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ACC > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

Give 7 differentials for GI abdominal pain:

A
  • Peptic ulcer disease
  • GI bleed
  • Appendicitis
  • Bowel Obstruction
  • Biliary tract infection
  • Diverticulitis
  • Pancreatitis
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2
Q

When looking at an AXR, how would you tell the difference between large bowel and small bowel obstruction?

A
  • Small bowel obstruction shows conniventes that completely cross the lumen
  • Large bowel obstruction shows haustra that do not cross the full lumen’s width
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3
Q

What is a paralytic Ileus?

A
  • A-dynamic bowel due to the absence of normal peristalsis contraction
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4
Q

What would you treat a pseudo-obstructive lesion with?

A

Neostigmine

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5
Q

What is a sigmoid volvulus?

A

The bowel twists on the mesentery causing severe, rapid strangulated obstruction

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6
Q

What sign can be seen with a sigmoid volvulus AXR?

A

Coffee bean

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7
Q

What signs would present in a gastric volvulus?

A
  • Vomiting
  • Pain
  • Failed attempts to pass an NGT
  • Regurgitation of saliva
  • Noisy, gastric peristalsis
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8
Q

What size of closed loop obstruction indicates urgent decompression/surgery?

A

> 12cm

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9
Q

What immediate action should be taken in bowel obstruction?

A
  • Drip and suck:

- NGT and IV fluids to rehydrate and correct electrolytes

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10
Q

What is oral gastrografin used for?

A
  • Identifying partial small bowel obstruction
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11
Q

What is diverticulitis?

A
  • Out-pouching and inflammation of gut wall usually at sites of entry of perforating arteries
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12
Q

Where do most diverticulum occur?

A

Sigmoid colon

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13
Q

What is a major cause of diverticulitis?

A

Low fibre diet

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14
Q

What is contraindicated during an acute attack of diverticulitis?

A

Barium enema + colonoscopy = increased risk of perforation

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15
Q

What are the main symptoms for diverticulosis?

A
  • Altered bowel habit
  • Left sided colic pain relieved by defecation
  • Nausea
  • Flatulence
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16
Q

What are the symptoms that differentiate diverticulosis from diverticulitis?

A
  • Pyrexia
  • Raised WCC, ESR, CRP
  • Tender colon/peritoneum
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17
Q

When is surgery indicated in diverticulitis?

A
  • Based on degree of infective complications
  • At time of attack
  • Stages 3-4 when evidence of peritonitis
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18
Q

What is Hartmann’s procedure?

A
  • Surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy.
19
Q

Where are peptic ulcers more commonly found?

A

Duodenum

20
Q

Name 4 risk factors for peptic ulcer disease

A
  • Age
  • H.Pylori
  • NSAIDs
  • Smoking
21
Q

Which signs/symptoms for PUD indicate urgent endoscopy?

A 
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena
Swallowing difficulties
22
Q

What other signs/symptoms are there for PUD?

A
  • Burning sensation
  • Pain in epigastric region relating to hunger
  • Bloating/Belching/sickness
23
Q

What signs help to differentiate between gastric and duodenal symptoms?

A
  • Duodenal = pain before meals or at night, relieved by milk, epigastric tenderness
  • Gastric = Mainly elderly and weight loss
24
Q

What test would you do for PUD?

A

H.Pylori test = Carbon-13 urea breath test

25
Q

What is the main treatment regimen for PUD?

A
  • PPI

- 2 x different antibiotics

26
Q

Which histamine 2 receptor antagonist could you also use for PUD?

A

Ranitidine

27
Q

What is a Mallory-Weiss tear?

A
  • Tear in junction between stomach and oesophagus caused by severe alcoholism, retching, coughing or vomiting
28
Q

What are oesophageal varices?

A
  • Extremely dilated submucosal veins commonly due to portal hypertension caused by cirrhosis
  • Scarring of liver slows blood flow and backs up portal causing high blood pressure in portal and surrounding veins
29
Q

What is the primary diagnostic investigation for upper GI bleeds?

A

Endoscopy

30
Q

What scoring system is used to assess the mortality risk for upper GI bleeds?

A

Rockall <3 = good prognosis

31
Q

What tool is used to assess whether a patient with an upper GI bleed will need medical intervention

A

Glasgow-Blatchford score

32
Q

How would you manage a GI bleed?

A
  • ABCDE
  • IV opioid and metoclopramide
  • 0.9% saline
  • CROSSMATCH
  • Refer to surgeons
33
Q

What is produced for the endocrine function of the pancreas?

A
  • Insulin
  • Glucagon
  • Somatostatin
  • Pancreatic polypeptide
34
Q

What is produced as the exocrine function of the pancreas?

A
  • Trypsin
  • Chymotrypsin
  • Amylase
  • Lipase
35
Q

What are the symptoms of acute pancreatitis

A
  • Severe pain in upper abdomen that radiates to the back
  • Relieved by sitting forward
  • Severe nausea, vomiting and retching
36
Q

What are the symptoms of chronic pancreatitis?

A
  • Similar to acute
  • Weight loss
  • Steatorrhoea
  • Brittle diabetes
37
Q

What signs would you look for in acute pancreatitis?

A
  • Upper abdominal tenderness
  • Tachycardia/hypotension
  • Absent bowel sounds
  • Jaundice
  • Cullen’s/Grey-Turner’s signs
38
Q

What causes acute pancreatitis?

A

I GET SMASHED

39
Q

What causes chronic pancreatitis?

A
  • Chronic alcohol consumption
  • CF
  • Haemochromatosis
  • Pancreatic duct obstruction
40
Q

How is severe pancreatitis diagnosed?

A 
PaO2 <8kPa
Age >55
Neutrophils >15x10^9
Calcium >2mmol/L
Renal function, urea >16mmol/L
Enzymes: LDH/AST
Albumin 
Sugars bgl >10mmol/L
41
Q

How would you manage pancreatitis?

A 
ABCDE
Analgesia - pethidine IM or morphine
Cyclizine
Cefuroxime
NBM
ERCP and gallstone removal if progressive
Surgery
42
Q

What investigations would you perform in suspected appendicitis?

A
  • Rovsigns test
  • Psoas test
  • Cope/obturator sign
43
Q

Which antibiotics should you use to treat appendicitis?

A
  • Metronidazole

- Cefuroxime

ACC (4 decks)

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