Abdomen and Surgery (random) Flashcards
Abdominal film of an elderly constipated woman shows an ‘inverted U’ loop of bowel
Volvulus
Chronic liver disease associated with:
Early onset emphysema
α1-antitrypsin deficiency
Signs on examination
Angular stomatitis
Iron deficiency anaemia
Constipation and bright-red blood coating her stools
Two bluish tender spongy masses are found protruding from the anus
They prolapse through the rectum on defecation but spontaneously reduce
Second-degree haemorrhoids
Hereditary nephritis, sensorineural deafness, ocular abnormalities
Alport’s
Early oliguria followed by recovery of renal function with an increase in renal output
Acute tubular necrosis
Signs on examination
Asterixis (liver flap)
Hepatic encephalopathy
21-year-old man presents with a history of constipation and rectal bleeding
On examination there are numerous dark freckles on the palm, lips and oral mucosa
Peutz-Jeghers syndrome
Pruritis, jaundice, pigmentation, Anti-mitochondrial antibodies (AMA) positive, middle-aged woman
Associated with: RA, Sjorgen’s syndrome, thyroid disease, renal tubular acidosis
Primary biliary cirrhosis (primary biliary cholangitis)
Testicular swelling that has increased in size over the last couple of months
The swelling is fluctuant and the underlying testis impalpable
Hydrocoele
Treatment of GI conditions
IBS patient complains of colicky pain and bloating
Mebeverine
Worsening eczema-like rash overlying the areola and nipple
Palpable mass can be felt under the rash
Paget’s disease of the breast
Chronic liver disease associated with:
Dysarthria, dyskinesia, dementia, Kayser-Fleishcer ring
Wilson’s disease
Vitamin D, folate and nicotinic acid (Vit B3) are absorbed in the…
jejunum
Classical presentation
Severe epigastric pain radiating to back associated with vomiting
Acute pancreatitis
Signs on examination
Glossitis
Vitamin B12 deficiency
Caused by occlusion of the hepatic veins that drain the liver
Classical triad of abdominal pain, ascites and liver enlargement
Budd-Chiari syndrome
Glomerulonephritis, pulmonary damage, anti-GBM antibody
Goodpasture’s
Treatment of GI conditions
Severe oesophagitis confirmed on endoscopy
High-dose PPI
Splenomegaly
Neutropenia
Rheumatoid arthritis
Felty’s syndrome
Tanned man with an ulcer on nose with rolled edge, due to necrosis of centre
Basal cell carcinoma
Most common cause of glomerulonephritis
IgA nephropathy / Berger’s disease
A 35-year-old woman is worried about an abdominal mass that has grown over the last six months and a similar length history of very heavy menstrual bleeding with no intermenstrual bleeding
On examination a knobbly mass can be felt in the middle lower quadrant that is dull to percussion
The lower edge is not palpable
Fibroids
Week history of fever and sore throat
Macular rash after ampicillin
Enlarged posterior cervical nodes
Palatal petechiae
Splenomegaly
Infectious mononucleosis (glandular fever)
Results from primary infection with EBV
Signs on examination
Expansile pulsatile mass
Aneurysm
Signs on examination
Buccal pigmentation
Peutz-Jeghers syndrome
Addison’s disease
Treatment of GI conditions
Cirrhosis, with haematemesis
Upper GI endoscopy (suspected oesophageal varices)
Classical presentation
Jaundice and constant right upper quadrant pain
Biliary colic
Hepatosplenomegaly
Anaemia
Bone involvement
Increased pigmentation on forehead and hands
Gaucher’s disease
Fever and bloody diarrhoea
Tachycardic and Hb of 10g/dL
Abdominal film shows loss of haustral pattern and a colonic dilatation of 8cm
Toxic megacolon - presentation of severe UC
Crohn’s patient complains of watery discharge from a puckered area 2cm from the anal canal
Anal fistula
Patient treated with broad-spectrum antibiotics presents a few days later with bloody diarrhoea
Pseudomembranous colitis
Soft lump in left groin
Expansile cough impulse
Fluid thrill felt when percussing lower down the legs
Saphena varix (A saphena varix, or a saphenous varix is a dilation of the saphenous vein at its junction with the femoral vein in the groin. Saphena varix is a common surgical problem)
Thirst, tiredness, depression, bone pain, constipation
Hypercalcaemia
Lump behind the anterior border of sternocleidomastoid on the upper left side of the neck
Branchial cyst
19-year-old man complains of severe pain and swelling of sudden onset in his right scrotum
Testes and epididymis are very tender
Has had unprotected sex recently
Acute epididymo-orchitis
Constipation and bright-red blood coating her stools
Two bluish tender spongy masses are found protruding from the anus
These do not reduce spontaneously and require digital reduction
Third-degree haemorrhoids
Chronic liver disease associated with:
Pigmentation, diabetes
Haemochromatosis
Man presenting with scrotal swelling is worried that he is growing a third testicle
On examination there is a smooth fluctuant swelling within the scrotum
Both left and right testes are palpable
Epididymal cyst
Woman who has recently given birth complains of excruciating pain on defecation, which persists for hours afterwards
Examination reveals a defect posterior to the anal canal
Anal fissure
62-year-old man presents with rectal bleeding and a year’s history of left iliac fossa pain and change in bowel habit
There is no weight loss
Diverticular disease
Vitamins B12 and C are absorbed in the…
terminal ileum
Transmural, non-caseating granulomatous inflammation, skip lesions
Crohn’s
65-year-old woman presents with constipation and colicky left-sided abdominal pain relieved by defecation
Diverticular disease
Treatment of GI conditions
Perforated gastric ulcer
Laparotomy
GET SMASHED
causes of pancreatitis
- *G**all stones
- *E**thanol
- *T**rauma
- *S**teroids
- *M**umps
- *A**utoimmune
- *S**corpion stings/spider bites
- *H**yperlipidaemia/hypercalcaemia (metabolic)
- *E**RCP
- *D**rugs
Classical presentation
Iliac fossa pain, positive pregnancy test
Ectopic pregnancy
Feeling of a lump in throat that causes discomfort on swallowing, but examination and imaging of the pharynx and oesophagus reveal no abnormality
Globus hystericus
Signs on examination
Craggy hepatomegaly
Liver malignancy
Signs on examination
Leuconychia
Hypoalbuminaemia
Irreducible lump in the left groin that is positioned below and lateral to the pubic tubercle
Femoral hernia
Signs on examination
Koilonychia
Iron deficiency anaemia
4-year-old presents with large swelling at the posterior triangle
Swelling is soft and fluctuant and transilluminates brilliantly
Cystic hygroma
Constipation and bright-red blood coating her stools
Two bluish tender spongy masses are found in the rectum
First-degree haemorrhoids
Signs on examination
Aphthous ulceration
IBD
Coeliac disease
55-year-old woman presents with abdominal pain, weight loss and fatty stools
She also complains of extremely uncomfortable itchy blisters on her knees and elbows
Particularly strong association with HLA-DR3 and -DQ2
Can develop iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)
Coeliac disease
6-year-old boy presents with a 2-week history of non-blanching rash over the buttocks and macroscopic haematuria
Complains of pain in both knees
Henoch-Schönlein purpura
Anaemia + mild jaundice
Reticulocytosis
Elevated serum unconjugated bilirubin
Reduced plasma haptoglobin
Raised LDH
Increased urinary urobilinogen
Haemolytic anaemia
Abdominal pain, vomiting and jaundice
Tender hepatomegaly and ascites
History of recurrent miscarriages
Budd-Chiari syndrome
Bleeding ulcer on upper region of left cheek
Everted edge
Palpable cervical lymph nodes
Squamous cell carcinoma
Calcium and iron are absorbed in the…
duodenum
UC patient presents with jaundice, pruritus and abdo pain
Raised ALP
Negative anti-mitochondrial antibodies
Association with HLA-B8 and HLA-DR3
Primary sclerosing cholangitis
Classical presentation
Colicky pain radiating to the groin
Ureteric colic
Crypt abscesses, goblet cell depletion, mucosal ulcers, continous
Ulcerative colitis
Barrett’s oesophagus is metaplasia from…
squamous to columnar
Presence of red cell casts in urine are strongly suggestive of…
glomerular pathology
Treatment of H. pylori
Triple therapy (PPI + 2 Abx)
- Abx:* amoxicillin + clarithromycin
- (for penicllin allergic):* clarithomycin + metronidazole
Pruritis, jaundice, abdominal pain, elevated ALP, AMA negative
Associated with IBD
Primary sclerosing cholangitis
At what plasma bilirubin level is jaundice usually visible at?
>35µmol/L
Double stranded DNA virus with the cytoplasm of hepatocytes
Hepatitis B
RNA virus in a patient with signs of hepatic inflammation
Hepatitis C
