Abdominal Flashcards
Risk factors for GORD?
Smoking, alcohol, hiatus hernia, pregnancy, obesity, nitrates, tricyclic antidepressants, acidic/fatty foods
Typical patient with GORD?
Obese man, retrosternal burning pain, worse on lying flat and after meals
Three major symptoms of GORD?
- Heart burn after eating/when lying, relieved by antacids
- Odynophagia
- Retrosternal burning
Two minor symptoms of GORD?
- Nocturnal cough
2. Morning hoarseness
Two investigations for GORD?
- Endoscopy
2. 24hr pH monitoring
Conservative treatment of GORD?
Reduce weight, cut down smoking, change diet
Four medical treatments of GORD?
Antacids
H2 receptor antagonists (ranitidine)
PPIs (omeprazole)
Prokinetics (metoclopramide)
Five complications of GORD?
Oesophagitis Oesophageal stricture Barrett's Ulceration Anaemia
Which sex is more likely to get peptic ulcer?
Men 2x more likely
Risk factors for peptic ulcer?
H. pylori (MOST COMMON) NSAIDs Smoking Stress Steroids
Typical patient with peptic ulcer?
Middle aged man, long-term epigastric pain, presents with melaena
Five symptoms of peptic ulcer?
Epigastric pain (worse at night/after food, relieved by antacids) Nausea/vomiting Haematemesis/melaena Weight loss Anaemia
Investigations for peptic ulcer?
H pylori screen (rapid urease/urea breath test)
Endoscopy
Conservative treatment of peptic ulcer?
Stop smoking/NSAIDS
Avoid foods that cause symptoms
Two treatments for peptic ulcer?
Acid suppression (PPIs, H2 receptor antagonists) H pylori triple therapy
Five complications of peptic ulcer?
Malignancy Haemorrhage (15-20%) Perforation Pyloric stenosis Anaemia
Who gets UC?
Age 15-30 yrs, more common in women and caucasians
Features of UC?
Insidious onset Diarrhoea with blood Distension Malaise, anorexia Severe colitis
Blood test changes in UC?
Low Hb
Raised CRP
Other investigations of UC?
Stool culture
Abdominal XR
Abdominal USS
Endoscopy with biopsy
Medical treatment of UC?
Mild: prednisolone, aminosalicylate
Severe: IV hydration, hydrocortisone, immunosuppression
Remission: Aminosalicylates, immunosuppression
Surgical treatment of UC?
Colectomy with ileostomy
Four complications of UC?
Perforation
Bleeding
Toxic megacolon
Colon cancer (30% after 35yrs)
Pathologic features of UC?
Continuous lesions
Ulcers
Goblet cell destruction
Crypt abscesses
Pathologic features of Crohn’s?
Skip lesions
Transmural inflammation
Fistulas
Risk factors for Crohn’s?
Smoking
High sugar, low fibre diet
Features of Crohn’s?
Diarrhoea (often non-bloody)
Abdo pain (RIF)
Weight loss, fever, malaise, anorexia
Mouth ulcers/perianal features
Blood test changes in Crohn’s?
Low Hb, raised platelets
Raised CRP
Low albumin
Other investigations for Crohn’s?
Abdominal XR
Small bowel MRI
Endoscopy
Conservative treatment of Crohn’s?
Stop smoking
Diet change
Medical treatment of Crohn’s?
Mild: Prednisolone, aminosalicylates
Severe: IV hydration, hydrocortisone
Remission: Aminosalicylates, methotrexate, metronidazole (infection), Anti-TNF
Surgical treatment of Crohn’s?
Resect as little bowel as possible as it is not curative
Five complications of Crohn’s?
Malabsorption Small bowel obstruction Strictures Abscesses Fistulae
Clinical features of infective gastroenteritis?
Diarrhoea +/- vomiting
Dysentery
Systemic symptoms
Investigations for gastroenteritis?
Raised WBC and CRP
Stool culture/sigmoidoscopy (if symptoms persist)
Treatment of gastroenteritis?
Rehydration
Antiemetics
Antibiotics (if systemic illness)
AVOID ANTIDIARRHEALS
Clinical features of ascites?
Abdominal distension
Shifting dullness on percussion
Fluid thrill
Investigations for ascites?
Aspirate colour (straw coloured = normal) Abdominal USS/CT
Conservative treatment of ascites?
Treat cause
Reduce Na+ intake and fluid restriction
Medical treatment of ascites?
Diuretics (spironolactone, furosemide)
Paracentesis
Three complications of ascites?
Spontaneous bacterial peritonitis
Hyponatraemia
Pleural effusion (resp distress)
Four risk factors for acute hepatitis?
Recent new medication
Recent foreign travel
Unprotected sex
IVDU
Typical patient with acute hepatitis?
Young girl, impulsively took many tablets two days ago, history of depression, presenting with nausea and epigastric pain
Features of acute hepatitis?
Jaundice
Abdominal pain
Rarely hepatic encephalopathy
Five important blood tests for acute hepatitis?
INR LFTs U&Es FBC ABG (pH, lactate, ammonia)
Treatment of acute hepatitis?
Treat underlying cause
Fluid resuscitation
Vitamin supplements (Vit K, thiamine)
Low threshold for antibiotics
Three complications of acute hepatitis?
Multi organ failure
Sepsis
Cerebral oedema
Three most common causes of chronic liver failure?
NAFLD
AFLD
Autoimmune
Typical patient with chronic liver failure?
Middle aged, presents with fever, malaise and profound jaundice
Clinical features of chronic liver failure?
Jaundice, fatigue, anorexia
Autoimmune: rash, arthritis
Alcoholic: parotid enlargement, neuropathy
NAFLD: diabetes, high cholesterol
Investigations for chronic liver failure?
Bloods: deranged LFTs
Imaging: USS/CT
Other: biopsy
Treatment of chronic liver failure?
Treat underlying cause Nutritional support (alcoholic) Immunosuppression (autoimmune)
What are the four Fs of gallstones?
Fat
Forty
Female
Fair (skinned)
Typical patient for gallstones?
40 year old overweight caucasian lady, RUQ pain especially after fatty food
Features of gallstones?
80% asymptomatic
Nausea, vomiting
+ve Murphy’s sign
Biliary colic
Gold standard investigation for gallstones?
USS
Treatment of gallstones?
Symptomatic until stone passes
Laparoscopic cholescystectomy
Three main complications of gallstones?
Cholecystitis
Cholangitis
Bile duct blockage (pancreatitis)
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
Symptoms of appendicitis?
Vomiting
Anorexia
Intense pain
Signs of appendicitis?
Guarding in RIF
Rebond tenderness
What do blood tests show in appendicitis?
Raised WBC and CRP
Treatment of appendicitis?
Appendectomy
IV fluids and metronidazole if severe
Typical patient presenting with small bowel obstruction?
Colicky abdominal pain with bile-stained vomit and abdo distension
Symptoms of small bowel obstruction?
Severe colicky spasms in central abdomen
Vomiting/constipation
Signs of small bowel obstruction?
Abdominal distension
Tinkling bowel sounds
Investigations in suspected small bowel obstruction?
Rectal exam
Bloods (lactate raised)
Plain abdo XR
Treatment of small bowel obstruction?
NG tube to remove bowel secretions
Ischaemia: emergency surgery
Hernia: herniotomy/manual release
Typical patient with large bowel obstruction?
Elderly patient presenting with abdo distension and absolute constipation
Symptoms of large bowel obstruction?
Complete constipation
Colicky spasmodic pain - more severe and constant than in small bowel obstruction
Signs of large bowel obstruction?
Distension
Anaemia
Investigations of large bowel obstruction?
Rectal exam
Bloods (lactate raised)
Plain abdo XR
Sigmoidoscopy
Treatment of large bowel obstruction?
Ischaemia: emergency surgery
Stenting
Less urgent obstructions: water soluble enema
Typical patient with acute pancreatitis?
60 year old man, severe upper abdo pain, came on suddenly, radiates to back with vomiting, also jaundiced
Symptoms of acute pancreatitis?
Sudden upper abdo pain radiating to back
Pain relieved on sitting forwards
Nausea/vomiting
Signs of acute pancreatitis?
Jaundice
Cullen’s sign: periumbilical bruising
Grey Turner’s sign: flank bruising
Epigastric tenderness
Blood test results in acute pancreatitis?
Raised pancreatic enzymes Highly raised amylase Raised lipase Raised WBC, CRP Raised AST (gallstones)
Treatment for acute pancreatitis?
Symptomatic until cause is treated
Gallstone removal
Pancreatic abscess surgery
Typical age of chronic pancreatitis presentation?
50s
Features of chronic pancreatitis?
Epigastric pain relieved on sitting forwards
Jaundice
Bloating
Malabsorption (steatorrhoea, weight loss, anorexia)
Investigations for chronic pancreatitis?
Stool: Low faecal elastase
Imaging: AXR shows clacification
Conservative treatment for chronic pancreatitis?
Alcohol cessation
Low fat diet
Medical treatment of chronic pancreatitis?
H2 receptor blocker (ranitidine)
Pancreatic supplements
Analgesia, lipase, fat soluble vitamins
Typical patient with oesophageal cancer?
65 year old man, two month history of progressive dysphagia and weight loss
Symptoms of oesophageal cancer?
Progressive dysphagia
Odynophagia
Significant weight loss
Haematemesis, hoarseness, vomiting, cough
SIgns of oesophageal cancer?
Anaemia
Anorexia
Ascites
Lymphadenopathy
Investigations for oesophageal cancer?
Endoscopy
Staging CT/endopic USS
Treatment of oesophageal cancer?
Resection
Chemotherapy
Radiotherapy
Typical patient with gastric cancer?
50 year old man presents with weight loss and haematemesis
Symptoms of gastric cancer?
Nausea/vomiting
Weight loss
Bowel changes
Abdo pain +/- haemorrhage
Signs of gastric cancer?
Palpable epigastric mass (50%)
Virchow’s node (30%)
Acanthosis nigrans
Investigations for gastric cancer?
Gastroscopy with biopsy
Staging CT/endoscopy
Treatment of gastric cancer?
Surgery
Chemotherapy
Radiotherapy
PPIs to reduce bleeding in ulcerating tumours
Typical patient with a femoral hernia?
Elderly female, tender groin swelling
Clinical features of femoral hernia?
Mass in upper medial thigh
Tenderness
Colicky abdo pain
Investigation of femoral hernia?
Ask the patient to stand and cough and watch direction of movement?
Treatment of a femoral hernia?
Surgical repair
Two real differences between femoral and inguinal hernias?
Inguinal = M>F
Location (inguinal is more superior and medial)
What is the classification criteria for colorectal carcinoma?
Dukes
Typical patient with colorectal cancer?
Elderly patient, weight loss and change in bowel habits
Symptoms of colorectal cancer?
Bowel habit change
Blood in stool
Weight loss
Pain
Investigations of colorectal cancer?
Colonoscopy with biopsy
Staging CT
Treatment of colorectal carcinoma?
Chemotherapy
Radiotherapy
Surgery
Most common cause of upper GI bleed?
Gastric ulcer
Symptoms of acute GI bleed?
Haematemesis
Melaena
Symptoms of blood loss (syncope, anaemia)
Investigations for acute GI bleed?
Bloods (high urea +normal creatinine)
Endoscopy if haemodynamically stable
Score used for prognosis of acute GI bleed?
Rockall Score
Management of acute GI bleed?
Small: Lifestyle advice (avoid alcohol, NSAIDs, etc.)
Large: ABCDE approach
What ages and sex are most likely to present with coeliac?
Females
Infants and ages 30-40 yrs
Features of coeliac disease?
Diarrhoea (50%) Foul smelling stool Weight loss Abdo pain Distension Mouth ulcers
Investigations for coeliac disease?
Auto-antibody tests
Endoscopy with biopsy
Treatment of coeliac disease?
Gluten free diet
Vitamin supplements
