DPD: Amir Sam Cases Flashcards by Georgia Leggett

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)

How well did you know this?

Not at all

Perfectly

What are the 5 broad causes of liver disease?

Alcohol
AI
Drugs
Viral
Biliary disease

How well did you know this?

Not at all

Perfectly

List 4 broad causes of splenomegaly

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

How well did you know this?

Not at all

Perfectly

What 2 natures of pain occur in the abdomen?

Colicky: Obstruction
Constant: Inflammation

How well did you know this?

Not at all

Perfectly

List 5 organs/ conditions causing epigastric pain

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

How well did you know this?

Not at all

Perfectly

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

Pain

Bloods- high amylase

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

List 5 organs/ conditions causing RUQ pain

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

How well did you know this?

Not at all

Perfectly

List 2 systems and causative conditions causing RIF pain

GI: Appendicitis, mesenteric adenitis, IBD, malignancy

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

How well did you know this?

Not at all

Perfectly

List 2 organs/ conditions causing suprapubic pain

Cystitis

Urinary retention

How well did you know this?

Not at all

Perfectly

List 2 systems and causative conditions causing LIF pain

GI: Diverticulitis, IBD, malignancy

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

How well did you know this?

Not at all

Perfectly

List 4 causes of diffuse abdominal pain

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

How well did you know this?

Not at all

Perfectly

List 5 medical causes of diffuse abdominal pain

DKA
Addisons
Hypercalcaemia
Porphyria
Lead poisoning

How well did you know this?

Not at all

Perfectly

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

Generalised abdominal pain
Ascites
WCC > 250 cell/mm3

How well did you know this?

Not at all

Perfectly

What are the 5 causes of abdominal distension?

Fat
Flatus 
Faeces
Fetus 
Fluid

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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