Abdominal Conditions Flashcards
Name 3 upper abdominal inflammatory conditions.
Gall stone disease (cholecystitis, cholangitis). Pancreatitis. Peptic ulcer disease. Gastro-oesophageal reflux disease (GORD). Oesophagitis.
Name 3 lower abdominal inflammatory conditions.
Appendicitis. Diverticular disease. Inflammatory bowel disease. Clostridioides (clostridium) difficile colitis. Radiation proctitis.
What 5F’s summarise gall stone disease?
Fat. Fair. Female. Fertile. Forty.
Name 3 complications of gall stone disease.
Biliary colic (sudden pain due to gallstone blocking cystic duct). Acute cholecystitis (infection). Obstructive jaundice. Ascending jaundice. Pancreatitis. Gallstone ileus.
What are the 3 types of Acute cholecystitis.
Empyema (pus) of the gallbladder. Gangrene (loss of blood supply) of the gallbladder. Perforation (holes) of the gallbladder.
When there is an interference of the blood supply for the gall bladder, it results in necrosis of the gall bladder known as…
Gangrene of the gallbladder.
Why is there pain in gall stone disease?
Stone obstructs the cystic duct.
What does the cystic duct do?
It transfers bile between the gallbladder and common and hepatic bile ducts.
Why does pain subside when a patient with gallstone disease lies down?
Gallstone falls back down cystic duct.
What’s the difference between cholangitis and cholecystitis?
Ascending cholangitis is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum . Cholecystitis is inflammation of the gallbladder.
What is gallstone ileus?
When the gallstone enters the small bowel via the cholecysto-duodenal fistula - causes bowel obstruction.
How do gall stones enter the small bowel?
Using the cholecysto-duodenal fistula.
Give 2 treatments for gall stone disease.
Ultrasound scan. Magnetic resonance cholangiopancreatography (MRCP). ERCP - endoscope used to examine a patients pancreatic and bile ducts.
What surgical procedure is used in gall bladder disease?
Laparascopic cholecystectomy (removal of gall bladder).
Give 3 causes of acute pancreatitis.
Gallstones. Idiopathic. Ethanol. Trauma. Steroids. Mumps. Infection.
Give 2 symptoms of acute pancreatitis.
Abdominal pain. Loss of appetite. Palpable, tender mass
How is acute pancreatitis diagnosed?
CT scan - visualisation of inflammation, necrosis, abscess, pancreatic pseudocysts. Ultrasound - Gallstones. Lab results - elevated serum amylase, lipase, bilirubin
Give 2 complications of acute pancreatitis.
Acute peripancreatic fluid collection. Pancreatic pseudocyst. Local complication of necrotizing pancreatitis. Severe manifestations e.g. Acute respiratory distress syndrome (ARDS).
What is peptic ulcer disease?
It refers to both gastric and duodenal ulcers. ↑ acid secretion, ↓ protective mechanisms → mucosal damage → ulceration.
Give 2 causal factors for peptic ulcer disease.
H. pylori infection (most common) -↑ gastric acid secretion, ↓ duodenal HCO3 secretion. NSAID - particularly low dose aspirin corticosteroids. Physiologic stress e.g. Cushing’s ulcer (intracranial hypertension), Curling ulcer (severe burns). Psychological stress. Hyperchlorydia. Smoking. Chronic obstructive pulmonary disease (COPD). Hypergastrinemia (Zollinger-Ellison syndrome).
What bacteria is responsible for peptic ulcer disease?
Helicobacter pylori. Spiral ram-negative infection.
What are proton-pump inhibitors?
Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production.
Name 2 things used to treat peptic ulcers.
Surgery - for bleeding and complications. Proton-pump inhibitors e.g. metronidazole, meprazole, esomeprazole - reduce stomach acid production. Antibiotics e.g. clarithromycin, amoxicillin.
Name 2 things used to diagnose peptic ulcers.
Abdominal CT scan. Barium abdominal radiography. Endoscopy.
Give 2 complications of peptic ulcer disease.
Upper GI bleed. Repeated ulcers. Peptic ulcer perforation. Pyloric stenosis.
What is gastro-oesophageal reflux disease (GORD)?
Prolonged content of gastric contents with lower oesophageal mucosa - stomach acid is able to pass back up oesophagus.
Give 2 causes fo gastro-oesophageal reflux disease (GORD).
Smoking. Pregnancy. Large meals. Surgical treatment of achalasia (lower oesophageal sphincter fails to open during swallowing).
Give 3 symptoms of gastro-oesophageal reflux disease (GORD).
Dyspepsia - burning feeling from stomach/lower chest. Acid brash - acid gets in your throat. Water brash - excessive salivation. Odynophagia - painful swallowing. Chest pain. Chronic cough.
What happens in Barret’s oesophagus?
Normal tissue lining the oesophagus – the tube that carries food from the mouth to the stomach – changes to tissue that resembles the lining of the intestine.
Give 2 differential diagnoses of dyspepsia (indigestion).
Oesophagitis. Infection. Peptic ulcer. Gastrointestinal malignancy.
What are 2 investigations for gastro-oesophageal reflux disease (GORD).
Full blood count - exclude anaemia. Endoscopy - assess for oesophagitis. Barium swallow.
What is a barium swallow?
It’s a test that may be used to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, bloodstained vomit, or unexplained weight loss. Barium sulfate is a metallic compound that shows up on X-rays and is used to help see abnormalities in the oesophagus and stomach.
Name 2 ways that gastro-oesophageal reflux disease (GORD) can be managed.
Lifestyle - encourage weight loss. Drugs - antacids to relieve symptoms. Surgery e.g. nissen fundoplication (fundus of stomach wrapped around oesophagus to prevent reflux).
Give 2 ways how appendicitis is prevented.
Central abdominal pain that migrates to right iliac fossa. Pain worse on movement, coughing. Nausea, vomiting and diarrhoea.
Give 2 things you would find on examination for an appendicitis patient.
Guarding. Rebound tenderness (pain upon removal of pressure). Percussion tenderness.
Give 2 causes of appendicitis.
Obstruction of lumen (e.g. foreign bodies, malignancy) blocks escape of mucosal secretions. Increased pressure causes engorgement (appendix swells with fluid) and inactivity.
Give 3 ways to investigate appendicitis.
Urine dipstick. Pregnancy test. CT scan with contrast.
How is appendicitis managed?
Laparoscopic appendicectomy - appendix removed through incision in the right lower abdominal wall.
What is diverticular disease?
Sac-like protrusion of mucosa through the muscular colonic wall.
Give 2 ways how diverticular disease.
Bloated. Constipation, diarrhoea. Tummy pain. Nausea.
Give 2 complications of diverticular disease.
Development of a fistula (abnormal channel). Development of an abscess (pus caused by a bacterial infection). Intestinal obstruction (mechanical impairment causes blockage of bowel). Dysuria (pain on urination).
How is diverticular disease treated?
Hartmann’s procedure - surgical resection (cutting out) of rectosigmoid colon.
What are the two types of inflammatory bowel disease?
Crohn’s disease. Ulcerative colitis.
What is the difference between Crohn’s disease and Ulcerative colitis?
Crohn’s disease - occurs anywhere between mouth and anus. Ulcerative colitis - limited to the inner lining of the colon.
Give 2 ways of how ulcerative colitis is presented.
Diarrhoea. Blood in stools. Cramping. Weight loss.
Give 2 ways of how Crohn’s disease is presented.
Diarrhoea. Weight loss. Increase in the frequency and urgency. Cramping and abdominal pain. Malaise (feeding of discomfort).
Name 2 ways of how inflammatory bowel disease is diagnosed.
Faecal calprotectin (protein biomarkers in faeces - determine inflammation). Stool culture. Bloods - FBC (anaemia) and C-reactive protein (rise).
Name 2 ways inflammatory bowel disease is treated.
Immunosuppressants e.g. adalimumab, infliximab. Surgery.
What surgery is carried out to treat inflammatory bowel disease?
Colectomy - surgical removal of part of the colon.
Give 3 differentials of inflammatory bowel disease.
Diverticulitis (type of disease affecting the digestive tract). Irritable bowel syndrome. Laxative use. Colorectal carcinoma.
What is Clostridiodes (Clostridium) difficile colitis?
Symptomatic infection due to spore forming bacteria.
Name 3 symptoms associated with Clostridiodes (Clostridium) difficile colitis.
Diarrhoea. Fever. Loss of appetite. Feeling sick. Colonic perforation. Abdominal compartment syndrome - organ dysfunction by intrabdominal hypertension.
What is procedure is used to treat Clostridiodes (Clostridium) difficile colitis?
Hartmann’s procedure - total abdominal colectomy with end ileostomy.
What is Radiation Proctitis?
Inflammation and damage to the lower parts of the colon after exposure to the x-rays.
Name 2 acute symptoms of Radiation Proctitis.
Diarrhoea. Mucus discharge. Urgency.
Name 2 chronic symptoms of Radiation Proctitis.
Bleeding more severe. Patients have obstructed defection - constipation, rectal bleeding, urgency, faecal incontinence.
