Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RLH MRCS > DrE: Abdomen > Flashcards

DrE: Abdomen Flashcards

1
Q

What are the stages of clubbing?

A
  1. Congestion
  2. Loss of angulation
  3. Increased AP diameter
  4. Drumsticking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of clubbing?

A
  • Gastrointestinal:
    • Cirrhosis - PBC
    • Inflammatory bowel disease - crohns
    • Malabsorption - coeliac disease
    • GI lmphoma
  • Respiratory
    • Chronic suppurative - CF, abscess, bronchiectasis, empyema
    • Intestitial disease - ideopathic fibrosis
    • Non-small cell Ca - bronchial carcinoma
    • Mesothelioma
    • Sarcoidosis
  • Cardiovascular:
    • Infective endocarditis
    • Cyanotic congenital heart disease
    • Atrial myxoma
    • ToF
  • Other:
    • Graves - autoimmune hyperthyroidism - thyroiid acropachy
    • Familial - pseudoclubbing
  • Unilateral:
    • Axillary artery aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is dyspagia?

A

Difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of dysphagia?

A
  • Congenital: oesophageal atresia
  • Acquired:
    • Luminal
      • Food bolus
      • Foreign body
      • Oesophageal web
      • Plummer Vinson syndrome (assoc Fe def)
    • Intramural:
      • Achalasia - increased risk of Ca
      • Carcinoma
      • GORD
      • Oeophagitis
      • Oesophageal dysmotility
      • Scleroderma
      • Stricture e.g. radiation
    • Extramural:
      • Hilar lymphadenopathy
      • Pharyngeal pouch
      • Retrosternal goitre
      • Lung Carcinoma
    • Neurological:
      • Stroke
      • Myasthenia gravis
      • Motor Neuron Disease
    • Other
      • Stomatitis
      • Glossitis
      • Tonsillitis
      • Pharyngitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is odynophagia?

A

Pain on swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
A

Barium swallow

1) Apple core - oesophageal Ca
2) Achalasia - bird’s beak
3) Oesophageal web

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of Odynophagia?

A
  • Trauma: pharyngeal trauma, radiation, oesophageal burn, mallory-weiss syndrome, ruptured oesophagua
  • Foreign body: oropharengeal/pharyngeal
  • Infection: pharyngitis, tonsillitis, osphagitis (HSV, candida), abscess
  • GORD: oesophagitis, ulceration
  • Neoplasia: pharyngeal, laryngeal, oesophageal carcinoma
  • Motility: achalasia, oesophageal dysmotility syndromes
  • Neurological: stroke, myasthenia gravis, MND
  • Other: plummer Vinson, pharyngeal pouch, sleroderma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of osophageal mass?

A
  • Skn and soft tissue:
    • cyst
    • lipoma
    • sarcoma
  • GI:
    • Epigastric herna
    • Gastric carcinoma
    • Pancreatic carcinoma
    • Pancreatic pseudocyst
  • Vascular:
    • AAA
    • Lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of hepatomegaly?

A
  • Physiological:
    • Riedel’s lobe
    • hyperexpanded chest
  • Infective
    • Viral: hepatitis, EBV, CMV
    • Bacterial: TB, abscess
    • Protozoal: malaria, schistosomiasis (protozoa)
  • Malignant:
    • Primary/secondary
    • Lymphoma
    • Leukaemia
  • Alcohol:
    • Fatty liver/crrhosis
  • Metabolc:
    • Amyloid
    • Hereditary haemochormatosis
    • Wilson’s disease
  • Congestive
    • Right heart failure
    • Tricuspid regurgitation (pulsatile liver)
    • Budd chiari syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the most common causes of hepatomegally in the UK?

A
  • Malignancy:
    • primary/secondary, haemotological (CML)
  • Alcohol related:
    • Fatty liver disease, alcoholic hepatitis
  • Infective:
    • Viral - Hep ABC, EBC
    • Bacterial - liver abscess
    • Parasitic - malaria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Budd Chari Syndrome?

A

hepatic vein obstruction e.g. thrombosis/carcinoma

Upper abdo pain, jaundice, hepatomegally, ascitis

LFTs deranged

Progress to encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the causes of cirrhosis?

A
  • Congenital:
    • HHC
    • Wilsons
    • Alpha 1 antitripsin deficiency
  • Autoimmune
    • Autoimmune hepatitis
  • Biliary:
    • Primary Biliary Cirrhosis (PBC)
    • Primary Sclerosis Cholangitis
  • Cardiac
    • CCF
  • Drugs:
    • ETOH
  • Infectve:
    • Hep B and C
    • Schistosomiasis
  • Other:
    • Sarcoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is portal hypertension?

A

Portal vein pressure >10mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of portal hypertension?

A
  • Pre-hepatic:
    • Portal vein thrombosis
    • Splenic vein thrombosis
    • Splenic arterio-venous fistula
  • Hepatic
    • Cirrhosis
    • Sarcoid
    • Schistosomiasis
  • Post hepatic:
    • Budd-Chiari syndrome
    • Constrictive pericarditis
    • Right heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are caput medusae?

A

Distended, engorged perumbilcal veins

due to severe portal hypertension

with porto-systemic shunting of bloods through the umbilical veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of distended umblical veins?

A
  • Physiological
  • Portal hypertension leading to porto-systemic shunting - blood flow central to distal
  • IVC obstruction - blood flow inferior - to- superior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is ascitis?

A

Fluid in the peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of ascitis?

A
  • Transudate (Protein <30g/L)
    • Cirrhosis
    • nephrotic syndrome
    • CCF
    • Pericarditis
  • Exudate
    • Inflammation e.g. pancreatitis
    • Infection e.g. TB
    • Malignancy e.g. primary/secondary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you investigate ascitis?

A
  • Blood tests
    • FBC, U&E, LFT, CRP, Coagulation, (group and save?)
  • Diagnostic paracentesis:
    • microbiology: MC&S
    • Cytology: malignant cells
    • Biochemistry: Protein, glucose, amylase
  • Serum ascites albumin gradient
    • difference <1.1 = exudate, >1.1 = transudate
  • USS
    • Intra-abdominal organs, extent of ascites, (guide drainage)
  • Doppler
    • portal vein flow, budd-chiari syndrome, portal vein thrombosis
  • Abdo CT
    • details inta abdo organism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the treatment opertions for ascites?

A
  • Conservative:
    • Salt restriction
    • Water restriction - if hyponatraemic
    • Weight monitoring - weight loss of no more than 0.5Kg/day (if ascites alone), 1Kg/day if peripheral oedema
  • Medical:
    • Rx cause
    • Diuretics: spironolactone
  • Surgical:
    • Paracentesis - diagnostic/therapeutic
    • TIPS - Transjugular intrahepatic portosystemic shunt (pt with advanced cirrhosis and recurrent ascites)
    • LeVeen Peritoneovenous shunt - drains ascites directly into venous circulation connecting peritoneal cavity to SVC/IJV via 1 way valve (prevents backflow)
      • Complication: fluid overload, shunt blockage, bacterial colonisation
    • Liver transplant: end stage liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the causes of gall bladder enlargement?

A
  • Jaundice
    • Pancreas carcinoma (head)
    • Cholangiocarcinoma
  • Non-jaundice:
    • Mucocoele
    • Empyema
    • Gall bladder carcinoma
    • Acute cholecystitis

Gallstones -> chronic inflammation -> firbous thickening (non-distended)

22
Q

What are the functions of the spleen?

A
  • Reticuloendothelial system
    • filters and removes FBC, WCC, platelets
  • Storage:
    • Holds c.35% platelets
  • Immunological:
    • Destruction of encapsulated organisms via phagocytosis e.g. Haemophilus influenzae, streptococcus pneumoniae, neisseria meningitidis
  • Synthesis:
    • antibodies & opsonins
23
Q

What are the causes of splenomegaly?

A
  • Haemolytic anaemia:
    • Sickle cell
    • Thalassaemia
    • Elliptocytosis
    • Spherocytosis
  • Neoplastic:
    • Leukaemia - chronic myeloid (MASSIVE)
    • Myelofibrosis (MASSIVE)
    • Non-hodgkin’s lymphoma
    • Tumour - primary/secondary
  • Infective
    • Bacterial - Abscess, TB, Endocarditis
    • Viral - HIV, EBV, hepatitis
    • Protozoa - malaria (MASSIVE), schisto
    • Parasite - hydatid cyst
  • Inflammatory:
    • Rheumatoid arthritis (Felty’s syndrome -RA, splenomegally, neutropenia)
    • Sarcoid
  • Splenic vein hypertension :
    • Cirrhosis
    • Budd-Chiari syndrome
    • Portal vein thrombosis
  • Other:
    • Amyloid
    • CCF
24
Q

What is hypersplenism?

A

Retrospective diagnosis

  • Splenomegaly
  • Cytopenia
  • normal/hyperplastic bone marrow
  • Response to splenectomy
25
Q

What are the causes of a kidney mass?

A
  • Congenital:
    • Simple solitary cyst
    • Polycystic kidney disease (PCLD)
    • Horseshoe kidney
    • Hypertrophic single kidney
  • Neoplastic:
    • RCC
    • Adenoma
    • Wilm’s tumour
    • Secondary metastasis
  • Infective:
    • Abscess
    • Hydatid cyst
    • TB
  • Inflammatory:
    • Sarcoid
  • Vascular:
    • Infarct
    • Renal vein thrombosis
  • Other
    • amyloid
    • Hydronephrosis
26
Q

What is PCKD?

A

characterised by the presence of bilateral renal cysts

Important cause of renal failure

May be classified as infantile or adult

27
Q

What is the difference between infantile and adult PCKD?

A
  • Infantile:
    • Genetic: AR
    • Yrs : @birth/infancy, USS in utero diagnosis
    • PC: Renal mass, poor renal function
    • Assoc: hepatic fibrosis -> portal hypertension -> splenomegaly
    • Prognosis: to childrhood only without transplant
  • Adult:
    • Genetic: AF
    • Yrs: commonly adulthood
    • PC: 5th decade, declining renal function. Mass/loin pain/haematuria/hypertension
    • Assoc: 40% berry aneurysms -> SAH
    • Prognosis: ESRF @ 50-70yo, good survival with dialysis
28
Q

Clinical features of chronic renal failure?

A
  • CV: HF, HTN, pericarditis (uraemia), PVD
  • Dermatological: yellow skin, pruritis
  • Endocrine: amenorrhoea, imptence, infertility
  • Fluid: JVP rise, Peripheral oedema, pulmonary oedema
  • GI: anorexia, diarrhoea, N&V
  • Haematological: anaemia, ecchymosis, epistaxis
  • Neurological: confusion, coma, fits, peripheral neuropathy
  • Resp: halitosis & pleural effusion
  • Surgical: fistula, nephrectomy scar
29
Q

What is IDB?

A

idiopathic inflammatory disease with genetic prdisposition & probable autoimmune component against the GI tract

Comprised of ulcerative colitis (UC) and Crohn’s disease (CD)

Both more prevalent in Ashkenazi jews, followed by white caucasian populations

Peak c.20-30yrs

Crohns = more prevalent in smokers

US = more prevalent in non-smokers

30
Q

What are the initial presenting features in IBD?

A

similar = e.g. diarrhoea, mucus PR but UC more severe

CD = growth retardation in children, anaemia, occult blood loss, low grade fever, weight loss

UC = acute PC abdo pain, diarrhoea, frank blood loss PR

CD = entire tract, UC = colon

31
Q

What features are characteristic of an acute exacerbation of UC?

A
  • Abdo pain & distension - may indicate perforated toxic megacolon
  • Bloody stool
  • Diarrhoea (>10 episodes in 24hrs)
  • Faecal urgency
  • Pallor
  • Pyrexia
  • Tachycardia
32
Q

What investigations would assist in the diagnosis of IBD?

A
  • Bloods - FBC, U&E, CRP
  • Imaging - AXR, braium enema, small bowel follow through
  • Procedure - colonoscopy
  • Histology - biopsy at colonoscopy
33
Q

whats the difference seen between CD & US on barium enema?

A
  • Chron’s:
    • string sign (terminal ileum strictures)
    • Cobblestone/skip lesions
    • Rose thorn ulcers
  • UC:
    • Lead piping (scarred, rigid colon)
    • Loss of haustration
    • Toxic megacolon
34
Q

What are the pathological differences between CD & UC?

A
  • Macroscopic
    • Crohns:
      • pseudopolyps
      • fistula
      • strictures
      • thickened wall
    • UC:
      • pseudopolyps
  • Microscopic
    • crohns:
      • granuloma
      • inflammation - patchy and transmural
    • UC:
      • crypt abscess
      • inflammation - continuous & mucosal
35
Q

Complications of IBD?

A
  • Crohn’s
    • infection
    • FTT
    • GI fistula
    • Subacute GI obstruction
  • UC:
    • infection
    • Toxic megacolon
    • Primary sclerosing colangitis (PSC)
      • PSC present in 6-7% of pt with UC
      • UC present in 60-70% of pt with PSC
    • Colorectal carcinoma
36
Q

What are the extra-intestinal associations of IBD?

A
  • Mouth ulcers - CD only
  • Perianal skin tags - CD only
  • Ankylosing spondylitis
  • Athritis
  • Iritis
  • Erythema Nodosum
  • Pyoderma gangrenosum
37
Q

What are the treatment options for CD?

A
  • Conservative:
    • diet modification
    • psycological
    • support groups
  • Medical:
    • systemic steroids
    • immunosuppressants e.g. azathioprine
    • anti-TNF alpha e.g. infliximab
  • Surgical:
    • drainage of perianal sepsis
    • seton fistulotomy
    • stricturoplasty
    • segmental resection
    • defunctioning loop ileostomy
38
Q

What are the treatment options for UC?

A
  • Conservative:
    • psychological
    • support groups
  • Medical:
    • topical steroids e.g. predfoam enemas
    • systemic steroids
    • 5-Aminosalicylic Acid e.g. mesalazine
  • Surgical:
    • proctocolectomy and end ileostomy
    • ileo-anal pouch formation
39
Q

Is surgery for IBD curative?

A

UC may be cured by surgery as the disease is limited to the colon

as CD affects the entire GIT relapses can occur even after surgical intervention

c.70% of CD and 30% of UC pt require surgery at some time

40
Q

What are the indications for surgery in IBD?

A
  • Medical treatment complications - pt who experience severe side effects from medical treatment
  • Medical treatment failure - IBD resistant to medical treatment
  • disease process complications:
    • acute - abscess, fistula, toxic megacolon
    • chronic - strictures, colonic dysplasia (-> carcinoma)
41
Q

What are the causes of an iliac fossa mass?

A
  • skin and soft tissue:
    • cyst, lypoma, sarcoma
  • GIT:
    • RIF: caecal carcinoma, IBD, appendix
    • LIF: diverticulitis, faeces
  • Vascular:
    • iliac aneurysm, lymphadenopathy
  • Gynaecological:
    • benign ovarian Tx, malignant ovarian Tx, fibroids
  • Testicular:
    • incomplete descent, ectopic testis
  • Urological:
    • transplant kidney
42
Q

What is a sinus?

A

Blind ending tract extending from an epithelial defect.

Normal e.g cardial, Pathological e.g. pilonidal sinus

43
Q

What is a fistula?

A

abnormal communication between 2 epithelial surfaces

44
Q

Give an example of a fistula

A
  • Acquired:
    • Trauma e.g. ear piercing
    • Infective e.g. TB/Perianal
    • Inflammatory e.g. CD
    • Neoplastic
  • iatrogenic
    • trauma - e.g. bowel refection
    • cimino brescia fistula - arteriovenous fistula for HD
  • congenital
    • parkes weber syndrome
    • tracheo-oesophageal fistula
45
Q

What is the cryptoglandular sepsis theory?

A

anorectal abscess is a disrete soft tissue infection around the anus

highly variable severity & depth

cavity of the abscess may discharge in a manner associated with formation of a fistulous tract

cryptoglandular sepsis theory attributes a particular level of an anal fistula development from a particular level of anorectal abscess

  • Perianal abscess = subcutaneous/submucosal fistula
  • intersphincteric = intersphincteric
  • ischiorectal = high anal (involves both anal sphincters), low anal (involves internal anal sphincter only)
  • supralevator = pelvirectal (above anal ring)
46
Q

How would you manage a patient with a perianal abscess?

A
  • Full history e.g. history of IBD, previous abscesses or immunosuppression e.g. diabetes, steroids, immunosuppresants, HIV
  • Clinical examination - incl PR
  • Proctoscopy/sigmoidoscopy - seek internal fistula opening if present
  • Surgery: GA incision & drainage, sending puss for MC&S, once deroofed, irrigate, deloculate, wash and pack abscess to assist healing by secondary intention. DO NOT EXPLORE FOR A FISTULA ACUTELY
  • Clinical follow up - if MC&S confirms presence of intestinal bacteria suspect a fistula and arrange further investigation e.g. MRI or treatment as necessary
47
Q

Surgical options for anal fistula?

A

depends on level and severity of fistula

  • lay open - subcutaneous, submucous, low anal
  • steon - high anal, intersphincteric
  • fistulotomy & flap - complicated fistulae
48
Q

what is goodsall’s rule?

A

describes the predictable course of an anal fistula, governed by its external opening

Patient in lithotomy position, imaginary line 3-9 o;clock

fistulae with openings above the line form a radial tract directly to the same position internally

fistulae with external openings below the line run a horseshowing course to midline internal openings

49
Q

Common abdominal scars:

A
  • R thoracoabdomina - R pleura and peritoneum exposure
  • Mercedes - upper GI
  • Rooftop - upper GI
  • Kocher’s - cholecystectomy
  • R loin - nephrectomy
  • R paramedian - R hemicolectomy
  • Laparotomy - AAA, bowel
  • Gridion/Lanz - appendicectomy
  • Pfannenstiel - caesarean section
  • L inguinal - inguinal hernia
  • L femoral - L femoral embolectomy
50
Q
A

RLH MRCS (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions