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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
Symptoms of acute pancreatitis?
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)
26
What tests should be ordered in suspected acute pancreatitis?
Serum amylase/serum lipase (3x the normal limit), ABG, AXR, CT/MRI, CRP
27
How is acute pancreatitis managed?
NBM, fluid resus, analgesia. ERCP and gallstone removal if worsening jaundice. Treat any complications that may arise
28
What is the name of the criteria that predicts severity of pancreatitis?
Glasgow criteria
29
What causes chronic pancreatitis?
Alcohol, cystic fibrosis, haemochromatosis, pancreatic duct obstruction, raised PTH, congenital, malnourishment
30
When the pancreas is imaged using US/CT, what confirms the diagnosis of chronic pancreatitis?
Pancreatic calcifications
31
What are gallstones usually made up of?
Cholesterol (80%). Also, bile pigment, or mixed stones
32
What 5 Fs make up the risk factors for gallstones?
Fat, forty, female, fair, fertile. Also smoking
33
With gallstones where does the epigastric/RUQ pain tend to radiate?
Right shoulder
34
What 3 things make up Charcot's triad for ascending cholangitis?
Jaundice, RUQ pain, rigors
35
What does a positive Murphy's sign indicate?
Gallstones
36
Who tends to get each type of hepatitis?
``` 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
Symptoms of hepatitis?
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
How is hepatitis managed?
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
What is the most common surgical emergency?
Appendicitis
40
What causes appendicitis?
Gut bacteria invade appendix wall after lumen obstruction by lymphoid hyperplasia leading to oedema, ischaemic necrosis and perforation
41
What signs indicate appendicitis?
RIF guarding, tachycardia, fever, furred tongue, lying still, pain on coughing, foetor, flushing, shallow breaths, pain at McBurney's point
42
Bowel obstruction accounts for roughly what percentage of acute abdomen hospital presentations?
~20%
43
What causes small bowel obstruction?
Hernias, adhesions, intussusception, malignancy, gallstones, ileus, TB
44
What causes large bowel obstruction?
Colon cancer, impacted faeces, diverticulitis, sigmoid or caecal volvulus
45
In bowel obstruction, what is the key test to help differentiate if the obstruction is small or large bowel?
AXR
46
Inguinal hernias are the most common type of hernia, what is the ratio of males to females that get them?
M 10:1 F | Femoral hernias are more common in elderly women
47
Where do most oesophageal carcinomas occur?
``` Middle part (50%) Proximal carcinomas tend to be squamous cell, distal carcinomas tend to be adenocarcinomas ```
48
Risk factors for oesophageal carcinoma?
Diet, alcohol excess, smoking, achalasia, Phimmer-Vinson syndrome, obesity, low vit A + C intake, nitrosamine exposure, reflux oesophagitis, Barrett's oesophagus
49
Where is the poor prognosis cancer gastric carcinoma more common?
Japan, eastern Europe, China, South America
50
Where within the pancreas do the majority of pancreatic carcinomas occur?
Head (60%) body (25%) tail (15%)
51
Why do pancreatic carcinomas have a particularly poor prognosis?
They metastasize early and present late, less than 20% are eligible for radical surgery
52
Symptoms of pancreatic carcinoma?
Head: painless, obstructive jaundice Body and Tail: epigastric pain radiating to back Both: anorexia, weight loss, diabetes, acute pancreatitis
53
Risk factors for colorectal carcinoma?
Neoplastic polyps, IBD, genes (FAP/HNPCC), low fibre, high red meat diet, excess alcohol, smoking, previous cancer
54
Symptoms of left sided Colorectal carcinoma?
Bleeding/mucus PR, altered bowel habit/obstruction, tenesmus, mass PR
55
Symptoms of right sided colorectal carcinoma?
Weight loss, low Hb, abdo pain
56
Symptoms that are seen in either side colorectal carcinoma?
Abdominal mass, perforation, haemorrhage, fistula
57
What is the name of the staging system that stages colorectal cancers?
Duke's staging
58
What causes ascites?
Liver cirrhosis, malignancy, heart failure, nephrotic syndrome, pancreatitis, TB, hypothyroidism
59
What is seen in Kwashiorkor?
Adequate energy intake but insufficient protein --> oedema and hepatomegaly
60
What is seen in Marasmus/
Inadequate energy and protein intake --> severe wasting
61
Deficiency of what can cause Beri-Beri?
Vitamin B1/thiamine
62
What conditions can cause malabsorption?
Coeliac disease, chronic pancreatitis, Crohn's disease
63
What is the gold standard investigation to confirm a suspected perforated viscus and why?
CT as on a standard erect CXR it can be easy to miss the layer of air under the diaphragm
64
Do upper or lower GI perforations normally cause severe sepsis?
Lower
65
What is coeliac disease?
Immune mediated, inflammatory systemic disorder provoked by gluten. Intolerance causes villous atrophy and malabsorption

Year 3 Core Conditions (12 decks)

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