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Year 3 Core Conditions > Abdominal conditions > Flashcards

Abdominal conditions Flashcards

1
Q

How many episodes of heartburn per week suggest Gastro-Oesophageal Reflux Disease?

A

At least 2

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2
Q

What drugs can cause GORD?

A

Tricyclics, anticholinergics, nitrates

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3
Q

What are the extra-oesophageal manifestations of GORD?

A

Nocturnal asthma, chronic cough, laryngitis, sinusitis

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4
Q

When is an endoscopy indicated for patients with GORD?

A

Symptoms >4 weeks/persistent vomiting/GI bleeding/Fe deficiency/palpable mass/age >55 years/dysphagia/symptoms persisting despite treatment/relapsing symptoms/weight loss

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5
Q

How is GORD managed?

A

Lifestyle changes: lose weight, raise bed head, cease smoking, small meals, avoid hot drinks/alcohol/citrus fruits/tomatoes/fizzy drinks/spicy foods/chocolate/eating before bed
Drugs: Antacids, algiantes (gaviscon)
Surgery: if severe

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6
Q

What can cause peptic ulcer disease?

A

H.pylori infection, NSAIDs, steroids, stress, alcohol, spicy meals

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7
Q

What symptoms does a patient with peptic ulcer disease experience?

A

Burning/gnawing pain that may radiate to neck/back before or after a meal, bloating, heartburn

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8
Q

How does the presentation of gastric and duodenal ulcers differ?

A

(normally
Gastric: pain worsened by eating
Duodenal: pain relieved by eating
(duodenal ulcers 4x more common)

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9
Q

What are the ALARM Symptoms in peptic ulcer disease that warrant urgent endoscopy?

A 
A - Anaemia (Fe deficiency)
L - Loss of weight
A - Anorexia
R - Recent onset/progressive symptoms
M - Melaena/Haemostasis
S - Swallowing difficulty
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10
Q

What causes acute GI bleeds?

A

Peptic ulcers, oesophageal varices, Mallory-Weiss tears, oesophagitis, gastritis, duodenitis
Upper GI bleeds 4x more common

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11
Q

What is the management plan for acute GI bleeds?

A

Insert large bore cannula and take bloods (crossmatch), CXR, ECG, ABG, urgent endoscopy, monitor pulse and BP
Rx: High flow O2, fluid resuscitation, transfuse blood, omeprazole, iv terlipressin/glycopressin/octreotide to vasodilate splenic artery and reduce BP

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12
Q

What is the name of the scoring system that determines low risk patients prior to endoscopy for GI bleeds?

A

Blatchford score

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13
Q

What is the name of the scoring system that determines risk of ongoing bleeding prior to endoscopy?

A

Randall score

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14
Q

What tends to be the causes of lower GI bleeds? (rarer)

A

Diverticulitis or ischaemic colitis

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15
Q

What are the 2 types of inflammatory bowel disease?

A

Ulcerative colitis and Crohn’s disease

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16
Q

Distinguishing features between UC and Crohn’s?

A

UC - continuous area of inflammation, only affects colon, smoking is protective
Crohn’s - patchy areas of inflammation (skip lesions), affects anywhere from mouth to anus, smoking causative

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17
Q

Symptoms of IBD?

A

(bloody, mucous) recurrent diarrhoea, abdo pain, weight loss, fever, malaise, fatigue, loss of apetite

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18
Q

How is UC managed?

A

Mild: sulfasalazine, steroids (prednisolone)
Moderate: oral prednisolone and twice daily steroid enemas
Severe: NBM and iv hydration, hydrocortisone, surgery to remove affected bowel
New: Infliximab and other immunomodulators can help

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19
Q

How is Crohn’s managed?

A

Mild: prednisolone
Severe: iv hydrocortisone, NBM, metranidazole
5-ASA analogues such as sulfasalazine, azathioprine, methotrexate
TNF-alpha inhibitors: infliximab
Surgery

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20
Q

How is Irritable Bowel Syndrome defined clinically?

A

12 weeks in 12 months of abdo discomfort and 2 of: stool frequency/abnormal stool form/abnormal stool passage

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21
Q

Symptoms of IBS?

A

Cramping pain in abdomen relieved by pooing, altered bowel habits, tenesmus, abdominal bloating

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22
Q

Given the sometimes uncurable (but manageable) nature of IBS, what is a common complication of IBS?

A

75% experience bouts of depression

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23
Q

What are the most common causes of infective gastoenteritis?

A

Norovirus or food poisoning with campylobacter or salmonella

Rotavirus more common in children

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24
Q

What causes acute pancreatitis?

A 
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps/malignancy
A - Autoimmune
S - Scorpion venom
H - Hyperlipidaemia/hypothermia/hypercalcaemia
E - ERCP
D - Drugs
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25
Q

Symptoms of acute pancreatitis?

A

Epigastric pain that radiates to back (relieved by sitting forward), N+V
Look for: Cullen’s sign (periumbilical bruising) or Grey Turner’s sign (flank bruising)

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26
Q

What tests should be ordered in suspected acute pancreatitis?

A

Serum amylase/serum lipase (3x the normal limit), ABG, AXR, CT/MRI, CRP

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27
Q

How is acute pancreatitis managed?

A

NBM, fluid resus, analgesia. ERCP and gallstone removal if worsening jaundice. Treat any complications that may arise

28
Q

What is the name of the criteria that predicts severity of pancreatitis?

A

Glasgow criteria

29
Q

What causes chronic pancreatitis?

A

Alcohol, cystic fibrosis, haemochromatosis, pancreatic duct obstruction, raised PTH, congenital, malnourishment

30
Q

When the pancreas is imaged using US/CT, what confirms the diagnosis of chronic pancreatitis?

A

Pancreatic calcifications

31
Q

What are gallstones usually made up of?

A

Cholesterol (80%). Also, bile pigment, or mixed stones

32
Q

What 5 Fs make up the risk factors for gallstones?

A

Fat, forty, female, fair, fertile. Also smoking

33
Q

With gallstones where does the epigastric/RUQ pain tend to radiate?

A

Right shoulder

34
Q

What 3 things make up Charcot’s triad for ascending cholangitis?

A

Jaundice, RUQ pain, rigors

35
Q

What does a positive Murphy’s sign indicate?

A

Gallstones

36
Q

Who tends to get each type of hepatitis?

A 
Hep A -children/young adults (faeco-oral route)
Hep B - travelers (blood)
Hep C - IVDU (blood)
Hep D - needs hep B to be active
Hep E - similar to hep A
Autoimmune - young/middle aged women
37
Q

Symptoms of hepatitis?

A

Initially, non-specific and flu-like: fever, myalgia, arthralgia, N+V+D, headache, loss of apetite, aversion to smoking in smokers, abdo discomfort, jaundice.

38
Q

How is hepatitis managed?

A

Hep A - self limiting, supportive measures
Hep B - avoid alcohol, immunise sexual contacts, antivirals if chronic liver inflammation, aim to clear HBsAg and prevent cirrhosis and HCC
Hep C - protease inhibitors
Hep D - liver transplant
Autoimmune - prednisolone, azathioprine

39
Q

What is the most common surgical emergency?

A

Appendicitis

40
Q

What causes appendicitis?

A

Gut bacteria invade appendix wall after lumen obstruction by lymphoid hyperplasia leading to oedema, ischaemic necrosis and perforation

41
Q

What signs indicate appendicitis?

A

RIF guarding, tachycardia, fever, furred tongue, lying still, pain on coughing, foetor, flushing, shallow breaths, pain at McBurney’s point

42
Q

Bowel obstruction accounts for roughly what percentage of acute abdomen hospital presentations?

A

~20%

43
Q

What causes small bowel obstruction?

A

Hernias, adhesions, intussusception, malignancy, gallstones, ileus, TB

44
Q

What causes large bowel obstruction?

A

Colon cancer, impacted faeces, diverticulitis, sigmoid or caecal volvulus

45
Q

In bowel obstruction, what is the key test to help differentiate if the obstruction is small or large bowel?

A

AXR

46
Q

Inguinal hernias are the most common type of hernia, what is the ratio of males to females that get them?

A

M 10:1 F

Femoral hernias are more common in elderly women

47
Q

Where do most oesophageal carcinomas occur?

A 
Middle part (50%)
Proximal carcinomas tend to be squamous cell, distal carcinomas tend to be adenocarcinomas
48
Q

Risk factors for oesophageal carcinoma?

A

Diet, alcohol excess, smoking, achalasia, Phimmer-Vinson syndrome, obesity, low vit A + C intake, nitrosamine exposure, reflux oesophagitis, Barrett’s oesophagus

49
Q

Where is the poor prognosis cancer gastric carcinoma more common?

A

Japan, eastern Europe, China, South America

50
Q

Where within the pancreas do the majority of pancreatic carcinomas occur?

A

Head (60%)
body (25%)
tail (15%)

51
Q

Why do pancreatic carcinomas have a particularly poor prognosis?

A

They metastasize early and present late, less than 20% are eligible for radical surgery

52
Q

Symptoms of pancreatic carcinoma?

A

Head: painless, obstructive jaundice
Body and Tail: epigastric pain radiating to back
Both: anorexia, weight loss, diabetes, acute pancreatitis

53
Q

Risk factors for colorectal carcinoma?

A

Neoplastic polyps, IBD, genes (FAP/HNPCC), low fibre, high red meat diet, excess alcohol, smoking, previous cancer

54
Q

Symptoms of left sided Colorectal carcinoma?

A

Bleeding/mucus PR, altered bowel habit/obstruction, tenesmus, mass PR

55
Q

Symptoms of right sided colorectal carcinoma?

A

Weight loss, low Hb, abdo pain

56
Q

Symptoms that are seen in either side colorectal carcinoma?

A

Abdominal mass, perforation, haemorrhage, fistula

57
Q

What is the name of the staging system that stages colorectal cancers?

A

Duke’s staging

58
Q

What causes ascites?

A

Liver cirrhosis, malignancy, heart failure, nephrotic syndrome, pancreatitis, TB, hypothyroidism

59
Q

What is seen in Kwashiorkor?

A

Adequate energy intake but insufficient protein –> oedema and hepatomegaly

60
Q

What is seen in Marasmus/

A

Inadequate energy and protein intake –> severe wasting

61
Q

Deficiency of what can cause Beri-Beri?

A

Vitamin B1/thiamine

62
Q

What conditions can cause malabsorption?

A

Coeliac disease, chronic pancreatitis, Crohn’s disease

63
Q

What is the gold standard investigation to confirm a suspected perforated viscus and why?

A

CT as on a standard erect CXR it can be easy to miss the layer of air under the diaphragm

64
Q

Do upper or lower GI perforations normally cause severe sepsis?

A

Lower

65
Q

What is coeliac disease?

A

Immune mediated, inflammatory systemic disorder provoked by gluten. Intolerance causes villous atrophy and malabsorption

Year 3 Core Conditions (12 decks)

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