Abdominal Pain, Lumps and Weight Loss Flashcards
how do you test for H.pylori?
urea breath test using radio-labelled carbon 13
stool hekicobacter antigen tests
rapid urease- during endoscopy
how is H.pylori eradicated?
triple therapy with a PPI (omeprazole) and 2 antibiotics (amoxicillin and clairithromycin)
what is Barrett’s oesophagus?
metaplasia of the squamous cells of the oesophagus into columnar epithelium. it is a pre-malignant state for the development of adenocarcinoma
what are the symptoms of acute cholecystitis?
colicky pain in the RUQ which may radiate to the right shoulder
what is the are diagnostic tests in acute cholecystitis?
abdominal ultrasound
magnetic resonance cholangiopancreatography (MRCP)
how is acute cholecystitis managed?
conservative management- nil by mouth, IV fluids, antibiotics, analgesia
endoscopic retrograde cholangiopancreatography (ERCP) to remove stones from the common bile duct
cholecystectomy
what is acute cholecystitis?
inflammation of the gallbladder which is caused by blockage of the cystic duct
what is acute cholangitis?
infection and inflammation in the bile ducts
what are the two main causes of acute cholangitis?
obstruction in the bile duct- gallstones
infection introduced during an ERCP
what are the symptoms of acute cholangitis?
charcots triad- RUQ pain, fever, jaundice
what are the 3 key causes of pancreatitis?
gallstones
alcohol
post- ERCP
what scoring system is used assess the severity of pancreatitis?
glasgow score
what blood test should be included in acute pancreatitis is suspected?
amylase
what is the peak incidence of appendicitis?
10-20 years
what is the typical pain in appendicitis?
abdominal pain which starts centrally and moves down and becomes localised in the RIF (McBurney’s point)
rebound tenderness
percussion tenderness
what is rosvigs sign?
palpation of the LIF causes pain in the RIF
what is the management of appendicitis?
emergency admission and removal of appendix (appendectomy) usually done laparoscopically
what is the difference between diverticulosis and diverticulitis?
diverticulosis refers to the presence of diverticula (pockets in the bowel wall)
diverticulitis is infection and inflammation of the diverticula
which area of the bowel is most likely to be affected by diverticulosis?
sigmoid colon
what is the presentation of diverticulitis?
pain/ tenderness in the LIF fever diarrhoea nausea vomiting rectal bleeding palpable abdominal mass if an abscess has formed
how is acute diverticulitis managed?
nil by mouth IV antibiotics IV fluids analgesia urgent investigations (CT) and surgery if complications
what are some common complications of diverticulitis?
perforation peritonitis peridiverticular abscess large heamorrhage fistula ileus/ obstruction
what is a major risk factor for the development of C.diff diarrhoea?
recent antibiotic use
hospitalisation
investigations in infectious diarrhoea?
stool sample/ culture
bloods- FBC, CRP, U&Es (dehydration), lactate/ blood cultures (sepsis)
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
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
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
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)
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
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)
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
what are some causes of upper GI bleeding (haematemesis)?
peptic ulcer disease gastroesophageal varices oesophageal/gastric cancer mallory weiss tear erosive oesophagitis/gastritis/duodenitis
what are some causes of lower GI bleeding (haematochezia)?
diverticulitis colitis- IBD, ischaemic, infective colorectal cancer haemorrhoids anal fissure
what is the typical presentation of a mallory Weiss tear?
profuse vomiting later with streaks of blood
which type of GI bleed is most likely to present with haemetemesis associated with jaundice or liver disease?
oesophageal varices
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
what are some red flag symptoms for upper GI cancer?
dysphagia- difficulty swallowing
weight loss with reflux, dyspepsia, abdominal pain
upper abdominal mass
what are red flags for pancreatic cancer?
painless jaundice
weight loss
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
what are some symptoms of hypothyroidism?
fatigue cold intolerance weight gain constipation depression dry skin and hair slow reflexes
how is hypothyroidism treated?
levothyroxine sodium (synthetic T4) taken orally on an empty stomach in the morning
what are some causes of hyperthyroidism?
graves disease- autoantibodies mimic TSH and stimulate the thyroid
toxic multinodular goitre
thyroiditis
what are some symptoms of hyperthyroidism?
anxiety/irritation heat intolerance tachycardia weight loss diarrhoea thirst increased appetite
what are some unique features of graves disease?
diffuse goitre
graves eye disease
exophthalmos
pretibial myxoedema
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
how does type 1 diabetes normally present?
polyuria
polydipsia
weight loss
DKA
how is type 1 diabetes managed?
subcutaneous insulin regimes
what capillary blood glucose is considered hyperglycaemia?
> 11mmol/L
how does DKA present?
polyuria/polydypsia nausea and vomiting dehydration hypotension altered consciousness
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)
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
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
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
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
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
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
which medications should be stopped in AKI?
ACE inhibitors ARBs NSAIDs diuretics diabetes medications- metformin
what are some complications of AKI?
hyperkalaemia
fluid overload
metabolic acidosis
increased urea
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
where are valvulae conniventes?
small bowel
what are the features of toxic megacolon?
significant colon dilation with absence of haustra
causes- infective colitis, IBD
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
what are indications for abdominal ultrasound?
gallstone disease
acute cholecystitis
renal tract calculi
AAA
what are indications for CT abdomen?
bowel obstruction
bowel perforation
colon cancer
intra-abdominal trauma
