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DPD > Abdomen > Flashcards

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
Q

List the differential diagnosis of a patient with diffuse abdominal pain

A 
Obstruction
Infection – peritonitis, gastroenteritis
Inflammation – IBD
Ischaemic – mesenteric ischaemia
Medical
· DKA
· Addison’s disease
· Hypercalcaemia
· Porphyria
· Lead poisoning
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26
Q

What is porphyria?

A

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

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27
Q

When do patients with mesenteric ischaemia tend to experience diffuse abdominal pain?

A

Post-prandial

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28
Q

What can cause a high amylase?

A

Any cause of acute abdomen

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29
Q

How is spontaneous bacterial peritonitis (SBP) diagnosed?

A

Ascites neutrophils > 250/mm^3

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30
Q

What are the three main signs of decompensated liver disease?

A

Ascites
Encephalopathy
Jaundice

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31
Q

What is the main sign of ascites on examination?

A

Shifting dullness

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32
Q

Describe some features of obstruction on examination

A

Nausea/vomiting
Not opening bowels
High-pitched tinkling bowel sounds

33
Q

Why is it important to ask a patient with suspected bowel obstruction about previous abdominal surgery?

A

Previous abdominal surgery increases the risk of adhesions forming, which can cause obstruction

34
Q

What can cause abdominal distension?

A 
Fat
Faeces
Foetus
Flatus
Fluid
Fulminant mass
35
Q

What was the old way of differentiating between causes of ascites?

A

Transudate vs Exudate

36
Q

What is the new way of differentiating between causes of ascites?

A

Based on albumin gradient

Albumin gradient = serum albumin – ascites albumin

37
Q

List causes of ascites that has a HIGH albumin gradient (> 11 g/L).

A

Portal hypertension

Constrictive pericarditis

Cardiac failure

Cirrhosis

38
Q

List causes of ascites that has a LOW albumin gradient (< 11 g/L).

A

Nephrotic syndrome

TB

Pancreatitis

Cancer

Peritonitis

39
Q

What gives faeces its brown colour?

A

Stercobilinogen

40
Q

Which enzyme conjugates bilirubin?

A

Glucoronyl transferase

41
Q

What happens to bilirubin after it has been conjugated?

A

It is excreted into the bile

It moves to the intestines where it gets converted to urobilinogen and stercobilinogen

42
Q

State two causes of unconjugated hyperbilirubinaemia

A

Haemolysis

Gilbert’s syndrome

43
Q

Explain why patients with hepatocellular jaundice will produce dark urine.

A

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
Q

List some causes of hepatitis.

A

Alcohol

Autoimmune

Drugs

Viruses

45
Q

Explain why patients with post-hepatic jaundice will have pale stools and dark urine.

A

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
Q

List some causes of post-hepatic jaundice

A

Gallstones in the common bile duct

Stricture

Cancer of the head of the pancreas

47
Q

State Courvoisier’s law

A

A palpable gallbladder in the presence of painless jaundice is unlikely to be due to gallstones (more likely due to cancer)

48
Q

The elevation of which liver enzymes suggest pathology in the biliary tree

A

ALP + GGT

49
Q 
What is the tumour marker for the following cancers:
Pancreatic
Colorectal
Liver
Ovarian
A

Pancreatic
CA19-9

Colorectal
CEA

Liver
a-fetoprotein

Ovarian
CA125

50
Q

What is Trousseau’s sign of malignancy?

A

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
Q

List the main cause of bloody diarrhoea

A

Infective colitis

Inflammatory colitis

Ischaemic colitis

Diverticulitis

Malignancy

52
Q

What are the main pathogens associates with infective colitis

A

CHESS

Campylobacter jejuni

Haemorrhagic E. coli

Entamoeba histolytica

Salmonella

Shigella

53
Q

List some extra-gastrointestinal manifestations of inflammatory bowel disease.

A

Eyes: episcleritis, scleritis, uveitis

Skin: erythema nodosum, pyoderma gangrenosum

54
Q

List two common causes of bloody diarrhoea in the elderly

A

Ischaemic colitis

Diverticulitis

55
Q

What causes leadpipe sign on AXR?

A

Inflammatory bowel disease

56
Q

What is the diameter of the colon in a patient with toxic megacolon?

A

More than 6 cm

57
Q

What is another name for overflow diarrhoea?

A

Spurious diarrhoea

58
Q

What may elderly patients with constipation present with?

A

Confusion

59
Q

Describe the management of an acute GI bleed.

A

ABC

IV access

Fluids

Group & Save/Crossmatch

OGD – find the underlying cause

60
Q

What additional measures will be used for variceal bleeds?

A

Antibiotics (e.g. tazocin, ciprofloxacin) – because of bacterial translocation

Terlipressin – causes splanchnic vasoconstriction

61
Q

Describe the management of acute abdomen.

A

NBM

Fluids

Analgesia

Anti-emetics

Antibiotics

Monitor vitals and urine output

62
Q

Which two antibiotics are commonly used in the management of acute abdomen

A

A cephalosporin (e.g. cefuroxime)

Cover anaerobes (metronidazole)

63
Q

What other investigations are important in patients with acute abdomen?

A

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
Q

List some important investigations for patients with jaundice

A

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
Q

Describe the investigations that will be undertaken in a patient presenting with dysphagia and weight loss.

A

OGD and biopsy

66
Q

Describe the investigations that will be undertaken in a patient presenting with PR bleeding and weight loss.

A

Colonoscopy

67
Q

What is Pabrinex

A

Water-soluble vitamin supplements given in chronic liver disease

It contains thiamine, which is necessary to prevent Wernicke’s encephalopathy

68
Q

Summarise the management of ascites.

A

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
Q

Explain how cirrhosis leads to secondary hyperaldosteronism.

A

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
Q

Describe the management of a patient with hepatic encephalopathy.

A

Lactulose

Phosphate enemas

Avoid sedation (e.g. benzodiazepines)

Treat infections (e.g. SBP)

Exclude GI bleed (an occult GI bleed can precipitate encephalopathy

71
Q

Why is lactulose used in patients with hepatic encephalopathy?

A

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
Q

What would you expect the urea of an alcoholic patient to be? What could cause this to rise?

A

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
Q

List three major complications of abdominal surgery and describe their features.

A

Wound infection – erythematous, discharge

Anastomotic leak – diffuse abdominal tenderness, guarding, rigidity, hypotensive/tachycardic

Pelvic abscess – pain, fever, sweats, mucus diarrhoea

74
Q

Describe the appearance of a perianal abscess and state how you would treat it.

A

Tender, red swelling around the anus

Treated with incision and drainage

75
Q

Describe the presenting symptoms of an anal fissure and state how you would treat it.

A

Rectal pain during defecation

Stool coated with blood

Treatment: advice regarding diet (increase fluids and fibre), GTN cream

76
Q

Describe the presentation of IBS.

A

Recurrent abdominal pain

Bloating

Relief with defecation

Change in frequency/form of stool

77
Q

What is a key difference between the pattern of symptoms of IBD and IBS?

A

IBS patients do NOT have any nocturnal symptoms

IBS patients will not have rectal bleeding, anaemia, weight loss or nocturnal symptoms

78
Q

Describe the treatment of IBS.

A

Diet and lifestyle modification

Symptomatic treatment:
· Abdo pain – antispasmodics
· Laxatives for constipation
· Anti-diarrhoeals

79
Q

How should Coeliac disease be excluded?

A

Tissue transglutaminase (tTG) test

DPD (4 decks)

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