MedEd: GI Med/Surg Flashcards
- A 41 year old female presents with fever, RUQ pain and nausea. She has icteral sclera and is intensely shaking
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
F. Cholangitis
Charcot’s triad: Jaundice, RUQ pain, rigors
41 year old woman (Fat, female, fertile, fourty fair- gallstones)
Fever, nausea (differentiates it from biliary colic- inflammatory component)
Cholangitis: bile duct infection causing RUQ pain, jaundice and rigors
Continuous epigastric/RUQ pain
Local peritonism and raised WCC
Fever, N/V
Acute cholecystitis
Follows from stone or sludge impaction in the neck of the gall bladder
No jaundice (as CBD is not blocked- differentiates it from cholangitis)
May be Murphy’s sign positive (inspiration and stop breathing- local peritonism)
RUQ pain, radiating to the back
Jaundice
Biliary colic
Symptomatic gallstones obstructing the cystic duct or CBD- jaundice
Pain radiates to back due to diaphragm?
RUQ pain, radiating to the back
Jaundice
Biliary colic
Symptomatic gallstones obstructing the cystic duct or CBD- jaundice
Pain radiates to back due to diaphragm?
- A 65 year old man presents with severe, acute onset abdominal pain. BP: 90/60,
HR 150. Upon examination he has an expansile umbilical mass
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
D. Ruptured AAA
severe, acute onset pain
Shock (hypotension and tachycardia)- so rupture
expansile umbilical mas
Increased risk of AAA >65 y.o.
Ruptured AAA Intermittent/continuous abdominal pain Radiates to back Expansile abdominal mass Shock
Screening programme for those >65, treat if >5.5cm across
- A man presents with severe burns to 50% of his body. He is vomiting blood and is pyrexial
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
J. Curling’s Ulcer
burns (buzzword)
vomiting blood (GI bleed)
pyrexia (very unwell)
Curling’s ulcer: acute peptic ulcer of gastrum/duodenum
Complication of severe burns (reduced plasma volume–>ischaemia and necrosis of gastric mucosa)
- A man presents with central, burning abdominal pain which presents immediately after meals
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
H. Gastric ulcer
Central, burning pain (gastric source)
Post-prandial
Immediately after eating (so gastric- duodenal before meals (hungry) or at night)
Differences between Gastric and Duodenal ulcers
Gastric: immediately after meals, relieved by antacids, H. pylori
Duodenal: more common than gastric, epigastric pain before meals or at night (hungry), H. pylori
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents with central, burning abdominal pain which sometimes wakes him up at night and is can be relieved slightly by eating.
A. Diverticulitis B. Ectopic pregnancy C. Ovarian Torsion D. Ruptured AAA E. Ureteric colic F. Cholangitis G. Splenic rupture H. Gastric Ulcer I. Duodenal Ulcer J. Curling’s Ulcer K. Zollinger-Ellison syndrome L. Oesophageal Varices M. Cholecystitis
I. Duodenal ulcer
Burning pain suggests ulcer
At night or in between meals (hungry) suggests it is duodenal (gastric is worst immediately after eating)
- A man presents to A&E with a PMHx of recurrent peptic ulceration. he is now vomiting blood.
K. Zollinger-Ellison syndrome
Recurrent peptic ulcers (?multiple ulceration)
Haematemesis (frequently presents as hamaetemesis)
Zollinger-Ellison syndrome: recurrent peptic ulceration and haematemesis. Gastrin-secreting tumour from the G cells of the pancreas (60% malignant). Increase HCl in gastric antrum. Multiple ulcers throughout upper GI.
Ix: raised serum gastrin
Tx: lanzoprazole, surgical resection
