DPD: Amir Sam Cases Flashcards
What are the causes of hepatomegaly? (3C’s + I)
Cancer (primary or secondary deposits)
Cirrhosis (early on)
Cardiac (congestive HF + constrictive pericarditis)
Infiltration (fatty, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases)
What are the 5 broad causes of liver disease?
Alcohol AI Drugs Viral Biliary disease
List 4 broad causes of splenomegaly
HTN (portal hypertension)
Haematological
Infection e.g. TB
Inflammation e.g. sarcoid
What 2 natures of pain occur in the abdomen?
Colicky: Obstruction
Constant: Inflammation
List 5 organs/ conditions causing epigastric pain
Stomach: Peptic ulcer, GORD Pancreas: Acute pancreatitis Heart: MI Aorta: Ruptured AAA Liver/ gall bladder: cholecystitis, hepatitis
What symptom characterises acute pancreatitis? What investigation would you perform? What would you expect to see?
Pain
Bloods- high amylase
List 4 characteristics of chronic pancreatitis. What would you expect to see in the bloods? What investigation is suggestive?
Pain Weight loss Loss of exocrine function Loss of endocrine function Normal amylase in blood Stool sample: Low faecal elastase
List 5 organs/ conditions causing RUQ pain
Gall bladder: cholecystitis, cholangitis, gallstones Liver: hepatitis, abscess Lungs: basal pneumonia Appendix: appendicitis Kidney: Pyelonephritis
List 2 systems and causative conditions causing RIF pain
GI: Appendicitis, mesenteric adenitis, IBD, malignancy
O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy
List 2 organs/ conditions causing suprapubic pain
Cystitis
Urinary retention
List 2 systems and causative conditions causing LIF pain
GI: Diverticulitis, IBD, malignancy
O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy
List 4 causes of diffuse abdominal pain
Obstruction
Infection: Peritonitis, gastroenteritis
Inflammation: IBD
Ischaemia: mesenteric ischaemia
List 5 medical causes of diffuse abdominal pain
DKA Addisons Hypercalcaemia Porphyria Lead poisoning
What symptoms/ signs/ figures are consistent with spontaneous bacterial peritonitis?
Generalised abdominal pain
Ascites
WCC > 250 cell/mm3
What are the 5 causes of abdominal distension?
Fat Flatus Faeces Fetus Fluid
How do you assess for the presence of fluid in abdominal distension? Features of what else may be present?
Percuss for shifting dullness
Liver disease
What causes flatus? What is a risk factor for this? What symptoms may accompany flatus? How may you detect it?
Obstruction Previous surgery (risk of adhesions) Nausea Vomiting Not opened bowel Tinkling, high pitched BS on auscultation
What are the 2 types of fluid found in ascites? What causes the presence of each?
Transudate: Less protein. (Failures- liver, heart, kidney)
Exudate: More protein (Malignancy, infection, Budd-Chiari syndrome)
Name 2 causes of pre-hepatic jaundice
Haemolysis
Gilberts syndrome
Name a broad cause of hepatocellular jaundice. How is the conjugated BR excreted?
Hepatitis (Alcohol, AI, Viruses, Drugs)
Conjugated BR leaks out of hepatocytes + is excreted as dark urine
List 3 causes of post-hepatic jaundice. Describe the urine and stool.
Gallstones in CBD Stricture Ca of head of pancreas Dark urine Pale stool (low stercobilinogen)
Which cause of jaundice results in pale stool? How may you differentiate between the causes?
Obstructive/ post-hepatic
Pancreatic cancer= painless
Gallstones= painfull
What is trousseau’s sign of malignancy?
Thrombophlebitis (inflammation of a vein due to a clot)
Acquired blood clotting disorder
Which liver enzymes are most markedly raised in hepatic and obstructive jaundice?
Hepatic: AST + ALT
Obstructive: ALP + GGT
List 5 main causative organisms of infective colitis presenting with bloody diarrhoea. Think CHESS
Campylobacter Haemorrhagic E.coli Entamoeba histolytica Salmonella Shigella
Excluding infection what is the more likely cause of bloody diarrhoea in the young and old? In the young, what other features may suggest this?
Young: Inflammatory colitis (IBD)- episcleritis, erythema nodosum
Old: Ischaemic colitis, malignancy, diverticulitis
List 5 steps in management of an acute GI bleed
ABC IV access Fluids G+S, X-match blood OGD
What 2 drugs are important to administer in a variceal bleed?
Abx Terlipressin (constricts splanchnic vessels)
What investigations are necessary in acute abdomen presentations?
FBC U+Es LFTs CRP Clotting G+S, X match blood Erect CXR CT
Describe 6 management principles/ administrations in acute abdomen presentations
NBM IV fluids Analgesic Anti-emetics Antibiotics Monitor vitals + UO
What investigations will you perform in a patient presenting with jaundice?
Bloods: FBC, LFTs, CRP Abdominal USS (post-fast)
What investigations will you perform in a patient presenting with dysphagia and weight loss?
OGD + Biopsy
What investigations will you perform in a patient presenting with PR bleeding and weight loss?
Colonoscopy
List 5 features involved in managing ascites
Diuretics (spironolactone +/- furosemide)
Dietary Na+ restriction
Fluid restriction in patients with hyponatraemia
Monitor daily weight
Therapeutic paracentesis (with IV albumin)
How is the albumin gradient calculated?
Serum albumiin - Ascites albumin
In which conditions does the albumin gradient rise >11g/L? Why?
Cirrhosis (make less albumin)+ HF
Increased pressure forces fluid out of the vessels into peritoneal cavity but leaves albumin in vessels
In which conditions does the albumin gradient drop <11g/L? Why?
Infection (TB), Inflammation, Malignancy
High albumin in ascitic fluid
+ Nephrotic syndrome
Serum albumin is low as losing in urine
What will you prescribe for encephalopathy? Why?
Lactulose (reduces gut transit time, reducing time to make ammonia) Phosphate enemas (increases bowel movement)
Other than laxatives, what else is involved in management of encephalopathy?
Avoid sedation
Treat infections
Exclude GI bleed (would act as large protein meal)
Describe 2 features of wound infection post-op
Erythematous
Discharge
Describe 3 features of anastomotic leak post-op
Diffuse abdo. tenderness
Guarding, rigidity
Hypotensive/ tachycardic
Describe 4 features of a pelvic abscess post-appendectomy
Pain
Fever
Sweats
Mucus diarrhoea
Describe a perianal abscess? How is it treated?
Tender, red swelling
Incision + drainage
Give 2 symptoms/ signs of an anal fissure. How is it treated?
Rectal pain on defecation
Stool coated with blood
Increase fluid + fibre
GTN cream
Describe 3 features of IBS presentation
Recurrent abdo. pain, bloating
Improves with defecation
Change in frequency/ form of stool
How is IBS treated?
Diet + lifestyle modification
Abdo pain: anti-spasmodics
Constipation: laxatives
Diarrhoea: antidiarrhoeals
