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Rahul's Basics > DPD Deck - GASTRO > Flashcards

DPD Deck - GASTRO Flashcards

1
Q

What do you look for on general inspection in an abdominal examination?

A

Jaundice

Pallor

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2
Q

What do you look for when inspecting the hands in an abdominal examination? (State with regards to signs of chronic liver disease)

A 
Asterixis (Liver flap)
Bruising
Clubbing
Dupuytren's contractures
Erythema  (palmar)
Fetor Hepaticus
Gynaecomastia
Hair loss 
Icterus 
Jaundice
Leuconychia
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3
Q

What do you look for when inspecting the forearms in an abdominal examination?

A

Look for an AV fistula it is a sign of current or previous renal replacement therapy (Chronic kidney disease)

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4
Q

What do you look for when inspecting the head and neck in an abdominal examination?

A

Look for anemia and jaundice

Observe the skin to check for jaundice, excoriations, spider naevi

On oral examination:
Pigmentation
Gum hypertrophy (could be due to Ciclosporin an immunosuppressant given after renal transplant)

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5
Q

What do you look for when inspecting chest in an abdominal examination?

A 
Gynaecomastia
Hair loss
Excoriation marks 
Spider naevi 
Abdominal distension
Caput medusae 
Scars
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6
Q

State the features of Caput Medusae

A

Caput medusae are distended superficial abdominal veins. BELOW the umbilicus, their direction of flow is TOWARDS the legs
Thus, if you occlude the vessel the direction of flow will be away from the umbilicus

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7
Q

Give the 2 names and surgery associated with a scar that is on the right and below the costal cartilage

A

Right Subcostal
Kocher’s incision
Biliary surgery

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8
Q

Give the name and surgery associated with a scar that involves 3 incisions near the top of the abdomen

A

Mercedes-Benz

Liver transplant

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9
Q

Give the name and surgery associated with a scar that goes down the midline

A

Midline laparotomy scar

GI or major abdominal surgery

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10
Q

Give the name and surgery associated with a scar that is located on the lower right of the abdomen

A

McBurney’s Scar
Gridiron scar
Appendicectomy

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11
Q

Give the name and surgery associated with a scar that is curved and located on either or right or left sides

A

J-shaped scar
Hockey stick incision
Renal transplant

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12
Q

Give the name and surgery associated with a scar that is curved and located in the suprapubic region

A

Low Transverse
Pfannenstiel
Gynaecological procedures

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13
Q

Give the name and surgery associated with a scar that is located outside the main abdomen

A

Inguinal

Hermia repair, vascular access

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14
Q

Give the name and surgery associated with a scar that is located on the flank and is sloped downwards

A

Loin incision

Nephrectomy

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15
Q

Name the causes of Hepatomegaly

A

Cancer (Primary or Secondary)
Cirrhosis (Ususally from alcohol and occurring early on)
Cardiac
Infiltrative

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16
Q

List the cardiac causes of Hepatomegaly

A

Congestive heart failure
Tricuspid regurgitation
Constrictive pericarditis

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17
Q

Name the infiltrative causes of Hepatomegaly

A 
Fatty infiltration 
Haemochromomatosis
Amyloidosis 
Sarcoidosis
Lymphoproliferative disease
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18
Q

What is Amyloidosis?

A 
It is abnormal deposition of protein in various organs
Causes include:
Chronic infection
Chronic inflammation 
Myeloma
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19
Q

List the 6 general causes of liver disease

A 
Alcohol
Autoimmune
Drugs (remember over the counter)
Viral (ask about sexual history and IV drug use)
Biliary disease
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20
Q

List the causes of Splenomegaly

A

2H’s and 2I’s:
portal Hypertension
Haemotological

Infection
Inflammation

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21
Q

What are the 6 things to consider when forming your differentials?

A 
Abdominal pain - CONSTANT OR COLICKY
Adbominal distension
Change in bowel habit
GI bleed - upper or lower
Jaundice
Ascites
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22
Q

What are the three ways of classifying Abdominal pain?

A
  1. Location
  2. Constant - due to inflammation
  3. Colicky - due to obstruction
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23
Q

List the differentials for EPIGASTRIC PAIN

A 
1. Stomach:
Peptic ulcer
GORD
Gastritis
Malignancy
2. Pancreas: Acute pancreatitis
3. ABOVE: HEART - MI
4. BELOW: Aorta - Ruptured aortic aneurysm 
5. RIGHT: Liver and gallbladder - cholecystitits, hepatitis
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24
Q

What are the RF for peptic ulcer that you would ask about?

A

NSAID use
‘Do you use ibuprofen, naproxen, diclofenac?’/’Are you taking any other drugs?’

  1. H. pylori
  2. Smoking
  3. Alcohol
  4. NSAIDs and Aspirin
  5. Blood group O
  6. Hypercalcaemia
  7. Physiological stress
  8. Burns (Curling’s ulcers) or Brain trauma (Cushing’s ulcers)
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25
Q

What are the RF for GORD that you would ask about?

A

Antacid use

‘Does it get better when you take antacids?’

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26
Q

What are the RF for Gastritis that you would ask about?

A

Retrosternal pain, alcohol intake

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27
Q

What are the RF for Acute pancreatitis that you would ask for?

A

Do you have gallstones, have you had gallstones, do you have a high amylase ?

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28
Q

Describe chronic Pancreatitis

A 
Pain
Weight loss
Loss of exocrine and endocrine functions
Normal amylase 
Low Faecal elastase
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29
Q

Which two structures could be involved in RUQ pain?

A

The liver

The gallbladder

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30
Q

List the DDx of RUQ Pain

A

Gallbladder:
Cholecystitis
Cholangitis
Gallstones

Liver:
Hepatitis
Abscess

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31
Q

List the other DDx of RUQ Pain

A

Above - LUNGS: Basal pneumonia
Below - APPENDIX: (eg in a pregnant woman)
Left - STOMACH & PANCREAS: Peptic ulcer, pancreatitis
Right - KIDNEY: Pyelonephritis

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32
Q

List the DDx of RIF Pain

A 
Remember, RIF pain may be either GI or Gynaecological in origin
GI causes include: 
Appendicitis
Mesenteric adenitis
Colitis (IBD) 
Malignancy

Gynaecological:
Ovarian cyst rupture, twist and bleed
Ectopic pregnancy

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33
Q

List the DDx of Suprapubic pain

A

Cystitis (inflammation of the bladder)

Urinary retention

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34
Q

List the DDx of LIF pain

A 
LIF can either be GI or gynaecological in origin
GI causes include: 
Diverticulitis
Colitis (IBD) 
Malignancy

Gynaecologica:
Ovarian cysts twist, rupture and bleed
Ectopic pregnancy

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35
Q

List the DDx of Diffuse Pain

A

Obstruction

Infection: Gastroenteritis, Peritonitis

Inflammation: IBD

Ischaemia: Mesenteric ischaemia

Medical causes: DKA, Addisons, Hypercalcaemia, Porphyria, Lead poisoning

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36
Q

What does the coeliac artery supply?

A

The stomach, spleen, liver and gallbladder

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37
Q

What does the Superior mesenteric artery supply?

A

The small intestine and right colon

38
Q

What does the Inferior mesenteric artery supply?

A

The left colon

39
Q

What does the iliomesenteric arcade supply?

A

The rectum

40
Q

LEARNING POINT: Any pathology or intervention on the abdomen will give you a high amylase

A

Also remember that in someone who is tachycardic they are likely to have an abnormal lactate due to the abnormal perfusion leads to anaerobic respiration

41
Q

When dealing with ascites, describe what your thought process should be

A
  1. Tap the ascities
  2. Ask yourself is this SPONTANEOUS BACTERIAL PERITONITIS
  3. Send it to the lab to check the NEUTROPHIL COUNT

If neutrophils are >= 250 cells/mm3 then it is SBP

42
Q

Is ascites what will you see?

A

Shifting dullness

Features of liver disease

43
Q

In flatus/bowel obstruction what do you see?

A

Nause and vomitting
Not opened bowels
High pitched tinkling bowel sounds

You must check for:
Previous surgeries which could have led to adhesions
A tender irreducible femoral hernia in the groin

44
Q

List the 3 signs of DECOMPENSATED LIVER DISEASE

A

Jaundice
Encephalopathy
Ascities

45
Q

What are the two classifications of Ascities?

A

Transudate and Exudate

46
Q

What are the causes of Transudate ascities?

A

Cirrhosis
Cardiac failure
Nephrotic syndrome

47
Q

What are the causes of Exudate ascities?

A

Infection - TB or Pyogenic

Malignancy - Abdominal, Pelvic, Peritoneal mesothelioma

Budd-Chiari syndrome - Hepatic vein/Portal vein thrombosis

48
Q

How do you calculate serum albumin gradient?

A

Serum albumin - Ascities albumin

49
Q

When would the serum albumin gradient be high?

A

> 11g/L is a sign of portal hypertension
Because the system is backed up there is increase orthostatic pressure which forces fluid out. As a result the reminaing albumin is CONCENTRATED and there is more protein in the serum

50
Q

When would the serum albumin gradient be low?

A

During infections, etc.
<11g/L is a sign of TB or peritonitis
The infection will result in increased fluid in the ascitic fluid

51
Q

What are the 3 types of Jaundice?

A

Pre-hepatic, Hepatic and Post-hepatic

52
Q

Describe the process of how bilirubin is made and digested

A

Red blood cells are broken down in the spleen
Unconjugated bilirubin is formed
Then via GLUCORONYLTRANSFERASE
Conjugated bilirubin is formed
Then it is later metabolised to urobilinogen and stercobilinogen

53
Q

Which molecule gives stool its brown colour?

A

Stercobilinogen

54
Q

List two causes of Pre-hepatic Jaundice and its effects on excretion

A

Haemolysis
Defective conjugation as seen in Gilbert’s syndrome

As a result CONJUGATED BILIRUBIN cannot be formed and there is NO EFFECT on excretion

55
Q

List the cause of Hepatocellular Jaundice and its effect on excretion

A

Hepatitis leading to damage to hepatocytes
Causes of hepatitis can be: alcohol, autoimmune, drugs, viruses (sexual/IV drug use)

Result is that bilirubin leaks out of hepatocytes and ends up in the urine turning it DARK

56
Q

List the cause of Post-hepatic Jaundice

A

Common bile duct obstruction:
Gallstone in the Common Bile Duct
A stricture
Cancer of head of the pancreas

57
Q

Explain the effect on Post-hepatic jaundice and excretion

A

The conjugated bilirubin is formed but cannot leave the liver and as a result get stuck. It leaks out of hepatocytes resulting in dark urine.

In addition, because the conjugated bilirubin cannot enter the digestive system it cannot be converted to UROBILINOGEN and then STERCOBILINIGOGEN and thus cannot turn stool brown

58
Q

Jaundice with no dark urine or pale stool indicates?

A

Pre-hepatic Jaundice

59
Q

Jaundice with dark urine ONLY indicates?

A

Hepatic Jaundice

60
Q

Jaundice with dark urine and pale stool indicates

A

Post-hepatic Jaundice

61
Q

What are the causes of Bloody Diarrhoea?

A

Infection
Inflammation
Ischaemia (it’s blood related!)
Diverticulitis/Malignancy

62
Q

What are the INFECTIOUS causes of Bloody Diarrhoea?

A 
Campylobacter
Haemolytic E.coli
Entamoeba
Salmonella
Shigella

So if someone comes in with bloody diarrhoea you want to take a stool sample

63
Q

What are the INFLAMMATORY causes of bloody diarrhoea and who are they likely to show up in?

A

Inflammatory Bowel Disease

Seen in the YOUNG and those with EXTRA GI MANIFESTATIONS

64
Q

What the are the ISCHAEMIC causes of bloody diarrhoea and who are they likely to show up in?

A

Ischaemic Colitis

Seen in the elderly

65
Q

What does a thumb print on an abdominal x-ray show?

A

Inflammation

66
Q

How do you treat an ACUTE GI BLEED?

A 
ABC approach
Achieve IV access
Fluids
G&amp;S, X-match 
Oesophagogastroduedenoscopy (OGD)
67
Q

How would you manage a variceal bleed?

A

Antibiotis
Terlipressin (vasopressin analgoue - vasoconstriction
1-2 mg 4-6 hourly)

68
Q

How do you investigate an acute abdomen?

A 
FBC
U&amp;Es
LFTs
CRP
Clotting 
G&amp;S
X-match
Erect CXR
CT
69
Q

Which is done first in the investigation of an acute abdomen - CT or erect CXR?

A

CT

70
Q

What is the management plan for an acute abdomen?

A 
Nil by mouth 
Fluids
Analgesia
Anti-emetics
Antibiotics
Monitor vitals and urine outputs
71
Q

A patient with Jaundice walks in, what are we going to do with him/her?

A

First we investigate:
FBC, LFTs, CRP

Then if LFTs are abnormal, we perform an USS

72
Q

When is the best time to perform an USS?

A

It is best to do an USS after a fast because the gallstones are better visualised in a distended, bile-filled gallbladder

73
Q

A patient with dysphagia and weight loss present, what investigations do we do?

A

OGD and Biopsy

74
Q

A patient with a PR bleed and weight loss presents, what investigations are we going to do?

A

Colonoscopy

75
Q

What is the treatment plan for a patient with Ascites?

A
  1. Diuretics (SPIRONOLACTONE w/ or w/out FUROSEMIDE)
  2. Dietary Sodium Restriction
  3. Fluid restriction in those with Hyponatraemia
  4. Monitor weight daily
  5. Therapeutic paracentesis
76
Q

List some of the causes of Encephalopathy

A

Bleeding
Constipation
Drugs
Electrolyte abnormalities

77
Q

List the necessary treatment for Encephalopathy

A

Lactulose
Phosphate enemas

Avoid Sedation
Treat infection
Exclude a GI bleed
TREAT THE UNDERLYING CAUSE

78
Q

List some of the complications of Post-Operative care

A

Wound Infection
Anastomotic Leak
Pelvic abscess - post appendectomy

79
Q

How would an infected wound look?

A

Erythematous, there would be discharge from the wound

80
Q

How would an anastomotic leak present?

A

Diffuse abdominal tenderness
Guarding, rigidity
Hypotensive
Tachycardic

81
Q

How would a pelvic abscess present and which surgery is it associated with?

A 
A pelvic abscess is associated with an appendectomy
Patient would have:
Pain
Fever
Sweats
Mucus
Diarrhoea
82
Q

Name 2 perianal diseases

A

Perianal abscess

Anal fissure

83
Q

List the characteristics of Perianal Abscess

A

It is a tender, red swelling

TREAT BY INCISION AND DRAINAGE

84
Q

List the features of an Anal Fissure

A

Severe rectal pain on defecation
Stool will be coated with blood

Tx: Give advice on their diet - fluids + fibre
Possibly GTN cream - relaxes internal sphincter, pain relief

85
Q

What are the presenting symptoms of IBS?

A

Recurrent abdominal pain
Bloating
Improves with defecation
Change in the frequency and form of the stool

86
Q

What are some symptoms NOT seen in IBS?

A

NO PR bleeds
No anaemia
No weight loss
No NOCTURNAL SYMPTOMS

87
Q

What are two things to remember before making the diagnosis of IBS

A
  1. Ask about NOCTURNAL symptoms, IBS patients will NOt have symptoms at night
  2. Exclude coeliac’s before making the diagnosis
88
Q

What is the treatment for IBS?

A 
Diet and lifestyle modification
Symptomatic treatment: 
For the abdominal pain - Give antispasmodics
For the constipation - Give laxatives
Anti-diarrheals
89
Q

What are the GI causes of clubbing?

A 
Inflammatory Bowel Disease
Cirrhosis
Malabsorption - Coeliac disease
Gastric lymphoma
Liver abscess
Liver or bowel cancer

Other causes: Congenital clubbing, Thyroid acropachy

90
Q

What are the causes of hepatitis?

A

VADA

Viral
Autoimmune
Drugs
Alcohol

Rahul's Basics (11 decks)

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