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Year 3 core conditions > abdominal > Flashcards

abdominal Flashcards

1
Q

what is GORD?

A

gastro oesopahgeal reflux

inflammatory disease causing reflux of acidic gastric content through the lower oesophageal sphincter

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2
Q

mechanism of GORD

A

Combination of:

  • transient relaxation of the lower oesophgeal sphincter
  • increased lower abdo pressure
  • reduced LOS tone
  • delyaed gastric emptying
  • impaired oesophgeal clearance

= all impair stomach emptying

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3
Q

risk factors of GORD

A 
preg/obesity
fatty foods
smoking
alcohol, chocolate, coffee
stress
anticholinergic drugs, calcium channel antagonists and nitrate drugs
hiatus hernia
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4
Q

presentation of GORD

A 
heart burn (dyspepsia)
acid taste in back of mouth
often related to eating and related to other symptoms - nausea, fullness in upper abdo or belching
worse lying down 
chest pain
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5
Q

investigation of GORD

A

mostly clinical diagnosis
if more complicated needs gastroscopy
- oesphagitis = symotoms +mucosal breaks, endoscopy-negaive reflux disease = symptoms + normal endoscopy

barium swallow and oesophageal pH monitoring in extremes

red flags for urgent endoscopic investigation

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6
Q

red flags in GORD presentation

A 
upper abdo mass
dysphagia
>55yo
weight loss
\+ upper abdo pain + reflux dyspepsia
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7
Q

treatment of GORD

A

lifestyle changes - try and denity and avoid precipitating dietary factors , lose weight, stop smoking, raise bed, stress reduction etc

medication - reduce acid with PPI an dH2-receptor antagonist

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8
Q

complications of GORD

A

BARRETS (basal cell hyperplasia and ulcers form if basal cell formation connot keep up)

= haemorrhage perforation, fibrosis, epithelial regeneration

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9
Q

what is H pyrlori

A

bacteria found in stomahc

produces urea = more stomach acid

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10
Q

treatment of H pylori

A

PPI + 2antibiotics (lansoprazole + clarithromycin + amoxicillin)

refer to endoscopy (if dysphagia, >55 and alarm symptoms)

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11
Q

alarm symptoms in peptic ulcer presentation

A 
anaemia
loss of weight
anorexia
recent onset/progressive symptoms
meleana/haematemesis
swallowing difficulties
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12
Q

risk factors for peptic ulcers

A 
H.pylori
smoking
NSAIDs
steorids
reflux of duodenal contents
delauyed gastric emptying
stress
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13
Q

presentation of peptic ulcers

A

upper abdo discomfort - burning sensation, heaviness, ache

related to eating and accompanied by other symptoms - nasea, fullness in upper abod or belching

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14
Q

epigasgtric pain associated with hunger =

specific foods =

A

duodenal

stomach

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15
Q

diagnosis of peptic ulcers

A

upper GI endoscopy
test for Hpylori
measure gastrin concentrations when off PPIs if zollinger ellison syndrme suspected

biopsy to exclude maligancy

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16
Q

treatment of peptic ulcers

A

lifestyle - decrease alcohol and tobacco

Hpylori eradication

drugs to reduce acid - PPI, H2 blockers

stop drugs that may have caused - NSAIDS, antiplatelets

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17
Q

complications of peptic uclers

A

bleeding, perforation, malignancy, decreased gastric outflow

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18
Q

causes of acute upper GI bleed

A

50% = bleeding from peptic uclers

other cuases - oesophageal varcies, oesophagitis, gastric erosions

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19
Q

presentation of acute upper GI bleeds

A

haematemesis - severe = red with clots, less severe = coffee ground

meleana - high urea (digestion of blood)
known dyspepsia/ulcer, liver disease oesphgeal varice, dysphagia, weight loss

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20
Q

investigations of acute GI bleeds

A 
signs of chronic liver disease
PR to check for meelana
peripherally cool and clammy - cap refil, low urine output
low GCS or encephalopathy
tachycardic

rockall risk assessment

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21
Q

treatment of upper GI bleed

A

pre endoscopy durg therapy
- stop Aspirin, NSAIDs and warfarin
PPIs to hgih risk patients
antibiotics to those with suspected variceal haemorrhgae
determine sight if bleeding
surgery fro thermal therpay if bleeding does not stop.

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22
Q

mallory weiss tear

A

A Mallory-Weiss tear is a tear of the tissue of your lower esophagus. It is most often caused by violent coughing or vomiting. A Mallory-Weiss tear can be diagnosed and treated during an endoscopic procedure. If the tear is not treated, it can lead to anemia, fatigue, shortness of breath, and even shock.

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23
Q

median age of onset of Crohns

A

30 yo

M=W

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24
Q

causes of crohns

A

3 essential co factors:

  • genetic susceptibility
  • environment (smoking increases risk in crohns, decreases in UC. stress precipitates relapses)
  • host immune repsonse
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25
Q

risk factors of crohns

A 
genes
smoking
stress
depression
appendectomy
NSAIDs
oral contraceptives
Family history
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26
Q

presentation of crohns

A

depends on part of bowel involved:
- commonest = ileocaecal
- small bowel = pain and wt loss
- colonic disease = diarhhoea, bleeding and pain on defeacation
- perianal disease = anal tags, fissures fistulae and abscess foramtion
full thicknes of wall is inflamed

iritis, arthritis, erythema nodosum pyoderma gangrenosum

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27
Q

signs of crohsn

A

mouth uclers
signs of systemic illness (anorexia, fatigue, malaise, fever, clubbing)
anal or peri anal ski tag, fisutal or abscess
abdo pain and tenderness
tenderness or mass in RLQ

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28
Q

investigation of crohns

A

FBC (anaemia)
C-reactive protein and erythrocyte sedimentation rate
U+Es
LFTs
stool microscpy and culture
cobblestone appearance of bowel on colonscopy
transmural inflammation

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29
Q

treatment of crohns

A 
smoking cessation
colorectal cancer screening
ensure risk of osteoprosis is managed
managed pain - analgesics
corticosteorids
immunosuppressants - azathioprine and mercaptopurine and methotrexate or cytokine modulating drugs (infliximab and adalimumab)

nutrition

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30
Q

causes of UC

A

GENETIC SUSEPCTIBILITY
- genetic association is stronger for CD than UC,
ENVIRONMENT
- smoking halves the risk, depression and stress precicpate relapses, altered enteric microflora
HOST IMMUNE REPOSNE

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31
Q

risk factors for UC

A

family history
oral contraceptives
not smoking

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32
Q

how does UC present

A 
diarrhoea, containing blood and mucus
course - perisstent diarrhoea, relapses, remissions, severe fulinant colitits
extraintestinal manifestations
faecal urgency
nocturnal defeacation
tenesmus
abdo pain (LLQ)
pre def. pain, releived on passage
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33
Q

tenesmus

A

persisent, painful urge to pass stool even when recutm is empt

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34
Q

signs on examination of UC

A

weight loss, faltering growth in children , anorexia, extraintesitnal manfedtations (uveitis, iritis, inflammatroy arthritis, erythema nodosum pyoderma gangrenosum)

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35
Q

investigations of UC

A 
FBC, inc ferritin
CRP and ESR
U+Es
LFTs
tissue transgulatminase
stool microscopy and culture - cdiff, campylobacter, escherichia coli
faecal calprotectin
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36
Q

treatment of UC

A

manage pain (paracetamol)
manage constipation or diarrhoea
manage fatigue (exclude depression or anaemia)
surgery - colectomy with ileoanal anastamosis)
terminal ilium sued to form reservoir

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37
Q

panprocxtoclectomy with ileostomy

A

whole colon and rectum removed and the ileum bought out onto the abdo wall as astoma

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38
Q

infective gastroenteritis

A

inflammation of the intestines

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39
Q

who gets infective gastroenteritis

A

20% of UK pop per year

young, old, travellers and immunocompromised

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40
Q

what causes infective gastroenteritis?

A

enteric infection with viruses, bacteria and protozoa

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41
Q

how does gastroenteritis present?

A

sudden onset diarrhoea +/- vomiting

blood or mucus in stool

fever or malaise

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42
Q

investgiations for gastroenteritis

A

diagnosis made clinically - symptoms and signs

culture of stool sample may be necessary to determine cause

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43
Q

treatment of infective gastroenteritis

A

adequate hydration

antimotility agents such as loperamide

empirical antibiotics given o thse with severe symptoms or blood diarrhoea, pending the results of stool sample

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44
Q

acute pancreatitis causes

A

1 GALLSTONES #2 ALCOHOL

l GET SMASHED

idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpian bites
hyperlipidaemia/hypothermia
ERCP
drugs
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45
Q

presentation of acute pancreatitis

A

severe abdo pain of sudden onset
may radiate into the back
nausea and vomtiing

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46
Q

treatment of acute pancreatitits

A

aggressive IV water and electrolyte replacement + opiate analgesia (not morphine)

if hypoxic, give O2

surgery to remove gallstones - ERCP

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47
Q

chronic pancreatitis

A

ongoing inflammation of pancreas accompanied by irreversible architectural changes

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48
Q

causes of chronic pancreatitis

A

mostly alcohol consumption

high fat and protein diets amplify damage by alcohol

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49
Q

4 pathological features of chronic pacnreatitis

A

continuous chronic inflammation
fibrous scarring
loss of pancreatic tissue
duct strictures with formation of calculi

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50
Q

presentation of chronic pancreatitis

A

prolonged ill health
chronic epigastric pain radiating through to back
steatorrhoea

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51
Q

diagnosis of chronic pancreatitis

A

normal serum amylase
fiagnosis by CT scan + endoscopic ultrasound or MRI
plain abdo radiography - speckled calcification
diabetes mellitus needs excluding

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52
Q

treatment of chronic pancreatitis

A

lifestyle changes - smoking anbd drinking
pain releif
screen for DM and osteoporosis
pancreatic enzyme supplementation
corticosteorids for autoimmune
treatment of hyper triglyc. or hypercal.
treatment of DM

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53
Q

SIGNS of acute pancreatitis

A

abdo tenderness
abdo distension
bluish discoloration around umbilicus (cullens sign) or flank (grey-turners sign) if haemorrhagic
tachycardia and hypotension - shock

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54
Q

investigation of acute pancreatitis

A

lipase or amylase levels

CT, MRI or ultrasound

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55
Q

risk factors for chronic pancreatitis

A 
smoking
autoimmune disease
genetic abnormalities
drugs
obstructive causes
tropical causes
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56
Q

who gets gall stones?

A

v common
4Fs
forty, fat, fair females

57
Q

what causes gallstones

A

imbalance in chemical composititon of bile - precipitation of stone

cholesterol stones = msot common
pigmented stones (bilirubin and calcium)

mixed stones

58
Q

risk factors for gallstones

A 
obesity
age
female
high triglycerides and low HDL
DM
OCP, HRT
smoking 
crohns diseasee
genetic and ethnic factors
59
Q

presentation of gallstones

A

biliary colic is most common presentation - RUQ pain, N+V,

cholecystitis - RUQ pain, N+V, fever and tenderness

cholangitis - charcots triad= fever (rigors), jaundice and RUQ pain

60
Q

investigations of gallstones

A

abdo ultrasound

LFTs (can be nromal)

61
Q

treatment of gallstones

A

asymptomatic = leave alone unless in CBD

treat by surgery, pain releif and avoid food/drinks thattrigger symptoms

62
Q

most common cause of liver injury

A

viral hepatitis

63
Q

common and uncommon cuases of viral hepatitis

A

common: hep A, B, C, E

less common: EBV, HepD, arbovirus

64
Q

acute viral hepatitis presentation

A

asymptomatic or symptomatic. with or without jaundice and itching

non specific flu like symptoms, gastroenteritis symtpoms.
fever, malaise, loss of apeitite, vomting, diarhrhoea, abdo pain, juandice, dark urine, light coloured stool

65
Q

inidcates hepatocyte damage/ hepatitis

A

raised serum transaminases

66
Q

diagnosis of acute hepatitis

A

liver function tests and serologic tests to identify the virus

67
Q

treatment of acute hepatitis

A

hep A +B = no specific treamtent, just symptomatic

hep C = antiviral therpay

68
Q

most common cause of acute abdomen

A

appendicitis

69
Q

causes of appendicitis

A

infection secondayr to obsturction of lumen of appendix

  • feaces, hyperplasia, bacterial overgrowth, necrosis
70
Q

risk factors of appendicitis

A

M>F
10-20 yo
frequent antibiotic use
smokinbg

71
Q

presetnation of appendicitis

A

abdo pain - preumbilical worsening 24hrs then migrates to right iliac fossa

pain worsened on movement

anorexia

nausea

constipation

vomiting

72
Q

signs on examination of appendicitis

A

tenderness on percussion, guarding, rebound tenderness

73
Q

investigations of appendicits

A

pregnancy test
urine dipstick - exclude UTI
FBC, CRP to rule out infection

74
Q

treatment of appendicits

A

surgery to remove

75
Q

causes of small bowel obstruction

A

adhesions (80%), hernias, crohns, intusseception, extrinsic involvement by cancer

76
Q

causes of large bowel obstruciton

A

colonic carcinomas of colon, signmoid volvulus, diverticula disease

77
Q

broad catagories of causes of bowel obstruction

A

mechanical - bowel above level of obstruction is dilated w increased secretion of fluid into lumen

functional - occurs with paralytic ileus - pseudoobstruction

78
Q

presentation of bowel obstruction

A

mechanical: colicky abdo pain, assoicated with vomiting and absolute constipation
functional: pain not often present

79
Q

signs of bowel obstruction

A

mechanical - tinkling sound and distension

functional - decreased bowel sounds

80
Q

investigations of bowel obstruction

A

abdo XR - see gas throughout bowel

81
Q

treatment of bowel obstruction

A

mechanical - small bowel obstruction may settle with conservative management (nasogastric suction and IV fluids to maintain hydration)

large bowel obstruction needs surgery

functional - conservative treamtnet

82
Q

who gets femoral hernias

A

1 in 20 groin hernias are femoral (rest inguinal)

odler females

83
Q

causes of femoral hernias

A

defect in surrounding msucle leading to fat or bowel poking into femoral canal

84
Q

risk factors of femoral hernias

A

straining on the toilet if constipated
carrying and pushing heavy loads
obesity and persistent heavy coughs

85
Q

presentation of femoral hernias

A

can appear suddenly due to strain and are normally a painful lump in inner upper part of thigh or groin

86
Q

signs on examination of femoral hernia

A

lump can often be pushed back in or dissapears when lie down

87
Q

treatment of femoral hernias

A

treatment is prompt due to risk of obstruction or strangulation

surgery

most ppl recover in 6 weeks, return to light activity in 2 weeks

88
Q

who gets inguinal hernias?

A

M>W

occur as get older and muscle gets weaker

89
Q

risk factors of inguinal hernias

A

straining on the toilet
carrying or psuhing heavy loads
persistent heavy cough

90
Q

presentation of inguinal hernia

A

swelling or lump in groin
enlarged scrotum
may be painful

91
Q

signs on examination of inguinal hernia

A

soft mass, may be reducible

92
Q

treatment of inguinal hernia

A

treatment if painful, causes severe or persistent symptoms or if any serious complications develop

93
Q

types of oesophgeal carcinoma and who gets it

A

adenocarcinoma = more in west, M»F

squamous caricnoma = less in west M»F

rhabdomysarcoma = very rare

Lipoma and GI stroma tumour = rare

94
Q

causes of oesophageal adenocarcinoma

A

dietary nitrosamines (carcinogens)
GORD
barrets metaplasia

95
Q

where does oesophgeal adenocarcinoma occur?

A

lower half of oesophagus

96
Q

causes of oesophageal squamous carcinoma?

A 
smoking
alcohol
low fresh fruit and veg diet
chronic achalasia
chronic caustic strictures
97
Q

where do oesophageal squamous carcinomas occur?

A

anywhere in oesophagus

98
Q

presentation of oesophageal carcinoma

A

dysphagia
haematemesis
incidental screening
symptoms of disseminated disease- lymphadenopathy, hepatomegaly (due to mets)
symptoms of local invasion - dysphonia, cough, haemoptysis, neck swelling, horners syndrome

99
Q

investigations of oesophageal carcinoma

A

flexible oesophagoscopy and biopsy

barium swallow if fialed intubation or suspected post cricoid carcinoma

100
Q

treatment of oesophageal carcinoma

A

squamous carcinoma - radical external radiotherapy + radical resection

adenocarcinoma (large) - neoadjuvant chemoradiotherapy + radical resection

adenocarcinoma (small) or high grade dysplasia in barrets - surgical resection

101
Q

who gets gastric carcinomas?

A

over 50s

M»F

102
Q

causes of gastric carcinoma

A

adenocarcinomas:

  • nitrosamines (fresh fish, picked fruit)
  • chronic atrophic gastritis
  • blood group A
  • chronic gastric ulceration related to H.Pylori
103
Q

presentation of gastric carcinoma

A 
dyspepsia
weight loss, anorexia, lethargy
anaemia
occasionally upper GI bleeding
dysphagia uncoomon unless proximal fundus and gastrooesophgeal junction involved
104
Q

examination signs of gastric carcinom

A

weight loss
palpable epigastric mass
palpable supraclavicular lymph node (troisiers sign) = disseminated disease

105
Q

investigations for gastric carcinoma

A

gastroscopy
barium swallow if gastroscopy contraindicated
staging by US and thoracoabdominal CT

106
Q

treatment of gastric carcinoma

A

if early - surgical resection if patient well enough

advanced - surgery only in palliative, local ablation for symptom control, palliative chemo occasionally effective

107
Q

who gets pancreatic carcinoma

A

60-70s

mostly ductal adenocarcinoma

108
Q

risk factors for pancreatic caricinoma

A 
cigarette smoking
age
high fat diet
diabetes
alcohol
chronic pancreatitis

exposure to naphthalene and benzidine
hereditary factors + FH

109
Q

presentation of pancreatic caricnoma

A

depends on location
- in head of pancreas:
obstructive jaundice + palpable gallbladder
pain - epigastric, LUQ, radiates to back
hepatomegaly due to mets
anorexia, N+V, fatigue malaise, dyspepsia, pruritis,

in body and tail:
asymptomatic in early stages
weight loss and back pain
epigastric mass
jaundice - spread to hilar lymph nodes or mets
thrombophlebitis migrans
diabetes mellitus
110
Q

investigations of pancreatic carcinoma

A 
FBC, LFTs, blood sugar
elevated serum CA 19-9
transabdominal US
doppler US of portal vein
helical CT scan of pancreas
FNA
ERCP
111
Q

treatment of pancreatic carcinoma

A

95% not suitable for surgery - even in resectable, 5yr survival is 12%

releive jaudice via ERCP
relief of duodenal obstruction (surgical gastric bypass)

relief of pain (morphine)

adjuvant chemo and resection can improve prognosis

112
Q

who gets colorectal carcinoma

A

M»F
peak age - 45-64
more in younger

113
Q

risk factors of colorectal cancer

A 
polyposis syndromes (FAP, HNPCC, juvenile polyposis)
strong FH
previous history of polyps or CRCa
chronic UC or chrons
diet poor in fruit and veg
114
Q

presentation of colorectal cancer

A

rectal location:

  • PR bleeding
  • change in bowel habit (diff defeacation, sense of incomplete, painful defecation (tenesmus))

descending sigmoid location:

  • PR bleeding,
  • change in bowel habit, increased fre, variable consistency, mucus PR bloating and flatulence

right sided location
- anaemia iron deficiency

emergency presentation:

  • large bowel obstruction = colicky pain, bloating, bowels not open)
  • perforation with peritonitis
  • acute PR bleeding
115
Q

investigations of colorectal cancer

A

PR examination or rigid sigmoidoscopy for rectal
flexible sigmoidoscopy

colonoscopy more reliable

tumour marker CEA not useful for diagnostic but used for monitoring

abdo CT

116
Q

treatment of colorectal cancer

A

surgical resection only curative treatment

suitable if mets so long as you can also resect liver and lung

preop chemo

chemo in palliative

117
Q

chronic liver failure is often the result of

A

cirrhosis

or alcohol related liver disease

118
Q

types of alcohol related liver failure

A

alcoholic fatty liver disease (obese and alcoholic)

alcoholic hepatitis (alcoholics)

alcoholic cirrhosis (most advanced form)

119
Q

symptoms of liver failure

A 
nausea
loss of apetite
fatigue
diarrhoea
jaundice
weight loss
brusing or bleeding
itching
oedema
ascites
120
Q

causes of ascites

A 
cirrhosis (commonest) 
liver cancer
heart failure
pancreatitis
hypoalbuminaemia
peritoneal tuberculosis
121
Q

how does cirrhosis cause ascites

A

late stage liver disease
extensive liver fibrosis blocks blood flow from portal vein

blood backs up in portal vein = portal hypertension

fluid leaks out of portal vein into abdomen

122
Q

signs of ascites

A

fullness in flanks
shifting dullness
tense ascites - uncomfortable and reduces respiratory distress
pleural effusion and peripheral oedema

123
Q

investigations of ascites

A

diagnostic aspiration of 20ml ascetic fluid

albumin >11g/L suggests transudate, < = exudate

neutrophil count, gram stain and culture - ctyology for malignant cells and amylase to exclude pancreatic ascites

124
Q

treatment of ascites

A

depends on cause

  • diuretics , aim to lose 500g of body weight per day
  • paracentesis if ascites is tense or resistant to standard medical therapy
125
Q

causes of malnutrition

A

diseases complicated by malnutrition: anorexia nervosa, carcinoma of oesophagus or stomach, post op states, dementia,

protein energy malnutrition coexists wth infections frequently - infections may exacerbate this deficiency

126
Q

presentation of malnutrition

A

children = kwashiorkor (swollen ankles, scaly skin, swollen abdo, depigmented hair) and marasmus (hair loss, wrinkled skin, severe wasting), cachexia

127
Q

what is a perforated viscus

A

hollow organ with an abnormal opening

128
Q

causes of perforated viscus

A

abdo trauma - stabbings, gunshots, RTA,

infections

129
Q

complications of perforated viscus

A

spilling materials from GI organs into abdo
= toxic inside body cavity

bacteria can reach blood system and cause sepsis

= immediate medical attention needed

130
Q

how does perforated viscus present

A

fever, low blood pressure, tachycardia, abdo pain, nausea, vomiting, abdo distention

131
Q

signs on examination of perforated viscus

A

severe pain with abdo feeling rigid or board like when touched

132
Q

treatment of perforated viscus

A

open surgery

133
Q

who gets coeliac disease

A

bimodal peaks in infancy and adults (50s)

134
Q

causes of coeliac disease

A

autoimmune inflammatory disease associated with LA DQ2 and DQ8

inflammatory cascade and release of mediators contribute to villous atrophy and crypt hyperplasia = typical histological features of coeliac disease

135
Q

presentation of coeliac disease

A

tiredness and malaise

symptoms of small intestine disease

136
Q

signs on examination of coeliac disease

A

few and non specific

anaemia and nutritional deficiency
dermatitis herpetiformis

137
Q

investigations of coeliac disease

A

serum antibodies - IgA transglutaminase tTG antibodies

distal duodenal biopsies - for definitive diagnosis

blood count - mild anaemia

small bowel radiology or capsule endoscopy as well as bone densitometry

138
Q

treatment of coeliac disease

A

gluten free diet and correct of any vitamin deficiences

Year 3 core conditions (15 decks)

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