abdominal Flashcards

1
Q

oesophageal cancer

  • risk factors for adenocarcinoma? 3
  • risk factors for squamous cell carcinoma? 4
  • risk factors for both? 3
A

adenocarcinoma:

  • barretts oesophagus
  • GORD
  • obese

squamous cell

  • alcohol
  • very hot drinks
  • poor diet
  • chewing tobacco

both

  • smoking tobacco
  • increased age (over 50)
  • male

nb

  • adenocarcinoma more common in west and lower 3rd of oesophagus
  • squamous cell more common in east and upper 3rd
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2
Q

oesophageal cancer:

  • symptoms/signs? 4
  • investigations? 1
  • treatments? 2
A
  • dysphagia
  • weight loss
  • retrosternal chest pain
  • neck swelling
    (- haematemesis)
    (- cervical lymphadenopathy)
    (- horners syndrome)

if in proximal 3rd:

  • hoarseness
  • cough
  • endoscopy with biopsy (occassionally barium swallow)
  • most commonly palliative chemo or radio
  • if small: radical resection surgery (preceeded by chemo or radio)

nb

  • radio used more for squamous cell
  • chemo used more for adenocarcinoma
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3
Q

gastric carcinoma:

  • types of cancer? 4
  • risk factors for commonest type? 4
  • age + gender affected?
A
  • adenocarcinoma (commonest)
  • leiomyomas
  • carcinoid
  • MALT/lymphomas
  • diet high in nitrosamines (smoked or fresh fish, pickled fruit)
  • chronic atrophic gastritis
  • blood group A
  • chronic gastric ulceration related to H pylori
  • norm >50
  • men 3x more likely
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4
Q

gastric carcinoma:

  • symptoms? 6
  • signs? 3
A
  • persistent indigestion + heartburn
  • epigastric pain
  • trapped wind/frequent burping
  • anaemia (iron deficient)
  • lethargy
  • weight loss +/- anorexia

signs:

  • weight loss
  • palpable epigastric mass
  • palpable supraclavicular lymph node (Troisiers sign) suggests disseminated disease

nb occasionally presents as upper GI bleeding

nb dysphaguia uncommon unless involving proximal fundus + gastro-oesophageal junction

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5
Q

gastric carcinoma:

  • investigations? 2
  • treatment?
A
  • diagnosis norm by gastroscopy
  • use US or CT for staging

vast majority present late so are unresectable but some may be suitable for surgery

treatment mainly directed at symptom control + palliation

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6
Q

pancreatic carcinoma:

  • most common type?
  • risk factors? 8
A

ductal denocarcinoma (90%)

  • chronic pancreatitis
  • exposure to naphthalene + benzidine
  • smoking
  • alcohol abuse
  • overweight/high fat diet
  • male
  • increasing age (norm >60)
  • FH

nb incidence of this is rising rapidly

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7
Q

pancreatic carcinoma:

  • presentation of tumour in head of pancreas? (65%) 4
  • presentation of tumour inn body or tail? (35%) 2
  • signs/symptoms common to both? 8
A

head:

  • obstructive jaundice
  • pruritis
  • palpable (often painless) gallbladder
  • vague pain (70%) radiating to back

body/tail:
(- asymptomatic in early stages)
- epigastric pain, raditing to back (relieved on sitting forward)
- palpable epigastric mass

both:

  • anorexia
  • weight loss
  • acute pancreatitis
  • diabetes
  • hepatomegaly (dt mets)
  • lymphadenopathy
  • splenomegaly
  • thrombophlebitis migrans (10%)***
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8
Q

pancreatic carcinoma:

  • bloods? 4
  • other investigations? 2
  • treatment? 3
A
  • FBCs
  • LFTs
  • blood sugar
  • serum CA19.9
  • ultrasound
  • CT

95% are not suitable for surgical resection on presentation

very poor prognosis

  • pain relief (morphine)
  • relieve jaundice via ERCP
  • adjunctive chemo or surgery if poss
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9
Q

colorectal carcinoma:

  • most common type?
  • modifiable risk factors?
  • non-modifiable risk factors?
A
  • usually adenocarcinoma
  • diet poor in fruit + veg
  • diet high in red + processed meat
  • smoking
  • high alcohol intake
  • familial syndrome (FAP, HNPCC, juvenile polyposis)
  • strong FH
  • PMH of polyps or cancer anywhere
  • chronic UC or crohn’s

nb about 20% are due to a familial syndrome

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10
Q

clinical presentation of colorectal carcinoma:

  • Right/ascending colon? 4
  • Left/descending colon? 4
  • rectum? 4
  • emergency presentation? 3
A
right/ascending:
- iron-deficient anaemia
- weight loss 
- abdo pain
- palpable mass
(- obstruction less likely) 
left/descending:
- PR bleeding (dark red mixed w stool)
- change in bowel habit (increase freq)
- bloating + flatulence
- palpable mass 
(- obstruction more likely)

rectum:

  • PR bleeding (dark red on stool surface)
  • change in bowel habit (difficulty defecating)
  • tenesmus (painful + sensation of incomplete defecation)
  • mass palpable on PR

emergency (40% picked up this way):

  • large bowel obstruction
  • perforation w peritonitis
  • acute OR bleeding
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11
Q

colorectal carcinoma:

  • investigations?
  • treatment?
A
  • FBC (for anaemia)
  • faecal blood
  • colonoscopy (or using CT)
  • if no mets, surgical removal with pre-operative chemo

nb chemo can also be used palliatively

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12
Q

chronic liver failure:

  • 2 most common causes?
  • other groups of causes? 4
A

most common:

  • chronic alcohol abuse
  • chronic hep B or C infection

genetic conditions:

  • haemochromatosis
  • a1-antitrypsin deficiency
  • wilson’s disease

non-alcoholic steatohepatitis (NASH)

autoimmune:

  • primary biliary cholangitis
  • primary sclerosing cholangitis
  • autoimmune hepatitis

drugs

  • amiodarone
  • methyldopa
  • methotrexate
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13
Q

chronic liver failure:

  • symptoms? 5
  • peripheral signs? 5
  • more central signs? 7
A
  • fatigue
  • pruritis
  • URQ pain
  • nausea
  • disorientation/confusion

peripheral:

  • leuconycia (low albumin)
  • clubbing
  • dupytens contracture
  • palmar erythema
  • liver flap
  • jaundice (sclera + skin)

central:

  • spider naevi
  • scratches from itching
  • ascites (shifting dullness)
  • caputs medusa
  • gynaeomastia
  • atrophic testes
  • hepatomegaly (small if late)
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14
Q

chronic liver failure:

  • blood tests? 4
  • other investigations? 4
A
  • LFTs
  • INR
  • FBC
  • U+Es
  • ultrasound
  • MRI
  • ascitic tap
  • liver biopsy (definitive)
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15
Q

chronic liver failure:

  • non-pharm management? 2
  • drugs to avoid? 3
  • pharm management?
  • surgical treatment? 1
A
  • good nutrition
  • alcohol abstinence

avoid:

  • NSAIDs
  • sedatives
  • opiates

symptomatic treatment
- colestyramine (for pruritis)

treat underlying cause (eg hep C or PBC)

fluid restrict + low salt if got ascites

  • liver transplant is only definitve treatment

nb consider spontaneous bacterial peritonitis (SBP) in any patient w ascites who deteriorates rapidly!

nb monitor kidney function

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16
Q

ascites:

  • most common cause of transudate?
  • other causes of transudate?
  • causes of exudate?
A

liver cirrhosis

transudate:

  • portal hypertension
  • hepatic outflow obstuction
  • budd-chiari syndrome
  • hepatic veno-occlusive disease
  • cardiac failure
  • tricuspid regurg
  • constrictive pericarditis
  • meig’s syndrome

exudate:

  • peritoneal carcinomatosis
  • peritoneal TB
  • pancreatitis
  • nephrotic syndrome
  • lymphatic ostruction

nb can get ascites with any advanced/malignant cancers

nb budd-chiari syndrome is occlusion of hepatic veins -> liver enlargement, ascites + abdo pain

nb meig’s syndrome is triad of ovarian fibroma, ascites + pleural effusion

17
Q

ascites:

  • clinical presentation?
  • investigation?
  • treatment?
A

fullness in the flank w shifting dullness

tense ascites is uncomfortable + produces respiratory distress

a pleural effusion (nor R sided) + peripheral oedema may be present

  • diagnostic aspiration of 20ml of ascetic fluid in all patients
  • high conc of albumin indicates a transudate. Neutrophil count, gram stain + culture, cytology for malignant cells + amylase to exclude pancreatic ascites

treat underlying cause

diuretics
- restrict sodium
- oral spiralactone
(- furosemide sometimes added)

monitor weight to see progress

paracentesis is used if ascites is tense or are resistant to standard medical therapy

18
Q

Protein-energy malnutrition:

  • causes due to reduce intake?
  • causes due to malabsorption?
  • causes due to high metabolic rate?
A
  • dementia
  • anorexia nervosa
  • coeliac disease
  • pancreatitis
  • crohns
  • carcinomas
  • prolonged infection or inflammation
19
Q

vit c deficiency

  • name?
  • risk factors? 3
  • groups of symptoms/signs? 5
A

scurvy

  • pregnant
  • poor
  • unusual diet

1) listlessness (no interest in things)/anorexia/cachexia
2) gingivitis/loose teeth/halitosis
3) bleeding from gums/nose/hair follicles/into joints/bladder/gut
4) muscle pain/weakness
5) oedema

20
Q

vit B1 deficiency

  • other name of vitamin?
  • name of two conditions? and signs/symptoms (3 each)
  • who at risk? 3
A

thiamine

Beriberi

  • heart failure
  • general oedema
  • neuropathy

Wernicke’s encephalopathy

  • confusion
  • ataxia
  • opthalplegia (nystagmus nerve palsies)

nb can progress to korsakoffs psychosis if untreated

  • chronic alcoholics
  • prolonged vomiting (e.g. chemo,morning sickness)
  • anyone malnourished/eating disorder
21
Q

coeliac disease:

  • risk factors? 3
  • pathophysiology?
A
  • female
  • FH
  • PMH autoimmune conditions

T-cell infiltration and subsequent inflammation in the mucosa of the small bowel leading to malabsorption

22
Q

coeliac disease

  • GI symptoms? 5
  • other symptoms? 6
A
  • diarrhoea (esp smelly)
  • bloating & flatulence
  • constipation
  • indigestion
  • abdo pain
  • fatigue (can be due to malnutrition or iron or B12 deficiency more specifically)
  • weight loss
  • itchy rash (dermatitis herpetiformis)
  • ataxia or neuropathy
  • depressions
  • inability to get pregnant
23
Q

coeliac disease:

  • blood tests? 2
  • other investigation?
  • management?
A
  • FBC and blood smear (iron deficiency anaemia is commonest presentation of coeliac in adults)
  • IgAtTG test

nb if suspected dermatitis herpetiformis is present then can take samples from this rash

  • endoscopy with biopsy
  • gluten-free diet