Gastro Flashcards
A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and abdominal radiograph reveals free at under the diaphragm.
Management?
Emergency laparotomy to repair a perforated viscus
The most likely cause of acute lower GI bleeding in patients >40 years of age
Diverticulosis
Diagnosis modality used when USS is equivocal for cholecystitis
Hepatobiliary iminodiacetic acid (HIDA) scan
Risk factors for cholelithiasis
Fat, female, fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ
Murphy sign, seen in acute cholecystitis
Most common cause of small bowel obstruction in patients with no history of abdominal surgery
Hernia
Most common cause of small bowel obstruction in patients with a history of abdominal surgery
Adhesions
Most common organism causing diarrhoea
Campylobacter
Diarrhoea caused by recent antibiotic use?
C.diff
Diarrhoea from recent camping
Giardia
Travellers diarrhoea
Enterotoxigenic E.coli (ETEC)
Diarrhoea from church picnics/ mayonnaise
Staph aureus
Diarrhoea from uncooked hamburgers?
E.coli O157:H7
Diarrhoea from fried rice
Bacillus cereus
Diarrhoea from poultry/eggs
Salmonella
Diarrhoea from raw seafood
Vibrio cholerae or hepatitis A virus (HAV)
Diarrhoea in AIDS
Isospora; cryptosporidium; mycobacterium avium complex (MAC)
Diarrhoea as pseudoappendicitis?
Yersinia; campylobacter
A 25 year old Jewish man presents with pain and watery diarrhoea after meals. Examination shows fistula between the bowel and skin and nodular lesions on his tibias
Crohn’s disease
Inflammatory disease of the colon with an increased risk of colon cancer
Ulcerative colitis (greater risk than Crohns)
Extraintestinal manifestations of IBD
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, PSC
Medical treatment for IBD
5-ASA agents and steroids during acute exacerbation
A 30 year old man with UC presents with fatigue, jaundice and pruritus
Primary sclerosing cholangitis (PSC)
Difference between Mallory-Weiss and Boerhaave tears?
MW: superficial tear in oesophageal mucosa
Boerhaave: full thickness oesophageal rupture
Charcot triad
RUQ pain, jaundice, fever/rigors
Reynolds Pentad
Charcots triad + shock + mental state changes
Medical treatment for hepatic encephalopathy
Reduce protein intake, lactulose, rifaximin
First step in management of a patient with an acute GI bleeding episode
Management ABCs
A 4 year old child presents with oliguria, petechia, and jaundice following an illness with bloody diarrhoea. Most likely Dx & cause?
HUS
Due to E.coli O157:H7
Treatment after exposure to hepatitis B virus (HBV)
HBV immunoglobulin
Classic causes of drug induced hepatitis
TB meds (INH, rifampicin, pyrazinamide); acetaminophen; tetracycline
A 40 year old obese woman with elevated ALP, bilirubin, pruritus, dark urine, and clay-coloured stools
Biliary tract obstruction
Hernia with greatest risk of incarceration - indirect, direct or femoral?
Femoral hernia
Severe abdominal pain or of proportion to the examination?
Mesenteric ischaemia
Diagnostic test for ileus
Abdo XR (could also do CT)
A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the diagnosis of acute pancreatitis with raised amylase and lipase
Make the patient nil per oral (NBM) and give IV fluids, O2, analgesia, and ‘tincture of time’
Colon cancer region based on anaemia of chronic disease, occult blood loss, vague abdo pain?
R sided: rare to have an obstruction
Colon cancer region based on obstructive symptx, change in bowel habits?
L sided: ‘apple core lesion’
Presents with watery diarrhoea, dehydration, muscle weakness & flushing
VIPoma (replace fluids and electrolytes, may need to surgically resect tumour, or use octreotide)
Presents with palpable, non tender gallbladder
Courvoisier sign (jaundice not due to gallstones - suggests pancreatic cancer)
