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Y4 Gastroenterology and Hepatology > GI Luminal Disease > Flashcards

GI Luminal Disease Flashcards

1
Q

RUQ pain - dDx?

A

Biliary colic, cholecystitis, cholangitis, Hep,Liver abscess, pancreatitis

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2
Q

Epigastrium pain - dDx?

A

Gastritis, GORD, PUD, Gastric peforation, pancreatitis, oesophagitis

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3
Q

LUQ pain - dDx?

A

Splenic rupture/infarct/abscess, pancreatitis

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4
Q

Right or left flank pain -dDx?

A

Renal colic, pyelonephritis, colitis

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5
Q

Periumbilical pain - dDx

A

SBO, Ruptured AAA, Gastroenteritis, Mesenteric ischaemia

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6
Q

RIF pain - dDx?

A

Appendicitis, ovarian torsion, tubo-ovarian abscess, ectopic pregancy, colitis, ovarian cyst

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7
Q

Suprapubic pain - dDx?

A

Cystitis, pelvic inflammatory disease, STI, pregnancy

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8
Q

LIF pain - dDx?

A

Colitis, diverticulitis eg. sigmoid colon, ovarian torsion, TOA, ovarian cyst, ectopic pregnancy

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9
Q

Visceral abdominal pain suggestive of?

A

Poorly localised, autonomic pain

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10
Q

Which structures are colicky pain more likely to be experienced in?

A

Luminal structures- pain gets more sever if bowel contracts against obstruction

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11
Q

How is the pain of peritonitis described

A

Sharp, well localiseed ( dermatomal innervation), but if perforated may be generalised, pain may get very severe

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12
Q

How does pain from cholecystitis radiate

A

RUQ to right shoulder

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13
Q

How does pain from pancreatitis radiate and what other Sx and FHx might there be

A

To back, vomitting and possible hc of gallstones or alcohol access

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14
Q

What disease can commonly cause peritonism

A

Appendictis

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15
Q

What does guarding indicate, and what other sign may be observed

A

Peritonitis, guarding

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16
Q

Common obs and blood in cholecystitis?

A

Pain and unwell, high CRP

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17
Q

Common obs and blood in cholangitis

A

Very unwell, deranges LFT- billi and ALP raised

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18
Q

Is pancreatitis more likely to be epigastric or RUQ pain

A

epigastric pain

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19
Q

Can appendicitis cause RUQ pain

A

yes if retrocaecal

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20
Q

Value of CRP in RUQ pain

A

Check for infxn (w/ WBC)

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21
Q

What is lactate a marker of

A

Bowel ischaemia- or just not very well

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22
Q

What are glucose and amylase markers of

A

Hepatitis

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23
Q

What is the role of urinalysis in abd pain

A

Signs of infxn or kidney stones (haematuria)

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24
Q

What can CXR show in abd pain

A

Air under diaphragm- perforation

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25
Q

Differnce in sensitivity of USS and MRCP for gallstones and bile duct stones

A

USS better for gallstones, MRCP for BDS

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26
Q

Appendicitis signs and Ix

A

Sudden, severe RIF pain, or pain from central (vague pain) to IF (Localised) , worse on coughing
Rebound tenderness
May have guarding and rigidity
Generally malaise and unwell
May have N+V+D
Mild fever,High CRP, WBC, normal Hb
If systemically unwell, may have high fever, severe abd pain and more generalised abdominal pain

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27
Q

ERCP findings for biliary colic and cholecystitis

A

Gallstones and thickened gallbladder wall resp.

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28
Q

Tx for acute cholecystitis

A

IV abx and cholecystectomy for acute cholecystitis

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29
Q

Biliary colic treatment

A

Cholecystitis, but in OPD

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30
Q

Likely cause of small amount of free air under diaphragm

A

Duodenal Ulcer

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31
Q

What to rule out in 22 yo lady with lower abd pain, what Ix for this

A

ectopic pregnancy, ovarian diseases, appendicitis, pelvic USS

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32
Q

Possible GI causes of lower abd pain

A

Appendicitis, diverticulitis

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33
Q

70 year old male with generalised abd pain, abd distention and vomitting
Grad onset, vomitting dark green liquid
Waves for the last 48 hrs
2 similar ep over past 12 mo (colicky pain), resolved spontaneously
Possible cause? Ox and Ix?

A

SBO. Tympanic to percussion,
Tinkling bowel sounds on ascul, mildy tender, RIF scar, tachycardia. Do CXR, may do CTAP - eg. can show SBO with transtition point in RIF, Dilatation of bowel -
Adhesion may be caused by scar tissue

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34
Q

Possible causes of SBO include

A

SBO
Hernias, adhesion (previous operations- should check for scars), CD ( CBO rare, suacute with colickly pain more common)

LBO
Colon cancer and volvulus ( eg. that of sigmoid colon)

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35
Q

Na and K levels in vomitting

A

Low

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36
Q

Early Mx for SBO

A

Analgesia, IV fluids + bowel rest, nil by mouth large bore NGT to decompress bowel

Conservative Mx in adhesions or partial obstruction in CD

Exploratory laoratomy to address pri cause eg. resect stricture or CRC

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37
Q

Operation vs observation for SBO

A

If ischaemic due to close loop obstruction, may need to cut scar tissue and resect bowel

If relatively well then NGT and fluids for 2? Days, pt may get better w/o op.

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38
Q

When should CXR be done most commonly for abd pain

A

obstruction (dilated loops) or perforation (free air)

39
Q

When should amylase be tested

A

suspected pancreatitis

40
Q

What is passing flatus a common sx of

A

BO

41
Q

Likely disease if particular foods trigger it

A

Gallstone disease

42
Q

What disease is more likely to improve with passing of motion or flatus

A

IBS

43
Q

Unwell, gen. abd pain, peritonism, tachycardia, hypotension, fever, guarding, generalised perionism - what may this be

A

May be perforated viscus?

44
Q

Signs of BO

A

Abd distension, not moving bowels or passing flatus , vomitting

45
Q

Where is pain likely to be in rupture AAA and other Sx

A

shoulder tip referred pain, palpable AA, pain that goes to the back, hyperT

46
Q

Sx in abdominal ischaemia, and is pain acut or chronic

A

Generalised peritonism and abd pain
High lactate, passage of red or darker blood in stool
Acute pain!

47
Q

Age of pts who get mesenteric ischaemia

A

Age > 50 years

48
Q

More severe Sx of acute mesenteric ischaemia

A

bowel necrosis and perforation, and, in advanced cases, fever, tachycardia, and hypotension will be present

49
Q

Ix of acute mesenteric ischaemia

A
  • CT of abdomen:
    • vessel thrombosis; thickened bowel wall; abnormal bowel wall enhancement; pneumatosis; portal or mesenteric venous gas
  • Plain abdominal x-rays:
    • may see dilated loops of bowel; air-fluid level; bowel wall thickening; formless loops of large or small bowel; pneumatosis; vascular gas‘
  • CXR:
    • Free air under diaphragm
50
Q

Sx of IBS

A

Bloating , const. or diarrheoa, esp if gets better on BO

51
Q

How might Crohn’s disease cause recurrent abdominal pain?

A

Prev resections- adhesions, or stricturing which may cause obstruction- more subacute/chronic than obstructing bowel cancer

52
Q

Difference in patient positioning in peritonism vs colic

A

Staying still ( as movement aggravates pain) vs writhing around

53
Q

What is pallor a sign of in acute abdomen

A

Shock - Sepsis, GI bleeding, perforation

54
Q

What is jaundice in acute abdomen sign of

A

Gallbladder or liver problems

55
Q

What are the causes of localised peritonism vs generalised peritonism

A

Appendicitis vs advance perforation

56
Q

Describe bowel sounds in peritonism

A

absent

57
Q

Describe bowel sounds in BO

A

Tinkling/high pitch

58
Q

What are deranged cholestatic liver FTs a sign of

A

Cholangitis, gallstones, cholecystitis

59
Q

What can urinalysis tell you in acute abdomen

A

Ketones + glucose suggest DKA, WCC may suggest pyelonephritis

60
Q

What does fluid level on AXR show

A

Obstruction

61
Q

What can be seen on AXR apart from dilated loops of bowel and fluid level

A

Toxic megacolon

62
Q

what can ultrasound abdomen show you

A

Gallstones, cholecystitis

63
Q

When would CTAP be done

A

Infective peforation or abdominal complications susp.

64
Q

What does sudden onset pain suggest

A

Perforation ( duodenal ulcer, IBD), rupture of aneurysm or ovarian cyst, torsion of ovarian cyst, acute pancreatitis

65
Q

what does back pain suggest

A

Acute pancreatits, rupture of aortic aneurysm ( back to front, sever pain), renal tract disease eg. kidney stones or pyelonephritis

66
Q

What does more gradual onset of abd pain suggest

A

Inflammatory conditions like appendicitis, IBD, diverticulitus

67
Q

abd pain with rectal bleeding/ melena
PMHx of AF and COPD, sats 91, BP 90/60, Pulse 160 AF, Temp 36, abdomen rigid and silent to auscultation. Elevated CRP, lactate and WCC

A

Intestinal ischaemia

68
Q

Causes of intestinal ischaemia

A

Acute - vascular occlusion due to embolism or rupture of pre-existing arterial thrombosis, in low output states like shock in pts with pre-existing vasc disease
Chronic- insidious development of ischaemic Sx like abdominal pain that is worse after eating

69
Q

Risk factors for Intestinal ischaemia

A

Elderly pts with vasc disease, co-existing cardiac arrhythmias and co-morbitites like diabetes
Secondary to conditions resulting in low output like shock of any cause

70
Q

Diff in presentation of colonic and SB ischaemia

A

Colonic- acute abdomen, significant LGIB ( fresh rectal), large areas of ulceration, Splenic flexure and left proximal colon often affected , usually resolves spontaneously

SB - may have sig. weight loss if chronic due to nutritional failure, may have acute abdomen, perotinsim, diarrheoa/ melena, fresh rectal bleeding, very unwell

71
Q

Mx of bowel ischaemia

A

Aspirin and statins for acute intestinal ischaemia

MRI and angiogram considered to see if there is a critical vasc lesion that can be treated by stenting

Exploratory laparotomy with potential resection of affected bowel can be considered in severe intestinal iachaemia with acute abd

72
Q

dDx for appendicitis

A

Ileo-caecal CD with abscess formation - often have RIF pain
Acute salpingitis in women - vaginal discharge and adnexal tenderness of vaginal examination
Non-specific mesenteric lymphadenitis in younger indiv
Acute Terminal ileitis sec to infxn

73
Q

How to confirm Dx of appendicitis

A

CTAP or ultrasound

74
Q

Mx of appendicitis

A

Laparoscopic or open removal
Treatment with abx and drainage if appendix mass or abscess is present due to rupture

75
Q

possible MHx in BO

A

CD- prone to stricturing or narrowinng of bowel
Gut or abd op - adhesions ( most common cause)
Opiates- slow transit constipation leading to obstruction

76
Q

Risk factors for LBO include

A

Colorectal adenomas, IBD, diverticular disease are all risk factors , so is radiotherapy

77
Q

Px of BO, Ox and Bloods

A

Central colicky abdominal pain, abdominal distention and vomiting, reduced/no bowel movement
May have constipation
Possible pyrexia or nausea
Increased bowel sounds, Tinkling bowel sounds in complete obstruction
Elevated WCC and CRP

78
Q

Initial Ix for SBO

A

AXR
also do DRE - may reveal lower colonic path like rectal cancer in LBO

CT or MRIAP may provide more accurate data on level of obst,
CT should be first line? ABG and FBC should also be done

79
Q

How is pain of abdominal colic described

A

Diffuse, vague visceral pain according to divisions of foregut, midgut and hindgut

80
Q

SBO vs LBO vs complete BO

A

Profuse vomiting vs less vomiting, no bowel movement ( and may have tenesmus) vs no passage of wind and sig. distention- and peritonitism will develop over time

81
Q

What does peritonism suggest in BO

A

Strangulation or perforation of intestine

82
Q

Mx of BO, including complete SBO

A

Bowel rest, nil by mouth
Large bore NGT to decompress
Complete- supportive care first line, dluid resusc, decompress and analgesia

83
Q

What is parlytic ileus

A

Cond where intestinal motility stops, can occur postoperatively or in electrolyte imbalances, features can mimic mechanical obst.

84
Q

How to diff parlaytic ileus from BO

A

Absent bowel sounds `

85
Q
A
86
Q

What causes peritonitis

A
  • gastroduodenal ulcers (UGI)
  • CD, appendicitis (SB)
  • Divericular disease ( Colon)
  • Following instrumentaiton eg. colonscopy
  • Breakdown of intestinal surgical anastomosis post-operatively
  • Pancreatic fluid in severe pancreatitis
  • Bile from free bile from gallbladder or bileducts
  • SBP, common in advance ALD pts
87
Q

Features of peritonitis

A

pain more localised, assoc with guarding
Pain worse with coughing and deep breathing, rebound and percussion tenderness, rigity

88
Q

Effect of peritonitis on gut motility, what is seen on XR

A

Toxix, may have silent abdomen with no bowel sounds, dilatation of intestines on X-ray

89
Q

Complication of peritonitis

A

If uncontrolled can lead to SIRS and septic shock

90
Q

Mx of peritonitis

A

If sec to intestinal perforation, need surgical intervention to resect tissue or repair perforation and wash out peritoneal cavity
IV abx

91
Q

What do Ix for adhesions show

A
  • dilated loops of proximal bowel with collapsed loops posterior to site of obstruction
  • May have high-pitched bowel sounds or absent bowl sounds, tenderness, involuntary guarding, distended abdomen?
  • Elevated CRP may be observed
  • Chest x ray may show free air under diaphragm
  • CXR shows dilated bowel (maybe)
92
Q

Sx of diverticulitis

A
  • LLQ pain
  • Fever, anorexia, nausea, vomitting
  • Abdominal distension with ileus
  • Fever, LLQ tenderness, peritoneal signs ( guarding, rebound tenderness, rigid abdomen) with perforation or ruptured abscess
  • Elevated WBC,CTAP - diverticulitis may be observed, bowel wall thickening , free abdominal air
93
Q

When should surgery be done for BO

A
  • Surgery is indicated in patients with adhesional obstruction if there are signs ofperitonitis, hernia strangulation, or bowel ischaemia.
  • Computed tomographic evidence of a non-adhesional cause (tumour, hernia, volvulus, or gallstone) a is an indication for surgery
94
Q
A

Y4 Gastroenterology and Hepatology (4 decks)

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