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DPD 2020 > interactive cases iii > Flashcards

interactive cases iii Flashcards

1
Q

What signs do you look for in the hands for an abdo exam?

A 
A sterixis (liver flap)
B ruising 
C lubbing
D upuytren's contracture
E rythema (palmar)
...
L euconychia
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2
Q

What is caput medusae indicative of?

A

Portal hypertension

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3
Q

Possible ddx of hepatomegaly

A 
C ancer
- primary/secondary
C irrhosis 
- early on, usually alcoholic
C ardiac
- congestive heart failure
- constrictive pericarditis
Infiltration
- fatty, haemochromatsis, amylodosis, sarcoidosis, hypoproliferative diseases
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4
Q

Main causes of liver disease

A 
Alcohol
Autoimmune
Drugs
Viral
Biliary disease
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5
Q

Possible ddx of splenomegaly

A

H - portae hypertension
H - haematological
I - infection
I - inflammation

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6
Q

What do you need to distinguish regarding abdo pain?

A 
Nature
- constant (inflammation) or colicky (obstruction)
Location
- 9 regions
- general pain
- medical cause?
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7
Q

Possible ddx of epigastric pain

A 
Stomach
- peptic ulcer (NSAID use)
- GORD (better with antiacids)
- gastritis (retrosternal, ETOH)
- malignancy
Pancreas
- acute pancreatitis (gallstones, high amylase)
Heart (above)
- MI
Aorta (below)
- ruptured aortic anuerysm
Liver/gallbladder (right)
- cholecystitis
- hepatitis
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8
Q

Differentiate between acute and chronic pancreatitis

A 
Acute
- high amylase
- pain
Chronic
- pain w/ wt loss
- normal amylase
- loss of endocrine and exocrine function (malabsorption hence wt loss) 
- faecal elastase decreased
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9
Q

Possible ddx of RUQ pain

A 
Gallbladder
- cholecystitis
- cholangitis
- gallstones
Liver
- hepatitis
- abscess
Lungs (above)
- basal pneumonia
Appendix (below)
- appendicitis
Stomach, pancreas (left)
- peptic ulcer, pancreatitis
Kidney (right)
- pyelonephritis
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10
Q

Possible ddx of RIF pain

A 
GI
- appendicitis
- mesenteric adenitis
- colitis (IBD)
- malignancy
Gynaecological
- ovarian cyst rupture/twist/bleed
- ectopic pregnancy
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11
Q

Possible ddx of suprapubic pain

A

Cystitis

Urinary retention

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12
Q

Possible ddx of LIF Pain

A 
GI
- diverticulitis
- colitis (IBD)
- malignancy
Gynaecological
- ovarian cyst rupture/twist/bleed
- ectopic pregnancy
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13
Q

Possible ddx of diffuse/generalised pain

A 
Obstruction
Infection (peritonitis, gastroenteritis)
Inflammation (IBD)
Ischaemia (mesenteric ischaemia)
Medical causes
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14
Q

What are medical causes of abdo pain?

A 
DKA
Addison's
Hypercalcaemia
Porphyria
Lead poisoning
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15
Q

Name the arteries of the GI blood supply

A

Coeliac
Superior mesenteric artery
Inferior mesenteric artery
Iliac

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16
Q

What does the coeliac artery supply?

A

Stomach, spleen, liver, gallbladder, duodenum

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17
Q

What does the SMA supply?

A

Small intestine, right colon

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18
Q

What does the IMA supply?

A

Left colon

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19
Q

What does the iliac artery supply?

A

Rectum

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20
Q

What reading would you expect from amylase when pt has abdo pain?

A

High amylase

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21
Q

What does an ascites neutrophil count greater/equal to 250 cells/mm3 indicate?

A

Evidence of spontaenous bacterial peritonitis

22
Q

What causes abdo distention?

A 
Fluid (ascites)
Flatus (obstruction)
Fat
Faeces
Foetus
Foreign body (mass)
23
Q

Features of ascites

A

Shifting dullness

Signs of liver disease

24
Q

Features of obstruction

A 
Nausea + vomiting
Not opened bowels
High pitched, tinkling bowel sounds
?previous surgeries (adhesions)
?tender, irreducible femoral hernia in groin
25
Q

Possible causes of transudate ascites

A

(transudate = albumin levels not high)
Cirrhosis
Cardiac failure
Nephrotic syndrome

26
Q

Possible causes of exudate ascites

A 
(exudate = albumin levels high)
Malignancy
- abdo, pelvic, peritoneal mesothelioma
Infection
- TB, pyogenic
Budd-Chiari syndrome (hepatic vein thrombosis)
Portal vein thrombosis
27
Q

What causes pale stool?

A

Low stercobilinogen

28
Q

Pre-hepatic causes of jaundice

A

Haemolysis
Defective conjugation
Gilbert’s syndrome (decreased glucuonidation)

=> unconjugated bilirubin present

29
Q

Hepatic causes of jaundice

A

Hepatitis
- alcohol, autoimmune, drugs, viral

=> conjugated bilirubin present

30
Q

Post-hepatic causes of jaundice

A

CBD obstruction

  • gallstones in CBD
  • stricture
  • Ca of head of pancreas

=> conjugated bilirubin present

31
Q

Which types of jaundice may also have dark urine and/or pale stool?

A

Hepatic => dark urine

Post-hepatic => dark urine and pale stool

32
Q

Which proteins are high in pancreatic cancer?

A

ALP and alpha-fetoprotein

33
Q

Possible ddx of bloody diarrhoea

A

Infective colitis
Inflammatory colitis (young, extra-GI manifestations)
Ischaemic colitis (elderly, high lactate)
Diverticulitis, malignancy

34
Q

Which bacteria commonly cause infective colitis?

A 
C ampylobacter
H aemorrhagic E Coli
E ntamoeba histolytica
S almonella
S higella
35
Q

What would you see in an abdo X-ray for the following conditions:

a) inflammation,
b) toxic megacolon,
c) overflow, spurios diarrhoea?

A

a) thickening of bowel wall, thumb print
b) dilated loops of large bowel
c) faecal loading

36
Q

How would you manage an acute GI bleed?

A 
ABCDE
IV access
Fluids
G&S, X-match blood
OGD
37
Q

Which drugs are used to treat variceal bleeds?

A

Antibiotics (evidence of reduced mortality)

Terlipressin (splanchnic vasoconstrictor)

38
Q

Which ix would you take for an acute abdo presentation?

A

Bloods: FBC, U&E, LFTs, CRP, clotting, G&S, X-match
Erect CXR
CT

39
Q

What mx would you do for an acute abdo presentation?

A 
NBM
Fluids
Analgesic
Anti-emetics
Antibiotics
Monitor fluids and urine output
40
Q

What specific ix would you do for the following PCs:

a) jaundice
b) dysphagia, wt loss
c) PR bleed, wt loss?

A

a) Bloods (FBC, LFTs, CRP) and abdo USS (after fast as gallstones better visualised)
b) OGD + biopsy
c) Colonoscopy

41
Q

How is ascites managed?

A

Diuretics (spironolactone and/or furosemide)
Dietary Na+ restriction
Fluid restriction in pt w/hyponatraemia
Monitor wt daily
Therapeutic paracentesis (with IV human albumin)

42
Q

What is SAAG?

A

Serum albumin ascites gradient:

serum albumin - ascites albumin

43
Q

What are ddx when SAAG > 11g/L?

A

Cirrhosis
Cardiac failure
Budd-Chiari syndrome

44
Q

What are ddx when SAAG < 11g/L?

A

TB
Cancer
Nephrotic syndrome

45
Q

What causes SAAG to increase?

A

Portal hypertension -> increase in hydrostatic pressure -> more fluid leaves circulatory system -> enter peritoneal space causing ascites -> albumin too large molecule to pass membrane -> serum albumin concentrated

tl;dr more water in peritoneal space, more albumin in vasculature

46
Q

How do you manage encephalopathy?

A 
Lactulose
Phosphate enemas
Avoid sedation
Treat infections
Exclude GI bleeds
47
Q

What are complications of post-op care?

A 
Wound infection
- erythematous
- discharge
Anastomotic leak
- diffuse abdo tenderness
- guarding, rigidity
- hypotensive/tachycardic
Pelvic abcess
- pain, fever, sweats, mucus diarrhoea
48
Q

Compare two perianal diseases pc and mx

A 
Perianal abcess
- tender, red swelling
- incision + drainage
Anal fissure
- rectal pain (defecation)
- stool coated w/blood
- GTN cream
- advice re diet (fluids, fibre)
49
Q

What is a typical hx of IBS?

A 
Recurrent abdo pain, bloating
Improves w/defecation
Change in freq./form of stool
No PR bleed, anaemia, wt loss or nocturnal sx
Exclude coeliac
50
Q

How is IBS managed?

A 
Diet + lifestyle modification
Symptomatic rx
- abdo pain: anti-spasmodics
- laxatives for constipation
- anti-diarrhoeals

DPD 2020 (6 decks)

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