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TCD Gastrointestinal > Epigastric Abdominal Pain > Flashcards

Epigastric Abdominal Pain Flashcards

1
Q

What is meant by the term ‘distended abdomen’?

A

The abdomen is greater in size than normal (may need to ask patient about this!).

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2
Q

What is meant by the term ‘tympanic abdomen’?

A

The abdomen is distended due to air (like a balloon).

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3
Q

What is meant by the term ‘tender abdomen’?

A

Abdominal pain is present in response to touch/pressure.

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4
Q

What is meant by the term ‘soft abdomen’?

A

There is no peritonism, even though pain might be present.

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5
Q

What is meant by the term ‘peritonitic’?

A

Inflammation of the peritoneum by a noxious substance.

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6
Q

What is meant by the term ‘rebound tenderness’?

A

Pain when releasing pressure from palpation (a sign of peritonism).

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7
Q

What is ‘guarding’?

A

Involuntary tensing of the abdominal wall muscle on palpation (a sign of local peritonism if in one quadrant only).

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8
Q

What is meant by the term ‘rigid abdomen’?

A

Involuntary guarding in all four quadrants (a sign of general peritonitis).

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9
Q

Which type of cell in the stomach secretes hydrochloric acid?

A

Parietal cells

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10
Q

What is the role of G cells in the stomach?

A

They secrete the hormone gastrin.

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11
Q

What type of cells in the stomach produce pepsinogen?

A

Chief cells

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12
Q

What abdominal structures arise from the embryological midgut?

A

Organs from the duodenum (distal to entrance of common bile duct) to junction of proximal 2/3 of transverse colon with distal 1/3.

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13
Q

Where is pain from abdominal structures of each embryological origin felt? (3)

A

Foregut - epigastrium (initially - can localise later on)
Midgut - umbilical region
Hindgut - hypogastric (suprapubic) region

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14
Q

What abdominal structures arise from the embryological foregut? (6)

A

Oesophagus, stomach, pancreas, liver, gallbladder, and duodenum (proximal to entrance of common bile duct).

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15
Q

What abdominal structures arise from the embryological hindgut?

A

Distal 1/3 of transverse colon to upper part of anal canal.

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16
Q

What is the limit for acceptable weekly alcohol consumption for a man?

A

Less than 14 units per week.

17
Q

What is Grey-Turner’s sign?

A

Ecchymosis (bruising) in either flank.

18
Q

What is Cullen’s sign?

A

Visible periumbilical ecchymosis (bruising)

19
Q

What are ‘caput medusae’?

A

Periumbilical varices that branch out from the umbilicus, that occur with portal hypertension from liver cirrhosis.

20
Q

What is Murphy’s sign?

A

Pain in the Right Upper Quadrant from local peritonism due to acute cholecystitis.

21
Q

What is Rovsing’s sign?

A

Pain felt in the right iliac fossa during palpation of the left iliac fossa, due to local peritonism from acute appendicitis.

22
Q

What abdominal signs are indicative of internal haemorrhage?

A

Cullen’s Sign and Grey-Turner’s Sign

23
Q

What causes of internal haemorrhage can cause abdominal signs? (3)

A

Acute pancreatitis, splenic rupture or perforated peptic ulcer disease.

24
Q

Why do peptic ulcers not cause guarding?

A

There is no peritonism.

25
Q

What is involved in a Nissen fundoplication?

A

A laparoscopic surgery offered to control symptoms of GORD, where the fundus of the stomach is wrapped around the lower oesophagus to reinforce the lower oesophageal sphincter.

26
Q

What are the indications for surgery for gastroesophageal reflux disease (GORD)? (3)

A

Failure of medical therapy (either through efficacy or side effects)
Desire to discontinue medical therapy
Presence of a hiatus hernia

27
Q

What red flag symptoms do you need to ask about in a patient with dyspepsia? (6)

A

Anaemia (lethargy, breathlessness)
Loss of weight
Anorexia
Recent onset/progressive symptoms
Malaena and haematemesis
Swallowing difficulty (dysphagia)

[ALARMS]

28
Q

What are the NICE criteria for a direct access upper GI endoscopy for suspected cancer? (2)

A

Individual with dysphagia OR age > 55 with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.

29
Q

What is the most common histological type of gastric cancer?

A

Adenocarcinoma

30
Q

What is linitis plastica?

A

A rare type of gastric adenocarcinoma where there is ‘thickening’ of the stomach wall, seen when adenocarcinoma spreads primarily through the musculature of the stomach wall.

31
Q

What does the TNM staging system mean in the context of gastric adenocarcinoma?

A

T - how far the tumour has grown into the stomach wall
N - degree of lymph node spread
M - presence of metastases

32
Q

What are the appropriate investigations required for gastric adenocarcinoma? (5)

A

-Upper GI endoscopy
-Minimum of 6 biopsies taken during the endoscopy
-Initial staging CT thorax, abdomen and pelvis
-Discussion at local upper GI cancer MDT
-If tumour is potentially resectable, a staging laparoscopy is performed, and perioperative chemotherapy is given.

33
Q

What is a peptic ulcer?

A

A break in the mucosal lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer) - this disruption extends into the submucosa or muscularis propria and is usually more than 5mm in diameter.

34
Q

What tests can confirm successful H. pylori eradication? (3)

A

Urea breath test, faecal antigen testing, and endoscopy (rapid urease test, histology and culture)

35
Q

What is involved in triple therapy for treatment of H. pylori infection?

A

Treatment with a PPI and two different antibacterials.

36
Q

What signs and symptoms may a patient with peptic ulcer perforation present with? (5)

A

-Rigid abdomen (indicative of generalised peritonitis secondary to florid bowel contents in the peritoneal cavity)
-Sudden onset of epigastric pain (before becoming more generalised in nature)
-Distention
-Nausea
-Vomiting.

37
Q

What investigations are diagnostic for gastric perforation? (2)

A

Erect chest x-ray (will show air under diaphragm indicative of perforation in around 60% of patients)
If clinical features of perforation but normal CXR, CT scan required to confirm diagnosis (98% sensitive)

38
Q

What is the standard management for a perforated gastric ulcer? (4)

A

-Laparotomy to repair perforation (usually by patching omentum over perforation)
-Washout of enteric contents from peritoneal cavity
-H. pylori eradication therapy
-Investigation for more sinister causes of perforation (such as cancer)

39
Q

What is the main cause of a distended abdomen following surgery?

A

A postoperative ileus - a functional bowel obstruction resulting from any noxious insult to the bowel; usually resolves within a week.

TCD Gastrointestinal (6 decks)

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