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Abdomen Flashcards

1
Q

What is Dupuytren’s contracture caused by?

A

It is thickening of the palmar fascia and it is associated with alcoholic liver disease

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2
Q

What is leuconychia a sign of?

A

Hypoalbuminaemia

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3
Q

What abdominal condition/treatment can cause gum hypertrophy?

A

Ciclosporine (following renal transplant)

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4
Q

List some features of abdominal pathology that can be seen on inspection of the chest.

A

Gynaecomastia

Spider naevi

Hair loss

Excoriation marks

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5
Q

What is caput medusae?

A

Distended superficial umbilical veins due to portal hypertension

Direction of blood flow in the dilated veins below the umbilicus is towards the legs

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6
Q

Describe how you would complete the abdominal examination of a patient.

A

Full history

DRE

Urinalysis

Examination of hernial orifices and external genitalia

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7
Q

List some causes of hepatomegaly

A

Cancer
Cirrhosis (early stage)
Cardiac - CCF, constrictive pericarditis
Infiltration - fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis and lymphoproliferative disease

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8
Q

Broadly speaking, what are the common aetiologies of liver disease?

A 
Alcohol
AI
Virus
Drugs
Biliary disease
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9
Q

List some causes of splenomegaly

A

Mnemonic: HHII
Portal Hypertension (e.g. in chronic liver disease)
Haematological (e.g. haemolytic anaemia, leukaemia, lymphoma)
Infection (e.g. malaria, schistosomiasis, glandular fever, TB, leishmaniasis, infective endocarditis)
Inflammation

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10
Q

What are the two most common differentials for epigastric pain?

A

Pancreatitis

Peptic ulcer disease

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11
Q

What is an important condition to consider in a patient with epigastric pain, radiating to the back who is also tachycardic and hypotensive?

A

Ruptured AAA

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12
Q

What are the two types of abdominal pain?

A

Constant - due to inflammation

Colicky - due to obstruction

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13
Q 
List some causes of abdominal pain that involves the following organs:
Stomach
Pancreas
Heart
Aorta
Liver/gallbladder
A 
Stomach
Peptic ulcer disease (NSAID use)
GORD (better with antacids)
Gastritis (retrosternal, history of alcohol abuse)
Malignancy

Pancreas
Acute pancreatitis (consider gallstones and alcohol consumption)

Heart
MI

Aorta
Ruptures AAA

Liver/Gallbladder
Cholecystitis
Hepatitis

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14
Q

What is a key difference between acute pancreatitis and chronic pancreatitis?

A

In chronic pancreatitis, serum amylase is NORMAL

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15
Q

What presenting symptom do you find in chronic pancreatitis that is unlikely to occur in acute pancreatitis?

A

Weight loss

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16
Q

List some other features of chronic pancreatitis that distinguish it from acute pancreatitis.

A

Chronic pancreatitis causes loss of endocrine and exocrine function

Weight loss

Steatorrhoea

Diabetes mellitus

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17
Q

What is the diagnostic test for chronic pancreatitis?

A

Faecal elastase – low in chronic pancreatitis

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18
Q

How can appendicitis cause RUQ pain?

A

Retrocaecal appendix

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19
Q 
List causes of RUQ pain that involve the following organs:
Gallbladder
Liver
Lungs
Appendix
Stomach and pancreas
Kidney
A

Gallbladder
Cholecystitis
Cholangitis
Gallstones

Liver
Hepatitis
Abscess

Lungs
Basal pneumonia

Appendix
Appendicitis

Stomach and pancreas
Peptic ulcer disease
Pancreatitis

Kidney
Pyelonepritis

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20
Q

List some GI causes of RIF pain

A

Appendicitis

Mesenteric adenitis (particularly important in children)

Colitis (IBD)

Malignancy

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21
Q

List some gynaecological causes of LIF pain.

A

Ovarian cyst rupture, torsion or bleed

Ectopic pregnancy

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22
Q

List two main causes of Suprapubic pain.

A

Cystitis

Urinary retention

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23
Q

List some GI causes of LIF pain.

A

Diverticulitis

Colitis (IBD)

Malignancy

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24
Q

List some gynaecological causes of LIF pain.

A

Ovarian cyst rupture, torsion or bleed

Ectopic pregnancy

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25
List the differential diagnosis of a patient with diffuse abdominal pain
``` Obstruction Infection – peritonitis, gastroenteritis Inflammation – IBD Ischaemic – mesenteric ischaemia Medical · DKA · Addison’s disease · Hypercalcaemia · Porphyria · Lead poisoning ```
26
What is porphyria?
One of a group of rare disorders due to inborn errors of metabolism in which there are deficiencies in the enzymes involved in the biosynthesis of haem. The accumulation of the enzyme’s substrate gives rise to symptoms
27
When do patients with mesenteric ischaemia tend to experience diffuse abdominal pain?
Post-prandial
28
What can cause a high amylase?
Any cause of acute abdomen
29
How is spontaneous bacterial peritonitis (SBP) diagnosed?
Ascites neutrophils > 250/mm^3
30
What are the three main signs of decompensated liver disease?
Ascites Encephalopathy Jaundice
31
What is the main sign of ascites on examination?
Shifting dullness
32
Describe some features of obstruction on examination
Nausea/vomiting Not opening bowels High-pitched tinkling bowel sounds
33
Why is it important to ask a patient with suspected bowel obstruction about previous abdominal surgery?
Previous abdominal surgery increases the risk of adhesions forming, which can cause obstruction
34
What can cause abdominal distension?
``` Fat Faeces Foetus Flatus Fluid Fulminant mass ```
35
What was the old way of differentiating between causes of ascites?
Transudate vs Exudate
36
What is the new way of differentiating between causes of ascites?
Based on albumin gradient Albumin gradient = serum albumin – ascites albumin
37
List causes of ascites that has a HIGH albumin gradient (> 11 g/L).
Portal hypertension Constrictive pericarditis Cardiac failure Cirrhosis
38
List causes of ascites that has a LOW albumin gradient (< 11 g/L).
Nephrotic syndrome TB Pancreatitis Cancer Peritonitis
39
What gives faeces its brown colour?
Stercobilinogen
40
Which enzyme conjugates bilirubin?
Glucoronyl transferase
41
What happens to bilirubin after it has been conjugated?
It is excreted into the bile It moves to the intestines where it gets converted to urobilinogen and stercobilinogen
42
State two causes of unconjugated hyperbilirubinaemia
Haemolysis Gilbert’s syndrome
43
Explain why patients with hepatocellular jaundice will produce dark urine.
The damage to the liver cells leads to leakage of conjugated bilirubin from the hepatocytes The conjugated bilirubin is soluble and excreted in the urine, causing dark urine
44
List some causes of hepatitis.
Alcohol Autoimmune Drugs Viruses
45
Explain why patients with post-hepatic jaundice will have pale stools and dark urine.
Obstruction means that conjugated bilirubin cannot be excreted into the duodenum Conjugated bilirubin leaks into the circulation and is renally excreted, producing dark urine Conjugated bilirubin does NOT reach the intestines and, so, is not converted to stercobilinogen so the stools are pale
46
List some causes of post-hepatic jaundice
Gallstones in the common bile duct Stricture Cancer of the head of the pancreas
47
State Courvoisier's law
A palpable gallbladder in the presence of painless jaundice is unlikely to be due to gallstones (more likely due to cancer)
48
The elevation of which liver enzymes suggest pathology in the biliary tree
ALP + GGT
49
``` What is the tumour marker for the following cancers: Pancreatic Colorectal Liver Ovarian ```
Pancreatic CA19-9 Colorectal CEA Liver a-fetoprotein Ovarian CA125
50
What is Trousseau’s sign of malignancy?
Episodes of thrombophlebitis that are recurrent or appearing in different locations over time It can be an early sign of gastric or pancreatic malignancy
51
List the main cause of bloody diarrhoea
Infective colitis Inflammatory colitis Ischaemic colitis Diverticulitis Malignancy
52
What are the main pathogens associates with infective colitis
CHESS Campylobacter jejuni Haemorrhagic E. coli Entamoeba histolytica Salmonella Shigella
53
List some extra-gastrointestinal manifestations of inflammatory bowel disease.
Eyes: episcleritis, scleritis, uveitis Skin: erythema nodosum, pyoderma gangrenosum
54
List two common causes of bloody diarrhoea in the elderly
Ischaemic colitis Diverticulitis
55
What causes leadpipe sign on AXR?
Inflammatory bowel disease
56
What is the diameter of the colon in a patient with toxic megacolon?
More than 6 cm
57
What is another name for overflow diarrhoea?
Spurious diarrhoea
58
What may elderly patients with constipation present with?
Confusion
59
Describe the management of an acute GI bleed.
ABC IV access Fluids Group & Save/Crossmatch OGD – find the underlying cause
60
What additional measures will be used for variceal bleeds?
Antibiotics (e.g. tazocin, ciprofloxacin) – because of bacterial translocation Terlipressin – causes splanchnic vasoconstriction
61
Describe the management of acute abdomen.
NBM Fluids Analgesia Anti-emetics Antibiotics Monitor vitals and urine output
62
Which two antibiotics are commonly used in the management of acute abdomen
A cephalosporin (e.g. cefuroxime) Cover anaerobes (metronidazole)
63
What other investigations are important in patients with acute abdomen?
FBC – raised WCC suggests infective process U&Es – allow assessment of renal function and hydration status CRP – marker of inflammation Clotting – surgeons need to know about bleeding tendency before an operation Erect CXR – check for air under the diaphragm
64
List some important investigations for patients with jaundice
FBC – low Hb may be due to haemolytic anaemia LFTs – important if liver pathology is suspected Abdominal ultrasound – performed after fasting because gallstones are better visualised in a distended, bile-filled gallbladder. Dilatation of the ducts would suggest obstruction.
65
Describe the investigations that will be undertaken in a patient presenting with dysphagia and weight loss.
OGD and biopsy
66
Describe the investigations that will be undertaken in a patient presenting with PR bleeding and weight loss.
Colonoscopy
67
What is Pabrinex
Water-soluble vitamin supplements given in chronic liver disease It contains thiamine, which is necessary to prevent Wernicke’s encephalopathy
68
Summarise the management of ascites.
Tap and send to lab for WCC Diuretics (spironolactone and furosemide) Dietary sodium restriction Fluid restriction in patients with hyponatraemia Monitor weight daily Therapeutic paracentesis (with IV human albumin)
69
Explain how cirrhosis leads to secondary hyperaldosteronism.
Cirrhosis causes vasodilation, which results in the body producing more renin and aldosterone to promote fluid retention Spironolactone and furosemide helps counteract this effect
70
Describe the management of a patient with hepatic encephalopathy.
Lactulose Phosphate enemas Avoid sedation (e.g. benzodiazepines) Treat infections (e.g. SBP) Exclude GI bleed (an occult GI bleed can precipitate encephalopathy
71
Why is lactulose used in patients with hepatic encephalopathy?
It is an osmotic laxative that reduces GI transit time such that bacteria doesn’t have enough time to produce toxic metabolites that can be absorbed and cause encephalopathy
72
What would you expect the urea of an alcoholic patient to be? What could cause this to rise?
Alcoholic patients tend to have low urea (~ 1 mmol/L) Digestion of red blood cells (due to a GI bleed) can lead to a rise in urea
73
List three major complications of abdominal surgery and describe their features.
Wound infection – erythematous, discharge Anastomotic leak – diffuse abdominal tenderness, guarding, rigidity, hypotensive/tachycardic Pelvic abscess – pain, fever, sweats, mucus diarrhoea
74
Describe the appearance of a perianal abscess and state how you would treat it.
Tender, red swelling around the anus Treated with incision and drainage
75
Describe the presenting symptoms of an anal fissure and state how you would treat it.
Rectal pain during defecation Stool coated with blood Treatment: advice regarding diet (increase fluids and fibre), GTN cream
76
Describe the presentation of IBS.
Recurrent abdominal pain Bloating Relief with defecation Change in frequency/form of stool
77
What is a key difference between the pattern of symptoms of IBD and IBS?
IBS patients do NOT have any nocturnal symptoms IBS patients will not have rectal bleeding, anaemia, weight loss or nocturnal symptoms
78
Describe the treatment of IBS.
Diet and lifestyle modification Symptomatic treatment: · Abdo pain – antispasmodics · Laxatives for constipation · Anti-diarrhoeals
79
How should Coeliac disease be excluded?
Tissue transglutaminase (tTG) test

DPD (4 decks)

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