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Year 4 - ACC Core Condition > Abdominal Pain 2 > Flashcards

Abdominal Pain 2 Flashcards

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1
Q

causes of acute pancreatitis

A

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
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2
Q

symptoms of acute pancreatitis

A

PAN

epigastric pain radiates to the back

Anorexia

Nausea and vomiting

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3
Q

clinical findings of acute pancreatitis

A

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)

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4
Q

investigation of acute pancreatitis

A
  • 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
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5
Q

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

A

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
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6
Q

management of acute pancreatitis

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

take 3 - 7 days to resolve

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7
Q

causes of chronic pancreatitis

A

CAMP

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

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8
Q

symptoms of chronic pancreatitis

A

epigastric pain radiates to the back

relieved by sitting forwards

worse when eating or drinking

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9
Q

clinical findings of chronic pancreatitis

A

DM

steatorrhoea (loss of insulin)

lipase insufficiency

severe weight loss due to anorexia

jaundice

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10
Q

investigation for chronic pancreatitis

A

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

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11
Q

management of chronic pancreatitis

A

alcohol cessation

analgesia - best tramadol

insulin if DM developed

pancreatic enzyme replacement therapy - - pancreatin + PPI cover

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12
Q

most common cause of peptic ulcer disease

A

NSAIDs and H.pylori

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13
Q

causes of peptic ulcers

A

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
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14
Q

symptoms of peptic ulcers

A

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

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15
Q

clinical findings of peptic ulcer

A

tenderness in epigastric caused by palpation

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16
Q

investigation for peptic ulcer

A

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

17
Q

management of peptic ulcer

A

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

18
Q

why women gets more UTI than man

A

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

19
Q

most common cause of UTI in adult

A

E.coli

20
Q

symptoms of acute pyelonephritis

A

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

21
Q

definition of oliguria

A

<500ml of urine in 24 hours

22
Q

symptoms of cystitis

A 
urine frequency 
dysuria 
urgency 
haematuria 
suprapubic pain
23
Q

symptoms of prostatitis

A

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

24
Q

clinical examination for UTI

A

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

25
Q

investigation for UTI

A

dip stick
FBC, U&Es
CRP
blood culture

USS, CTKUB, cystoscopyy
urodynamics if in children

26
Q

treatment for UTI

A

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

women 3 days course
men 7 days course

Year 4 - ACC Core Condition (3 decks)

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