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Year 3 - Exams > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Ascites Ddx - exudate

A

(Protein > 30g/L)

  1. Infection (TB, pyogenic infection)
  2. Inflammation (pancreatitis)
  3. Malignancy (luminal, pancreas, liver, ovarian, lymphoma)
  4. Lymphoedema
  5. Hypothyroidism
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2
Q

Aetiology of ascites in CLD

A
  1. Portal HTN
  2. Hypoalbuminaemia
  3. Salt and water retention (RAAS Activation)
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3
Q

Gynaecomastia Ddx

A
  1. Physiological (puberty,elderly)
  2. Testicular failure
  3. Increased estrogen
  4. Drug-induced
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4
Q

Gynaecomastia - Testicular failure Ddx

A
  1. Klinefelter’s syndrome
  2. Viral orchitis/testicular trauma
  3. Haemodialysis
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5
Q

Gynaecomastia - increased oestrogen Ddx

A
  1. Chronic liver disease
  2. Thyrotoxicosis
  3. Oestrogen-secreting tumour
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6
Q

Gynaecomastia - Drug-induced Ddx

A

DISCO MTV

  1. Digoxin
  2. Isoniazid
  3. Spironalactone
  4. Cimetidine/calcium channel blocker
  5. Osteogens
  6. Methyldopa
  7. Tricyclics
  8. Verapamil
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7
Q

Hepatomegaly Ddx

A

BI INCH

  1. Biliary
  2. Infection
  3. Infiltrative
  4. Neoplastic
  5. Congestion (venous)
  6. Haematological
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8
Q

Hepatomegaly - infection Ddx

A
  1. Hepatitis*
  2. EBV*
  3. Malaria*
  4. Liver abscess
    * causes hepatosplenomegaly
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9
Q

Hepatomegaly - neoplasm Ddx

A
  1. Primary

2. Metastatic

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10
Q

Hepatomegaly - congestion (venous) Ddx

A
  1. RHF
  2. Tricuspid regurgitation
  3. Budd-Chiari syndrome
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11
Q

Hepatomegaly - haematological Ddx

A
  1. Lymphoma/leukaemia
  2. Myelofibrosis
  3. Sickle-cell anaemia
    All these cause hepatosplenomegaly
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12
Q

Hepatomegaly - infiltration Ddx

A
  1. Sarcoid/Amyloid*
  2. Haemochromotosis
  3. Fatty liver
    * causes hepatosplenomegaly
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13
Q

Hepatomegaly - biliary Ddx

A
  1. PBC

2. PSC

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14
Q

Splenomegaly - mild Ddx

A

GRIP

  1. Glandular fever
  2. RA (Felty’s syndrome)
  3. Infective Endocarditis
  4. Pernicious anaemia
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15
Q

Splenomegaly - moderate Ddx

A
  1. Lymphoma / leukaemia
  2. Portal hypertension
  3. Haemolytic anaemia
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16
Q

Splenomegaly - massive Ddx

A
  1. Malaria

2. Myeloproliferative (myelofibrosis, CML)

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17
Q

Smooth liver edge Ddx

A
  1. Venous congestion

2. Fatty infiltration

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18
Q

Knobbly liver edge Ddx

A
  1. Metastases

2. Cysts

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19
Q

Pulsating liver dx

A

TR

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20
Q

Tender liver edge Ddx

A
  1. Hepatitis

2. RHF

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21
Q

Liver bruit Ddx

A
  1. HCC
  2. AV malformation
  3. TIPSS
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22
Q

Peripheral IBD Signs

A
  1. Finger clubbing
  2. Mouth ulcers (especially crohn’s)
  3. Eyes - episcleritis, conjunctivitis
  4. Skin - erythema nodosum, pyoderma gangrenosum
  5. Joints - seronegative spondyloarthropathy
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23
Q

Pancreatitis - causes

A

GET SMASHED

  1. Gallstones
  2. Ethanol
  3. Trauma
  4. Steroids
  5. Mumps
  6. Autoimmune
  7. Scorpion envenomation
  8. Hyperlipidaemia/parathyroidism
  9. ERCP/surgey
  10. Drugs
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24
Q

Pancreatitis risk factors

A
  1. Gallstones
  2. Ethanol
  3. FHx of pancreatitis
  4. High TGs
  5. Smoking
  6. CF
  7. Medications - some ABx and oestrogen
  8. Congenital - pancreas divisum
25
Q

Biliary colic Ddx

A
  1. Acute cholecystitis
  2. Ascending cholangitis
  3. Pancreatitis
26
Q

Biliary colic investigations

A
  1. LFT (raised ALP and bilirubin)
  2. lipase/amylase normal (Ddx pancreatitis)
  3. Urine normal
  4. Gallbladder USS - 95% sensitive
  5. CXR - normal
27
Q

Biliary colic - management

A
  1. Analgesia - paracetamol, NSAIDS, opioids
  2. Antiemetics - omeprazole
  3. Laparoscopic cholecystectomy (definitive)
  4. Shockwave lithotripsy
28
Q

Peptic ulcer disease - causes

A
  1. NSAID usage - up to 20% in long term users
  2. H. Pylori -90%
  3. Acid induced
  4. Chronic disease I.e. COPD, CF, CKD, cirrhosis
29
Q

Peptic ulcer disease - risk factors

A
  1. Aspirin, NSAIDs
  2. Alcohol I.e. Gastritis
  3. Smoking
  4. Coffee
  5. Corticosteroids
30
Q

Duodenal vs. Gastric ulcer - history

A

Duodenal - Epigastric pain, relieved by antacids, nocturnal pain
Gastric ulcer - Epigastric pain, relieved by antacids, aggravated by food, may have anorexia, weight loss, N&V

31
Q

Peptic ulcer disease - red flags

A
  1. Age > 50
  2. Dysphagia
  3. Early satiety
  4. Vomiting
  5. Jaundice
  6. FHx of gastric cancer
  7. Weight loss
  8. GI bleed
32
Q

Peptic ulcer disease - Ddx

A
  1. Cholecystitis
  2. Pancreatitis
  3. Appendicitis
  4. Gastric cancer
  5. Ischemic bowel if elderly
  6. IBD
33
Q

Peptic ulcer disease - investigations

A
  1. Trial of PPI
  2. H. Pylori stool antigen
  3. Gastroscopy if any red flags
34
Q

Peptic ulcer disease - management

A
  1. Stop NSAIDs
  2. Start PPI
  3. Treat H. Pylori (metronidazole, tetracycline. Bismuth, omeprazole)
35
Q

Peptic ulcer disease - complications

A
  1. Perforation

2. Haemorrhage

36
Q

AAA - risk factors

A
  1. Smoking
  2. FHx
  3. Atherosclerosis
  4. HTN
  5. Age
  6. Male
37
Q

AAA - causes

A
  1. 25% associated with atherosclerosis
  2. Aortic dissection
  3. Ehler’s danlos syndrome
38
Q

AAA - presentation

A

75% a symptomatic

  1. Sudden onset back pain
  2. Pulsatile mass
  3. Hypotension
39
Q

AAA - investigations

A
  1. USS - sensitivity is 100%
  2. CT if obese
  3. Pre-op evaluation is done by CT/MRI angiogram
40
Q

AAA - management + indication

A

Surgical repair

  1. Pain
  2. Asymptomatic & >5.4cm or enlarging
41
Q

AAA - pre-op risk reduction

A
  1. Stop smoking
  2. Beta-blocker
  3. COPD optimisation
  4. Renal function optimisations
42
Q

Types of Gallstone pathology

A
  1. Biliary colic - transient cystic duct obstruction
  2. Cholelithiasis - presence of gallstones
  3. Cholecystitis - persistent cystic duct obstruction
  4. Choledocholithiasis - stones in CBD
  5. Ascending cholangitis - infection of the biliary tract due to bacteria ascending from duodenum
43
Q

Gallstone - risk factors

A
  1. Female, forty, fair skinned, FHx, fat
  2. High calorie diet
  3. Associated with obesity, DM, cirrhosis
  4. HRT, oral contraceptive
44
Q

Types of gallstones

A
  1. Cholesterol

2. Black pigment stones (bilirubin)

45
Q

Gallstone Ddx

A
  1. Hepatitis
  2. Pancreatitis
  3. Gastritis
  4. Peptic ulcer disease
  5. GORD
  6. PID
46
Q

Renal colic - risk factors

A
  1. Age
  2. Male
  3. Congenital
  4. Corticosteroids
  5. Low urine volume
47
Q

Renal colic - types of stones

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Uric acid
  4. Struvite
  5. Cysteine
48
Q

Renal colic - presentation

A
  1. Sudden, severe abdominal pain
  2. Unilateral flank pain (loin to groin)
  3. N & V
  4. Haematuria
49
Q

Renal colic - Ddx

A
  1. UTI

2. Acute prostatitis

50
Q

Renal colic - investigations

A
  1. Non-Contrast CT Urogram (gold standard - 95% sensitivity + specificity)
  2. Abdominal USS - good to rule out stones but not to find them
  3. Intravenous pyelogram (good if CT not available and not pregnant)
  4. MSU - haematuria
  5. Urine culture
  6. RFT - BUN, creatinine
51
Q

Renal colic - management

A
  1. Analgesia - NSAIDs are highly effective
  2. Nifedipine or tamsulosin
  3. Shock wave lithotripsy
  4. Stent
  5. Open surgery
  6. Fluid - prevention
52
Q

NSAIDs and AKI

A
  1. Afferent arteriole constricts with NSAID use (pre-renal failure)
  2. Interstitial nephritis
  3. Need to monitor renal function
    Triple whammy: NSAID, diuretic, ACEi
    Monitor renal function
53
Q

Splenomegaly - investigations

A
  1. FBC
  2. LFT
  3. Echo (cardiac cause)
  4. ESR - RA
  5. ANA - SLE
  6. Splenic USS
  7. Abdominal CT
  8. Gallium scan (lymphoma or infection)
54
Q

Internal vs external haemorrhoids

A

Weakness of connective tissue in anorectal vessels
Internal - above dentate line, painless
External - below dentate line, may be painful

55
Q

Haemorrhoids - causes

A
  1. Constipation - straining
  2. Diarrhoea
  3. FHx
  4. Obesity
  5. Portal hypertension and ascites
56
Q

Haemorrhoids - presentation

A
  1. Itchiness
  2. Rectal bleeding
  3. Rectal pain
  4. Prolapse
57
Q

Haemorrhoids - examination

A
  1. Inspect
  2. PR exam
  3. Anoscopy
58
Q

Haemorrhoids - Ddx

A
  1. Anal fissure
  2. Abscess
  3. Rectal fistula
  4. Cancer
  5. IBD
  6. Skin tags
  7. Rash
59
Q

Ascites Ddx - transudate

A

(Protein < 30g/L)

  1. CLD (75%)
  2. CHF
  3. Volume Overload
  4. Hypoalbuminaemia
  5. Constrictive pericarditis

Year 3 - Exams (25 decks)

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