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TCBL > Abdominal Pain, Lumps and Weight Loss > Flashcards

Abdominal Pain, Lumps and Weight Loss Flashcards

1
Q

how do you test for H.pylori?

A

urea breath test using radio-labelled carbon 13
stool hekicobacter antigen tests
rapid urease- during endoscopy

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2
Q

how is H.pylori eradicated?

A

triple therapy with a PPI (omeprazole) and 2 antibiotics (amoxicillin and clairithromycin)

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3
Q

what is Barrett’s oesophagus?

A

metaplasia of the squamous cells of the oesophagus into columnar epithelium. it is a pre-malignant state for the development of adenocarcinoma

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4
Q

what are the symptoms of acute cholecystitis?

A

colicky pain in the RUQ which may radiate to the right shoulder

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5
Q

what is the are diagnostic tests in acute cholecystitis?

A

abdominal ultrasound

magnetic resonance cholangiopancreatography (MRCP)

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6
Q

how is acute cholecystitis managed?

A

conservative management- nil by mouth, IV fluids, antibiotics, analgesia
endoscopic retrograde cholangiopancreatography (ERCP) to remove stones from the common bile duct
cholecystectomy

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7
Q

what is acute cholecystitis?

A

inflammation of the gallbladder which is caused by blockage of the cystic duct

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8
Q

what is acute cholangitis?

A

infection and inflammation in the bile ducts

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9
Q

what are the two main causes of acute cholangitis?

A

obstruction in the bile duct- gallstones

infection introduced during an ERCP

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10
Q

what are the symptoms of acute cholangitis?

A

charcots triad- RUQ pain, fever, jaundice

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11
Q

what are the 3 key causes of pancreatitis?

A

gallstones
alcohol
post- ERCP

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12
Q

what scoring system is used assess the severity of pancreatitis?

A

glasgow score

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13
Q

what blood test should be included in acute pancreatitis is suspected?

A

amylase

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14
Q

what is the peak incidence of appendicitis?

A

10-20 years

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15
Q

what is the typical pain in appendicitis?

A

abdominal pain which starts centrally and moves down and becomes localised in the RIF (McBurney’s point)
rebound tenderness
percussion tenderness

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16
Q

what is rosvigs sign?

A

palpation of the LIF causes pain in the RIF

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17
Q

what is the management of appendicitis?

A

emergency admission and removal of appendix (appendectomy) usually done laparoscopically

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18
Q

what is the difference between diverticulosis and diverticulitis?

A

diverticulosis refers to the presence of diverticula (pockets in the bowel wall)
diverticulitis is infection and inflammation of the diverticula

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19
Q

which area of the bowel is most likely to be affected by diverticulosis?

A

sigmoid colon

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20
Q

what is the presentation of diverticulitis?

A 
pain/ tenderness in the LIF 
fever 
diarrhoea 
nausea vomiting 
rectal bleeding 
palpable abdominal mass if an abscess has formed
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21
Q

how is acute diverticulitis managed?

A 
nil by mouth 
IV antibiotics 
IV fluids 
analgesia 
urgent investigations (CT) and surgery if complications
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22
Q

what are some common complications of diverticulitis?

A 
perforation 
peritonitis 
peridiverticular abscess 
large heamorrhage 
fistula 
ileus/ obstruction
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23
Q

what is a major risk factor for the development of C.diff diarrhoea?

A

recent antibiotic use

hospitalisation

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24
Q

investigations in infectious diarrhoea?

A

stool sample/ culture

bloods- FBC, CRP, U&Es (dehydration), lactate/ blood cultures (sepsis)

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25
what is the pathophysiology in coeliac disease?
auto-antibodies are created in response to gluten which target the epithelial cells leading to inflammation in the small bowel (jejunum) which leads to atrophy of the intestinal villi leading to malabsorption of nutrients
26
what tests should be carried out for coeliac disease ?
anti-tissue transglutaminase (anti-TTG) (1st line) anti- EMA- other antibody total IgA- exclude IgA deficiency endoscopy and intestinal biopsy
27
how is irritable bowel syndrome diagnosed?
> 6 month Hx of symptoms (abdominal pain/ discomfort, bloating, change in bowel habit) and other causes have been excluded diagnosis of exclusion
28
where does Crohns and ulcerative colitis affect
crohns- affects any part of the GI tract- mouth to anus, most commonly distal ileum UC- confined to colon and rectum, worst distally (rectum almost always involved)
29
differences between UC and crohns?
crohns- affects any part of the GI tract, transmural (full thickness) inflammation, skip lesions (spaces of unaffected tissue), smoking- risk UC- confined to colon and rectum, continuous inflammation, inflammation confined to mucosa and submucosa, smoking- protective
30
what investigations are important in inflammatory bowel disease?
BLOODS- FBC- anaemia, Inflammatory markers- CRP, ESR, U&Es ad LFTs, B12 & folate- anaemia in crohns, antibody testing, coeliac screen STOOL- culture, faecal calprotectin IMAGING- abdo X-ray, CT, colonoscopy, MRE (MRI with small bowel enterography)
31
how is inflammatory bowel disease managed?
MEDICAL steroids- induce remission but not maintain 5ASAs (mesalazine)- induce and maintain remission biologics (infliximab, adalimumab) immunosuppressants- azathioprine- used in severe cases which have not responded to other treatments SURGICAL removal of the bowel- often leading to stoma formation
32
what are some causes of upper GI bleeding (haematemesis)?
``` peptic ulcer disease gastroesophageal varices oesophageal/gastric cancer mallory weiss tear erosive oesophagitis/gastritis/duodenitis ```
33
what are some causes of lower GI bleeding (haematochezia)?
``` diverticulitis colitis- IBD, ischaemic, infective colorectal cancer haemorrhoids anal fissure ```
34
what is the typical presentation of a mallory Weiss tear?
profuse vomiting later with streaks of blood
35
which type of GI bleed is most likely to present with haemetemesis associated with jaundice or liver disease?
oesophageal varices
36
what is the Glasgow blachford score?
assess the likelihood that a person with an acute upper gastrointestinal bleeding (UGIB) will need to have medical intervention such as a blood transfusion or endoscopic intervention
37
what are some red flag symptoms for upper GI cancer?
dysphagia- difficulty swallowing weight loss with reflux, dyspepsia, abdominal pain upper abdominal mass
38
what are red flags for pancreatic cancer?
painless jaundice | weight loss
39
what are some red flags for lower GI/colorectal cancer?
unexplained rectal bleeding unexplained weight loss with abdominal pain iron deficiency anaemia change in bowel habit
40
what are some symptoms of hypothyroidism?
``` fatigue cold intolerance weight gain constipation depression dry skin and hair slow reflexes ```
41
how is hypothyroidism treated?
levothyroxine sodium (synthetic T4) taken orally on an empty stomach in the morning
42
what are some causes of hyperthyroidism?
graves disease- autoantibodies mimic TSH and stimulate the thyroid toxic multinodular goitre thyroiditis
43
what are some symptoms of hyperthyroidism?
``` anxiety/irritation heat intolerance tachycardia weight loss diarrhoea thirst increased appetite ```
44
what are some unique features of graves disease?
diffuse goitre graves eye disease exophthalmos pretibial myxoedema
45
how is hyperthyroidism managed?
carbimazole- 1st line antithyroid, given in either a block and replace (with levothyroxine) or titration block regimen propylthiouracil- 2nd line antithyroid, used similarly to carbimazole radioactive iodine- destroys thyroid cells, may need replacement with levothyroxine surgery- remove thyroid
46
how does type 1 diabetes normally present?
polyuria polydipsia weight loss DKA
47
how is type 1 diabetes managed?
subcutaneous insulin regimes
48
what capillary blood glucose is considered hyperglycaemia?
>11mmol/L
49
how does DKA present?
``` polyuria/polydypsia nausea and vomiting dehydration hypotension altered consciousness ```
50
what are the 3 diagnostic components of DKA?
hyperglycaemia (blood glucose >11mmol/L) ketosis (blood ketones >3mmol/L, urine ketones >2+) acidosis (pH <7.3, or bicarbonate <15mmol/L)
51
how is DKA managed?
fluid resuscitation IV insulin infusion in 0.9% NaCl to a concentration of 1 unit/ml, infuse at a rate of 0.1 units/kg/hour monitor blood glucose and ketones once blood glucose is <14 give IV glucose 10% in addition to the infusion
52
how is type 2 diabetes diagnosed?
HbA1c- >48 random glucose- >11mmol/L fasting glucose- >7mmol/L oral glucose tolerance test 2 hour result- >11mmol/L
53
what are the treatment targets for type 2 diabetes?
HbA1c- 48mmol/L for new type 2 diabetes, 53mmol/L for diabetics who have moved on from metformin alone
54
how is type 2 diabetes managed?
lifestyle changes- diet modification, exercise and weight loss, stop smoking MEDICAL 1st line- metformin titrated from 500mg once daily 2nd line- add a sulfonurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor 3rd line- triple therapy with metformin plus two 2nd line drugs, or metformin plus insulin
55
what is the criteria for an AKI?
rise in creatinine of >25micromol/L in 48 hours rise in creatinine of >50% in 7 days urine output of <0.5ml/kg/hour for >6 hours
56
how are the causes of AKI classified?
pre-renal- inadequate blood supply- dehydration, hypotension, heart failure renal- glomerularnephritis, interstitial nephritis, actue tubular necrosis post-renal causes- obstruction to outflow- kidney stones, masses in abdomen/pelvis, uretal strictures, enlarged prostate/ prostate cancer
57
which medications should be stopped in AKI?
``` ACE inhibitors ARBs NSAIDs diuretics diabetes medications- metformin ```
58
what are some complications of AKI?
hyperkalaemia fluid overload metabolic acidosis increased urea
59
how is hyperkalaemia treated?
10ml 10% calcium gluconate IV over 5-10 minutes- stabilises cardiac muscle insulin (actrapid) 10 units in 50ml of 50% dextrose- drive K+ into cells nebulised salbutamol 10-20mg- drive K+ into cells consider dialysis to remove k+ from body
60
where are valvulae conniventes?
small bowel
61
what are the features of toxic megacolon?
significant colon dilation with absence of haustra | causes- infective colitis, IBD
62
what is riglers sign?
both inside and outside wall of the bowel are visible on X-ray due to free air in abdomen- bowel perforation
63
what are indications for abdominal ultrasound?
gallstone disease acute cholecystitis renal tract calculi AAA
64
what are indications for CT abdomen?
bowel obstruction bowel perforation colon cancer intra-abdominal trauma

TCBL (4 decks)

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