Abdominal symptoms Flashcards
1
Q
What is gastroenteritis
A
Inflammation of the GI tract (stomach, small and large intestine)
2
Q
Causes of gastroenteritis
A
Viral
bacterial
parasitic
non-infective
3
Q
What does viral gastroenteritis typically present with
A
watery diarrhoea
cramping / abdominal pain
nausea and vomiting
sometimes low grade fever
4
Q
how to prevent viral gastroenteritis
A
improved sanitation
behavioural change / infection control
vaccination (rotavirus)
5
Q
Treatment for gastroenteritis
A
no specific treatment
need to make sure they are kept hydrated
6
Q
How is diarrhoea defined
A
passage of three or more loose or liquid stools per day (or more frequent passage than normal)
frequent passing of normal stools is NOT diarrhoea
7
Q
what is diarrhoea usually a symptom of
A
an infection of the intestinal tract
8
Q
three clinical types of diarrhoea - define them
A
acute watery diarrhoea - lasts several hours or days, and includes cholera
acute blood diarrhoea - also called dysentery
persistent diarrhoea - lasts 14 days or more
9
Q
4 most common causes of viral gastroenteritis
A
rotavirus - commonest cause pre-vaccine
calicivirus (norovirus and sapovirus)
Adenovirus
Astrovirus
10
Q
fact about adenovirus (one of the viruses that cause gastroenteritis)
A
second most common cause of infantile diarrhoea in temperate climates
11
Q
global epidemiology of viral gastroenteritis
A
considered benign but second leading cause of death in developing countries in children under 5
yet preventable and treatable
12
Q
transmission of viral gastroenteritis
A
faecal - oral spread
13
Q
natural defences of GI tract
A
lysozyme in saliva
gastric acid pH 2
mucus in GIT traps microbes
bile salts - duodenum, disrupt some cell surfaces
normal flora - modify environments with metabolites , nutrient competition, natural antibiotics
mucosal immunity - cell mediated immunity, and secretory IgA
Motility - vomiting and diarrhoea probably important in clearing pathogens
14
Q
describe the transmission of viral gastroenteritis
A
infectivity high ( as few and 10 virions)
virus excretion high - up to 10 >8 virions/mL faeces
environmental survival good - no viral envelope, survives heating, drying, gastric acid secretions, and bile salts
15
Q
general clinical features of viral gastroenteritis
A
dehydration causing hypotension, tachycardia and oliguria
distended abdomen - in some cases muscle guarding and hyperactive bowel sounds
16
Q
Risk groups of viral gastroenteritis
A
Children - never been exposed before (no immunity), poor hygiene, high SA to volume ratio (susceptible to dehydration)
Elderly - frailty (low reserves), Co - morbidities
Immunosuppressed - suboptimal immune response and immune memory, prolonged shedding/infectivity
17
Q
since rotavirus vaccination what causes the most cases of viral gastroenteritis in the UK and USA
A
norovirus
18
Q
define incubation period
A
time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent.
19
Q
incubation period of rotavirus
A
1-3 days
20
Q
norovirus incubation period
A
10-50 hours
21
Q
astrovirus incubation period
A
3-4 days
22
Q
signs of severe dehyrdation
A
apathy/lethargy/unconscious/unable to drink easily
deep sunken eyes, no tears, parched mouth, cold/mottled appearance
tachycardia (bradycardia if extreme), weak pulse, deep breathing, prolonged capillary refill, skin recoil >2 secs, minimal urine output
23
Q
pathogenesis if vomiting is main cause of fluid loss
A
metabolic alkalosis and hypercholeramia (elevated chloride ions)
24
Q
pathogenesis if diarrhoea is main cause of fluid loss
A
acidosis more likely
25
how to diagnose viral gastroenteritis
stool enzyme immunoassays
| molecular diagnosis - PCR of faeces or vomit (preferred type)
26
what is jaundice characterised by
elevated bilirubin in plasma causing yellowing of the skin or mucosa
27
unconjugated bilirubin
excess production cannot be cleared, e.g. haemolysis
28
what does high conjugated bilirubin mean
liver cell damaged
29
what is hepatitis
hepatocellular inflammation
30
causes of hepatitis
```
infective
toxic
autoimmune
metabolic
obstructive
```
31
how is hepatitis A transmitted
through faecal oral transmission
32
how common is hepatitis A cases in the uk
rare
33
Hepatits A clinical features
spectrum from asymptomatic to acute liver failure
no chronic infection
jaundice incidence increases with age
34
Four clinical phases of hepatitis A - explained
Incubation/pre-clinical (range 15-50 days) - person is well but infectious for 2 weeks before illness upset
prodromal/pre-icteric (few days to 10 days) - flu like illness and loss of appetite
icteric phase - fever, jaundice (rarely pale stool and dark urine), liver enlargement and tenderness, anorexia, vomiting, fatigue, lasting 1-3 weeks
convalescence (recovering)
35
rare complications of a hepatitis A infection
fulminant hepatitis
cholestatis
relapsing hepatitis
36
pathogenesis of jaundice
probably due to immune mediated T lymphocyte destruction of hepatocytes
37
how to diagnose hepatitis A
clinical suspicion
biochemical features
epidemiological clues (age, risk groups, prior exposure, travel)
however need lab tests -antibody genome (RNA)
38
management of acute hepatitis A
dont need antivirals
check liver function, clotting and U&Es
if vomiting, dehydrated and altered consciousness then admit (bad signs)
transplant for acute liver failure
39
what do hepatitis B, D and C have in common
all bloodborne viral hepatitis agents
40
transmission of hepatitis B
typical blood borne virus so ..
sexually transmitted
mother to child
needle sharing - blood products
41
acute clinical features of hepatitis B
incubation period of 60-90 days
virtually all children and infants are asymptomatic with 50% adults being so too
ALT up to 2000 IU/L
42
relevance of hepatitis B surface antigen serology
abbreviation (HBsAg)
| relevance - infected, acute or chronic
43
Acute management of hepatitis B
supportive
antivirals not usually given
check clotting, electrolytes; transplant for acute liver failure
counsel regarding transmission, screen for other blood borne viruses, STDs
44
management of chronic hepatitis B
assess need for antiviral therapy
| most should be treated
45
Therapy of chronic hepatitis B
achieved by reducing HBV DNA levels - nucleoside antiviral drugs, immunomodulators
46
Hepatitis B prevention
avoid/reduce risk - safe sex, needle exchange, infection control
screening - blood products, high risk groups, pregnancy
treatment of chronic infections
Vaccine
47
describe hepatits C virus
Flavivirus, Hepacivirus
positive single stranded RNA
enveloped
48
what type of virus is hepatitis C
blood borne virus
49
Who has higher risk of severe fibrosis with hepatitis C
```
increased alcohol intake
age >40yrs
HIV co - infection
Male
Chronic HBV co-infection
```
50
management of hepatitis c
counsel on routes of transmission
avoid alcohol
vaccine against HAV and HBV
usually supportive - wait to see if it clears
51
what is considered change in bowel habit
depends on the patient
change in stool frequency
diarrhoea or constipation
Tenesmus - constant inclination to empty bowels
Bleeding
Steatorrhoea - excretion of abnormal amount of fat with faeces
52
what is tenesmus
constant inclination to empty bowels
53
what is steatorrhoea and what does it look like
excretion of abnormal amount of fat with faeces
| looks pale and oily - can be especially foul smelling
54
common causes of altered bowel movement
```
IBS
gastroenteritis
medication
diet
coeliac disease
```
55
Less common but important causes of altered bowel movement
malignancy
IBD - inflammatory bowel disease
diverticular disease
bowel obstruction
56
difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)
IBS is a disorder of the GI tract whereas IBD is inflammation or destruction of the bowel wall, which can lead to sores and narrowing of the intestines
57
how can we investigate altered bowel habit
```
bloods
endoscopy
capsule endoscopy
CT
MRI
US
Stool samples
nuclear medicine
```
58
blood tests to consider with altered bowel habits
```
FBC
ferritin
CRP
LFTs
GLucose
thyroid function tests
calcium
lipase
TTG - tissue transglutaminase
```
59
what do stool samples look for
microscopy, culture and sensitivity (MC&S)
faecal calprotectin
helicobacter pylori stool antigen
faecal elastase
60
differentials for diarrhoea
```
Drugs
infection
IBD
IBS
coeliac disease
malignancy
diverticultis
bile acid malabsorption
hyperthyroidism
diabetes mellitus
constipation (overflow)
ischaemic colitis
```
61
red flags in abdominal symptoms
```
PR bleeding
weight loss
family history colorectal cancer
nocturnal symptoms
abdominal mass
anaemia
```
62
difference between ulcerative colitis and crohn's
UC is limited to the colon whereas crohn's can occur anywhere between the mouth and the anus
in crohn's there are healthy parts mixed with inflamed parts whereas UC will be inflamed areas together
63
causes of small bowel obstruction
```
adhesions
hernia
malignancy
strictures
foreign bodies
```
64
causes of large bowel obstruction
primary malignancy
strictures
volvulus
luminal bodies
65
what is a volvulus
an obstruction caused by twisting of the stomach or intestine
66
what is paralytic ileus
muscle or nerve problem that stops peristalsis - not a physical blockage
common post-operatively
67
what is obstipation
severe constipation - i.e. no flatus either
68
3 things that cause obstipation
small bowel obstruction
paralytic ileus
large bowel obstruction
69
function of the large bowel
absorb salt and water
absorb short chain fatty acids
store faeces
expel faeces
70
rectosphinteric reflex
reflex characterized by a transient involuntary relaxation of the internal anal sphincter in response to distention of the rectum.
71
what is parenteral nutrition and when is it used
it is delivered into a large vein, bypassing the intestine and portal system
it is used if the absorptive function of the intestine is severely impaired
72
what is the main source of glucose for the brain
gluconeogenesis
73
what is refeeding syndrome
the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result from hormonal and metabolic changes and may cause serious clinical complications
74
when you start feeding a malnourished patient what need monitoring daily
```
sodium
potassium
glucose
magnesium
phosphate
urea
creatine
```
75
when you start feeding a malnourished patient what needs monitoring twice weekly
LFT (including clotting)
76
when you start feeding a malnourished patient what needs monitoring weekly
calcium
albumin
FBC
red cell indices
77
when you start feeding a malnourished patient what needs monitoring every 2-4 weeks
zinc
copper
folate
B12
78
When you start feeding a malnourished patient what needs monitoring every 3-6 months
```
Vit D
Ferritin
iron
Mn
Se
```
79
Type 1 intestinal failure
acute onset, usually self-limiting
| most often seen after abdominal surgery
80
type 2 intestinal failure
less common
acute onset
usually following catastrophic effect (e.g. intestinal ischaemia)
81
type 3 intestinal failure
chronic
patients are metabolically stable but IV support is required over months - years
may or may not be reversible
82
what does the proximal small intestine absorb (nutrients)
```
fats
sugars
peptides and amino acids
iron
folate
calcium
water
electrolytes
```
83
what does the middle small intestine absorb (nutrients)
```
sugars
peptides and amino acids
calcium
water
electrolytes
```
84
what does the distal small intestine absorb (nutrients)
bile acids
vitamin B12
water electrolytes
85
what is short bowel syndrome
a condition in which your body is unable to absorb enough nutrients from the foods you eat because you don't have enough small intestine
86
what causes short bowel syndrome
```
post operative
mesenteric ischaemia
Chron's disease
trauma
neoplasia
radiation enteritis
```
87
management of short bowel syndrome
oral rehydration
parenteral nutrition
enteral nutrition
vitamin and mineral supplements
88
how to prevent refeeding syndrome
can be prevented by electrolyte infusions and a slower refeeding regimen.
89
What is TPN
total parenteral nutrition
90
what dose of paracetamol would cause an overdose
>10g or >200mg/kg
91
why is paracetamol toxic in high doses
because its byproduct NAPQI combines with glutathione to produce a toxic compound
92
what happens if a patient develops acute liver failure after paracetamol toxicity
it is fatal without a liver transplant
93
treatment for paracetamol toxicity
N-acetylcysteine
94
describe acute liver failure
- onset of hepatic encephalopathy <8weeks from onset of liver dysfunction
- no history of liver disease prior
- subacute if 2-6 months from onset
95
what is hepatic encephalopathy
a nervous system disorder brought on by severe liver disease . when the liver doesn't work properly toxins build up in the blood
toxins then travel to the brain and affect brain function
patients with condition may seem confused
96
Causes of acute liver failure
```
paracetamol overdose
acute viral hepatitis
drug induced liver injury
autoimmune hepatitis
wilson's disease
```
97
test for hepatitis B
hepatitis B surface antigen test (HBsAg)
98
test for hepatitis C
hepatitis C antibody (HCV Ab)
99
autoimmune hepatitis test
```
smooth muscle antibody (anti-SMA)
immunoglobulin G (IgG)
```
100
primary biliary cholangitis (PBC) test
```
anti-mitochondrial antibody (AMA)
immunoglobulin M (IgM)
```
101
primary sclerosing cholangitis (PSC) test
anti-nuclear cytoplasmic antibody (ANCA)
102
alpha 1 antitrypsin deficiency test
alpha 1 antitrypsin
Alpha-1-Antitrypsin is an acute phase reactant. This means that it will be elevated in acute and chronic inflammatory conditions, infections, and with some cancers.
if they have a deficiency then... AAT is a protein that is made in the liver. It helps protect your lungs from damage and diseases, such as emphysema and chronic obstructive pulmonary disease (COPD).
103
haemochromatosis test
ferritin (transferrin saturation)
104
Wilson's disease test
Caeruloplasmin
105
what is cholangitis
inflammation of the bile duct system
106
what is non alcoholic fatty liver disease associated with
```
with metabolic syndrome:
type 2 diabetes
obesity
hypertension
hypertriglyceridaemia
```
107
how to measure fibrosis
serum fibrosis scores
fibrosis markers or fibroscan
liver biopsu
108
route of transmission for hep A
faecal - oral
109
route of transmission for hep B
blood-borne
sexual
vertical
110
route of transmission for hep C
blood-borne
111
route of transmission for hep E
faecal - oral
112
what hepatitis virus are there vaccines for
vaccines for hep A and B not for C and E
113
what is haemachromatosis
a hereditary disorder in which iron salts are deposited in the tissues , leading to liver damage , diabetes mellitus, and bronze discolouration of the skin
114
what is Wilson's disease
is a rare inherited disorder that causes copper to accumulate in the liver, brain and other vital organs
most are diagnosed between 5-35
Symptoms
Fatigue, lack of appetite or abdominal pain.
jaundice
Golden-brown eye discoloration (Kayser-Fleischer rings)
oedema / ascites
Problems with speech, swallowing or physical coordination.
Uncontrolled movements or muscle stiffness.
115
what is PBC
primary biliary cholangitis
disease that harms the livers ability to function
chronic condition
bile duct gets injured then inflamed and eventually permanently damaged
116
what is PSC (what does it stand for and what is it actually?)
primary sclerosing cholangitis
chronic disease in which the bile ducts inside and outside the liver become inflamed and scarred and are eventually narrowed or blocked
117
what is compensated cirrhosis
where the liver is coping with the damage and maintaining its important function
118
what is decompensated cirrhosis
the liver is not able to perform all its functions adequately
119
what is portal hypertension
elevated blood pressure in the portal venous system (portal vein is the main vein that runs to the liver)
120
what is the most common cause of portal hypertension
cirrhosis (scarring) of the liver
121
signs of portal hypertension
```
ascites (fluid on the abdomen)
caput medusae (a cluster of swollen veins in your abdomen. )
splenomegaly
```
122
what is referred pain
NOT radiating pain
| pain felt in a part of the body that is not the source of the pain
123
examples of referred pain
```
brain freeze
MI
biliary colic
pancreatitis
phantom limb pain
```
124
what is colicky pain
pain characterised by either intermittent nature or variable/cyclical intensity
125
examples of colicky pain
biliary colic
bowel obstruction
renal colic
126
what is peritonitic pain
abdominal pain due to inflammation of the peritoneum
127
describe visceral peritonitic pain
vague, poorly localised
dull ache
embryological origin
128
describe somatic peritonitic pain
sharp
| localised
129
what could right upper quadrant pain refer to
```
biliary colic
acute cholecystitis
peptic ulcer (+/- perforation)
abscess
pancreatitis
pneumonia
```
130
what could epigastrium pain refer to
```
peptic ulcer
reflux oesophagitis
gastritis
AAA (abdominal aortic aneurysm)
pancreatitis
biliary colic
acute cholecystitis
```
131
what could left upper quadrant pain refer to
```
peptic ulcer
pancreatitis
splenic rupture (or cyst rupture)
abscess
pneumonia
```
132
what could central (umbilical) pain refer to
```
small bowel obstruction
appendicitis
mesenteric ischaemia
AAA (abdominal aortic aneurysm)
IBS
```
133
What could cause right iliac fossa pain
```
appendicitis
mesenteric adenitis
Meckel's diverticulum
tubal/ovarian pathology (including ectopic)
IBD
PID (pelvic inflammatory disease)
renal/ureteric colic
diverticulitis
```
134
what could cause suprapubic pain
```
diverticulitis
IBD
large bowel obstruction
PID (pelvic inflammatory disease)
Ectopic pregnancy
retention of urine
```
135
what could cause left iliac fossa pain
```
diverticulitis
IBD
tubal/ovarian pathology (including ectopic)
PID (pelvic inflammatory disease)
renal/ureteric colic
```
136
what is biliary colic
distention and contraction of a gall bladder against an obstructed cystic duct
137
in the over 50s what is the most common diagnosis when they come in with abdominal symptoms
gallstones
138
in the under 50s what is the most common diagnosis when they come in with abdominal symptoms
appendicitis
139
describe gallstone disease
pain often right upper quadrant but can be epigastric
attack of biliary colic can last 30min to 4hrs
can recur every few hours
often follows a meal or in the evening
140
describe cholecystitis - symptoms
constant, lasting days or hours
worse with moving including deep breaths
systemic sepsis and sudden cessation = think ischaemia
sudden generalised pain = think perforation
141
describe pancreatitis
can be left upper quadrant for tail of pancreas
radiates to the back
fairly sudden onset, with gradual deterioration
constant
142
investigations for query pancreatitis
amylase vs. lipase (serum vs. urine) (if they're high can indicate pancreatitis)
bloods for grading
USS (gallstonees))
CT (diagnostic , prognostic, survellience)
143
complications of pancreatitis
```
pancreatic necrosis
acute fluid collections
pseudoaneurysm
duodenal ileus
chronic pancreatitis
pseudo-cyst
```
144
presentation of peptic ulcer disease (uncomplicated ulcer)
pain relating to eating (pre or post)
unaffected by movement or examination
"deep knawing pain" "burning pain"
often worse at night
145
presentation of peptic ulcer disease (perforated ulcer)
4 quadrant peritonitis
localised peritonitis (RUQ usually)
right iliac fossa pain and peritonitis
146
investigations for query peptic ulcer disease
endoscopy
consider H pylori
CT if concerned about perforation
CT angiogram if bleeding not arrested endoscopically
147
Appendicits brief presentation
classic migratory pain
raised inflammatory markers
fever
localised peritonism in the right iliac fossa
148
appendicitis signs
```
McBurneys sign
Rovsing sign
Psoas stretch
Obturator sign
Starts at umbilicus and goes to right iliac fossa pain (this is because it is a midgut structure so pain originally presents in the umbilicus but as it gets worse it affects the more superficial nerves which causes right iliac fossa pain)
```
149
what is McBurney's sign
McBurney's point is located two thirds the distance from the navel to the right anterior superior iliac spine, or the bony projection of the right hip bone. It is found at about 3.8–5.1 cm (1.5–2 inches) from the top of the hip bone towards the navel.
McBurney's point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis.
150
what is a perforated viscus also known as
intestinal or bowel obstruction
151
What is GORD
gastro -oesophageal reflux disease
| where acid from the stomach leaks up into the oesophagus
152
what is pyelonephritis
type of urinary tract infection where one or both kidneys become infected
153
what is a bowel infarction
also known as gangrenous bowel
| it is an irreversible injury to the intestine resulting from insufficient blood flow
154
causes of upper gastro - intestinal bleeding
varices
mallory-weiss tear
peptic ulcers
oesophagi-gastric malignancy
155
what are varices
significantly dilated sub-mucosal veins in Gi tract
156
what is a Mallory Weiss tear
typically small self-limiting slight superficial laceration to the oesophagus
occurs after severe and forceful, often multiple episodes of vomiting
157
what is an ulcer
a breach of the continuity of the skin, epithelium or mucous membrane with disintegration and necrosis of epithelial tissue and often pus
158
causes of peptic ulcers
helicobacter pylori
non steroidal anti inflammatory
physiological stress
diet (alcohol)
159
presentation of gastric malignancy
```
more generic:
anaemia
heart burn
naseau
weight loss
poor appetites
```
160
What causes bleeding from the colon
```
diverticular disease
IBD
large bowel malignancy
haemorrhoids
anal fissure
```
161
what is diverticular disease
a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon
162
Two conditions under umbrella term IBD
ulcerative colitis
| crohns disease
163
what is ulcerative colitis
a long term chronic condition where the colon and rectum become inflamed - it is limited to the colon and rectum
164
what is crohns disease
inflammatory condition of any part of the GI tract and inflammation affects the full thickness of the bowel wall
165
bleeding in ulcerative colitis
rarely torrential
often associated with diarrhoea with blood mixed in it
may lead to anaemia due to prolonged low level blood loss
166
what are haemorrhoids
(also called piles)
vascular structures in the anal canal
in normal state - they are cushions that help with stool control
become a disease when swollen or inflamed
167
what is an anal fissure
small tear in lining of anus
often caused by constipation
168
define haematemesis
vomiting blood
169
define meleana
black tarry stools as a result of upper GI bleeding
170
what patients would you take a blood culture from
patients with:
fever
sepsis
or signs of a systemic infection
171
how do you take a blood culture
aseptic non - touch technique
inoculate blood culture bottles before taking other bloods
fill in clinical details including travel history
172
gram positive cocci in chains
enterococci
| streptococci
173
gram negative rods
aerobic - E coli, Klebisella, Enterobacter
| anaerobic - bacteriodes,fusarium
174
gram positive rods
anaerobic - lactobacillus , clostridium
175
regimen 1 antibiotics for gram positive bacteria
Then regimen 2 and 3
1) amoxicillin
2) beta lactum plus beta lactamase inhibitor (for example Co-amoxiclav)
3) teicoplanin (for penicillin allergy)
176
WHO definition of diarrhoea
passage of three or more loose or liquid stools per day
177
salmonella species
```
gram-negative
flagellated
7 subspecies
human infection usually faecal-oral
(consumption of contaminated poultry, eggs, and milk)
```
178
what is enteric fever
also known as typhoid fever
common infectious disease in low and middle income countries
systemic illness characterized by fever, abdominal pain, and non-specific symptoms including nausea, vomiting, headache, and anorexia
179
how to diagnose enteric fever
culture - blood, stool, bone marrow
| serology
180
management of enteric fever (typhoid fever)
antibiotics - amoxicillin, cotrimoxazole, ciprofloxacin, ceftriaxone
steroids
surgery if ileal perforation
181
prevention of enteric fever
vaccination
182
```
(abdominal symptoms case)
24yr old female presents in ED with right lower quadrant pain
3/7 dull pain
now more severe and sharp - slightly worse on urination
bowels open normally
no increased urinary frequency or dysuria
no fever
feeling unwell , bit faint
last menstrual period 7 weeks ago
some light bleeding in past 24 hrs
on examination:
clammy and in pain
P 88
BP 90/60
Tender right iliac fossa with guarding
pregnancy test positive
diagnosis?
```
ruptured ectopic pregnancy
183
biggest risk factors for ectopic pregnancy
past infection -PID and chlamydia
| also previous ectopic, smoking, infertility
184
Management of ectopic pregnancy
if ruptured - management of shock and salpingectomy
| unruptured - option of watch and wait, or medical management (methotrexate)
185
what is pelvic inflammatory disease
infection of upper genital tract , including the womb, ovaries and connecting tubes
symptoms of pain in tummy, pain on urination and heavy painful periods
treatment with antibiotics
186
shingles brief description
common 1:25
reactivation of latent herpes zoster virus
blister rash in dermatomal distribution
can be anywhere but abdomen/chest are most common
most common in elderly and immunocompromised
symptomatic management and antivirals
187
red flags for urinary symptoms
```
haematuria
sudden incontinence
obstruction of urine flow , stream changes or retention
fever, riggers, nausea
loin pain
```
188
3 sites for a urinary tract infection
urethra (urethritis): think STIs
Bladder (cystitis): lower UTI
kidney (pyelonephritis): upper UTI
189
management of uncomplicated UTIs
symptomatic treatment of pain
ensure fluids
maybe antibiotics
190
what is MSU
midstream specimen of urine
| a sample of urine (wee) that is sent to a laboratory to be tested for evidence of infection.
191
when is a MSU sent with a patient with a UTI
if they're over 65 or if impaired renal function, abnormal urinary tract, or immunosuppresion
192
when would you admit a patient with pyelonephritis
if unwell
pregnant
high risk
unable to take orals
193
what is mesenteric adenitis
inflammation (swelling) of the lymph nodes in the abdomen (belly).
194
What symptom means an urgent referral for an oesophago-gastro-duodenoscopy (OGD)
dysphagia
195
presentation of oesophageal cancer
```
progressive dysphagia
couhging
aspiration
hoarseness
weight loss
anorexia
anaemia
lymphadenopathy
```
196
rule about gastric ulcer
its gastric cancer until proven otherwise
197
what is Courvoisier sign
states that in a patient with painless jaundice and an enlarged gallbladder (or right upper quadrant mass), the cause is unlikely to be gallstones and therefore presumes the cause to be an obstructing pancreatic or biliary neoplasm (cancer) until proven otherwise
198
different types of GI malignancy
```
oesophageal
gastric
pancreatic
liver
colorectal
anal
```
199
what test do you do if someone has altered bowel habits
colonoscopy
200
presentation of gastric cancer
```
epigastric pain
nausea
dysphagia
vomiting
epigastric mass
lymphadenopathy
virchows node
dermatomyotitis
acanthosis nigricans
```
201
investigations of gastric cancer
OGD
| staging with: CT, PET-CT, laparoscopy
202
presentation of pancreatic cancer
```
epigastric pain
jaundice
anorexia
weight loos
abdominal mass
Courvoisier's sign
thrombophlebitis migrans
splenic vein thrombosis
```
203
what is virchows node
is a lymph node and is a part of the lymphatic system. It is the thoracic duct end node. It receives afferent lymphatic drainage from the left head, neck, chest, abdomen, pelvis, and bilateral lower extremities, which eventually drains into the jugulo-subclavian venous junction via the thoracic duct
left supraclavicular lymph node
204
what is thrombophlebitis migrans
an inflammatory reaction of the vein accompanied by a thrombus. It is characterized by the involvement of one vein group first, then improving and followed by the involvement of other vein groups
Thrombophlebitis is a phlebitis (inflammation of a vein) related to a thrombus (blood clot). When it occurs repeatedly in different locations, it is known as thrombophlebitis migrans (migratory thrombophlebitis).
205
presentation of liver cancer
```
anorexia
weight loss
pain
ascites
jaundice
abdominal mass
hepatomegaly
```
206
investigations for liver cancer
```
USS
CT
ERCP
needle biopsy
AFP
```
ERCP-Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope—a long, flexible, lighted tube.
AFP-An AFP tumor marker test is a blood test that measures the levels of AFP in adults. Protein made in liver when a baby is born. adults are supposed to have low levels
207
Presentation of colorectal cancer
```
iron deficiency anaemia
change in bowel habit
PR bleeding
tenesmus
weight loss
abdominal mass
PR mass
```
208
what is tenesmus
the feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping. Food passes from the stomach into the small intestine.
209
investigations for colorectal cancer
flexible sigmoidoscopy
colonoscopy
CT
CT colonography
210
presentation of anal cancer
```
pain
bleeding
mass
faecal incontinence
fistula
PR is painful/impossible
```
211
what does functional abdominal pain mean
pain that is not caused by anatomical, biochemical, inflammatory or infectious abnormality
212
NICE criteria for IBS
any of the following for at least 6 months:
- abdominal pain or discomfort
- bloating
- change in bowel habit
plus at least two of:
- symptoms made worse by eating
- passage of mucous
- abdominal bloating
- altered passage (urgency, straining, incomplete evacuation)
213
what diet is recommended for those with IBS
low FODMAP diet
214
things to ask in bowel habit
```
timing
consistency
colour
offensive smell
ease of flushing
blood
melaena (black, tarry stools)
```
215
how many units is a typical glass of wine
2.3 units
