Abdominal Flashcards
75 year old man • Epigastric pain • Back pain • High HR • Low BP - haemodynamically compromised
Diagnosis?
Ruptured aortic aneurysm
Classic test in chronic pancreatitis?
Normal amylase
Faecal elastase
What endocrine disorder can someone with chronic pancreatitis present with?
Diabetes - loss of pancreatic endocrine function
What is mesenteric adenitis, in whom does it present and where in the body?
- Inflamed mesenteric lymph nodes
- Children
- RIF
What does the superior mesenteric artery supply?
- Small intestine
- Ascending (right) colon
- 2/3 of transverse colon
What does the inferior mesenteric artery supply?
Descending (left) colon
65 year old man • AAA repair 2 days ago • Diffuse abdominal pain • High HR • High RR
What is likely to be seen on a blood test?
High amylase
Seen in any cause of acute abdominal pathology
Neutrophil count consistent with SBP?
Ascites neut ≥ 250 cells/mm^3
Causes of transudative ascites (with SAAG)?
- Cirrhosis (> 11)
- Cardiac failure (> 11)
- Budd-Chiari syndrome - portal vein thrombosis (> 11)
- Nephrotic syndrome (< 11)
Causes of exudative ascites (with SAAG)?
- Malignancy
- Infection e.g. TB
< 11
Cause of pale stool in jaundice?
Low stercobilinogen
- Obstructive, post-hepatic jaundice
- No conjugated bilirubin / urobilinogen for bacteria to turn brown
Syndrome with mild pre-hepatic jaundice caused by unconjucated bilirubin?
Gilbert’s syndrome
haemolysis is also pre-hepatic
Cause of dark urine in jaundice?
Conjugated bilirubin leaking out of hepatocytes
hepatic jaundice
Which enzyme conjugates bilirubin?
Glucuronyltransferase
Symptom of hepatic jaundice?
Dark urine
Symptoms of post-hepatic jaundice?
Dark urine and pale stool
3 causes of post-hepatic jaundice?
- Gallstones in common bile duct
- Stricture
- Cancer of head of pancreas
- Painless jaundice
- Weight loss
- Dark urine
- Pale stool
Which 2 things would you expect to see elevated in a blood test?
- ALP - raised in obstruction
* CA19-9
Causes of bloody diarrhoea (5)
- Infective colitis (Campylobacter, Haemorrhagic E. coli, Entamoeba histolytica, Salmonella, Shigella)
- Inflammatory colitis - young, extra-GI manifestations
- Ischaemic colitis - elderly
- Diverticulitis
- Malignancy
What blood tests would be abnormal in ischaemic bowel problems?
- Lactate
* CK
What is a feature of inflammation on AXR?
Thumb printing - thick haustral folds
What is a feature of UC in barium enema?
Lead pipe colon - featureless abdomen
Diameter in toxic megacolon?
> 6cm
Management of acute GI bleed, and what would you add in a variceal bleed?
- ABC
- IV access
- Fluids
- G&S, X-match blood
- OGD
Variceal:
+ ABx
+ Terlipressin
Which LFTs go up in hepatocyte damage?
AST and ALT
AST and ALT in paracetamol overdose and in alcoholic hepatitis?
- PO - in 1000s
* Alcoholic hepatitis - AST:ALT = 2:1
Treatment for acute abdomen?
- NBM
- IV fluids
- Analgesia
- Anti-emetics
- ABx
- Monitor vitals + urine output
Patient presents with (jaundice has) ABNORMAL LFTs. What is the next investigation and why?
Abdominal USS - after fast
• Better visualisation of gallstones in a distended gallbladder
Patient presents with dyphagia and weight loss. What is the next investgation?
OGD + biopsy
Patient presents with PR bleed and weight loss. What is the next investigation?
Colonoscopy
Treatment for ascites?
- Spironolactone ± furosemide
- Sodium restriction
- Fluid restriction if hyponatraemia
- Monitor weight daily
- Therapeutic paracentesis
Treatment for encephalopathy, what do you avoid and what do you need to treat/exclude?
- Lactulose
- Phosphate enemas
- Avoid sedatives
- Treat infections and exclude GI bleed - high protein meal for bacteria
Features of a pelvic abscess e.g. post-appendectomy ?
- Pain
- Fever
- Sweats
- Mucus diarrhoea
Patient who has just had surgery presents with:
• diffuse abdominal tenderness
• guarding
• hypotensive/tachycardic
Cause?
Anastomotic leak
peritonitis
Treatment of perianal abscess?
Incision and drainage
Presentation and treatment of anal fissure?
- Rectal pain (on defaecation)
- Stool coated with blood
- Advice - fluids, fibre
- GTN cream
Presentation of IBS and what do you not see and what should you particularly exclude?
- Recurrent abdominal pain
- Bloating
- Relieved with defecation
- Change in frequency and form of stool
- No PR bleeds, no anaemia, no weight loss, no nocturnal symptoms
- Exclude Coeliac disease
Treatment of IBS?
Diet and lifestyle modification
Symptomatic treatment
• Pain - anti-spasmodics
• Constipation - laxatives
• Diarrhoea - anti-diarrhoeals
