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DPD Stuff > Gen Med 3 Abdo > Flashcards

Gen Med 3 Abdo Flashcards

1
Q

What are the headings you talk about in your presentation of a patient?

A

• General inspection (patient & bedside) • Hands (& arms) • Head & neck • Inspection of the chest • Abdomen (inspection, palpation, percussion & auscultation)

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2
Q

General inspection what might you see?

A

Jaundice? Pallor?

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3
Q

What is the ABCDE (L) of the hand?

A

• Asterixis (liver flap) • Bruising • Clubbing • Dupuytren’s contracture • Erythema (palmar) • Leuconychia

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4
Q

What might you see on the arms in CKD?

A

• AV fistulae • Current or previous renal replacement therapy

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5
Q

What might you see in the Head and Neck?

A

• Anaemia • Jaundice • Skin: jaundice, excoriation marks or spider naevi? • Oral examination: – Pigmentation – Gum hypertrophy (? On ciclosporine after renal transplant)

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6
Q

What might you see on the chest?

A

• Gynaecomastia • Hair loss • Excoriation marks • Spider naevi (fill centrally out)

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7
Q

What might you see on inspection of the abdo?

A

• Abdominal distension? • Caput Medusae? – distended superficial abdominal veins – direction of flow in the veins below the umbilicus is towards the legs. • Scars?

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8
Q

What scars might you see in the abdo?

A
  1. Right subcostal (Kocher’s) incision (biliary surgery) 2. Mercedes-Benz incision (liver transplant) 3. Midline laparotomy incision (GI or any major abdominal surgery) 4. McBurney’s (Gridiron) incision (appendicectomy) 5. J-shaped/ ‘hockey stick’ incision (renal transplant) 6. Low transverse (Pfannenstiel) incision (gynaecological procedures) 7. Inguinal incision (hernia repair, vascular access) 8. Loin incision (nephrectomy)
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9
Q

What are the causes of hepatomegaly?

A

3 C’s • Cancer (primary or secondary deposits) • Cirrhosis (early, usually alcoholic) • Cardiac: – Congestive cardiac failure – Constrictive pericarditis • Infiltration – Fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

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10
Q

What do you always forget to examine but which gives you thinking time?

A

Lymphadenopathy

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11
Q

What causes liver disease?

A

• Alcohol • Autoimmune • Drugs • Viral • Biliary disease

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12
Q

What are the causes of splenomegaly?

A

• H (portal Hypertension) • H (Haematological) • Infection • Inflammation

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13
Q

• Abdominal pain • Abdominal distension • Change of bowel habit • GI bleed • Jaundice • Ascites Differentials for symptoms in isolation?

A

• Peptic ulcer • Pancreatitis • Pancreatic cancer • Cholecystitis • Hepatitis • Chronic liver disease • Appendicitis • Diverticulitis • Ruptured aortic aneurysm • IBD • Coeliac

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14
Q

• 75 year old man • Epigastric pain • Back pain • PR: 130 bpm • BP: 80/50 mm Hg Most likely diagnosis?

A

Ruptured AAA

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15
Q

What do you need to know about abdo pain?

A

Nature: constant (infl.), colicky (obstruction) Location: Epigastric, RUQ, RIF, Suprapubic, LIF, General, Medical

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16
Q

Differentials for epigastric pain

A

• Stomach: – Peptic ulcer (?NSAID use) – GORD (better with antacids) – Gastritis (retrosternal, ETOH) – Malignancy • Pancreas: • Acute Pancreatitis – (?Gallstones, high amylase) • Above (heart) – MI • Below (Aorta) – ruptured aortic aneurysm • Right: (liver/gall bladder) – Cholecystitis – Hepatitis

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17
Q

What would you have in acute pancreatitis?

A

• Pain • High amylase

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18
Q

What would you see in chronic pancreatitis?

A

• Pain, wt loss • Loss of exocrine function • Loss of endocrine function • Normal amylase • Faecal elastase (high)

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19
Q

What are the differentials for RUQ pain?

A

• Gall bladder: – Cholecystitis – Cholangitis – Gallstones • Liver: • Hepatitis • Abscess • Above (lungs) – Basal pneumonia • Below (appendix) – Appendicitis • Left (Stomach, pancreas) – Peptic ulcer, Pancreatitis • Right: (kidney) – pyelonephritis

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20
Q

Differentials RIF pain

A

• GI – Appendicitis – Mesenteric adenitis – Colitis (IBD) – Malignancy • Gynaecological – Ovarian cyst rupture, twist, bleed – Ectopic pregnancy

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21
Q

Differentials Suprapubic pain

A

• Cystitis • Urinary retention

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22
Q

Any acute abdominal problem might have a high…

A

Amylase

23
Q

What is the level of of neutrophils from an ascites tap in SBP?

A

>250 cells/ mm3

24
Q

LIF pain differentials?

A

Colitis Colonic malignancy Diverticulitis Gynae- testicular/ ovarian torsion, Ovarian Cysts (rupture, twist, bleed), ectopic pregnancies

25
Q

Causes of diffuse abdominal pain

A

Peritonitis/ gastroenteritis Obstruction IBD IBS Mesenteric ischaemia DKA, Addisons, Hypercalcaemia, porphyria, lead poisoning

26
Q

What is the structure of the abdominal arteries?

A

AORTA > Coeliac trunk >> Stomach, spleen, liver, gallbladder, duodenum >>>Pancreaticoduodenal arcade >Superior Mesenteric Artery >> Small intestine, right colon >>>Arch of riolan, marginal artery of drummond >Inferior Mesenteric Artery >> Left colon >>>Ileomesenteric arcade >Iliac artery >> Rectum

27
Q

65 yr old man, triple A repair 2 days ago Diffus abdo pain 120 bpm RR30 What are his blood tests likely to show?

A

High amylase due to acute abdomen

28
Q

What can abdominal distension be?

A

Fat Flatus Foetus Fluid Faeces Foreign bodies (tumours)

29
Q

What is fluid (ascites) a sign of?

A

Liver disease Found via shifting dullness

30
Q

What is flatus (diffuse tympanism) associated with?

A

obstruction

Also: N/V Not opening bowels High pitched tinkling BS Previous surgery (adhesions) Tender irreducible femoral hernia in groin

31
Q

What are the causes of transudate (ascites)?

A

Transudate = low protein

Cirrhosis

Cardiac failure

Nephrotic syndrome

32
Q

What are the causes of exudate (high protein)?

A

Malignancy

Infection

Budd-Chiari (hepatic vein thrombosis)

Portal vein thrombosis

33
Q

Jaundice is due to…

A

…Low stercobilinogen (due to BR not being conjugated and put in bile acids)

34
Q

What are the classes of jaundice?

A

Pre hepatic (haemolytic anaemia and defective conjugation /Gilberts/) Hepatic (hepatitis) Post hepatic (CBD obstruction)

35
Q

What are the causes of hepatitis?

A

Alcohol

Autoimmune

Drugs

Viruses

36
Q

50 M painless jaundice, weight loss, dark urine, pale stool and erythema What type of jaundice is this and what is likely to be raised in his bloods?

A

Obstructive jaundice caused by pancreatic tumour Will have a raised ALP and CA19-9(cancer) (and Alk phosphatase for cancer)

37
Q

What is raised in obstructive jaundice?

A

ALP

38
Q

What is raised in hepatic jaundice?

A

ALT

39
Q

What is Ca 125 elevated in?

A

Gynaecological malignancies (women)

40
Q

What is AST raised in?

A

Hepatocyte damage

41
Q

What are the causes of blood diarrhoea?

A

Infective colitis (Campylo bacter, haemorrhagic E.Coli, Entamoeba histolytica, salmonella, shigella) Inflammatory colitis/ IBD (young with extra GI manifestations) Ischaemic colitis (elderly) Diverticulitis/ malignancy

42
Q

What do you see in inflammatory conditions?

A

Thumbprinting (inflammation)

43
Q

When do you see lead pipe colon?

A

Ulcerative colitis

44
Q

What does AXR show in obstruction?

A

Bowel dilation

45
Q

What is the management of an acute GI bleed?

A

ABC IV access- fluids Group and save/ Cross match OGD Variceal bleed- Abx/ terlipressin

46
Q

How do you manage an acute abdomen?

A

Inx: - FBC/ U&E/ LFT/ CRP/ Clotting/ G&S/ X-mathc - Erect CXR - CT

Tx:

  • NBM
  • FLuids
  • analgesia
  • Anti emetics
  • Antibiotics
  • Monitor vitals and UO
47
Q

How do you assess a patient with GI disease?

A

Jaundice- FBC/ LFT/ CRP, Abdo USS (after a fast) Dysphagia, wt loss- OGD/ biopsy PR bleed, wt loss- Colonoscopy

48
Q

What is the management for a patient with ascites?

A

Diuretics (Spirinolactone / furosemide) Dietary sodium restriction Fluid restriction Monitor wt daily Therapeutic paracentesis (IV human albumin)

49
Q

How do you use albumin in ascites to figure out the causative condition?

A

Serum albumin minus ascites albumin >11 g/L - cirrhosis, cardiac failure <11 g/L TB, cancer (nephrotic syndrome

50
Q

How do you treat encephalopathy?

A
  • Lactulose - Phosphate enemas - Avoid sedation - Treat infections - Exclude GI bleed
51
Q

What are the forms of perianal disease and treatment?

A

Peri anal abscess (incision and drainage) Anal fissure- rectal pain, stool coated with blood, (advice re diet- fluids/ fibre GTN cream)

52
Q

What is the presentation and treatment of IBS?

A

Presentation - Recurrent abdo pain, bloating - improves with defacation - Change in frequency/ form of stool - No PR bleed, anaemia, wt loss or nocturnal symptoms except coeliac Treatment - Diet and lifestyle modifications - Symptomatic treatment- antispasmodics, laxatives, anti diarrhoeals

53
Q

What can you give for post op care?

A

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