Abdominal Flashcards
Who does GERD Affect?
60% of people, Women, >40
What are the Risk Factors for GERD?
Obesity, Hiatal Hernia, Diabetes, Pregnancy
GERD Presentation
Heartburn, Chest Pain, Dysphagia, Sour Taste, Inflammation of gums
GERD Investigations
PPI trial, OGD, Ambulatory acid probe
GERD Treatment
Stop Smoking/NSAIDs/Alcohol, Antacids, PPIs, H2 Antagonists, Prostaglandin analogue
Where are Peptic Ulcers most commonly found?
Duodenum
Risk Factors for Peptic Ulcer
H.Pylori (main), NSAIDs, Smoking, Crohn’s, Zollinger-Ellison Syndrome
Peptic Ulcer Presentation
Upper Abdo Pain, Belching, Vomiting (haematemesis), Anaemia, Maelaena Cachexia, Poor appetite
Peptic Ulcer Investigations
H.Pylori (Urease test, Stool, Serology), Endoscopy
Peptic Ulcer Treatment
Antacids, H2 antagonists, Prostaglandin analogue, PPIs (Stop NSAIDs)
Where is a GI Bleed most common?
Upper GI
Causes of Upper GI Bleed?
Peptic ulcer, Cirrhosis, Cancer
Causes of Lower GI Bleed?
Haemorrhoids, Cancer, IBD
Presentation of GI Bleed
Haematemesis, Maelaena (upper), Fatigue, Chest pain, SOB, Anaemia
GI Bleed Investigations
Bloods (FBC, LFT, Clotting), Endoscopy
GI Bleed Treatment
Transfusion, Endoscopy, PPI
Who does Inflammatory Bowel Disease Effect?
Under 30yrs, White Jewish, Industrialised country
Which IBD is smoking protective for?
Ulcerative Colitis
Inflammatory Bowel Disease Presentation
Abdominal Pain, Diarrhoea, Maelaena, Anorexia, Fatigue
Inflammatory Bowel Disease Investigations
Bloods, Stool test, Endoscopy, Imaging
Inflammatory Bowel Disease Treatment
Aminosalicylates (UC), Steroids, Immunosuppressive’s
Who commonly gets IBS?
20-30yrs, Women
IBS Risk Factors
Foods (dairy, beans), Stress, Family Hx, Mental Health Issues
IBS Presentation
Abdo Pain, Bloating, Flatus, Change in Bowel Habits, Anorexia, Rectal Bleeding
IBS Investigations
Bloods, Sedimentation rate, Coeliac test, Stool analysis
What virus commonly causes Gastroenteritis in children?
Rotavirus
What virus commonly causes Gastroenteritis in adults?
Norovirus
Infective Gastroenteritis Presentation
Diarrhoea, Dysentery, Dehydration, Cramps
Infective Gastroenteritis Investigations
Bloods, Culture, ELISA, Electron microscopy
Infective Gastroenteritis Treatment
Rehydrate, Antiemetic’s (Antibiotics if systemic)
Who is most likely to get Pancreatitis?
30-40yrs, Men, 70% due to Alcohol Abuse
Pancreatitis Risk Factors
Alcohol, Smoking, Family Hx, Gallstones, Surgery, CF, Infection, Cancer
Pancreatitis Presentation
Abdo pain worse after eating, Vomting, Steatorrhea, Anorexia, Fever
Pancreatitis Investigations
Serum amylase/lipase, Faecal Elastase, USS, Imaging
Pancreatitis Treatment
Fluids, Anti-Inflamms, Analgesia, Surgery
Who is most likely to get Gallstones?
Female (had children), Combined Pill/Oestrogen therapy, Overweight, >40yrs
Why do Gallstones form?
Too much bilirubin, Too much cholesterol, Not enough bile salts (+ incomplete/infrequent emptying of GB)
Gallstones Risk Factors
Low nutrient intake, Constipation, Rapid weight loss, Coeliac, Cirrhosis
Gallstone Presentation
Biliary Colic pain in RUQ, Vomiting, Itching, Confusion, Fever, Jaundice
Gallstones give what Sign on Physical Examination?
Murphy’s sign
Gallstone Investigations
USS, Bloods (FBC, LFT, Amylase/Lipase)
Gallstone Treatment
Ursodeoxycholic acid (oral), Cholecystectomy
Which Viral Hepatitis is there a Vaccine for but no Treatment?
Hepatitis A
Which Viral Hepatitis is there no Vaccine but Treatment?
Hepatitis C
Which Viral Hepatitis can you only get together with Hepatitis B?
Hepatitis D
Which Viral Hepatitis has a Vaccine and Treatment available?
Hepatitis B
What are the Blood-Borne Viral Hepatitis’s?
Hepatitis B and Hepatitis C
Who is Hepatitis E bad in?
Pregnant Women
What are the Causes of Hepatitis?
Infectious (virus and parasites), Metabolic (alcohol and drugs), Ischemic (heart failure), Autoimmune (hemochromatosis, Wilsons disease)
Hepatitis Presentation
Flu-like, Joint pain, Pruritis, Jaundice, Fever
Hepatitis Investigations
Blood tests (liver enzymes, serology (nucleic acid, FBC), Imaging, Liver biopsy
Hepatitis Treatment
Supportive, Antivirals (tenofovir) Treat alcoholism)
Appendicitis Presentation
RLQ Pain, Vomiting, Fever, Rebound Tenderness
What sign do you get with Appendicitis?
Dunphy Sign (pain on coughing)
Appendicitis Treatment
Appendectomy, Antibiotics
What is the most common cause of Small Bowel Obstruction?
Adhesions
also: hernia, crohn’s, neoplasms, foregin bodies
What is the most common cause of Large Bowel Obstruction?
Neoplasm
also: diverticulitis, IBD, volvulus, adhesions, constipation
Risk Factors for Bowel Obstruction
Previous Surgery, Cancer Treatment, IBD
Bowel Obstruction Presentation
Abdo pain, Vomiting (faecal), Constipation, Dehydration, Absent Bowel Sounds, Distension
Bowel Obstruction Investigations
Bloods, Imaging, Contrast Enema, Endoscopy
Who gets Hernias?
Males, Smokers, >50
Hernia Risk Factors
Smoking, COPD, Obesity, Pregnancy, Peritoneal Dialysis
Hernia Presentation
Pain at Site, Vomiting, Tender, Fever
Hernia Treatment
Leave it, Mesh Repair, Surgery
Oesophageal Carcinoma Presentation
Dyphagia, Odynophagia, Weight loss, Hoarse Voice, Large Nodes, Dry cough, Haemoptysis/Haemetemesis
Risk Factors of SCC Oesophageal Carcinoma
Male, Developing World, Smoking, Alcohol, Hot Drinks, Betel Nut
Risk Factors of Adeno Oesophageal Carcinoma
Male, Developed world, Smoking, Obesity, Acid Reflux
Oesophageal Carcinoma Investigations
Biopsy done by Endoscopy
Gastric Carcinoma Main Risk Factor?
H.Pylori (60% of cases)
Also: Male, Smoking, Diet (pickled veg), Obesity Genetics
Gastric Carcinoma Presentation
Heartburn, Upper Abdo Pain, Nausea, Weight loss, Jaundice, Dysphagia, Blood in stool
How is Gastric Carcinoma Diagnosed?
Biopsy done during Endoscopy
Gastric Carcinoma Treatment
H.pylori, Stop smoking, Mediterranean Diet, Surgery, Chemo/Radio
What is the most common Pancreatic Carcinoma?
Adenocarcinoma (85%)
Pancreatic Carcinoma Presentation
Jaundice, Abdo/Back Pain, Weight Loss, Steatthorea, Dark urine
Pancreatic Carcinoma Risk Factors
Smoking, Obesity, Diabetes, Genetic Conditions
Colorectal Carcinoma Presentation
Blood in stool, Change in Bowel Habits, Weight loss, Fatigue
Colorectal Carcinoma Causes
Old age, Red Meat, Alcohol, Smoking, FAP, HNPCC, IBD
At what age is Colorectal Carcinoma Screened for?
50 - 75 years old
Who gets Colorectal Cancer?
Developed World, Men
3rd most common cancer
Chronic Liver Disease Presentation
Anaemia, Ascites, SOB, Fatigue, Hands (clubbing, erythema, flap), Chest (spider naevi, gyneacomastia)
Chronic Liver Disease Causes
Viral (Hep B/C, CMV, EBV), Toxic (Alcohol, Methotrexate, Nitrofurantoin, Paracetamol), Metabolic (Fatty liver disease, Wilson’s, Autoimmune), Cholangitis, Obesity
Which LFT result is most sensitive for Chronic Liver Disease?
ALT
What is the Supportive Therapy for Chronic Liver Disease?
Diuretics, Albumin, Vitamin K, Antibiotics, Nutrition
How much fluid in the peritoneal cavity constitutes ascites?
> 25ml
Causes of Ascites
Liver Cirrhosis (most common), Cancer, Heart Failure, TB, Pancreatitis, Blockage of Hepatic Vein
Ascites Treatment
Low salt diet, Diuretics, Drainage, Liver Transplant
Causes of Malnutrition
Poverty, Infectious Diseases (gastroenteritis, pneumonia, malaria), Anorexia nervosa, Bariatric surgery
GI Perforation Presentation
Sever abdo Pain, Sepsis, Tachycardia, SOB, Confusion
Where in the GI Tract does a Perforation present more acutely?
Stomach / Small Intestine / Upper
Causes of GI Perforation
Trauma, Colonoscopy, Obstruction, Ulcer, Ischaemia, Infection (c.diff)
What Drug Combo’s are used to treat GI Perforation?
‘Piperacillin and Tazobactam’ or ‘Ciprofloxacin and Metronidazole’
Coeliac Presentation
Diarrhoea, Distension, Loss of Appetite, Failure to grow
non-specific = hard to diagnose
Why does Coeliac lead to Anaemia?
Autoimmune inflammatory reaction to gluten proteins = Villous Atrophy
Where does Coeliac Affect?
Small Bowel
Coeliac Investigations
Blood antibody tests, Intestinal biopsies, Genetic testing
Who is Coeliac commonly found in?
Children, Women
