, phosphate, urate KUB x-ray or CT

Management renal colic

IV/IM analgesic (probably opioid) and antiemitic (e.g. IM metoclopramide) Admit if shock/persisting pain/pregnant/risk AKI (CKD)/dehydration due to vomiting/unresponsive to Rx/fever If no admission then ongoing analgesia and antiemitics, normal fluid intake, sieve urine so can send stone to lab, safety net to seek medical attention if fever, rigors, pain increasing. Refer to urology within 7 days onset. 1st line- let it pass itself (sieve urine) 2nd- calcium channel blocker (nifedipine) 3rd- alpha blocker (e.g. tamsulosin) 4th- lithotripsy/surgery

What is the usual pathogen of UTI

Anaerobes Gram -ve bacteria Often E coli Staph saprophyticus 5-10%

Investigations UTI

Dip MSU in pregnant, male, child, unresponsive to Rx Bloods if systemically unwell- U+E, FBC, CRP, blood culture Consider USS

Management UTI

Non pregnant women with 3+ signs cystitis and no vaginal discharge- trimethoprim or nitro for 3 days Pregnant- seek expert help, antibiotics and confirm eradication Men- trimethoprim or nitro for 7days Catheterised- change the catheter and refer to local guidelines

All catheterised urine samples are bacteriuric true or false?

True

When do you MSU a catheterised ?UTI

If symptomatic