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CSI 1b > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

Sudden and severe abdominal pain causes?

A

Perforated ulcer
Ruptured aortic aneurism
Ureteral colic

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2
Q

Colicky, crampy, intermittent pain causes?

A

Biliary colic
Small bowel obstruction
Colonic obstruction
Ureteral colic

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3
Q

Gradual and more progressive pain causes?

A

Cholecystitis, hepatitis
Pancreatitis
Diverticulitis
Appendicitis
Tubo-ovarian abscess or ectopic pregnancy

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4
Q

Cullen sign?

A

Periumbilical discolouration

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5
Q

Grey-turner sign?

A

Bruising of flanks

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6
Q

Lab tests for abdo pain?

A

FBC
Serum electrolytes
Urinalysis
Pregnancy test

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7
Q

Imaging?

A

X-ray
US
MRI
CT
Fluroscopy
Endoscopy

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8
Q

Right hypochondriac pain?

A

Gallstones
Cholangitis
Hepatitis
Liver abscess
Cardiac
Lung

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9
Q

Epigastric pain?

A

Esophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis

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10
Q

Left hypochondriac pain?

A

Spleen abscess
Acute splenomegaly
Spleen rupture

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11
Q

Right lumbar pain?

A

Ureteric colic
Pyelonephritis

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12
Q

Umbilical pain?

A

Early appendicitis
Mesenteric lymphadenitis
Meckel diverticulitis
Lymphomas

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13
Q

Left lumbar pain?

A

Ureteric colic
Pyelonephritis

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14
Q

Right iliac pain?

A

Apendicitis
Crohn’s
Caecum obstruction
Ovarian cyst
Ectopic pregnancy
Hernias

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15
Q

Hypogastric pain?

A

Testicular torsion
Urinary retention
Cystitis
Placental abruption

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16
Q

Left iliac pain?

A

Diverticulitis
Ulcerative colitis
Constipation
Ovarian cyst
Hernias

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17
Q

Acute cholecystitis?

A

Severe epigastric, RUQ abdominal pain
Radiates to scapula
Fever, nausea, vomiting
Murphy’s sign (inspiratory pause)
Emphysematous cholecystitis (diabetic elderly male)
Systemically unwell, raised inflammatory markers

18
Q

Ascending cholangitis?

A

Abdominal pain, jaundice, fever (Charcot triad)
Charcot triad + confusion, hypotension (Reynolds pentad)
Hepatomegaly
Pale stools, dark urine, sepsis
High WCC + CRP

19
Q

Biliary colic/choleliliathis

A

Epigastric, RUQ abdominal pain
Steady pain, often after eating
Radiates to scapula
Systemically well, normal bloods

20
Q

Hyperechoic

A

Lots of echoes on an US

21
Q

Bile composition?

A

97-98% water
0.7% bile salts
0.5% fats
0.2% bilirubin

22
Q

Factors for stone formation?

A

Supersaturation
Nucleation
Hypomotility

23
Q

5 Fs

A

Fair
Fat
Female
Fertile
Forty

24
Q

Gallstone complications?

A

Biliary obstruction (in common bile duct)
Acute cholecystitis (in cystic duct)
Gallstone pancreatitis (in pancreatic duct)
Gallstone ileus
Fistula
Mirizzi syndrome (in common hepatic duct)

25
Q

Fistula?

A

Inflammation and damage due to gallstones, which can cause a perforation and a connection between organs that shouldn’t be there

26
Q

Gallstone ileus?

A

Stone blocks ileocaecal valve after migrating through fistula

27
Q

Consent 7 principles?

A
  1. Right to be involved
  2. Meaningful dialogue
  3. Right to be listened to
  4. Benefits and harms
  5. Capacity
  6. Must benefit them if they lack capacity
  7. If consent affected by law, should still be part of decision-making process
28
Q

3 elements of consent

A

Voluntary
Informed
Capacity

29
Q

3 types of consent?

A

Written
Verbal
Implied

30
Q

Things to discuss when getting consent

A

Explain procedure
Benefits and risks - common risks (1%) and serious risks
What happens if they don’t go through with the surgery
Alternative options

31
Q

Ways to categorise complications

A

Generic vs specific
Early vs late

32
Q

Generic complications of laporascopic cholecystectomy

A

Infections
Bleeding
Damage to surrounding structures
Anaesthetic risk
Scarring
Hernia development
Clots (DVT, PE)

33
Q

Specific complications of lap-cho

A

Bile duct injury
Liver or intestine injury

34
Q

What is supersaturation?

A

Cholesterol concentration exceeds the concentration at which it remains soluble
Can result in the formation of multilamellar vesicles that may then fuse and aggregate as solid cholesterol crystals, which can grow in size to form stones

35
Q

How does gut hypomotility cause stones?

A

Usually stones are flushed from the gallbladder during postprandial contractions, but impaired gallbladder motility means they stay

36
Q

How can kinetic factors cause stones (nucleation)

A

Formation of microcrystals in supersaturated bile is modulated by kinetic protein factors
Mucin (glycoprotein mixture that is secreted by biliary epithelial cells) is a nucleation-promoting protein in gallbladder sludge

37
Q

Biliary obstruction involves?

A

Common bile duct

38
Q

Acute cholecystitis involves?

A

Cystic duct

39
Q

Gallstone pancreatitis involves?

A

Pancreatic duct

40
Q

Mirizzi syndrome involves?

A

Common hepatic duct

CSI 1b (8 decks)

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