Abdominal station Flashcards

Question

Signs of chronic stable liver disease

Answer 1

palmar erythema, spider naevi, gynaecomastia, dupytrens contracture, testicular atrophy

Answer 2

Variceal bleed = terlipressin + banding Ascites = spironolactone, ascitic drain, TIPS Encep = lactulose SBP = broad spec Abx Hepatorenal syndrome = terlipressin, albumin, TIPS

Answer 3

alcohol related

Answer 4

General = cachexia, jaundice, excoriations, bruising, lack of axillary hair Hands = dupuytren’s, palmer erythema, clubbing Face = icteric sclerae, parotid swelling Abdomen = spider naevi, caput medusae, gynaecomastia, ascites, splenomegaly

Answer 5

Parotid swelling = alcohol Needle marks = hepatitis C Bronze complexion = haemochromatosis Obesity + diabetes = NAFLD Xanthelasma = cholestatic disease

Answer 6

“Today I examined this gentleman’s abdominal system. On general inspection he is cachectic, jaundiced and has a distended abdomen. He has digital clubbing and multiple spider naevi. There was no hepatic asterixis present. His abdomen was soft and non tender. Shifting dullness was present. On palpation there was no organomegaly. These signs are consistent with decompensated chronic liver disease with ascites but not encephalopathy. I would like to take a full history and perform blood tests to determine the cause.”

Answer 7

Infective = hep B , hep C (serology) Toxic = alcohol Metabolic = NAFLD, haemochromatosis, A1AD, wilson’s disease (ferritin, transferrin, caeruloplasmin) Autoimmune = autoimmune hepatitis, PSC, PBC

Answer 8

1. Portal hypertension - variceal haemorrhages/spontaneous bacterial peritonitis, thrombocytopaenia 2. Hepatocellular failure - encephalopathy, HCC, hypoalbuminemia, coagulopathy

Answer 9

young, pallor, ileostomy, oral ulcerations, pyoderma gangrenosum, clubbing, medications e.g. azathioprine or mesalazine

Answer 10

Scars from Hickman lines for Parenteral nutrition, cushingoid, gum hypertrophy, jaundice, urosdeoxycholic acid, hepatosplenomegaly

Answer 11

Ileostomy = usually right sided, spouted, looser contents Colostomy = left sided, flush to skin, thicker contents Urostomy = urine coloured

Answer 12

Today I examined this gentleman’s abdominal system. On inspection he was pale and slim. There was no digital clubbing. He had a stoma in his right iliac fossa and a midline laparotomy scar. His abdomen was soft and non tender. There were no hernias or fistulae. These signs would point to a diagnosis of Crohn’s disease with a defunctioning ileostomy, or ulcerative colitis with an end ileostomy, or a panproctolectomy for familial adenosis polyposis. I would like to take a full history and examine him for any perianal disease

Answer 13

Eyes = uveitis, episcleritis, scleritis Skin = pyoderma gangrenosum, erythema nodosum Other = clubbing, oligoarthritis, anaemia

Answer 14

strictures, obstruction, fistulae

Answer 15

toxic megacolon, colonic carcinoma, PSC

Answer 16

failure of medical management, obstruction, fistulae

Answer 17

failure of medical management, toxic megacolon or malignancy

Answer 18

de-functioning loop ileostomy

Answer 19

end ileostomy for a panproctocolectomy or a diversion ilesotomy with a ileal rectal pouch formation if emergency = hartmanns = colostomy

Answer 20

Erythema nodosum SORE SHINS Step, IBD, sarcoid, drugs

Answer 21

Today I performed an abdominal examination of X year old Y. On general inspection the patient was normal body habitus, was comfortable at rest and did not have any catheters or drains. On closer inspection of the hands and arms, the patient did not exhibit any stigmata of abdominal disease such as palmar erythema, clubbing or signs of IVDU. Extremities were warm with normal capillary refill. There was no asterixis. Pulse was regular at Z. On closer inspection of face and chest, no anaemia, scars or spider nevi were identified. JVP was non raised and the abdomen did not show any hernias or scars. Abdomen was soft non tender and with no organomegaly. Abdominal aortic pulse was present and non-expansile. Bowel sounds were present and normal, and there were not bruits audible. In conclusion this was a normal abdominal examination. To complete my examination, I would like to take full history, examine the external genitalia and the hernial orifices. I would like to take a full set of observations, perform a DRE as well as capillary glucose and urinary dipstick I would like to order bloods, including FBC, U&Es and LFTs for baseline, and order an abdominal CT if indicated.

Answer 22

Inspection 1. Location 2. Spouted vs. flush 3. Pink/healthy 4. Bag content 5. Number of lumens Palpation 1. Para-stomal hernia Completion 1. Examination of perineum 2. Removal of bag and digital examination of stoma

Answer 23

Ca <4-5cm from anal verge

Answer 24

- AAA repair (emergency or elective) - Hartmann’s - Trauma - Colon Ca removal - Perforated ulcer (duodenal) repair/resection - (Conversion from laparoscopic procedure to open)

Answer 25

* Pain * Infection * Haemorrhage * High output – electrolyte & fluid balance

Answer 26

Late * Prolapse * Skin reactions * Stenosis/stricture * Psychological impact

Answer 27

Diabetes mellitus 34% Glomerulonephritis 21% Hypertension 12%

Answer 28

dialysis washout bacteremia bleeding associated amyloidosis

Answer 29

bacterial peritonitis failure DM hernia infection

Abdominal station Flashcards

(53 cards)