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Amir Sam Lectures > Lecture 2 - Abdo > Flashcards

Lecture 2 - Abdo Flashcards

1
Q

What does it mean when a patient has a Right subcostal scar?

A

Possible history of biliary surgery.

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2
Q

What does it mean when a patient has a Mercedes-Benz Scar?

A

Possible history of Liver Transplant.

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3
Q

What does it mean when a patient has a midline laparotomy incision?

A

Possible history of GI/Any major Abdo surgery.

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4
Q

What does it mean when a patient has a McBurney’s Scar?

A

Possible history of appendicectomy.

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5
Q

What does it mean when a patient has a J shaped/hockey stick incision?

A

Possible history of Renal Transplant.

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6
Q

What does it mean when a patient has a ‘Low Transverse’ Scar?

A

Possible history of gynaecological surgery.

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7
Q

What does it mean when a patient has an Inguinal Scar?

A

Possible history of hernia repair/vascular access.

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8
Q

What does it mean when a patient has a Loin scar?

A

Possible history of nephrectomy.

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9
Q

What are the main causes of Hepatomegaly?

A

Cancer (Primary or Secondary)

Cirrhosis (early, usually alcoholic)

Cardiac:

  • Congestive Heart failure
  • Constrictive Pericarditis

Could also be Infiltrative, due to: fatty infiltration, haemochromatosis, amyloidosos, sarcoidosis or lymphoproliferative disease.

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10
Q

What are the main causes of Liver Disease and abnormal LFTs?

A

Alcohol

Autoimmue

Drugs

Viruses

Biliary

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11
Q

What are the causes of Splenomegaly?

A

Portal Hypertension

Haematological

Infection

Inflammation

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12
Q

What would be the most likely diagnosis if a 75yo M presents with:

Epigastric pain that radiates to the back

Tachycardia

Hypotension

?

A

Ruptured Aortic Aneurysm

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13
Q

How can Abdominal pain be classified?

A

Nature:

  • Constant (Inflammation)
  • Colicky (Obstruction)

Location

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14
Q

Name a medical cause of acute abdominal pain.

A

Addisonian Crisis

DKA

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15
Q

What would be your Ddx if a patient presents with epigastric pain?

A

Stomach:

  • Peptic Ulcer (?NSAIDs)
  • Gord (Response to antacids)
  • Gastritis (retrosternal, ?ETOH use)
  • Malignancy

Pancreas

-Acute Pancreatitis (?Gallstones, high amylase)

Hepatobilliary

  • Cholecystitis
  • Hepatitis

Other

  • AAA
  • MI
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16
Q

How does Acute Pancreatitis present?

A

Epigastric pain

High Amylase

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17
Q

How does Chronic Pancreatitis present?

A

Pain

Weight Loss

Loss of exocrine (malabsorption) & endocrine function (diabetes)

Normal Amylase, High Faecal Elastase

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18
Q

What would your Ddx be if a patient presents with RUQ pain?

A

Gall Bladder:

  • Cholecystitis
  • Cholangitis
  • Gallstones

Liver:

  • Hepatitis
  • Abscess

Other:

  • Basal Pneumonia
  • Appendicitis
  • Peptic Ulcer
  • Pancreatitis
  • Pyelonephritis
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19
Q

What would be your Ddx if a patient presented with RIF pain?

A

GI:

  • Appendicitis
  • Mesenteric Adenitis
  • Colitis (IBD)
  • Malignancy

Gynae:

  • Ovarian Cyst
  • Ectopic pregnancy
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20
Q

What would be your Ddx if a patient presented with acute suprapubic pain?

A

Cystitis

Urinary retention

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21
Q

What would be your Ddx if a patient presented with LIF pain?

A

GI:

  • Diverticulitis
  • Colitis
  • Malignancy

Gynae:

  • Ovarian Cyst
  • Ectopic Pregnancy
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22
Q

What would be your Ddx if a patient presented with diffuse abdominal pain?

A

Obstruction

Infection: Peritonitis, Gastroenteritis

Inflammation: IBD

Ischaemia: Mesenteric Ischaemia

Medical:

  • DKA
  • Addison’s
  • Hypercalcaemia
  • Porphyria
  • Lead Poisoning
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23
Q

Which artery supplies the Left Colon?

A

Inferior Mesenteric Artery

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24
Q

Which artery supplies the small intestine and right colon?

A

Superior Mesenteric Artery

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25
Q

Which artery supplies the Stomach, Spleen, Liver and Gallbladder?

A

Coeliac Artery

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26
Q

What blood abnormality is likely to be present in a patient presenting with acute, diffuse abdominal pain post-surgery?

A

High Amylase is likely to be present in all patients who present with abdominal pain.

The level will be distinctively higher in those presenting with Acute Pancreatitis.

27
Q

How is Spontaneous Bacterial Peritonitis defined?

A

Ascites Neutrophiles >250 cells/mm3

28
Q

How would you classify the causes of Abdominal Distension?

A

Fluid: Ascites (presents with shifting dullness and commonly features of liver disease.)

Flatus: Due to obstruction

Also: Fat, Faeces, Fetus, Fucking huge tumour

29
Q

How does Bowel Obstruction present?

A
  • Distension
  • Nausea, vomiting
  • Lack of bowel movements
  • High-pitched ‘tinkling’ Bowel Sounds.
  • ?Hx of abdo surgery (adhesions)
  • ?Tender irreducible femoral hernia in the groin
30
Q

What are the main causes of Ascites?

A

Cirrhosis

Cardiac Failure

Nephrotic Syndrome

Malignancy

Infection (eg. TB, pyogenic)

Budd-Chiari Syndrome (Hepatic Vein Thrombosis), portal vein thrombosis.

31
Q

What makes faeces brown?

A

Stercobilinogen

32
Q

How is jaundice classified?

A

Pre-hepatic:

  • Haemolysis
  • Defective Conjugation (Gilbert’s)

Hepatic:

-Hepatitis

Post-Hepatic:

-CBD Obstruction

33
Q

Which enzyme is defective in Gilbert’s Syndrome?

A

Glucuronyltransferase

34
Q

Which symptoms are typically present in a patient with Pre-hepatic Jaundice?

A

Just yellowing of the skin.

35
Q

Which symptoms will a patient with hepatic jaundice typically present with?

A

Yellowing of the skin

Dark Urine (leakage of conjugated bilirubin from hepatocytes)

36
Q

Which symptoms will a patient with post-hepatic jaundice typically present with?

A

Yellow skin

Dark urine

Pale stools

37
Q

What can cause post-hepatic jaundice?

A

Gallstones

CBD Stricture

Carcinoma in the head of the pancreas

38
Q

Which blood tests are likely to be elevated in a patient presenting with:

Painless Jaundice

Weight Loss

Dark Urine

Pale Stools

?

A

ALP

CA19-9

39
Q

What are the main causes of Bloody Diarrhoea?

A

Infective Colitis

Inflammatory Colitis (Patients will be younger and present with extra-GI manifestations)

Ischaemic Colitis (Typically Elderly)

Diverticulitis

Malignancy

40
Q

Which organisms most commonly cause Infective Colitis?

A

CHESS

Campylobacter

Haemorrhagic E.Coli

Entamoeba histolytica

Salmonella

Shigella

41
Q

How would you investigate a patient with bloody diarrhoea?

A

Stool Test, for infective causes

Colonoscopy, for inflammatory causes

CT & AXR, for ischaemia.

Lactate & CK, for ischaemia.

42
Q

What does this AXR show?

A

Thickening of the bowel wall, most likely due to inflammatory causes.

43
Q

What does this AXR show?

A

‘Lead Pipe Colon’

Featureless colon typical of chronic UC

44
Q

What is shown in this AXR?

A

Megacolon (Toxic, if the patient is acutely unwell)

45
Q

What does this AXR show in a patient who presents with diarrhoea?

A

Faecal Overload.

The Diarrhoea is Overflow Diarrhoea, which requires laxatives to treat.

46
Q

How would you manage an Acute GI Bleed (non-variceal)?

A

ABC

IV Access

Fluids - 0.9% NaCl

G&S X-match blood

OGD

47
Q

How would you manage an Acute Variceal Bleed?

A

Same as normal Acute GI Bleed

+ Antibiotics

+Terlipressin

48
Q

Which investigations would you order for a patient presenting with an Acute Abdomen?

A

FBC, U&Es, LFTs, CRP, Clotting Profile, G&S, X-Match

Erect CXR

CT

49
Q

What would be the first line management for a patient being investigated for an Acute Abdomen?

A

Nil-by-Mouth

Fluids

Analgesic

Anti-emetics

Antibiotics

Monitor vitals & urine output

50
Q

How would you investigate a jaundiced patient?

A

Bloods: FBC, LFTs, CRP

Abdominal USS (after fasting)

51
Q

How would you investigate a patient presenting with Dysphagia & Weight Loss?

A

OGD & Biopsy

52
Q

How would you investigate a patient presenting with PR bleed & Weight Loss?

A

Colonoscopy

53
Q

What would be your next investigation in a patient with deranged LFTs?

A

Abdominal Ultrasound

54
Q

How would you manage a patient with Ascites?

A

Diuretics (Spironolactone +- furosemide)

Dietary Na restriction

Fluid restriction in patients with hyponatraemia

Daily weight monitoring

Therapeutic Paracentesis (with IV human albumin)

55
Q

How should you classify Ascites?

A

Serum Ascites Albumin Gradient (SAAG)

Serum Albumin - Ascites Albumin

>11g/L = Cirrhosis, Cardiac Failure

<11g/L = TB, Cancer, Nephrotic Syndrome

56
Q

How would you manage a patient with Hepatic Encepalopathy?

A

Lactulose (Increased Bowel movements helps flush toxins out, compensating for Liver Failure)

Phosphate Enemas

Avoid Sedation (eg. benzodiazepines)

Treat infections

Exclude GI bleeds (Bleeding provides toxin-producing bacteria with a plentiful supply of proteins to feast on)

57
Q

How would you identify an infected wound post-op?

A

The wound would be:

  • Erythematous
  • Would be secreting discharge
58
Q

How would you identify an Anastomotic Leak post-op?

A

Diffuse Abdominal Tenderness

Guarding, rigidity of the abdomen

?Hypotensive & Tachycardic.

59
Q

How would you identify a Pelvic Abscess post-op (commonly post-appendicectomy)?

A

Pain

Fever

Sweats

Mucous

Diarrhoea

60
Q

How would you identify and treat a Perianal Abscess?

A

Tender red swelling around the back passage.

Treat with incision & drainage.

61
Q

How would you identify an Anal Fissure?

A

Patient presents with rectal pain on defaecation.

The stool would be coated in blood.

62
Q

How would you manage a patient with an Anal Fissure?

A

Give lifestyle advice RE. Diet (Adequate fluid intake, high fibre)

GTN cream

63
Q

How would you identify a case of IBS?

A

Diagnosis of exclusion.

Bloating tends to improve with defecation.

No Red Flag symptoms:

-No PR Bleed, Anaemia, Weight loss, or Nocturnal Symptoms

-Must exclude Coeliac

64
Q

How would you treat a patient with IBS?

A

Diet & lifestyle Advice

Symptomatic treatment:

Abdominal Pain - Antispasmodics

Constipation - Laxatives

Diarrhoea - Anti-Diarrhoeals

Amir Sam Lectures (6 decks)

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