Abdominal pain Flashcards
loose, frequent stools with blood and mucus, passing stools overnight, weight loss, family hx
IBD
what intolerance can last following an infectious gastroenteritis + how can it be managed
Lactose intolerance
Lactose exclusion diet for up to 6-8 weeks
what can cause blood on the outside of a hard stool
constipation
Coeliac screen
IgA anti tissue transglutaminase
protein biomarker present in faeces when intestinal inflammation present
Faecal Calprotectin
what investigation can be used in place of Barium studies
- Small bowel MR enterography
patchy inflammation/skip lesions
chrons disease
continuous inflammation in large bowel
ulcerative colitis
pattern seen in chrons
cobblestoning pattern
inflammation affects which layers in chrons and UC
chrons: transmural involvement
UC: limited to mucosa
trx coeliac disease
lifelong gluten free diet
symptoms/features coeliac disease (7)
- abdo pain
- faltering growth
- iron deficiency (microcytic anaemia)
- stool: freq, bulky, pale
- weight loss
- fatigue
- pallor
cause of Haemolytic uremic syndrome
E coli 0169
commonly from poorly processed meat
where is bacillus cereus found
reheated rice
features of HUS
- diarrhoea becomes bloody
- thromocytopenia
- anaemia
- haematuria
- Creatine levels raise
protein low in pancreatic involvement of CF
faecal elastase
inflammatory causes of abdominal pain
- gastroenteritis
- UTI
- Hepatitis
- IBD
- appendicitis
- pancreatitis
what is intussception
when a segment of the intestine invaginates into adjoining intestinal lumen
risk factors to ask about in a history of abdominal pain
- history of recent foreign travel
- infectious contact
- contacts with similar symptoms
- eaten foods out of ordinary
what is recurrent abdo pain defined as
at least 1 episode per month for at least 3 consecutive months, which is severe enough to interfere with routine functioning
vomiting red flags
- haematemesis
- abdo tenderness/distension
- blood in stools
- bulging fontanelle
presentation of proximal intestinal obstruction
- billous vomiting
- abdo pain
- abdo distension
risks of rapid weight loss
- refeeding syndrome
- hypoglycaemia
- infection
- cardiac arrhythmia
what is refeeding syndrome
a metabolic disturbance associated with malnourishment
causes of rapid weight loss in adolescents
- coeliac disease
- IBD
- anorexia
- malignancy
- achalasia
- addisons disease
- juvenile arthritis
- T1DM
- hyperthyroidism
investigations for rapid weight loss
- phosphate
- ECG
- U+E
- blood glucose
- calcium
- magnesium
- LFTs
- CRP
- TFT
- coeliac screen
- ESR
- WCC
DSM 5 criteria for anorexia nervosa
- restriction of energy intake relative to requirements leading to a sig low body weight
- intense fear of gaining weight despite being underweight
- disturbance in the way in which ones body image is experienced
physiological abnormalities of anorexia nervosa
- low: oestrogen, testosterone, FSH, LH
- raised: cortisol + GH
- high cholesterol
- hypercarotinaemia
- impaired glucose tolerance
- low T3
3 main types of eating disorders
- anorexia nervosa
- bulimia nervosa
- EDNOS
behavioural and psychological features of anorexia (4)
- feeling fat
- disturbed body image
- wont eat in front of others
- compulsive exercise
clinical features of anorexia
- low weight for height
- amenorrhoea
- headaches, dizziness, fainting
- constipation
- dry skin
- cool peripheries
- hair loss
- hypotensive, tachycardia, hypothermia
- peripheral oedema
- enlarged salivary glands
short term management for anorexia nervosa
- physical stabilisation
- if < 75% weight to height ratio then start: thiamine, vit b complex, multivitamins
medium term management of anorexia nervosa
MDT package in community
long term management of anorexia nervosa
- prevention
- BEAT charity
how can CBT help those with anorexia
help to build self esteem, cope with social pressure, identify certain thought patterns
complications of anorexia nervosa
starvation causing muscle loss including heart and diaphragm resulting in difficulty breathing and cardiac failure
GI tract - constipation, nausea, bloating
osteoporosis
brain atrophy
halitosis from repeated vomiting
What is lanugo
soft hair covering body which develops as a response of loss of insulating effect of fat
2 support organisations for anorexia nervosa
BEAT charity
FEAST
what is a marker of refeeding syndrome
drop in phosphate level
what is refeeding syndrome
when refeeding stimulates insulin secretion resulting in cells taking in K+ and Mg2+ and phosphate –> leaving low levels in serum –> cardiac arrhythmias + death
what is bulimia
type of eating disorder characterised by episodes of binge eating, followed by intentional vomiting or other purgative behaviours
name 4 purgative behaviours
- laxatives
- diuretics
- exercising
- vomiting
durance of bulimia symptoms for diagnosis
- at least once a week for 3 months
side effects of repeated vomiting
- eroded enamel
- sialadenosis
- halitosis
- russel sign
- mallory weiss tears
- dehydration
- electrolyte depletion
long term effects of laxative use
- loss of bowel motility
- worsening constipation
- rectal prolapse w/ slow healing
4 surgical causes of abdominal pain
1) Testicular torsion
2) appendicitis
3) Bowel obstruction
4) Intussception
not passing meconium within 48 hours of birth - possible causes (2)
- Hirschsprung’s disease
- Cystic fibrosis
what is 1st line laxative for chronic constipation?
movicol
why does GORD occur in babies?
in babies their is immaturity of the lower oesopahgeal sphincter, allowing stomach contents to easily reflux
metabolic disturbance seen in pyloric stenosis
hypocholoraemic, hypokalaemic metabolic alkalosis
diagnostic invx for pyloric stenosis
albomdinal USS
derm symptom in Coeliac disease
Dermatitis herpetiformis is an itchy blistering skin rash
Endoscopy and intestinal biopsy findings in coeliac disease
- villous atrophy
- crypt hypertrophy
causes of intestinal obstruction
- Intussception
- Meconium ileus
- Imperforate anus
- Strangulated hernia
- Oesophageal/duodenal atresia
AXR finidngs in bowel obstruction
dilated loops of bowel
- haustra indicate large bowel
- valvulae conniventes indicate small bowel (complete circle around width of bowel)
pathophysiology of Hirschprungs disaease?
absent nerve cells in the myenteric plexus (auerbach plexus) in the distal bowel & rectum
absence of parasympathetic ganglion cells
3 conditions associated with Hirschprungs disease?
Downs syndsome
Neurofibromatosis
MEN Type 2
presentation of hirscprungs disease
- failure to pass meconium
- chronic constipaton
- abdominal distension & vomiitng
- failure to thrive & poor weight gain
typical presenting age of Intussception
6 months to 2 years
3 differentials for appendicitis
- ectopic pregnancy
- ovarian cysts
- Meckel’s diverticulum
a cause of prolonged jaundice (lasting longer than 14 days)
Biliary atresia
what is biliary atresia?
progressive destruction of the extrahepatic biliary system
