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YR6: GASTRO > DPD: Amir Sam Cases > Flashcards

DPD: Amir Sam Cases Flashcards

1
Q

What are the causes of hepatomegaly? (3C’s + I)

A

Cancer (primary or secondary deposits)
Cirrhosis (early on)
Cardiac (congestive HF + constrictive pericarditis)
Infiltration (fatty, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases)

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2
Q

What are the 5 broad causes of liver disease?

A 
Alcohol
AI
Drugs
Viral
Biliary disease
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3
Q

List 4 broad causes of splenomegaly

A

HTN (portal hypertension)
Haematological
Infection e.g. TB
Inflammation e.g. sarcoid

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4
Q

What 2 natures of pain occur in the abdomen?

A

Colicky: Obstruction
Constant: Inflammation

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5
Q

List 5 organs/ conditions causing epigastric pain

A 
Stomach: Peptic ulcer, GORD
Pancreas: Acute pancreatitis
Heart: MI
Aorta: Ruptured AAA
Liver/ gall bladder: cholecystitis, hepatitis
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6
Q

What symptom characterises acute pancreatitis? What investigation would you perform? What would you expect to see?

A

Pain

Bloods- high amylase

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7
Q

List 4 characteristics of chronic pancreatitis. What would you expect to see in the bloods? What investigation is suggestive?

A 
Pain 
Weight loss
Loss of exocrine function
Loss of endocrine function
Normal amylase in blood
Stool sample: Low faecal elastase
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8
Q

List 5 organs/ conditions causing RUQ pain

A 
Gall bladder: cholecystitis, cholangitis, gallstones
Liver: hepatitis, abscess
Lungs: basal pneumonia 
Appendix: appendicitis
Kidney: Pyelonephritis
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9
Q

List 2 systems and causative conditions causing RIF pain

A

GI: Appendicitis, mesenteric adenitis, IBD, malignancy

O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy

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10
Q

List 2 organs/ conditions causing suprapubic pain

A

Cystitis

Urinary retention

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11
Q

List 2 systems and causative conditions causing LIF pain

A

GI: Diverticulitis, IBD, malignancy

O+G: Ovarian cyst rupture, twist, bleed. Ectopic pregnancy

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12
Q

List 4 causes of diffuse abdominal pain

A

Obstruction
Infection: Peritonitis, gastroenteritis
Inflammation: IBD
Ischaemia: mesenteric ischaemia

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13
Q

List 5 medical causes of diffuse abdominal pain

A 
DKA
Addisons
Hypercalcaemia
Porphyria
Lead poisoning
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14
Q

What symptoms/ signs/ figures are consistent with spontaneous bacterial peritonitis?

A

Generalised abdominal pain
Ascites
WCC > 250 cell/mm3

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15
Q

What are the 5 causes of abdominal distension?

A 
Fat
Flatus 
Faeces
Fetus 
Fluid
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16
Q

How do you assess for the presence of fluid in abdominal distension? Features of what else may be present?

A

Percuss for shifting dullness

Liver disease

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17
Q

What causes flatus? What is a risk factor for this? What symptoms may accompany flatus? How may you detect it?

A 
Obstruction
Previous surgery (risk of adhesions)
Nausea
Vomiting
Not opened bowel
Tinkling, high pitched BS on auscultation
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18
Q

What are the 2 types of fluid found in ascites? What causes the presence of each?

A

Transudate: Less protein. (Failures- liver, heart, kidney)
Exudate: More protein (Malignancy, infection, Budd-Chiari syndrome)

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19
Q

Name 2 causes of pre-hepatic jaundice

A

Haemolysis

Gilberts syndrome

20
Q

Name a broad cause of hepatocellular jaundice. How is the conjugated BR excreted?

A

Hepatitis (Alcohol, AI, Viruses, Drugs)

Conjugated BR leaks out of hepatocytes + is excreted as dark urine

21
Q

List 3 causes of post-hepatic jaundice. Describe the urine and stool.

A 
Gallstones in CBD
Stricture
Ca of head of pancreas
Dark urine 
Pale stool (low stercobilinogen)
22
Q

Which cause of jaundice results in pale stool? How may you differentiate between the causes?

A

Obstructive/ post-hepatic
Pancreatic cancer= painless
Gallstones= painfull

23
Q

What is trousseau’s sign of malignancy?

A

Thrombophlebitis (inflammation of a vein due to a clot)

Acquired blood clotting disorder

24
Q

Which liver enzymes are most markedly raised in hepatic and obstructive jaundice?

A

Hepatic: AST + ALT
Obstructive: ALP + GGT

25
Q

List 5 main causative organisms of infective colitis presenting with bloody diarrhoea. Think CHESS

A 
Campylobacter
Haemorrhagic E.coli
Entamoeba histolytica
Salmonella
Shigella
26
Q

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?

A

Young: Inflammatory colitis (IBD)- episcleritis, erythema nodosum
Old: Ischaemic colitis, malignancy, diverticulitis

27
Q

List 5 steps in management of an acute GI bleed

A 
ABC
IV access
Fluids
G+S, X-match blood
OGD
28
Q

What 2 drugs are important to administer in a variceal bleed?

A 
Abx
Terlipressin (constricts splanchnic vessels)
29
Q

What investigations are necessary in acute abdomen presentations?

A 
FBC
U+Es
LFTs
CRP
Clotting
G+S, X match blood
Erect CXR
CT
30
Q

Describe 6 management principles/ administrations in acute abdomen presentations

A 
NBM
IV fluids
Analgesic
Anti-emetics
Antibiotics
Monitor vitals + UO
31
Q

What investigations will you perform in a patient presenting with jaundice?

A 
Bloods: FBC, LFTs, CRP
Abdominal USS (post-fast)
32
Q

What investigations will you perform in a patient presenting with dysphagia and weight loss?

A

OGD + Biopsy

33
Q

What investigations will you perform in a patient presenting with PR bleeding and weight loss?

A

Colonoscopy

34
Q

List 5 features involved in managing ascites

A

Diuretics (spironolactone +/- furosemide)
Dietary Na+ restriction
Fluid restriction in patients with hyponatraemia
Monitor daily weight
Therapeutic paracentesis (with IV albumin)

35
Q

How is the albumin gradient calculated?

A

Serum albumiin - Ascites albumin

36
Q

In which conditions does the albumin gradient rise >11g/L? Why?

A

Cirrhosis (make less albumin)+ HF

Increased pressure forces fluid out of the vessels into peritoneal cavity but leaves albumin in vessels

37
Q

In which conditions does the albumin gradient drop <11g/L? Why?

A

Infection (TB), Inflammation, Malignancy
High albumin in ascitic fluid
+ Nephrotic syndrome
Serum albumin is low as losing in urine

38
Q

What will you prescribe for encephalopathy? Why?

A 
Lactulose (reduces gut transit time, reducing time to make ammonia)
Phosphate enemas (increases bowel movement)
39
Q

Other than laxatives, what else is involved in management of encephalopathy?

A

Avoid sedation
Treat infections
Exclude GI bleed (would act as large protein meal)

40
Q

Describe 2 features of wound infection post-op

A

Erythematous

Discharge

41
Q

Describe 3 features of anastomotic leak post-op

A

Diffuse abdo. tenderness
Guarding, rigidity
Hypotensive/ tachycardic

42
Q

Describe 4 features of a pelvic abscess post-appendectomy

A

Pain
Fever
Sweats
Mucus diarrhoea

43
Q

Describe a perianal abscess? How is it treated?

A

Tender, red swelling

Incision + drainage

44
Q

Give 2 symptoms/ signs of an anal fissure. How is it treated?

A

Rectal pain on defecation
Stool coated with blood
Increase fluid + fibre
GTN cream

45
Q

Describe 3 features of IBS presentation

A

Recurrent abdo. pain, bloating
Improves with defecation
Change in frequency/ form of stool

46
Q

How is IBS treated?

A

Diet + lifestyle modification
Abdo pain: anti-spasmodics
Constipation: laxatives
Diarrhoea: antidiarrhoeals

YR6: GASTRO (61 decks)

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