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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
Q

what is the pathophysiology in coeliac disease?

A

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

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26
Q

what tests should be carried out for coeliac disease ?

A

anti-tissue transglutaminase (anti-TTG) (1st line)
anti- EMA- other antibody
total IgA- exclude IgA deficiency
endoscopy and intestinal biopsy

27
Q

how is irritable bowel syndrome diagnosed?

A

> 6 month Hx of symptoms (abdominal pain/ discomfort, bloating, change in bowel habit) and other causes have been excluded
diagnosis of exclusion

28
Q

where does Crohns and ulcerative colitis affect

A

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
Q

differences between UC and crohns?

A

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
Q

what investigations are important in inflammatory bowel disease?

A

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
Q

how is inflammatory bowel disease managed?

A

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
Q

what are some causes of upper GI bleeding (haematemesis)?

A 
peptic ulcer disease 
gastroesophageal varices 
oesophageal/gastric cancer 
mallory weiss tear 
erosive oesophagitis/gastritis/duodenitis
33
Q

what are some causes of lower GI bleeding (haematochezia)?

A 
diverticulitis 
colitis- IBD, ischaemic, infective
colorectal cancer 
haemorrhoids 
anal fissure
34
Q

what is the typical presentation of a mallory Weiss tear?

A

profuse vomiting later with streaks of blood

35
Q

which type of GI bleed is most likely to present with haemetemesis associated with jaundice or liver disease?

A

oesophageal varices

36
Q

what is the Glasgow blachford score?

A

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
Q

what are some red flag symptoms for upper GI cancer?

A

dysphagia- difficulty swallowing
weight loss with reflux, dyspepsia, abdominal pain
upper abdominal mass

38
Q

what are red flags for pancreatic cancer?

A

painless jaundice

weight loss

39
Q

what are some red flags for lower GI/colorectal cancer?

A

unexplained rectal bleeding
unexplained weight loss with abdominal pain
iron deficiency anaemia
change in bowel habit

40
Q

what are some symptoms of hypothyroidism?

A 
fatigue 
cold intolerance 
weight gain 
constipation 
depression 
dry skin and hair 
slow reflexes
41
Q

how is hypothyroidism treated?

A

levothyroxine sodium (synthetic T4) taken orally on an empty stomach in the morning

42
Q

what are some causes of hyperthyroidism?

A

graves disease- autoantibodies mimic TSH and stimulate the thyroid
toxic multinodular goitre
thyroiditis

43
Q

what are some symptoms of hyperthyroidism?

A 
anxiety/irritation 
heat intolerance 
tachycardia 
weight loss 
diarrhoea 
thirst 
increased appetite
44
Q

what are some unique features of graves disease?

A

diffuse goitre
graves eye disease
exophthalmos
pretibial myxoedema

45
Q

how is hyperthyroidism managed?

A

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
Q

how does type 1 diabetes normally present?

A

polyuria
polydipsia
weight loss
DKA

47
Q

how is type 1 diabetes managed?

A

subcutaneous insulin regimes

48
Q

what capillary blood glucose is considered hyperglycaemia?

A

> 11mmol/L

49
Q

how does DKA present?

A 
polyuria/polydypsia
nausea and vomiting 
dehydration 
hypotension 
altered consciousness
50
Q

what are the 3 diagnostic components of DKA?

A

hyperglycaemia (blood glucose >11mmol/L)
ketosis (blood ketones >3mmol/L, urine ketones >2+)
acidosis (pH <7.3, or bicarbonate <15mmol/L)

51
Q

how is DKA managed?

A

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
Q

how is type 2 diabetes diagnosed?

A

HbA1c- >48
random glucose- >11mmol/L
fasting glucose- >7mmol/L
oral glucose tolerance test 2 hour result- >11mmol/L

53
Q

what are the treatment targets for type 2 diabetes?

A

HbA1c- 48mmol/L for new type 2 diabetes, 53mmol/L for diabetics who have moved on from metformin alone

54
Q

how is type 2 diabetes managed?

A

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
Q

what is the criteria for an AKI?

A

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
Q

how are the causes of AKI classified?

A

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
Q

which medications should be stopped in AKI?

A 
ACE inhibitors 
ARBs 
NSAIDs 
diuretics 
diabetes medications- metformin
58
Q

what are some complications of AKI?

A

hyperkalaemia
fluid overload
metabolic acidosis
increased urea

59
Q

how is hyperkalaemia treated?

A

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
Q

where are valvulae conniventes?

A

small bowel

61
Q

what are the features of toxic megacolon?

A

significant colon dilation with absence of haustra

causes- infective colitis, IBD

62
Q

what is riglers sign?

A

both inside and outside wall of the bowel are visible on X-ray due to free air in abdomen- bowel perforation

63
Q

what are indications for abdominal ultrasound?

A

gallstone disease
acute cholecystitis
renal tract calculi
AAA

64
Q

what are indications for CT abdomen?

A

bowel obstruction
bowel perforation
colon cancer
intra-abdominal trauma

TCBL (4 decks)

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