Abdominal Flashcards

1
Q

Refeeding syndrome definition:

A
  • Potentially fatal shift in fluids and electrolytes from rapid artificial feeding in malnourished patients
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2
Q

How does refeeding syndrome work?: (3)
- I S
T U
M R

A
  • 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.
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3
Q

Prevention of refeeding syndrome:

A
  • Monitoring of the patients K, Ca, PO4, Mg
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4
Q

Short bowel syndrome:

A
  • A condition where the body is unable to absorb enough nutrients from food due to lack of small intestine
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5
Q

Consequences of short bowel syndrome: (5)
L D
G D
B O
N D
K D

A
  • Liver disease
  • Gallbladder disease
  • Bacterial overgrowth (small intestine)
  • Nutrient deficiencies
  • Kidney disease
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6
Q

Total parenteral nutrition (TPN):

A
  • A method of feeding that bypasses the GI tract
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7
Q

When is TPN useful?
How is TPN delivered?

A
  • When all or part of a persons GI tract doesn’t work
  • Into a vein
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8
Q

Urea cycle defect:

A
  • Leads to hyperammonaemia
  • Must restrict diet (protein)
  • Supplementation required to stop muscle atrophy
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9
Q

Medium chain aceyl-CoA dehydrogenase deficiency (MCAD):

A
  • Defect in fatty acid oxidation
  • Can lead to hypoglycaemia, potentially fatal to babies
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10
Q

Clinical features of Acute (fulminant) liver disease:
N
D
J
B E
A
H E
V
S

A
  • Nausea
  • Diarrhoea
  • Jaundice
  • Bleeding easily
  • Ascites (fluid in belly)
  • Hepatic encephalopathy
  • Varices
  • Splenomegaly
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11
Q

Chronic liver disease clinical features: (3)

A
  • Similar symptoms to acute
  • liver cirrhosis
  • Portal hypertension
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12
Q

Chronic liver disease and portal hypertension:
Effects (3)

A
  • Ascites
  • Oesophageal varices
  • Splenomegaly -> thrombocytopenia
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13
Q

Stigmata of chronic liver disease: (2)

A
  • Spider nevi
  • Palmar erythema
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14
Q

Common causes of liver disease:
A
F
H
P B C
P S C

A
  • Alcoholism
  • Fat
  • Hepatitis A/B/autoimmune
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
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15
Q

How to test for liver dysfunction: (3)

A
  1. Serum fibrosis score
  2. Fibrosis markers or fibroscan
  3. Liver biopsy (best but invasive)
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16
Q

Paracetamol overdose:
- why?
- Treatment

A
  • Narrow therapeutic window, >10g can cause toxicity
  • N-acetylcysteine
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17
Q

Rotavirus epidemiology:
- Global prevalence
- Peak incidence group
- Uncommon in ……
- Seasonal peak

A
  • Most common cause of diarrhoea world wide
  • 6-24months
  • Uncommon in >5 year olds
  • Winter peak
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18
Q

Norovirus epidemiology:
- Most common cause where?
- Peak incidence group
- Seasonal peak

A
  • Most common cause in the UK & US
  • 6-18 months
  • Winter peak
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19
Q

Rotavirus pathophysiology:
- Replicates in….
- Activation of …..

A
  • Replicates in enterocytes, causing damage but little inflammation
  • Activation of enteric nervous system may contribute to pathogenesis
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20
Q

Rotavirus clinical features:
(wide spectrum) (4)

A

▪ severe diarrhoea
▪ Vomiting in 90% children
▪ Fever
▪ Can be Asymptomatic

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21
Q

Rotavirus & norovirus transmission:

A
  • Breathe in aerosolised vomit/faeces and swallow
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22
Q

Rotavirus diagnosis:
S E M
S E I
M D

A

▪ Stool electron microscopy
▪ Stool enzyme immunoassays
- Molecular diagnosis (PCR of faeces)

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23
Q

Norovirus pathophysiology:

A

▪ No enterotoxins
▪ Enterocytes infected
▪ Histo blood group antigens (HBGA) may function as a receptor for norovirus

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24
Q

Norovirus clinical features:
V
D
H
M
A C

A
  • Vomiting in children
  • Diarrhoea in adults
  • Headaches
  • Myalgia
  • Abdo cramps
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25
Hepatitis A: pathophysiology
- Immune mediated T lymphocyte destruction of hepatocytes
26
Hepatitis A transmission:
- Faecal-oral (contaminated food and water)
27
Hepatitis A: clinical features F L of A F J H A V
- Flu like - Loss of appetite - Fever - Jaundice - Hepatomegaly - Anorexia - Vomiting
28
Hep A diagnosis: - Biochem features (3) - Onset
- LFTs, Clotting, U&Es - HEP A IS ACUTE
29
HEP E: pathophysiology
- Single stranded RNA, no envelope
30
Hep E transmission:
- Faecal-oral, association with pork
31
Hep E: clinical features - Similar to .... - Difference - Duration
- Similar to Hep A but more severe - Higher mortality - Acute in immunocompetent
32
Diagnosis of Hep E:
- Clinical features not enough, lab tests required
33
Hep B: pathophysiology (2)
- Immune response causes hepatocellular damage - HBV DNA persists in the host cell as cccDNA
34
Hep B transmission: (3)
- Sexual - mother to child - Needle sharing, blood products
35
Hep B clinical features: acute
- Acute: all children and 50% of adults are asymptomatic, if symptomatic, similar to Hep A
36
Hep B clinical features: chronic
- Low prognosis, likely to cause cirrhosis and hepatocellular carcinoma
37
Hepatitis C pathophysiology:
- Enters liver cells and reproduces, simultaneously causing cell death - Via chronic inflammation, immune mediated cytotoxicity, high cell turnover
38
Hep C transmission: (2)
- Percutaneous (NEEDLE INJURIES) - Permucosal (sexual)
39
Hep C clinical features: acute
- all children and 50% adults asymptomatic, if symptomatic, features similar to Hep A
40
Hep C clinical features: chronic
- low prognosis, likely to cause cirrhosis and hepatocellular carcinoma
41
Hep C diagnosis: (2)
- Picked up by screening risk groups, contacts or as part of liver disease work up - Antibody or RNA
42
Hep B & C as chronic illnesses:
- Hep C is much more likely to be chronic, poor prognosis for both cases
43
Causes of diarrhoea: common I G M D C
- Irritable bowel syndrome - Gastroenteritis - Medication - Diet - Coeliac disease
44
Uncommon causes of diarrhoea: M I B D D D B O
o Malignancy o Inflammatory Bowel Disease o Diverticular disease o Bowel Obstruction
45
Irritable bowel syndrome:
– functional GI disorder categorized by a large group of symptoms including abdominal pain and changes in bowel movements
46
Coeliac disease:
- autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten
47
Inflammatory bowel disease:
- group of inflammatory conditions of the colon and small intestine
48
Diverticular disease:
- the condition of having diverticula (multiple pouches) in the colon that are not inflamed
49
Causes of obstipation (no flatus or faeces): (2)
- Small/large bowel obstruction - Paralytic illeus (peristalsis is paralyzed)
50
Large bowel function: (3)
- Absorb salt and water - Absorb short chain fatty acids - Store/expel faeces
51
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
52
Pancreatic cancer symptoms: D B P A P N/V N D C
▪ Diarrhoea ▪ Back Pain ▪ Abdo pain ▪ Nausea/vomiting ▪ Constipation ▪ New-onset diabetes
53
Steatorrhea:
- Pale bulk stools difficult to flush due to increased fat content
54
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
55
Referred pain:
– Pain felt in a part of the body that is not the source (does not radiate)
56
Colicky pain:
- Pain characterised by either intermittent nature or variable/cyclic intensity
57
Peritonic pain:
- Abdominal pain felt due to inflammation of the peritoneum
58
Biliary colic: definiton
- Where a colic (pain) suddenly occurs due to gallstones temporarily blocking the cystic duct
59
Biliary colic: pathophysiology
- Distension and contraction of the gall bladder against an obstructed cystic duct due to stones made of cholesterol
60
biliary colic: pain profile - Location - Type - Onset - Duration - Radiation
- Pain in the RUQ - Colicky - Often occurs after meals - 0.5 - 4hrs, can recur every few hrs - Shoulder or breastbone
61
Biliary colic: investigation
- Ultrasound
62
Pancreatitis: pathophysiology
- Inflammation of the pancreas
63
Pancreatitis pain profile: - Location - Description - Radiation - Onset - Duration
- LUQ - Severe, dull - To the back - Fairly sudden, with gradual deterioration - Constant
64
Pancreatitis symptoms: (4)
- Pain in LUQ - Nausea/vomiting - Steatorrhea/diarrhoea - Weight loss
65
Pancreatitis investigations:
- - amylase vs lipase - Bloods for grading - USS (gallstones) - CT
66
Cholecystitis: pathophysiology
- Inflammation of the gall bladder
67
Cholecystitis: pain profile - location - Type - Duration - Exasberating
- RUQ/epigastric - colicky - constant (lasts hrs to days) - Worse with moving including deep breaths
68
Cholecystitis: investigations
- CT scan
69
Gastro-oesophageal Reflux Disease (GORD): pathophysiology
- Stomach contents and acid rise up into the oesophagus
70
GORD symptoms: (4)
- Acidic taste in month - Heartburn - Regurgitation - Pain with swallowing
71
GORD investigation:
- Abdo Xray
72
Progression of pain in developing appendicitis: pathophysiology
- Inflammation of the appendix
73
Progression of pain in developing appendicitis: symptoms (4)
- RLQ pain - Nausea/vomiting - Fever - Palpable on inspection
74
Progression of pain in developing appendicitis: investigation (3)
- Imaging (rule in vs rule out) - Scoring systems & novel biomarkers - McBurney's point
75
Renal colic: pathophysiiology
- Obstruction of ureter from dislodged kidney stone
76
Pyelonephritis: pathophysiology
- Inflammation of the kidney
77
Renal colic: symptoms - Location - Characteristics - Radiation
- L and R iliac pain - Severe pain - Below ribs or groin
78
Pyelonephritis: symptoms L & R F W L M H
- L and R iliac pain - Fever - Weight loss - Malaise - Haematuria
79
Renal colic and pyelonephritis investigations: (3)
- Urinalysis - Renal function - CTKUB
80
Irritable bowel syndrome (IBS): pathophysiology
- Functional GI tract disorder characterised by a group of symptoms accompanied together including abdominal pain and changes in the consistency of bowel movements
81
IBS symptoms: A C T B
- Abdominal pain - Constipation/frequent diarrhoea - Tenesmus (phantom shit) - Bloating
82
IBS: investigations S B T A U E B
- Stool microscopy - blood tests - Abdo ultrasound - Endoscopy - Biopsy
83
Inflammatory bowel disease (IBD): pathophysiology (2)
- group of inflammatory conditions of the colon and small intestine - Crohn's disease and ulcerative colitis being the principle types
84
Crohn's disease:
Type of IBD that may affect any segment of the GI
85
Ulcerative colitis:
- Type of IBD that leads to inflammation and ulceration of the colon and rectum
86
IBD symptoms: A P D R B S I C / M S W (CD) T (UC)
- Abdominal pain - Diarrhoea (varies between crohn's and UC) - Rectal bleeding - Severe intestinal cramps/muscle spasms - Weight loss (CD) - Tenesmus (UC)
87
IBD: investigations (3)
- Biopsy - Colonoscopy - LFT's (Crohn's)
88
diverticulitis pathophysiology:
- Presence of diverticula in the colon
89
Diverticulitis: symptoms P F N D C B
o Pain in LQ, sudden onset o fever o nausea o diarrhoea o constipation o blood in stool
90
Diverticulitis: investigations (3)
- Inflammation markers - Early CT - Laparoscopy
91
Mesenteric Ischaemia: Acute symptoms (4)
▪ Abrupt, severe, abdominal pain ▪ Urgent, need to have a bowel movement ▪ Fever ▪ Nausea and vomiting
92
Mesenteric ischaemia: chronic symptoms (3)
▪ Abdominal pain that starts 30 minutes after eating ▪ Pain worsens over the hour ▪ Pain goes away with 1 to 3 hours
93
bowel perforation symptoms; (5) E P N/V/H F A pain difference
▪ Epigastric pain worsened by movement ▪ Nausea/vomiting/hematemesis ▪ Fever ▪ Abdomen rigid/rebound tenderness ▪ Pain sudden in small Intestine, gradual in large intestine
94
Small bowel obstruction: - General symptom (C) - ......... varies depending on ...... - First 24 hrs? - Extra symptom
▪ Crampy central pain, every few minutes ▪ Distention varies depending on site of SBO ▪ May still be opening bowels in first 24hrs ▪ Vomiting often prominent
95
Large bowel obstruction: - Duration compared to SBO - Distension variation - main symptom
▪ Periodicity of pain longer ▪ Distension varies due to competence of ileocaecal valve ▪ Constipation more common early, including flatus
96
Bowel obstruction: investigation
- CT
97
Bowel obstruction: progression (2)
- Mesenteric ischaemia - Perforation
98
UGI bleeds: varices
- significantly dilated sub-mucosal veins in GI tract (most commonly in the oesophagus and stomach)
99
UGI bleeds: varices causes
rising pressure in portal venous system due liver cirrhosis
100
UGI bleeds: Mallory-weis tear
- Small laceration on the oesophagus
101
UGI bleeds: Mallory-weis tear causes
- Several episodes of severe, forceful vomiting
102
UGI bleeds: peptic ulcer
– breach of the skin, epithelium, or mucous membrane with disintegration and necrosis of epithelial tissue, and often pus
103
Peptic ulcer causes: (4) H N S D
- Helicobacter pylori - NSAIDS - Stress - Diet (alcohol)
104
UGI bleeds: Oesophago-gastric malignancy symptoms (5)
- Dysphagia (problem swallowing) - Heart burn - Nausea - Weight loss - Later increase in vomit
105
LGI bleeds: diverticular disease
- Presence of diverticula on mucosa and submucosa through the muscular layer of the colonic wall
106
LGI bleeds: Inflammatory bowel disease: (3)
* Often associated with diarrhoea with blood mixed in * May lead to anaemia due to prolonged low level blood loss * Malabsorption
107
LGI bleeds: large bowel malignancy - Most common type - Character of blood loss
* most commonly colonic or rectal adenocarcinoma (tumour arising from glandular tissue) * Usually, slow loss leading to anaemia
108
LGI bleeds: Haemorrhoids
- vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed.
109
LGI bleeds: anal fissures
– small tear or ulcer in the mucosa of the anus
110
What is a microbiome?:
- The collective genomes of the micro-organisms in a collective environment
111
The gut requires bacteria that are ..... (4):
- Gram-positive - Gram-negative - Anaerobic - Fungi
112
How to identify bacteria in blood cultures: Gram positive - How - Examples
- Gram positive cocci in chains - Enterococci, streptococci
113
How to identify bacteria in blood cultures: gram negative - Aerobic - ANaerobic
- Gram-negative rods - e.coli, klebsiella, enterobactar - Bacteroides, fusarium
114
GI infections and antibiotic treatment:
- All conditions result in translocation of gut commensal bacteria into sterile spaces - Antibiotics need to be able to work on the wide array of different microbes
115
Infectious diarrhoea: texture signs
- Watery with blood: large bowel pathology - Fatty/foul smelling
116
Infectious diarrhoea: timing signs
- Acute: bacterial or viral - Chronic: parasitic/non-infectious
117
Infectious diarrhoea: general signs (4)
- Fever - Dehydration - Hypotension - Signs of shock
118
Infectious diarrhoea investigation: bloods (5)
- FBC - U&Es - LFT's - Clotting - Blood cultures
119
Infectious diarrhoea investigations: Imaging
- X-ray/USS/CT - Exclusion of surgical cases
120
Infectious diarrhoea investigations: stool samples (4)
- Microscopy - Culture - Toxin detection - Molecular test (PCR)
121
Salmonella species: - Description - Transmission
- Gram-negative, flagellated, bacilli belonging to the enterobacteriaceae - Faecal-oral
122
Enteric fever: caused by
- Salmonella enterica serotype Typhi or paratyphi (A,B,C)
123
Enteric fever: symptoms F B H R C A
- Fever - Bradycardia - Hepatosplenomegaly - Rose spots - CNS involvement - Abdominal symptoms
124
Enteric fever: diagnosis (2)
- Culture: Blood, stool, bone marrow - Serology
125
Ectopic pregnancy pathophysiology:
- A pregnancy in which the fetus develops outside the uterus, typicallu in a fallopian tube
126
Ectopic pregnancy: symptoms (4) V P T A
- Vaginal bleeding - Pelvic pain - Tender cervix/adnexal tenderness - An adrenal masss
127
Sings/investigations of Ectopic pregnancy: (2)
- Increased hCG - Urine hCG test
128
Other gynaecological causes of abdominal pain: M E O M L P
- Menstrual pain - Endometriosis - Ovarian cyst - Miscarriage - Ligament pain, labour, placental problems - Pelvic inflammatory disease
129
Pelvic inflammatory disease: pathophysiology
- Infection of the upper part of the female reproductive tract
130
Pelvic inflammatory disease: symptoms A P P D P M D P D
- Often asymptomatic - Pelvic pain - Deep dyspareunia - Malaise - Dysuria - Purulent discharge
131
Diabetic Ketoacidosis (DKA): pathological
- Complication of diabetes where body produces too much blood acids ketones
132
Diabetic Ketoacidosis (DKA): symptoms N P P A H
- Nausea/vomiting - Polyuria - Polydipsia - Abdominal pain - hyperventilation
133
DKA investigation:
- Urine analysis for ketones
134
UTI - sites (3)
- Urethra (urethritis) think STI's - Bladder (cystitis) - Lower UTI's - Kidney (pyelonephritis) - Upper UTI's
135
UTI symptoms: (3)
- Dysuria - Frequent urination - Pubic bone and lower back pain
136
Psychological causes of abdominal pain: (3)
- "butterflies in my stomach" - Chronic daily pains - Abdominal migraines
137
Endocrine causes of abdominal pain: - Main symptom - Secondary - Prevalence
- Mesenteric adenitis - May be proceeded by flu like illness - Children>adults - Diffuse abdo pain > RIF pain
138
Oesophageal cancer: symptoms P D A H A
- Progressive dysphagia - Coughing - Aspiration - Hoarseness - Anaemia
139
Oesophageal cancer: investigations - RULE 1
- Rule 1: dysphagia = urgent OGD (gastroscopy/endoscopy)
140
Gastric cancer symptoms: E P D E M V N D
- Epigastric pain - Dysphagia - Epigastric mass - Virchow's node/lymphadenopathy - Dermatomyositis
141
Gastric cancer: Rule 2
- Gastric ulcer = gastric cancer until proven otherwise
142
Gastric cancer investigations: (2)
- OGD - Staging with CT, PET-CT, laparoscopy
143
Pancreatic cancer: symptoms - E P - J - A M - C S - T M - S V T
- Epigastric pain - Jaundice - Abdominal mass - Courvoisier's sign - Thrombophlenitis migrans (infl. of veins causes clots) - Splenic vein thrombosis
144
Pancreatic cancer: RULE 3
- (Courvoisier): painless jaundice + palpable gallbladder = cancer
145
Liver cancer: symptoms A A M R P A J H
- Anorexia/weight loss - Abdominal mass - RUQ pain - Ascites - Jaundice - Hepatomegaly
146
Liver cancer: Rule 4
- Most common are metastases