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CP1 > Abdomen- Signs and Symptoms > Flashcards

Abdomen- Signs and Symptoms Flashcards

Memorize the signs and symptoms of each disease of the abdomen included in CP1

1
Q

List the symptoms of acute appendicitis.

A
  • Abdominal pain, starting dull and central before becoming localised and sharp in the RIF at McBurney’s point. (1/3rd of the way between the ASIS and the umbilicus)
  • Constipation
  • Anorexia
  • Nausea and vomiting (AFTER the pain)
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2
Q

List the signs of acute appendicitis.

A
  • Rebound (when examiner moves his hand away) in the RIF
  • Percussion tenderness
  • Guarding
  • Rosving’s sign (more painful in RIF than LIF when LIF is pressed)
  • PR painful on RHS (if pelvic appendix, or pus in pouch of Douglas)
  • Tachycardia
  • Mild fever, flushing and fetor
  • Tender mass (occasionally)
  • Psoas sign (pain on R. hip extension)
  • Obturator sign (pain on internal rotation of R. hip: pelvic appendix)
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3
Q

What is the usual presentation of Meckel’s diverticulum, and what conditions may it mimic?

A

Meckel’s diverticulum is usually asymptomatic. The conditions it may mimic include;

  • Caecal volvulus (if tethered to the umbilicus, the diverticulum may act as the apex of a volvulus)
  • Intussusception (often gangrenous by the point of operation)
  • Appendicitis (diverticulum becomes inflamed, presenting identical to appendicitis (sometimes also with umbilical cellulitis)
  • Peptic Ulceration (pain around the umbilicus that is related to mealtimes, due to ulceration of the gastric secreting epithelium)
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4
Q

What is the location of Meckel’s diverticulum?

A

20 inches (60cm) from the ileocecal valve

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5
Q

Describe the symptoms that may suggest a diagnosis of IBS.

A

In the preceding 12 months there should be at least 12 consecutive weeks of abdominal discomfort or pain, with 2 out of 3 of the following features:

- Relieved with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form of stool
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6
Q

List other symptoms of IBS that may present alongside those within the definition of IBS.

A
  • Bloating
  • Passage of mucus
  • Stool passage symptoms (tenesmus; feeling of incomplete evacuation)
  • Associated gynaecological symptoms (dysmenorrhoea/ dyspareunia)
  • Urinary symptoms (frequency, urgency, nocturia)
  • back pain.
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7
Q

Describe the common presenting symptoms of Crohn’s disease.

A
  • Abdominal pain - Diarrhoea (steatorrhea in ileal disease, bloody in colonic disease)
  • Weight loss
  • Severe apthous ulceration of the mouth (early sign)
  • Anal complications (fissure, fistula, haemorrhoids, skin tags, abscesses)
  • Extra GI manifestations
  • Can present with acute RIF pain/mass
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8
Q

Describe the common presenting symptoms of Ulcerative Colitis.

A
  • Crampy lower abdominal discomfort
  • Gradual onset diarrhoea (often bloody)
  • Urgency and tenesmus if disease confined to rectum
  • Extra GI symptoms
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9
Q

List the extra-colonic manifestations of Inflammatory Bowel Disease.

A
  • Eyes: conjunctivits/ episcleritis/ iritis
  • Joints: Arthralgia of the large joints
  • Skin: Erythema nodosum, Pyoderma gangrenosum
  • Others: Venous thrombosis, fatty liver
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10
Q

List diseases associated with IBD, unrelated to disease activity.

A
  • Autoimmune hepatitis
  • Gallstones
  • Renal calculi
  • Primary sclerosing cholangitis
  • Cholangiocarcinoma
  • Ankylosing spondylitis (related to HLA B27)
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11
Q

Discuss the definition of ‘dyspepsia’.

A
  • Chronic upper abdominal pain/ discomfort
  • It can be subdivided into 1) Reflux type (heartburn and regurgitation aka GORD) 2) Ulcer type (epigastric pain)
    3) Dysmotility type ( bloating and nausea)
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12
Q

Name the typical symptoms of gastro-oesophageal reflux disease

A
  • Heartburn/ Indigestion (dyspepsia) (worse on bending/lying down, when drinking hot liquids or alcohol) (relieved by antacids)
  • Regurgitation of food/acid (passive process, c.f vomiting) (More common when bending/ lying)
  • Aspiration
  • Odynophagia
  • There may be atypical chest pain due to distal oesophageal muscle spasm and a nocturnal cough/ wheeze giving asthma type symptoms.
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13
Q

List the symptoms that would suggest gastric cancer

A
  • Often non-specific
  • Epigastric pain (as with gastric peptic ulcer)
  • Nausea and vomiting
  • Dysphagia (if the tumour is near the fundus)
  • Anorexia and weight loss
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14
Q

List the signs that would suggest gastric cancer

A
  • Palpable epigastric mass
  • Large left supraclavicular node (Virchow’s)
  • Hepatomegaly, jaundice, ascites
  • Acanthosis nigracans
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15
Q

List the symptoms of gastric ulcer disease

A
  • Epigastric pain (related to food intake, relieved by antacids)
  • Nausea
  • Anorexia and Weight Loss
  • Haematemisis/ Maleana
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16
Q

List the symptoms and signs of Upper Gastrointestinal Bleeding

A

Symptoms: - Haematemis - Malaena - Haematochezia - Abdominal pain
Signs: of any underlying cause, and shock

17
Q

List the clinical features of diverticular disease

A
  • Left sided colic, relieved by defecation
  • Altered bowel habit (including blood and mucus passage)
  • Nausea
  • Flatulence
  • Severe pain and constipation if severe
18
Q

List the symptoms of diverticulitis

A
  • Severe left sided colic
  • Constipation (or overflow diarrhoea)
  • Symptoms mimicking appendicitis but on the left
19
Q

List the signs of diverticulitis

A
  • Fever and tachycardia
  • Tenderness, guarding and rigidity on the left side
  • Can be palpable mass in the LIF
  • Raised WCC and inflammatory markers
20
Q

List the common symptoms suggestive of carcinoma of the colon, rectum and anus

A

Any colorectal tumour may present with an abdominal mass, abdominal pain, perforation or fistula

  • Right sided (proximal) tumours are often asymptomatic and may present with IDA/ weight loss
  • Left sided tumours more commonly present with PR blood/mucus, altered bowel habit, tenesmus, obstruction and a mass on PR examination
  • Anal tumours may present with bleeding, pain, changes in bowel habit, pruritis ani, masses or a stricture
21
Q

Describe the symptoms of Haemorrhoids

A
  • Rectal bleeding (bright red blood on paper)
  • Prolapse
  • Mucous discharge
  • Pruritis ani
  • Pain if the piles become thrombosed
22
Q

Describe the complications of Haemorrhoids

A
  • Anaemia (If severe/ continued bleeding)
  • Thrombosis (If prolapsing piles are gripped by the anal sphincter the venous return is occluded, leading to thrombosis. The haemorrhoids swell , become purple and cause significant pain and distress)
23
Q

Outline the symptoms of a patient with perianal infection

A

Present with a visibly red, exquisitely tender swelling next to the anus

24
Q

Describe the symptoms of a patient with Fissure in Ano

A
  • Pain (worse of defacation, lasting for hours afterwards)
  • Associated constipation
  • Pruritis ani
  • Bleeding on defecation
25
Q

Describe the signs O/E of a patient with Fissure in Ano

A
  • Midline longitudinal tear in the rectal mucosa (90% posterior)
  • ‘Sentinal pile’ or mucosal tag at the external aspect
  • PR may not be possible due to pain or muscle spasm
26
Q

List the symptoms within a classical history of Chronic Liver Disease

A
  • Fatigue
  • Weight Loss/ anorexia (due to early satiety with hepatomegaly. There may however be central ‘weight gain’ due to ascites)
  • Jaundice
  • Leg swelling (increased intra-abdominal pressure, low oncotic pressure)
  • Bleeding/ Bruising (decreased synthetic function)
  • Itching (bile salt accumalation in the peripheral nerves)
27
Q

List the signs of chronic liver disease

A
  • Nails : leoconychia due to low albumin; clubbing
  • Hands: palmar erythema, Dupuytren’s contracture, liver flap
  • Skin: pigmentation, spider naevi, striae
28
Q

List the signs of decompensated liver disease

A
  • Encephalopathy
  • Ascites
  • Jaundice
29
Q

List the clinical manifestations of portal hypertension

A
  • Variceal bleeding
  • Haemorrhoids/ caput medusae
  • Ascites
  • Splenomegaly (portal congestion)
  • Porto systemic encephalopathy (toxins bypass liver)
30
Q
  • List the Classical Clinical Features of Obstructive Jaundice
A
  • Jaundice of sclera, and skin
  • pruritis
  • pale stools
  • dark urine
  • steatorrhoea (reduced fat soluble vitamin absorption)
31
Q

Describe the presentation of carcinoma of the head of the pancreas

A
  • jaundice (obstructive), pain develops as the disease progresses
  • Signs related to obstructive jaundice (Courviosier’s sign or a palpable abdominal mass)
  • Hepatosplenomegaly or ascites are common.
  • Can present as acute pancreatitis or diabetes
32
Q

Describe the presentation of carcinoma of the tail of the pancreas

A
  • More likely to present late with a dull abdominal pain readiating through to the back, partially relieved by sitting forward.
  • Non specific B symptoms common
  • Often no physical signs on examination
  • Can present with acute pancreatitis or diabetes

CP1 (4 decks)

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