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DPD > Abdominal > Flashcards

Abdominal Flashcards

1
Q 
75 year old man
• Epigastric pain
• Back pain
• High HR
• Low BP - haemodynamically compromised

Diagnosis?

A

Ruptured aortic aneurysm

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2
Q

Classic test in chronic pancreatitis?

A

Normal amylase

Faecal elastase

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3
Q

What endocrine disorder can someone with chronic pancreatitis present with?

A

Diabetes - loss of pancreatic endocrine function

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4
Q

What is mesenteric adenitis, in whom does it present and where in the body?

A
  • Inflamed mesenteric lymph nodes
  • Children
  • RIF
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5
Q

What does the superior mesenteric artery supply?

A
  • Small intestine
  • Ascending (right) colon
  • 2/3 of transverse colon
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6
Q

What does the inferior mesenteric artery supply?

A

Descending (left) colon

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7
Q 
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?

A

High amylase

Seen in any cause of acute abdominal pathology

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8
Q

Neutrophil count consistent with SBP?

A

Ascites neut ≥ 250 cells/mm^3

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9
Q

Causes of transudative ascites (with SAAG)?

A
  • Cirrhosis (> 11)
  • Cardiac failure (> 11)
  • Budd-Chiari syndrome - portal vein thrombosis (> 11)
  • Nephrotic syndrome (< 11)
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10
Q

Causes of exudative ascites (with SAAG)?

A
  • Malignancy
  • Infection e.g. TB

< 11

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11
Q

Cause of pale stool in jaundice?

A

Low stercobilinogen

  • Obstructive, post-hepatic jaundice
  • No conjugated bilirubin / urobilinogen for bacteria to turn brown
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12
Q

Syndrome with mild pre-hepatic jaundice caused by unconjucated bilirubin?

A

Gilbert’s syndrome

haemolysis is also pre-hepatic

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13
Q

Cause of dark urine in jaundice?

A

Conjugated bilirubin leaking out of hepatocytes

hepatic jaundice

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14
Q

Which enzyme conjugates bilirubin?

A

Glucuronyltransferase

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15
Q

Symptom of hepatic jaundice?

A

Dark urine

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16
Q

Symptoms of post-hepatic jaundice?

A

Dark urine and pale stool

17
Q

3 causes of post-hepatic jaundice?

A
  • Gallstones in common bile duct
  • Stricture
  • Cancer of head of pancreas
18
Q
  • Painless jaundice
  • Weight loss
  • Dark urine
  • Pale stool

Which 2 things would you expect to see elevated in a blood test?

A
  • ALP - raised in obstruction

* CA19-9

19
Q

Causes of bloody diarrhoea (5)

A
  • Infective colitis (Campylobacter, Haemorrhagic E. coli, Entamoeba histolytica, Salmonella, Shigella)
  • Inflammatory colitis - young, extra-GI manifestations
  • Ischaemic colitis - elderly
  • Diverticulitis
  • Malignancy
20
Q

What blood tests would be abnormal in ischaemic bowel problems?

A
  • Lactate

* CK

21
Q

What is a feature of inflammation on AXR?

A

Thumb printing - thick haustral folds

22
Q

What is a feature of UC in barium enema?

A

Lead pipe colon - featureless abdomen

23
Q

Diameter in toxic megacolon?

A

> 6cm

24
Q

Management of acute GI bleed, and what would you add in a variceal bleed?

A
  • ABC
  • IV access
  • Fluids
  • G&S, X-match blood
  • OGD

Variceal:
+ ABx
+ Terlipressin

25
Q

Which LFTs go up in hepatocyte damage?

A

AST and ALT

26
Q

AST and ALT in paracetamol overdose and in alcoholic hepatitis?

A
  • PO - in 1000s

* Alcoholic hepatitis - AST:ALT = 2:1

27
Q

Treatment for acute abdomen?

A
  • NBM
  • IV fluids
  • Analgesia
  • Anti-emetics
  • ABx
  • Monitor vitals + urine output
28
Q

Patient presents with (jaundice has) ABNORMAL LFTs. What is the next investigation and why?

A

Abdominal USS - after fast

• Better visualisation of gallstones in a distended gallbladder

29
Q

Patient presents with dyphagia and weight loss. What is the next investgation?

A

OGD + biopsy

30
Q

Patient presents with PR bleed and weight loss. What is the next investigation?

A

Colonoscopy

31
Q

Treatment for ascites?

A
  • Spironolactone ± furosemide
  • Sodium restriction
  • Fluid restriction if hyponatraemia
  • Monitor weight daily
  • Therapeutic paracentesis
32
Q

Treatment for encephalopathy, what do you avoid and what do you need to treat/exclude?

A
  • Lactulose
  • Phosphate enemas
  • Avoid sedatives
  • Treat infections and exclude GI bleed - high protein meal for bacteria
33
Q

Features of a pelvic abscess e.g. post-appendectomy ?

A
  • Pain
  • Fever
  • Sweats
  • Mucus diarrhoea
34
Q

Patient who has just had surgery presents with:
• diffuse abdominal tenderness
• guarding
• hypotensive/tachycardic

Cause?

A

Anastomotic leak

peritonitis

35
Q

Treatment of perianal abscess?

A

Incision and drainage

36
Q

Presentation and treatment of anal fissure?

A
  • Rectal pain (on defaecation)
  • Stool coated with blood
  • Advice - fluids, fibre
  • GTN cream
37
Q

Presentation of IBS and what do you not see and what should you particularly exclude?

A
  • 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
38
Q

Treatment of IBS?

A

Diet and lifestyle modification

Symptomatic treatment
• Pain - anti-spasmodics
• Constipation - laxatives
• Diarrhoea - anti-diarrhoeals

DPD (6 decks)

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