Abdominal Pain 2 Flashcards
causes of acute pancreatitis
I GET SMASHED
I - Idiopathic
G - gallstones
E - ethanol
T - trauma
S - steroids M - Mumps/Malignancy A - Autoimummune S - Scorpion Beat H - Hyper lipidaemia/calcamia/parathyroidism E - ERCP D - drugs
symptoms of acute pancreatitis
PAN
epigastric pain radiates to the back
Anorexia
Nausea and vomiting
clinical findings of acute pancreatitis
epigastric tenderness with guarding and rigidity
fever
tachycardia
abdo distension
dyspnoea, jaundice , acute resp distress syndrome
Grey Turner’s sign –> associated with necrotising pancreatitis
Cullen’s sign - periumbilical brusing (associated with necrotising pancreatitis)
investigation of acute pancreatitis
- Raised serum amylase must be 3x the normal upper limit when measured within 24 hour of onset of pain
- Serum lipase (more sensitive and specific) elevated in acute pancreatitis and remain elevated for a longer period of time
- ABG, FBC, U&Es, LFT, glucose, Ca2+
- Erect CXR perforation
- Abdo USS gallstone
- MRCP liver causes/gallstones
- ERCP both to investigate and treat gallstones
- contrast-enhanced CT should be performed after 72 hours to assess the extend of pancreatic necrosis
what criteria score used to rate the severity of both acute and chronic pancreatitis
PANCREAS
P - PaO2 (<7.9) = 1 A - Age > 55 = 1 N - Neutrophils (WBC>15) = 1 C - calcium <2 = 1 R - renal function (urea > 16) = 1 E - enzyme (ALT and LDH) = 1 A - albumin <32 = 1 S - sugar > 10 = 1
management of acute pancreatitis
supportive mainly NBM IV fluids Analgesia treat underlying causes ERCP if gallstone
take 3 - 7 days to resolve
causes of chronic pancreatitis
CAMP
C - Cystic fibrosis
A - alcohol
M - malnourishment
P - pancreatic duct obstruction
symptoms of chronic pancreatitis
epigastric pain radiates to the back
relieved by sitting forwards
worse when eating or drinking
clinical findings of chronic pancreatitis
DM
steatorrhoea (loss of insulin)
lipase insufficiency
severe weight loss due to anorexia
jaundice
investigation for chronic pancreatitis
Stool sample - dec faecal fat
glucose - insuline insufficiency
AXR - show calcification of pancreas
USS/CT - also show calcification of pancreas, dilated and irregular outline of pancreas
MRCP/ECRP - invasive procedure which both accurately diagnose chronic pancreatitis
management of chronic pancreatitis
alcohol cessation
analgesia - best tramadol
insulin if DM developed
pancreatic enzyme replacement therapy - - pancreatin + PPI cover
most common cause of peptic ulcer disease
NSAIDs and H.pylori
causes of peptic ulcers
most common - nsaids and H.pylori
other rarers Crohn's disease Zollinger-ellison syndrome (hypersecreation of gastric acid due to neuro-endocrine snydrome) gastric ischaemia hyperparathyrodisim
symptoms of peptic ulcers
burning epigastric pain esp when pt hungry and relieve by anteacid
pointing sign - pt able to point to single point of pain
N+V
anorexia
Upper GI bleed symptoms
clinical findings of peptic ulcer
tenderness in epigastric caused by palpation
investigation for peptic ulcer
pt < 60 –> urea breathe test or stool antigen test
pt > 60 –> upper GI endoscopy to identify benign or malignant cause of ulcer
FBC –> if GI bleed then microcytic anaemia might occur
management of peptic ulcer
if H.pylori -ve –> PPI to stop NSAIDs damage to gastric lining, misoprostol (prostaglandin analogue) specifically for NSAIDs
IF H.pylori +ve –> eradiation –> Triple therapy –> PPI + clarithromycin + amoxicillin
why women gets more UTI than man
women have a shorter urethra that is closer to the anus and so facilitating the transfer of bowel organism
most common cause of UTI in adult
E.coli
symptoms of acute pyelonephritis
high fever, rigours, vomiting, loin pain/tenderness, oliguria
definition of oliguria
<500ml of urine in 24 hours
symptoms of cystitis
urine frequency dysuria urgency haematuria suprapubic pain
symptoms of prostatitis
flue like symptoms
low backache
few urinary symptoms
swollen tender prostate on PR
clinical examination for UTI
fever, abdo pain, loin tenderness, foul smelling urine
occasional distended bladder
enlarged prostate
investigation for UTI
dip stick
FBC, U&Es
CRP
blood culture
USS, CTKUB, cystoscopyy
urodynamics if in children
treatment for UTI
trimethoprim
nitroflurotonin (lower UTI)
amoxicillin/cefalexin (alternatives and caould cause C.DIFF)
co-amoxiclav (upper UTI)
women 3 days course
men 7 days course
