Abdominal Pain 2

Question 1

causes of acute pancreatitis

Answer 1

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

Question 2

symptoms of acute pancreatitis

Answer 2

PAN

epigastric pain radiates to the back

Anorexia

Nausea and vomiting

Question 3

clinical findings of acute pancreatitis

Answer 3

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)

Question 4

investigation of acute pancreatitis

Answer 4

• 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

Question 5

what criteria score used to rate the severity of both acute and chronic pancreatitis

Answer 5

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

Question 6

management of acute pancreatitis

Answer 6

supportive mainly 
NBM
IV fluids 
Analgesia 
treat underlying causes 
ERCP if gallstone

take 3 - 7 days to resolve

Question 7

causes of chronic pancreatitis

Answer 7

CAMP

C - Cystic fibrosis
A - alcohol
M - malnourishment
P - pancreatic duct obstruction

Question 8

symptoms of chronic pancreatitis

Answer 8

epigastric pain radiates to the back

relieved by sitting forwards

worse when eating or drinking

Question 9

clinical findings of chronic pancreatitis

Answer 9

DM

steatorrhoea (loss of insulin)

lipase insufficiency

severe weight loss due to anorexia

jaundice

Question 10

investigation for chronic pancreatitis

Answer 10

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

Question 11

management of chronic pancreatitis

Answer 11

alcohol cessation

analgesia - best tramadol

insulin if DM developed

pancreatic enzyme replacement therapy - - pancreatin + PPI cover

Question 12

most common cause of peptic ulcer disease

Answer 12

NSAIDs and H.pylori

Question 13

causes of peptic ulcers

Answer 13

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

Question 14

symptoms of peptic ulcers

Answer 14

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

Question 15

clinical findings of peptic ulcer

Answer 15

tenderness in epigastric caused by palpation

Question 16

investigation for peptic ulcer

Answer 16

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

Question 17

management of peptic ulcer

Answer 17

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

Question 18

why women gets more UTI than man

Answer 18

women have a shorter urethra that is closer to the anus and so facilitating the transfer of bowel organism

Question 19

most common cause of UTI in adult

Answer 19

E.coli

Question 20

symptoms of acute pyelonephritis

Answer 20

high fever, rigours, vomiting, loin pain/tenderness, oliguria

Question 21

definition of oliguria

Answer 21

<500ml of urine in 24 hours

Question 22

symptoms of cystitis

Answer 22

urine frequency 
dysuria 
urgency 
haematuria 
suprapubic pain

Question 23

symptoms of prostatitis

Answer 23

flue like symptoms
low backache
few urinary symptoms
swollen tender prostate on PR

Question 24

clinical examination for UTI

Answer 24

fever, abdo pain, loin tenderness, foul smelling urine
occasional distended bladder
enlarged prostate

Question 25

investigation for UTI

Answer 25

dip stick
FBC, U&Es
CRP
blood culture

USS, CTKUB, cystoscopyy
urodynamics if in children

Question 26

treatment for UTI

Answer 26

trimethoprim
nitroflurotonin (lower UTI)
amoxicillin/cefalexin (alternatives and caould cause C.DIFF)
co-amoxiclav (upper UTI)

women 3 days course
men 7 days course