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4th Year ACC > Abdo pain > Flashcards

Abdo pain Flashcards

1
Q

Features of GORD

A

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

Dry cough

Increased salivation

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2
Q

GORD Rx

A

Antacids, PPI, H2 antagonist

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3
Q

Criteria for endoscopy in GORD

A

Dysphagia

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

> /=55 and resistant to Rx.

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4
Q

Pancreatitis features

A

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)

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5
Q

Pancreatitis causes

A

Gallstones (35%)

Ethanol (35%)

Trauma (1.5%)

Steroids

Mumps

Autoimmune

Scorpion

Hyperlipidaemia/hypothermia/hypercalcaemia

ERCP (5%), emboli

Drugs

Pregnancy

Idiopathic

Cancer (neoplasia)

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6
Q

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

A

First 24-48hrs

> 1000u/ml or 3x normal

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7
Q

What else can amylase be raised in?

A

Renal failure

Cholecystitis

Mesenteric infarct

GI perforation

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8
Q

What is a more specific marker than amylase for pancreatitis?

A

Lipase is more sensitive and specific

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9
Q

How can CRP predict severe pancreatitis?

A

> 150 36hrs post admission

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10
Q

Investigations for pancreatitis

A

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

CRP

ABG

AXR

Erect CXR

CT

US if gallstones and raised AST

ERCP if LFTs worsen

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11
Q

What might an AXR show in pancreatitis?

A

Decreased psoas shadow (fluid)

Sentinel loop of proximal jejunum due to ileus

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12
Q

Why do you get an erect CXR in pancreatitis?

A

Excludes e.g. perf

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13
Q

Why do you CT in pancreatitis?

A

Severity and complications e.g. necrotising pancreatitis and oedema

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14
Q

What score can you use for pancreatitis severity?

A

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

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15
Q

Management pancreatitis?

A

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

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16
Q

How do you monitor pancreatitis?

A

Repeat CT

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17
Q

Features of peptic ulcer

A

Epigastric pain related to hunger/food/time of day

Fullness after meals

Heartburn

Tender epigastrium

(±dizziness, fainting if bleeding)

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18
Q

Red flags with peptic ulcer

A

ALARMS

Anaemia

wt Loss

Anorexia

Recent onset or progressive sx

Melaena/haematemesis

Swallowing difficulty

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19
Q

What are the two scoring systems used for GI bleeds?

A

Glasgow Blatchford score and Rockall score

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20
Q

What is the Blatchford score for in GI bleed

A

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

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21
Q

What is the Rockall score for in GI bleed?

A

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

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22
Q

Other causes of GI bleeding?

A

Mallory-weiss tear

Oesoph varices

Gastritis

Oesophagitis

Duodenitis

Malignancy

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23
Q

What is it important to establish in acute GI bleed?

A

Are they shocked?

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24
Q

What should your ABCDE management be in GI bleed

A

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

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25
Q

What useful things do you get on a VBG?

A

pH and lactate (sepsis)

Hb (quicker than FBC)

glucose (good in DKA)

Potassium (hyperkalaemia)

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26
Q

What is the significance of rebleeding GI bleed?

A

40% mortality

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27
Q

Food ____ gastric ulcer, ____ duodenal ulcer

A

Worsens gastric

Relieves duodenal

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28
Q

When would you transfuse in GI bleed?

A

Hb <70

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29
Q

What are the five gall bladder stone issues?

A
  1. cholelithiasis
  2. biliary colic
  3. cholecystitis
  4. choledocholithiasis
  5. cholangitis
30
Q

What is cholelithiasis?

A

Harmless stones in GB

31
Q

what is biliary colic?

A

after a fatty meal, pain <6h and apyrexial

32
Q

What is cholecystitis?

A

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

33
Q

What is choledocholithiasis?

A

gallstones in CBD. LFT derangement, pain, apyrexial

34
Q

What can choledocholithiasis lead to?

A

Pancreatitis or cholangitis

35
Q

What is cholangitis?

A

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

36
Q

Management biliary colic

A

Analgesia

Rehydrate

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

37
Q

Presentation of acute cholecystitis

A

Epigastric/RUQ pain radiating to right shoulder

Vomiting

Fever

May have RUQ mass

Murphy’s sign (inhale when palpate the GB having breathed out)

38
Q

Investigations for acute cholecystitis?

A

FBC, U+E, glucose, amylase, LFT

CXR

ECG (pain could be atypical MI presentation)

USS (shows thickened GB containing stones, fluid, dilated CBD)

39
Q

Management acute cholecystitis or cholangitis

A

Analgesia

NBM

IV fluids

Antibiotics (e.g. coamox)

Refer to surgeons for lap-chole

40
Q

Aneurysm is dilatation of ?%

A

> 50% original

41
Q

What is a pseudoaneurysm

A

Blood in adventitia, communication with lumen. Often following trauma

42
Q

What tissue disorders can cause AAA

A

Marfans, Ehlers danlos

43
Q

Is there screening for AAA?

A

Yes men age 65 USS

44
Q

Risk of rupture <5.5cm

A

<1%/yr

45
Q

Risk of rupture >6cm?

A

25%/yr

46
Q

When is rupture more likely

A

Smoker

Woman

FHx

HTN

47
Q

When do you get elective surgery for AAA?

A

> 5.5cm

Expanding >1cm/year

Symptoms

48
Q

Investigations to do with AAA

A

ECG

FBC, cross match 10-40u

2LB cannulae

49
Q

Management AAA

A

Straight to theatre. Inform vascular surgeons, anaesthetist and theatre

Give blood if shocked but keep systolic BP <100

50
Q

What is Rovsing’s sign

A

Appendicitis- pain in RIF when LIF is palpated

51
Q

What is psoas sign?

A

Pain on extending hip in retrocaecal appendix

52
Q

What is cope sign?

A

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

53
Q

What would be raised in blood tests appendicitis

A

Neutrophils and CRP

54
Q

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

A

CT

55
Q

What is a closed loop bowel obstruction?

A

2 points e.g. sigmoid volvulus, risk perf

56
Q

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

A

Strangulated

57
Q

Most common cause of small bowel obstruction?

A

Adhesions 75%

58
Q

Bowel obs investigations

A

FBC, U+E, amylase

AXR

erect CXR

Could do CT for cause

59
Q

Can you colonoscopy in bowel obs?

A

NO might perf

60
Q

Management bowel obs

A

Drip and suck

Analgesia

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

61
Q

Where are 95% diverticuli?

A

Sigmoid colon

62
Q

Should you colonoscopy in diverticulitis?

A

No may perf

63
Q

Investigations diverticulitis

A

CT diagnose

AXR perf

FBC (WCC raised) CRP

64
Q

Rx diverticulitis

A

If mild then home- could do no solids ± Abx

Could admit for:

Analgesia

NBM

Fluids

IV Abx

65
Q

How is the pain in renal colic?

A

Severe unilat abdo pain in loin radiating to testicle/labia/tip of penis. Constant underlying pain with excruciating spasms.

±N+V, haematuria

66
Q

Investigations in renal colic

A

Urine dip and MSU (haematuria usually. See if concurrent infection)

U+E, Creatanine, glucose, calcium, phosphate, urate

KUB x-ray or CT

67
Q

Management renal colic

A

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

68
Q

What is the usual pathogen of UTI

A

Anaerobes

Gram -ve bacteria

Often E coli

Staph saprophyticus 5-10%

69
Q

Investigations UTI

A

Dip

MSU in pregnant, male, child, unresponsive to Rx

Bloods if systemically unwell- U+E, FBC, CRP, blood culture

Consider USS

70
Q

Management UTI

A

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

71
Q

All catheterised urine samples are bacteriuric true or false?

A

True

72
Q

When do you MSU a catheterised ?UTI

A

If symptomatic

4th Year ACC (9 decks)

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