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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
What are the RF for GORD that you would ask about?
Antacid use | 'Does it get better when you take antacids?'
26
What are the RF for Gastritis that you would ask about?
Retrosternal pain, alcohol intake
27
What are the RF for Acute pancreatitis that you would ask for?
Do you have gallstones, have you had gallstones, do you have a high amylase ?
28
Describe chronic Pancreatitis
``` Pain Weight loss Loss of exocrine and endocrine functions Normal amylase Low Faecal elastase ```
29
Which two structures could be involved in RUQ pain?
The liver | The gallbladder
30
List the DDx of RUQ Pain
Gallbladder: Cholecystitis Cholangitis Gallstones Liver: Hepatitis Abscess
31
List the other DDx of RUQ Pain
Above - LUNGS: Basal pneumonia Below - APPENDIX: (eg in a pregnant woman) Left - STOMACH & PANCREAS: Peptic ulcer, pancreatitis Right - KIDNEY: Pyelonephritis
32
List the DDx of RIF Pain
``` 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
33
List the DDx of Suprapubic pain
Cystitis (inflammation of the bladder) | Urinary retention
34
List the DDx of LIF pain
``` 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
35
List the DDx of Diffuse Pain
Obstruction Infection: Gastroenteritis, Peritonitis Inflammation: IBD Ischaemia: Mesenteric ischaemia Medical causes: DKA, Addisons, Hypercalcaemia, Porphyria, Lead poisoning
36
What does the coeliac artery supply?
The stomach, spleen, liver and gallbladder
37
What does the Superior mesenteric artery supply?
The small intestine and right colon
38
What does the Inferior mesenteric artery supply?
The left colon
39
What does the iliomesenteric arcade supply?
The rectum
40
LEARNING POINT: Any pathology or intervention on the abdomen will give you a high amylase
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
When dealing with ascites, describe what your thought process should be
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
Is ascites what will you see?
Shifting dullness | Features of liver disease
43
In flatus/bowel obstruction what do you see?
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
List the 3 signs of DECOMPENSATED LIVER DISEASE
Jaundice Encephalopathy Ascities
45
What are the two classifications of Ascities?
Transudate and Exudate
46
What are the causes of Transudate ascities?
Cirrhosis Cardiac failure Nephrotic syndrome
47
What are the causes of Exudate ascities?
Infection - TB or Pyogenic Malignancy - Abdominal, Pelvic, Peritoneal mesothelioma Budd-Chiari syndrome - Hepatic vein/Portal vein thrombosis
48
How do you calculate serum albumin gradient?
Serum albumin - Ascities albumin
49
When would the serum albumin gradient be high?
>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
When would the serum albumin gradient be low?
During infections, etc. <11g/L is a sign of TB or peritonitis The infection will result in increased fluid in the ascitic fluid
51
What are the 3 types of Jaundice?
Pre-hepatic, Hepatic and Post-hepatic
52
Describe the process of how bilirubin is made and digested
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
Which molecule gives stool its brown colour?
Stercobilinogen
54
List two causes of Pre-hepatic Jaundice and its effects on excretion
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
List the cause of Hepatocellular Jaundice and its effect on excretion
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
List the cause of Post-hepatic Jaundice
Common bile duct obstruction: Gallstone in the Common Bile Duct A stricture Cancer of head of the pancreas
57
Explain the effect on Post-hepatic jaundice and excretion
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
Jaundice with no dark urine or pale stool indicates?
Pre-hepatic Jaundice
59
Jaundice with dark urine ONLY indicates?
Hepatic Jaundice
60
Jaundice with dark urine and pale stool indicates
Post-hepatic Jaundice
61
What are the causes of Bloody Diarrhoea?
Infection Inflammation Ischaemia (it's blood related!) Diverticulitis/Malignancy
62
What are the INFECTIOUS causes of Bloody Diarrhoea?
``` Campylobacter Haemolytic E.coli Entamoeba Salmonella Shigella ``` So if someone comes in with bloody diarrhoea you want to take a stool sample
63
What are the INFLAMMATORY causes of bloody diarrhoea and who are they likely to show up in?
Inflammatory Bowel Disease | Seen in the YOUNG and those with EXTRA GI MANIFESTATIONS
64
What the are the ISCHAEMIC causes of bloody diarrhoea and who are they likely to show up in?
Ischaemic Colitis | Seen in the elderly
65
What does a thumb print on an abdominal x-ray show?
Inflammation
66
How do you treat an ACUTE GI BLEED?
``` ABC approach Achieve IV access Fluids G&S, X-match Oesophagogastroduedenoscopy (OGD) ```
67
How would you manage a variceal bleed?
Antibiotis Terlipressin (vasopressin analgoue - vasoconstriction 1-2 mg 4-6 hourly)
68
How do you investigate an acute abdomen?
``` FBC U&Es LFTs CRP Clotting G&S X-match Erect CXR CT ```
69
Which is done first in the investigation of an acute abdomen - CT or erect CXR?
CT
70
What is the management plan for an acute abdomen?
``` Nil by mouth Fluids Analgesia Anti-emetics Antibiotics Monitor vitals and urine outputs ```
71
A patient with Jaundice walks in, what are we going to do with him/her?
First we investigate: FBC, LFTs, CRP Then if LFTs are abnormal, we perform an USS
72
When is the best time to perform an USS?
It is best to do an USS after a fast because the gallstones are better visualised in a distended, bile-filled gallbladder
73
A patient with dysphagia and weight loss present, what investigations do we do?
OGD and Biopsy
74
A patient with a PR bleed and weight loss presents, what investigations are we going to do?
Colonoscopy
75
What is the treatment plan for a patient with Ascites?
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
List some of the causes of Encephalopathy
Bleeding Constipation Drugs Electrolyte abnormalities
77
List the necessary treatment for Encephalopathy
Lactulose Phosphate enemas Avoid Sedation Treat infection Exclude a GI bleed TREAT THE UNDERLYING CAUSE
78
List some of the complications of Post-Operative care
Wound Infection Anastomotic Leak Pelvic abscess - post appendectomy
79
How would an infected wound look?
Erythematous, there would be discharge from the wound
80
How would an anastomotic leak present?
Diffuse abdominal tenderness Guarding, rigidity Hypotensive Tachycardic
81
How would a pelvic abscess present and which surgery is it associated with?
``` A pelvic abscess is associated with an appendectomy Patient would have: Pain Fever Sweats Mucus Diarrhoea ```
82
Name 2 perianal diseases
Perianal abscess | Anal fissure
83
List the characteristics of Perianal Abscess
It is a tender, red swelling | TREAT BY INCISION AND DRAINAGE
84
List the features of an Anal Fissure
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
What are the presenting symptoms of IBS?
Recurrent abdominal pain Bloating Improves with defecation Change in the frequency and form of the stool
86
What are some symptoms NOT seen in IBS?
NO PR bleeds No anaemia No weight loss No NOCTURNAL SYMPTOMS
87
What are two things to remember before making the diagnosis of IBS
1. Ask about NOCTURNAL symptoms, IBS patients will NOt have symptoms at night 2. Exclude coeliac's before making the diagnosis
88
What is the treatment for IBS?
``` Diet and lifestyle modification Symptomatic treatment: For the abdominal pain - Give antispasmodics For the constipation - Give laxatives Anti-diarrheals ```
89
What are the GI causes of clubbing?
``` Inflammatory Bowel Disease Cirrhosis Malabsorption - Coeliac disease Gastric lymphoma Liver abscess Liver or bowel cancer ``` Other causes: Congenital clubbing, Thyroid acropachy
90
What are the causes of hepatitis?
VADA Viral Autoimmune Drugs Alcohol

Rahul's Basics (11 decks)

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