Abdomen - DPD Flashcards
What are the signs you are looking for in the hands?
Asterixis Bruising Clubbing Dupuytren's Contracture Palmar Erythema Leuconychia Koilonychia
What are the signs you are looking for in the forearms?
AV fistulae
What are the signs you are looking for in the head and neck?
Anaemia
Jaundice
Skin: jaundice, scratch marks (excoriation marks) or spider naevi
Oral Examination:
Pigmentation
Gum hypertrophy
What are the signs you are looking for on the chest?
Gynaecomastia
Hair Loss
Excoriation Marks
Spider Naevi
Causes of hepatomegaly
Cancer (primary or secondary deposits)
Cirrhosis (later on in cirrhosis, the liver will shrink)
Cardiac:
Congestive cardiac failure
Constrictive pericarditis
Infiltration: Fatty infiltration Haemochromatosis Amyloidosis Sarcoidosis Lymphoproliferative disease
Summary of liver disease
Alcohol Autoimmune Drugs Viruses Biliary Disease NOTE: these are the things to think about when you have any patient with jaundice, raised AST/ALT, raised BR
Causes of splenomegaly
Portal hypertension
Haematological:
E.g. haemolytic anaemia, lymphoma, leukaemia
Infection:
E.g. malaria, schistosomiasis, leishmaniasis, TB, infective endocarditis, infectious mononucleosis
Inflammation
DDx of: 75 y/o man Epigastric pain HR: 130bpm BP: 80/50mmHg
Ruptured AAA (pain radiating to back, tachycardiac, low BP)
Pancreatitis
Peptic Ulcer
What does constant abdominal pain usually indicate?
Inflammation
What does colicky abdominal pain usually indicate?
Obstruction
How does acute pancreatitis present? What is the main test to confirm?
Epigastric pain
HIGH amylase
How does chronic pancreatitis present? What is the main test to confirm?
Epigastric pain, weight loss
Loss of exocrine/endocrine function
NORMAL amylase
Faecal elastase (main test)
DDx of right upper quadrant pain
Gallbladder:
Gallstones
Cholecystitis
Cholangitis
Liver:
Hepatitis
Abscess
Above (Lungs)
Basal Pneumonia
Below (Appendix)
Appendicitis
Left (Stomach, Pancreas)
Peptic Ulcer Disease
Pancreatitis
Right (Kidney)
Pyelonephritis
DDx of right iliac fossa pain
GI: APPENDICITIS Mesenteric adenitis Colitis (IBD) Malignancy
Gynaecological:
Ovarian cyst rupture, torsion or bleed
Ectopic pregnancy
DDx of suprapubic pain:
Cystitis
Urinary retention
DDx of left iliac fossa pain:
GI Causes:
DIVERTICULITIS
Colitis (IBD)
Malignancy
Gynaecological:
Ovarian cyst rupture, torsion, bleed
Ectopic pregnancy
DDx of diffuse abdominal pain
Obstruction
Infection:
Peritonitis
Gastroenteritis
Inflammation:
IBD
Ischaemia:
Mesenteric Ischaemia
Medical Causes: DKA Addison's Disease Hypercalcaemia Porphyria Lead poisoning
Which organs does the coeliac artery supply?
Stomach Spleen Liver Gallbladder Duodenum
Which organs does the superior mesenteric artery supply?
Small intestine
Right colon
Which organs does the inferior mesenteric artery supply?
Left colon
65 y/o man AAA repair 2 days ago Diffuse abdominal pain HR: 120bpm RR: 30
What will the blood test likely show?
Any cause of acute abdomen causes HIGH AMYLASE
Unlikely to have a normal amylase because he is tachycardic and tachypnoeic- indicates poor tissue perfusion and therefore some lactic acidosis
55 y/o man Excess ETOH use Cirrhosis Abdominal pain Abdominal distension
O/E: Ascites, liver flap
How many neutrophils are you likely to see in spontaneous bacterial peritonitis?
Ascites neutrophils > 250 cells/mm3
Decompensated features of liver disease
Jaundice
Encephalopathy
Ascites
Causes of abdominal distension
Fluid Flatus Fat Faeces Foetus
Signs of ascites
Shifting dullness
Features of liver disease
Signs of obstruction
Nausea, vomiting Not opened bowel High pitched tinkling bowel sounds ?Previous surgery ?Tender irreducible femoral hernia in the groin