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Core Conditions Y3 > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Risk factors for GORD?

A

Smoking, alcohol, hiatus hernia, pregnancy, obesity, nitrates, tricyclic antidepressants, acidic/fatty foods

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2
Q

Typical patient with GORD?

A

Obese man, retrosternal burning pain, worse on lying flat and after meals

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3
Q

Three major symptoms of GORD?

A
  1. Heart burn after eating/when lying, relieved by antacids
  2. Odynophagia
  3. Retrosternal burning
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4
Q

Two minor symptoms of GORD?

A
  1. Nocturnal cough

2. Morning hoarseness

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5
Q

Two investigations for GORD?

A
  1. Endoscopy

2. 24hr pH monitoring

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6
Q

Conservative treatment of GORD?

A

Reduce weight, cut down smoking, change diet

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7
Q

Four medical treatments of GORD?

A

Antacids
H2 receptor antagonists (ranitidine)
PPIs (omeprazole)
Prokinetics (metoclopramide)

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8
Q

Five complications of GORD?

A 
Oesophagitis
Oesophageal stricture
Barrett's
Ulceration
Anaemia
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9
Q

Which sex is more likely to get peptic ulcer?

A

Men 2x more likely

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10
Q

Risk factors for peptic ulcer?

A 
H. pylori (MOST COMMON)
NSAIDs
Smoking
Stress
Steroids
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11
Q

Typical patient with peptic ulcer?

A

Middle aged man, long-term epigastric pain, presents with melaena

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12
Q

Five symptoms of peptic ulcer?

A 
Epigastric pain (worse at night/after food, relieved by antacids)
Nausea/vomiting
Haematemesis/melaena
Weight loss
Anaemia
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13
Q

Investigations for peptic ulcer?

A

H pylori screen (rapid urease/urea breath test)

Endoscopy

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14
Q

Conservative treatment of peptic ulcer?

A

Stop smoking/NSAIDS

Avoid foods that cause symptoms

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15
Q

Two treatments for peptic ulcer?

A 
Acid suppression (PPIs, H2 receptor antagonists)
H pylori triple therapy
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16
Q

Five complications of peptic ulcer?

A 
Malignancy
Haemorrhage (15-20%)
Perforation
Pyloric stenosis
Anaemia
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17
Q

Who gets UC?

A

Age 15-30 yrs, more common in women and caucasians

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18
Q

Features of UC?

A 
Insidious onset
Diarrhoea with blood
Distension
Malaise, anorexia
Severe colitis
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19
Q

Blood test changes in UC?

A

Low Hb

Raised CRP

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20
Q

Other investigations of UC?

A

Stool culture
Abdominal XR
Abdominal USS
Endoscopy with biopsy

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21
Q

Medical treatment of UC?

A

Mild: prednisolone, aminosalicylate
Severe: IV hydration, hydrocortisone, immunosuppression
Remission: Aminosalicylates, immunosuppression

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22
Q

Surgical treatment of UC?

A

Colectomy with ileostomy

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23
Q

Four complications of UC?

A

Perforation
Bleeding
Toxic megacolon
Colon cancer (30% after 35yrs)

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24
Q

Pathologic features of UC?

A

Continuous lesions
Ulcers
Goblet cell destruction
Crypt abscesses

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25
Pathologic features of Crohn's?
Skip lesions Transmural inflammation Fistulas
26
Risk factors for Crohn's?
Smoking | High sugar, low fibre diet
27
Features of Crohn's?
Diarrhoea (often non-bloody) Abdo pain (RIF) Weight loss, fever, malaise, anorexia Mouth ulcers/perianal features
28
Blood test changes in Crohn's?
Low Hb, raised platelets Raised CRP Low albumin
29
Other investigations for Crohn's?
Abdominal XR Small bowel MRI Endoscopy
30
Conservative treatment of Crohn's?
Stop smoking | Diet change
31
Medical treatment of Crohn's?
Mild: Prednisolone, aminosalicylates Severe: IV hydration, hydrocortisone Remission: Aminosalicylates, methotrexate, metronidazole (infection), Anti-TNF
32
Surgical treatment of Crohn's?
Resect as little bowel as possible as it is not curative
33
Five complications of Crohn's?
``` Malabsorption Small bowel obstruction Strictures Abscesses Fistulae ```
34
Clinical features of infective gastroenteritis?
Diarrhoea +/- vomiting Dysentery Systemic symptoms
35
Investigations for gastroenteritis?
Raised WBC and CRP | Stool culture/sigmoidoscopy (if symptoms persist)
36
Treatment of gastroenteritis?
Rehydration Antiemetics Antibiotics (if systemic illness) AVOID ANTIDIARRHEALS
37
Clinical features of ascites?
Abdominal distension Shifting dullness on percussion Fluid thrill
38
Investigations for ascites?
``` Aspirate colour (straw coloured = normal) Abdominal USS/CT ```
39
Conservative treatment of ascites?
Treat cause | Reduce Na+ intake and fluid restriction
40
Medical treatment of ascites?
Diuretics (spironolactone, furosemide) | Paracentesis
41
Three complications of ascites?
Spontaneous bacterial peritonitis Hyponatraemia Pleural effusion (resp distress)
42
Four risk factors for acute hepatitis?
Recent new medication Recent foreign travel Unprotected sex IVDU
43
Typical patient with acute hepatitis?
Young girl, impulsively took many tablets two days ago, history of depression, presenting with nausea and epigastric pain
44
Features of acute hepatitis?
Jaundice Abdominal pain Rarely hepatic encephalopathy
45
Five important blood tests for acute hepatitis?
``` INR LFTs U&Es FBC ABG (pH, lactate, ammonia) ```
46
Treatment of acute hepatitis?
Treat underlying cause Fluid resuscitation Vitamin supplements (Vit K, thiamine) Low threshold for antibiotics
47
Three complications of acute hepatitis?
Multi organ failure Sepsis Cerebral oedema
48
Three most common causes of chronic liver failure?
NAFLD AFLD Autoimmune
49
Typical patient with chronic liver failure?
Middle aged, presents with fever, malaise and profound jaundice
50
Clinical features of chronic liver failure?
Jaundice, fatigue, anorexia Autoimmune: rash, arthritis Alcoholic: parotid enlargement, neuropathy NAFLD: diabetes, high cholesterol
51
Investigations for chronic liver failure?
Bloods: deranged LFTs Imaging: USS/CT Other: biopsy
52
Treatment of chronic liver failure?
``` Treat underlying cause Nutritional support (alcoholic) Immunosuppression (autoimmune) ```
53
What are the four Fs of gallstones?
Fat Forty Female Fair (skinned)
54
Typical patient for gallstones?
40 year old overweight caucasian lady, RUQ pain especially after fatty food
55
Features of gallstones?
80% asymptomatic Nausea, vomiting +ve Murphy's sign Biliary colic
56
Gold standard investigation for gallstones?
USS
57
Treatment of gallstones?
Symptomatic until stone passes | Laparoscopic cholescystectomy
58
Three main complications of gallstones?
Cholecystitis Cholangitis Bile duct blockage (pancreatitis)
59
Typical patient with appendicitis?
25 year old student, one day history of fever and severe pain centrally and in RIF, guarding and tenderness in RIF
60
Symptoms of appendicitis?
Vomiting Anorexia Intense pain
61
Signs of appendicitis?
Guarding in RIF | Rebond tenderness
62
What do blood tests show in appendicitis?
Raised WBC and CRP
63
Treatment of appendicitis?
Appendectomy | IV fluids and metronidazole if severe
64
Typical patient presenting with small bowel obstruction?
Colicky abdominal pain with bile-stained vomit and abdo distension
65
Symptoms of small bowel obstruction?
Severe colicky spasms in central abdomen | Vomiting/constipation
66
Signs of small bowel obstruction?
Abdominal distension | Tinkling bowel sounds
67
Investigations in suspected small bowel obstruction?
Rectal exam Bloods (lactate raised) Plain abdo XR
68
Treatment of small bowel obstruction?
NG tube to remove bowel secretions Ischaemia: emergency surgery Hernia: herniotomy/manual release
69
Typical patient with large bowel obstruction?
Elderly patient presenting with abdo distension and absolute constipation
70
Symptoms of large bowel obstruction?
Complete constipation | Colicky spasmodic pain - more severe and constant than in small bowel obstruction
71
Signs of large bowel obstruction?
Distension | Anaemia
72
Investigations of large bowel obstruction?
Rectal exam Bloods (lactate raised) Plain abdo XR Sigmoidoscopy
73
Treatment of large bowel obstruction?
Ischaemia: emergency surgery Stenting Less urgent obstructions: water soluble enema
74
Typical patient with acute pancreatitis?
60 year old man, severe upper abdo pain, came on suddenly, radiates to back with vomiting, also jaundiced
75
Symptoms of acute pancreatitis?
Sudden upper abdo pain radiating to back Pain relieved on sitting forwards Nausea/vomiting
76
Signs of acute pancreatitis?
Jaundice Cullen's sign: periumbilical bruising Grey Turner's sign: flank bruising Epigastric tenderness
77
Blood test results in acute pancreatitis?
``` Raised pancreatic enzymes Highly raised amylase Raised lipase Raised WBC, CRP Raised AST (gallstones) ```
78
Treatment for acute pancreatitis?
Symptomatic until cause is treated Gallstone removal Pancreatic abscess surgery
79
Typical age of chronic pancreatitis presentation?
50s
80
Features of chronic pancreatitis?
Epigastric pain relieved on sitting forwards Jaundice Bloating Malabsorption (steatorrhoea, weight loss, anorexia)
81
Investigations for chronic pancreatitis?
Stool: Low faecal elastase Imaging: AXR shows clacification
82
Conservative treatment for chronic pancreatitis?
Alcohol cessation | Low fat diet
83
Medical treatment of chronic pancreatitis?
H2 receptor blocker (ranitidine) Pancreatic supplements Analgesia, lipase, fat soluble vitamins
84
Typical patient with oesophageal cancer?
65 year old man, two month history of progressive dysphagia and weight loss
85
Symptoms of oesophageal cancer?
Progressive dysphagia Odynophagia Significant weight loss Haematemesis, hoarseness, vomiting, cough
86
SIgns of oesophageal cancer?
Anaemia Anorexia Ascites Lymphadenopathy
87
Investigations for oesophageal cancer?
Endoscopy | Staging CT/endopic USS
88
Treatment of oesophageal cancer?
Resection Chemotherapy Radiotherapy
89
Typical patient with gastric cancer?
50 year old man presents with weight loss and haematemesis
90
Symptoms of gastric cancer?
Nausea/vomiting Weight loss Bowel changes Abdo pain +/- haemorrhage
91
Signs of gastric cancer?
Palpable epigastric mass (50%) Virchow's node (30%) Acanthosis nigrans
92
Investigations for gastric cancer?
Gastroscopy with biopsy | Staging CT/endoscopy
93
Treatment of gastric cancer?
Surgery Chemotherapy Radiotherapy PPIs to reduce bleeding in ulcerating tumours
94
Typical patient with a femoral hernia?
Elderly female, tender groin swelling
95
Clinical features of femoral hernia?
Mass in upper medial thigh Tenderness Colicky abdo pain
96
Investigation of femoral hernia?
Ask the patient to stand and cough and watch direction of movement?
97
Treatment of a femoral hernia?
Surgical repair
98
Two real differences between femoral and inguinal hernias?
Inguinal = M>F | Location (inguinal is more superior and medial)
99
What is the classification criteria for colorectal carcinoma?
Dukes
100
Typical patient with colorectal cancer?
Elderly patient, weight loss and change in bowel habits
101
Symptoms of colorectal cancer?
Bowel habit change Blood in stool Weight loss Pain
102
Investigations of colorectal cancer?
Colonoscopy with biopsy | Staging CT
103
Treatment of colorectal carcinoma?
Chemotherapy Radiotherapy Surgery
104
Most common cause of upper GI bleed?
Gastric ulcer
105
Symptoms of acute GI bleed?
Haematemesis Melaena Symptoms of blood loss (syncope, anaemia)
106
Investigations for acute GI bleed?
Bloods (high urea +normal creatinine) | Endoscopy if haemodynamically stable
107
Score used for prognosis of acute GI bleed?
Rockall Score
108
Management of acute GI bleed?
Small: Lifestyle advice (avoid alcohol, NSAIDs, etc.) Large: ABCDE approach
109
What ages and sex are most likely to present with coeliac?
Females | Infants and ages 30-40 yrs
110
Features of coeliac disease?
``` Diarrhoea (50%) Foul smelling stool Weight loss Abdo pain Distension Mouth ulcers ```
111
Investigations for coeliac disease?
Auto-antibody tests | Endoscopy with biopsy
112
Treatment of coeliac disease?
Gluten free diet | Vitamin supplements

Core Conditions Y3 (2 decks)

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