Abdominal Flashcards
Refeeding syndrome definition:
- Potentially fatal shift in fluids and electrolytes from rapid artificial feeding in malnourished patients
How does refeeding syndrome work?: (3)
- I S
T U
M R
- Increased insulin secretion drive K+, Mg2+ into cells, reducing them intravascularly
- Increases thiamine utilisation
- Increases metabolic rate which increases strains on CVS and resp.system.
Prevention of refeeding syndrome:
- Monitoring of the patients K, Ca, PO4, Mg
Short bowel syndrome:
- A condition where the body is unable to absorb enough nutrients from food due to lack of small intestine
Consequences of short bowel syndrome: (5)
L D
G D
B O
N D
K D
- Liver disease
- Gallbladder disease
- Bacterial overgrowth (small intestine)
- Nutrient deficiencies
- Kidney disease
Total parenteral nutrition (TPN):
- A method of feeding that bypasses the GI tract
When is TPN useful?
How is TPN delivered?
- When all or part of a persons GI tract doesn’t work
- Into a vein
Urea cycle defect:
- Leads to hyperammonaemia
- Must restrict diet (protein)
- Supplementation required to stop muscle atrophy
Medium chain aceyl-CoA dehydrogenase deficiency (MCAD):
- Defect in fatty acid oxidation
- Can lead to hypoglycaemia, potentially fatal to babies
Clinical features of Acute (fulminant) liver disease:
N
D
J
B E
A
H E
V
S
- Nausea
- Diarrhoea
- Jaundice
- Bleeding easily
- Ascites (fluid in belly)
- Hepatic encephalopathy
- Varices
- Splenomegaly
Chronic liver disease clinical features: (3)
- Similar symptoms to acute
- liver cirrhosis
- Portal hypertension
Chronic liver disease and portal hypertension:
Effects (3)
- Ascites
- Oesophageal varices
- Splenomegaly -> thrombocytopenia
Stigmata of chronic liver disease: (2)
- Spider nevi
- Palmar erythema
Common causes of liver disease:
A
F
H
P B C
P S C
- Alcoholism
- Fat
- Hepatitis A/B/autoimmune
- Primary biliary cholangitis
- Primary sclerosing cholangitis
How to test for liver dysfunction: (3)
- Serum fibrosis score
- Fibrosis markers or fibroscan
- Liver biopsy (best but invasive)
Paracetamol overdose:
- why?
- Treatment
- Narrow therapeutic window, >10g can cause toxicity
- N-acetylcysteine
Rotavirus epidemiology:
- Global prevalence
- Peak incidence group
- Uncommon in ……
- Seasonal peak
- Most common cause of diarrhoea world wide
- 6-24months
- Uncommon in >5 year olds
- Winter peak
Norovirus epidemiology:
- Most common cause where?
- Peak incidence group
- Seasonal peak
- Most common cause in the UK & US
- 6-18 months
- Winter peak
Rotavirus pathophysiology:
- Replicates in….
- Activation of …..
- Replicates in enterocytes, causing damage but little inflammation
- Activation of enteric nervous system may contribute to pathogenesis
Rotavirus clinical features:
(wide spectrum) (4)
▪ severe diarrhoea
▪ Vomiting in 90% children
▪ Fever
▪ Can be Asymptomatic
Rotavirus & norovirus transmission:
- Breathe in aerosolised vomit/faeces and swallow
Rotavirus diagnosis:
S E M
S E I
M D
▪ Stool electron microscopy
▪ Stool enzyme immunoassays
- Molecular diagnosis (PCR of faeces)
Norovirus pathophysiology:
▪ No enterotoxins
▪ Enterocytes infected
▪ Histo blood group antigens (HBGA) may function as a receptor for norovirus
Norovirus clinical features:
V
D
H
M
A C
- Vomiting in children
- Diarrhoea in adults
- Headaches
- Myalgia
- Abdo cramps
Hepatitis A: pathophysiology
- Immune mediated T lymphocyte destruction of hepatocytes
Hepatitis A transmission:
- Faecal-oral (contaminated food and water)
Hepatitis A: clinical features
F
L of A
F
J
H
A
V
- Flu like
- Loss of appetite
- Fever
- Jaundice
- Hepatomegaly
- Anorexia
- Vomiting
Hep A diagnosis:
- Biochem features (3)
- Onset
- LFTs, Clotting, U&Es
- HEP A IS ACUTE
HEP E: pathophysiology
- Single stranded RNA, no envelope
Hep E transmission:
- Faecal-oral, association with pork
Hep E: clinical features
- Similar to ….
- Difference
- Duration
- Similar to Hep A but more severe
- Higher mortality
- Acute in immunocompetent
Diagnosis of Hep E:
- Clinical features not enough, lab tests required
Hep B: pathophysiology (2)
- Immune response causes hepatocellular damage
- HBV DNA persists in the host cell as cccDNA
Hep B transmission: (3)
- Sexual
- mother to child
- Needle sharing, blood products
Hep B clinical features: acute
- Acute: all children and 50% of adults are asymptomatic, if symptomatic, similar to Hep A
Hep B clinical features: chronic
- Low prognosis, likely to cause cirrhosis and hepatocellular carcinoma
Hepatitis C pathophysiology:
- Enters liver cells and reproduces, simultaneously causing cell death
- Via chronic inflammation, immune mediated cytotoxicity, high cell turnover
Hep C transmission: (2)
- Percutaneous (NEEDLE INJURIES)
- Permucosal (sexual)
Hep C clinical features: acute
- all children and 50% adults asymptomatic, if symptomatic, features
similar to Hep A
Hep C clinical features: chronic
- low prognosis, likely to cause cirrhosis and hepatocellular
carcinoma
Hep C diagnosis: (2)
- Picked up by screening risk groups, contacts or as part of liver disease work up
- Antibody or RNA
Hep B & C as chronic illnesses:
- Hep C is much more likely to be chronic, poor prognosis for both cases
Causes of diarrhoea: common
I
G
M
D
C
- Irritable bowel syndrome
- Gastroenteritis
- Medication
- Diet
- Coeliac disease
Uncommon causes of diarrhoea:
M
I B D
D D
B O
o Malignancy
o Inflammatory Bowel Disease
o Diverticular disease
o Bowel Obstruction
Irritable bowel syndrome:
– functional GI disorder categorized by a large group of
symptoms including abdominal pain and changes in bowel movements
Coeliac disease:
- autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten
Inflammatory bowel disease:
- group of inflammatory conditions of the colon and small intestine
Diverticular disease:
- the condition of having diverticula (multiple pouches) in the colon that are not inflamed
Causes of obstipation (no flatus or faeces): (2)
- Small/large bowel obstruction
- Paralytic illeus (peristalsis is paralyzed)
Large bowel function: (3)
- Absorb salt and water
- Absorb short chain fatty acids
- Store/expel faeces
Recto-sphicteric reflex:
- Faeces in the rectum stimulates mass movement
- Relaxation of IAS and contraction of EAS,
- If inappropriate to defaecate, IAS contracts and rectal contents return to colon by
retroperistalsis
Pancreatic cancer symptoms:
D
B P
A P
N/V
N D
C
▪ Diarrhoea
▪ Back Pain
▪ Abdo pain
▪ Nausea/vomiting
▪ Constipation
▪ New-onset diabetes
Steatorrhea:
- Pale bulk stools difficult to flush due to increased fat content
Causes of steatorrhea:
- If it affects the …. , ……… production/transport or causes …….
P E D
B D
C D
C
C F
If it affects the pancreas, bile salt production/transport or causes malabsorption
- Pancreatic exocrine deficiency
- Blockage of bile ducts
- Coeliac disease (malabsorption)
- Chron’s (malabsorption)
- Cystic fibrosis
Referred pain:
– Pain felt in a part of the body that is not the source (does not radiate)
Colicky pain:
- Pain characterised by either intermittent nature or variable/cyclic intensity
Peritonic pain:
- Abdominal pain felt due to inflammation of the peritoneum
Biliary colic: definiton
- Where a colic (pain) suddenly occurs due to gallstones temporarily blocking the cystic duct