Amir sam 4 Flashcards
What should you look for in the hands in a patient presenting with an abdominal complaint. (6)
Asterixis (liver flap). Bruising. Clubbing. Dupuytren's contracture. Erythema (palmar). Leuconychia.
What should you look at in the forearms of a patient presenting with an abdominal complaint.
AV fistulae (current or previous renal replacement therapy).
What should you look for in the head and neck of a patient presenting with an abdominal complaint. (6)
Anaemia. Jaundice. Excoriation marks. Spider naevi. Oral examination: pigmentation, gum hypertrophy.
Right subcostal incision.
Kocher’s incision for biliary surgery.
Mercedes-Benz incision.
Liver transplant.
Midline laparotomy incision.
GI or any major abdominal surgery.
McBurney’s incision.
Appendicectomy.
J-shaped/ hockey stick incision.
Renal transplant.
Low transverse incision.
Gynaecological procedures.
Inguinal incision. (2)
Hernia repair.
Vascular access.
Loin incision.
Nephrectomy.
What are the causes of hepatomegaly. (5)
Cancer (primary or secondary deposits). Cirrhosis (early, usually alcoholic). Congestive cardiac failure. Constrictive pericarditis. Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases.
What are the main causes of liver disease. (5)
Alcohol. Autoimmune. Drugs. Viral. Biliary disease.
What are the causes of splenomegaly. (4)
Portal hypertension.
Haematological.
Infection.
Inflammation.
What are some causes of epigastric pain. (9)
Peptic ulcer disease. GORD. Gastritis. Malignancy. Acute pancreatitis. MI. Ruptured AAA. Cholecystitis. Hepatitis.
What are the main features of acute pancreatitis. (2)
Pain.
High amylase.
What are the main features of chronic pancreatitis. (5)
Pain. Weight loss. Loss of exocrine and endocrine function of the pancreas. Normal amylase. Faecal elastase.
What are some causes for RUQ pain. (10)
Cholecystitis. Cholangitis. Gallstones. Hepatitis. Liver abscess. Basal pneumonia. Appendicitis. Peptic ulcer disease. Pancreatitis. Pyelonephritis.
What are some causes for RIF pain. (8)
Appendicitis. Mesenteric adenitis. Colitis (IBD). Malignancy. Ovarian cyst rupture. Ovarian torsion. Ovarian bleed. Ectopic pregnancy.
What are some causes of suprapubic pain. (2)
Cystitis.
Urinary retention.
What are some causes of LIF pain. (7)
Diverticulitis. Colitis (IBD). Malignancy. Ovarian cyst rupture. Ovarian torsion. Ovarian bleed.
What are some causes of generalized abdominal pain. (10)
Obstruction. Peritonitis. Gastroenteritis. IBD. Mesenteric ischaemia. DKA. Addison's disease. Hypercalcaemia. Porphyria. Lead poisoning.
What structures does the celiac artery supply. (5)
Stomach. Spleen. Liver. Gallbladder. Duodenum.
What strutures does the SMA supply. (2)
Small intestine.
Right colon.
What structures does the IMA supply.
Left colon.
What structure does the ileomesenteric arcade supply.
Rectum.
What are the causes of abdominal distention. (5)
Fluid. Flatus. Fat. Faeces. Fetus.
What are the clinical features of bowel obstruction. (6)
Nausea and vomiting. Not opened bowels. High pitched tinkling bowel sounds. Previous surgery (adhesions?). Tender irreducible femoral hernia in the groin?
What is the most common cause of bowel obstruction post surgery.
Adhesions.
What are the two subsets of ascites. (2)
Trasudate.
Exudate.
What are the causes of ascites caused by transudate. (3)
Cirrhosis.
Cardiac failure.
Nephrotic syndrome.
What are the causes of ascites caused by exudate. (3)
Malignancy (abdominal, pelvic, peritoneal mesothelioma).
Infection (TB, pyogenic).
Budd-Chiari syndrome (hepatic vein thrombosis, portal vein thrombosis).
What are the causes of jaundice. (3)
Pre-hepatic.
Hepatic.
Post hepatic.
What are some pre-hepatic causes of jaundice. (2)
Haemolysis. Defective conjugation (eg Gilber's syndrome).
What is a hepatic cause of jaundice.
Hepatitis (alcohol, autoimmune, drugs, viruses).
What is a post hepatic cause of jaundice.
Common bile duct obstruction (eg gallstones).
Strictures.
Cancer of the head of the pancreas.
What happens to the urine in hepatic and post-hepatic jaundice.
It is dark.
What occurs the the stools in post-hepatic jaundice.
They are pale.
What the organisms responsible for infective colitis. (5)
Camplylobacter. haemorrhagic E coli. Entamoeba histolytica. Salmonella. Shigella.
Who tends to get inflammatory colitis.
The young.
Who tends to get ischaemic colitis.
The elderly.
How do you manage an acute GI bleed. (6)
ABC. IV access. Fluids. Group and save, cross match blood. OGD. Variceal bleed: terlipressin, antibiotics.
What investigations should be carried out in an acute abdomen. (9)
FBC. UandEs. LFTs. CRP. Clotting screen. Group and save. Cross match blood. Erect CXR. CT.
How should you manage an acute abdomen. (6)
NMB. Fluids. Analgesic. Anti-emetics. Antibodies. Monitor vitals and urine output.
How should you investigate a patient with jaundice. (2)
Bloods: FBC, LFTs, CRP.
Abdominal ultrasound: after a fast (gallstones better visualised in a distended, bile-filled gallbladder).
How should you investigate a patient with dysphagia and weight loss.
OGD and biopsy.
How should you investigate a patient with PR bleeding and weight loss.
Colonoscopy.
How is ascites treated. (5)
Diuretics (spirinolactone and furosemide).
Dietary sodium restriction.
Fluid restriction in patients with hyponataemia.
Monitor weight daily.
Therapeutic paracentesis (with IV human albumin).
How is encephalopathy treated. (4)
Lactulose. Phosphate enemas. Avoid sedation. Treat underlying infections. (Exclude GI bleed).
What are the features of a wound infection following abdominal surgery. (2)
Erythematosus.
Discharge.
What are the features of an anastomotic leak following abdominal surgery. (5)
Diffuse abdominal tenderness. Guarding. Rigidity. Hypotensive. Tahcycardic.
What are the features of a pelvic abscess following abdominal surgery (eg appendectomy). (4)
Pain.
Fever.
Sweats.
Mucus diarrhoea.
What is the presentation of a perianal abcess. (2)
Tender, red swelling.
How are perianal abscesses treated.
Incision and drainage.
What are the features of an anal fissure. (2)
Rectal pain on defaecation.
Stools coated in blood.
What is the treatment for anal fissures. (2)
Advice re: diet (fluids and fibre).
GTN cream.
What is the typical presentation of IBS. (8)
Recurrent abdominal pain.
Bloating.
Pain improves with defecation.
Change in the frequency/form of the stool.
No PR bleeding, anaemia, weight loss or nocturnal symptoms.
What must be excluded in a patient presenting with symptoms of IBS.
Coeliac.
What is the treatment for IBS. (4)
Diet and lifestyle modification.
Abdominal pain: antispasmodics.
Laxatives for constipation.
Anti-diarrhoeals.
