GI Flashcards
causes of pneumoperitoneum and appearance on an erect CXR?
bowel perforation
gas-forming infection e.g. C perfringens
iatrogenic e.g. open or laparoscopic surgery
seen on CXR as air under the diaphragm
causes of RUQ pain?
acute cholecystitis hepatitis right lung pneumonia appendicitis e.g. in a pregnant woman pyelonephritis duodenal ulcer
causes of epigastric pain?
peptic ulcer MI acute cholecystitis pancreatitis perforated oesophagus
causes of LUQ pain?
ruptured spleen gastric ulcer AA perforated colon pyelonephritis left lung pneumonia
causes of RLQ pain?
appendicitis Crohn's mesenteric adenitis meckel's diverticulitis strangulated hernia renal/ureteric stone perforated caecum salpingitis TO abscess ruptured ectopic pregnancy psoas abscess
causes of LLQ pain?
UC Crohn's perforated colon strangulated hernia renal/ureteric stones sigmoid diverticulitis salpingitis TO abscess ruptured ectopic pregnancy
GI causes of clubbing?
cirrhosis
IBD espec. Crohn’s
GI lymphoma
malabsorption e.g. celiac disease
causes of hepatomegaly?
malignancy hepatic congestion e.g. RHF infection e.g. hepatitis viruses lymphoma early cirrhosis e.g. alcoholic liver
causes of splenomegaly?
portal hypertension
glandular fever
lymphoma
infections
importance of enlarged Virchow’s node (L supraclavicular node)?
may indicate gastric cancer
when might jugulo-digastric LN be enlarged?
tonsillitis (tonisillar node)
which LN may be enlarged in oral cancer?
jugulo-omohyoid
along which blood vessel do the deep cervical lymph nodes lie?
IJV
examples of deep cervical LNs?
internal jugular: jugulo-digastric
jugulo-omohyoid
spinal accessory
supraclavicular (transverse cervical)
describe Murphy’s sign
2 fingers laid over RUQ and ask patient to breathe in. This causes pain and arrest of inspiration as an inflamed GB impinges on your fingers. Only +ve if test repeated in LUG does not cause pain.
pain with inspiration as diaphragm flattens, so GB moves down aswell so can impinge on fingers.
+ve in acute cholecystitis- where stone or sludge impaction in neck of gallbladder which may cause continuous epigastric (foregut derived) or RUQ pain referred to right shoulder- diaphragmatic irritation as inflammtory fluid from GB can escape into subphrenic space in contact with diaphragm- central innervation phrenic nerve-C3, C4 and C5.
contrast presentations of biliary colic, acute cholecystitis and ascending cholangitis.
biliary colic= just PAIN, that comes and goes- colicky with peristaltic movement of ducts when GB squeezed. symtpomatic gallstones with cystic duct obstruction or bypassing into common bile duct.
Acute cholcystitis= stone impaction in neck of GB causing inflammation- fever and pain.
Ascending cholangitis= INFECTION- stone obstructing common bile duct, so conjugated bilirubin goes into the blood, causing JAUNDICE. Charcot’s triad: RUQ pain, jaundice and rigors.
start and end of foregut derivatives?
oesophagus to 2nd part of duodenum up to and including entry of common bile duct
start and end of midgut derivatives?
duodenum distal to entry of common bile duct to proximal 2/3 of transverse colon.
start and end of hindgut derivatives?
distal 1/3 of transverse colon to anal verge.
causes of pancreatitis?
GETSMASHED: gallstones ethanol trauma steroids mumps AI scorpion venom hyperlipidaemia and calcaemia, and hypothermia ERCP drugs
signs in acute pancreatitis?
tachycardia, fever, jaundice, shock, rigid abdomen, local/general tenderness
periumbilical bruising= cullen’s sign
flank bruising= grey turner’s sign, from blood vessel autodigestion adn retroperiotneal haemorrhage as elastase release within pancreas.
marker for acute pancreatitis, raised in blood?
serum amylase
Explain what Crohn’s disease is
- the wall of the gut, which can be thought of as a long tube travelling from your mouth down to your anus which allows that we eat to get to the areas of the body that require it in order to give us energy, become inflamed- red, hot, swollen, painful, protective mechanism in body. Any part of this tube can be affected, but most commonly affects end of small bowel/intestine= ileum, responsible for food breakdown and absorption into blood, and 1st part of large bowel where water is taken into the blood.
- symptoms and why- diarrhoea, abdominal pain, generally feeling unwell, weight loss.
- cause= unknown, may be related to immune cells normally protecting us from infection causing damage, possbile linked to a bacterial or viral infection. May be genetic link- FH? Could be that an infection triggers the immune sytem to produce an inflammatory response in someone who is genetically susceptible to the disease.
- on-going disease- chronic, not a cure, but can be managed with drugs or surgery to reduce symptoms, and symptoms might come and go- relapsing
symptoms and signs of Crohn’s disease and why?
diarrhoea- can be mixed with mucus, pus or blood- if an ulcer forms and bleeds, often urgency and maybe tenesmus= feeling of wanting to go to the toilet but can’t pass anything.
weight loss- NOT INTENTIONAL! Not absorbing food into the blood in areas of gut where inflamed.
abdominal pain- often lower right side of abdomen in ileum location- RLQ/right inguinal region?
active disease= fever, malaise, anorexia
Signs:
anaemia- blood loss- pallow, pale palamar creases, fatigue, pale conjuctivae
mouth ulcers- apthous ulcers- painful
anal fissures- painful cracks in skin, and skin tags- small fleshy lumps, and perianal abscesses
right iliac fossa mass.
ALSO extra-intestinal: clubbing, conjuctivitis, large joint arthritis, renal stones, erythema nodosum= painful purple nodules, commonly on shins, regress after a few wks to leave bruised appearance, also caused by sarcoidosis, TB, drugs. Inflammation triggered in other areas?
common age on onset of Crohn’s?
between 15 and 30
women more often than men
indications from a history that a patient has Crohn’s?
young- between 15 and 30
female
SH-smoker
PMH-appendicectomy in last 5 yrs
FH-Crohn’s, IBD, mutations in different genes increase the risk.
DH- NSAIDs may exacerbate disease, OCP may also trigger disease onset.
