deck_1672105 Flashcards
Give four common presentations for abdominal disorders
DyspepsiaAbdominal PainConstipationDysphagia
Define dyspepsia
Upper abdominal pain
Give four causes of dyspepsia
o Chronic peptic ulcer diseaseo GORDo Malignancyo Functional/non ulcer
What is functional dyspepsia?
60% of dyspepsiaNo functional problem found to account for symptoms - 3 months of dyspepsia with no structural causes found
What are the three main actions when someone presents with dyspepsia?
o Empirical acid suppressiono Non invasive H-pylori testing/eradicationo Early endoscopy
How common is abdominal pain as a presentation?
2% of all admissions
What is the first thing you need to do when thinking about abdominal pain?
Localise it
How do you localise abdominal pian?
Is it intra-peritoneal/extra-peritoneal?What embryological division does it belong to?
WHat are the three embryological divisions of the abdomen and where does pain localise?
Foregut – Up to 2nd part of Duodenum - Epigastric area Midgut – Up until the distal third of the transverse colon - Peri-umbilical Hindgut – Supra-pubic
Give three causes of foregut pain
o Ulcers-epigastric pain Commonly in the first part of the duodenum / lesser curve of the stomacho Pancreatits – Epigastric pain, back pain (retroperitoneal structure)o Gallstones – Epigastric pain, can also get Right Upper Quadrant (RUQ) pain. Often refered to as colicky pain (slight misnomer as the pain fairly constant).
Give two examples of causes of midgut pain
‘Real’ colicky paino Small bowel – Every 2-3 minuteso Large bowel – Every 10-15 mins
Give four signs and symptoms of small bowel obstruction
o Vomiting (fairly early feature)o Abdominal distensiono Xray may show central abdominal distended loops Circular folds (extending the full width of the bowel lumen)
Give one cause of hindgut pain
Sigmoid volvulus
What is a sigmoid volvulus?
Causes 8% of all intestinal obstructionTwists on itself or its mesentery, causing bowel obstruction and an interrupted blood supply
What is anorexia?
Loss of appetite
Give five causes of anorexia
o Subjectively unpleasant food or surroundingso Anxietyo Anger/fearo Symptom of a physical disordero Symptom of a psychological disorder
Give five physical causes of anorexia
Cancer (in particular GI tract) Chemotherapy/certain Antibiotics Pregnancy Depression Endocrine disorders
What do you need to distinguis between when asking about weight loss?
Intentional or unintentional?More than a 5% unintentional weight loss should be investigated
What is nausea?
Subjective sensation of needing toi vomit
Give four causes of nausea
o Food poisoning (Staphlococcal, salmonella, E-coli)o Gastroenteritis (viral- Norwalk)o Cholecystitiso Appendicitis
HOw is constipation classified?
Defecate less than 3 times a week - Change in bowel habit more important
Give four causes of constipation
DietMedicationDehydrationImmobility
Why is a good history necessary for diarrhoea?
Many causes which change depending on the time and place of onset
What are five categories of diarrhoea?
o Secretory (Infection)o Osmotic (Lactose intolerance)o Abnormal Intestinal Motility (Thyrotoxicosis, IBS)o Exudative (Colitis, Cancer)o Malabsorption (Pancreatic enzyme/Bile Salt Deficiency)
What is dyspagia?
o Difficulty swallowing (solids and liquids)o Differentiate from painful swallowing (Odynophagia)
What are two broad categories of dysphagia?
Difficulty initating swallowFood sticking in oesophagus
Give five causes of bleeding from oesophagus (haematemesis)
o Acute/chronic peptic ulcero Mallory-Weiss tear Tear in oesophagus from repetitive retchingo Oesophageal/Gastric Variceso Erosive Oesophagitiso Gastric/Oesophageal cancer
Give six causes of rectal bleeding
o Angiodysplasia Vascular malformation of the gut blood vesselso Diverticular diseaseo Colonic carcinomao Haemorrhoids/Anal fissureo Inflammatory Bowel Diseaseo Massive upper GI bleed Malaena
Give course for hepatic portal vein so superior vena cava
Hepatic portal vein -> Left gastric vein-> Oesophageal veins -> Azygous vein -> Upper extremities vein > SVC
Give five causes of abdominal distension
The five F’so Fato Fluido Faeceso Flatuso Foetus
Give three cause sof fluid ascites
Liver fialurePortal hypertension Cancer
Give two causes of flatulus
Aerophagia (air swallowing)Gas production in gut