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medical causes of abdominal pain Flashcards

1
Q

sx to ask about in an abdominal pain Hx

A

SOCRATES

site - upper or lower

  • epigastic - stomach, duodenum, pancreas
  • LLQ - sigmoid colon = diverticulum
  • RLQ - appencitis, crohn’s

Waves, colicky (muscular tube contracting repeatedly due to obstruction of the tube) or constant.

All time or come and go – freq and duration

Associated sx – vom/diarrhoea etc

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2
Q

inflammatory GI causes of abdo pain

A

gastroenteritis

appendicitus

gastritis

oesophagitis

diverticulitis

crohn’s

UC

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3
Q

GI obstructive causes of abdo pain

A

hernia

intissesception

volvulus

post-surgical adhesions

tumour

severe constipation

haemorrhoids

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4
Q

vascular GI causes of abdo pain

A

embolism

thrombosis

haemorrhage

SCD - thrombotic type sx

abdominal angina - mesenteric ischemia

blood vessel compressiuon - coeliac artery compression syndrome

superior mesenteric artery syndrome

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5
Q

digestive GI causes of abdo pain

A

peptic ulcer

lactose intolerance

coeliac disease

allergies

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6
Q

bile system causes of abdo pain

A

inflammatory - cholecystitis, cholangitis

obstruction - cholelithiasis, tumours

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7
Q

liver causes of abdo pain

A

hepatitis

abscess

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8
Q

pancreatic cause of abdo pain

A

pancreatitis

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9
Q

renal and urological inflammatory causes of abdo pain

A

pyelonephritis

bladder infection

indigestion

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10
Q

onstruction causes of renal and urological abdo pain

A

kidney stones

urolithiasis

urinary retention

tumours

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11
Q

renal and urological vascular causes of abdo pain

A

left renal vein entrapment

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12
Q

gynae causes of abdo pain

A

inflammatory - pelvic inflammatory disease

mechanical - ovarian torsion

endocrinological - menstruation, mittelschmerz

tumours - endometriosis, fibroids, ovarian cyst, ovarian cancer

pregnancy - ruptured ectopic pregnancy, threatened abortion

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13
Q

abdominal wall causes of abdo pain

A

muscle strain or trauma

muscular infection

neurogenic pain - herpes zoster (dermatomal), radiculitis in Lyme disease, abdominal cutaneous nerve entrapment syndrem (ACNES), tabes dorsalis

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14
Q

referred pain in abdo

A

from thorax - pneumonia, PE, IHD, pericarditis

from spine - radiculitis

from genitals - testicular torsion (also to the back)

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15
Q

metabolic disturbance cause of abdominal pain

A

uraemia

DKA

porphyria

C1- esterase inhibitor deficiency

adrenal insufficiency

lead poisening

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16
Q

BV cause of abdo pain

A

aortic dissection

AAA

mesenteric ischemia

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17
Q

immune system cause of abdo pain

A

sarcoidosis

vasculitis

familial mediterranean fever

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18
Q

idiopathic cause of abdo pain

A

IBS - effects 20% of the population, most common cause of recurrent and intermittent abdo pain

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19
Q

dyspepsia

A

range of sx from upper GIT - >4wks - upper abdo pain ot discomfort, heartburn, gastric refluc, nausea or vomiting

related to eating

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20
Q

epidemiology fo dyspepsia

A

majority of GI GP consultations are related to dyspepsia

2% of population consult dr about dyspepsia annulay

£600 million on prescription drugs and GI endoscopy for dyspepsia/yr

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21
Q

major conditions to identify in dyspepsia

A

severe (stricturing) oesophagitis

peptic ulcer disease

oesophageal cancer

gastric cancer

?barretts oesophagus

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22
Q

Ix for dyspepsia

A

if sx and no red flag (<50, not anaemic, no dysphagia) - H pylori test and eradication

endoscopy is definite Ix

Barrett’s – surveillance – squamous -> columnar metaplasia -> dysplasia -> cancer - endoscopy and relatively few people transform

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23
Q

definition of diarrhoea

A

passage of 3 or more loose or liquid stools /day. or more frequent than normal for person

faecal weight of more tha 200g/day

acute <2wks

chronic >4wks

definitions irrelevant - pt have own idea - need accurate Hx

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24
Q

hx for diarrhoea

A

frequency

consistency

presence of blood and mucus

associated features - pain, vomiting and fever

BO at night - suggests significant physical cause, less inIBS

urgency - colitis - rectal inflammation - rush as soon as stool is in the rectum

does it flush - malabsorption – steatorrhea – if not absorbing fat its difficult to flush

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25
bristol stool chart
26
mechanisms of diarrhoea
**secretory** - cholera toxin make gut pump out a lot of salt and water into lumen -\> dehydrated **osmotic** eg hypolactasia, drugs, malabsorption – suck water into lumen, **lactase deficiency –** don’t break down lactose – osmotically active = suck water in. **lactulose (osmotic laxative**), **bile acid malabsorptipn** - bile salt in colon osmotically active = watery diarrhoea **exudative** - secretion of exudate into lumen, associated with inflammation in the mucosa. eg IBD/severe infection **abnormal motility** - IBS push things through too fast. If problem with motility too slow – bacterial overgrowth from the stasis = diarrhoea – osmotically active and water. Previous surgery mixed
27
what is overflow diarrhoea
become so constipated that they get overflow diarrhoea – liquid squeeze around the constipated stool
28
what is dysentry
diarrhoea assiciated with the passage of frank blood - associated with fever, abdo pain and vomiting mainly infective: * bacillary dysentry due to shigella, salmonella, yersinia, campylobacter or e coli * amoebic dysentry - entamoeba histolytica - hard to dx (need hot stool sample to see cysts)
29
causes of diarrhoea
Viral is the most common Giardia – upper small bowel and causes malabsorption = sig wht loss – if biopsy don’t see any changes – need to catch the giardia Coeliac – gluten enteropathy Bacterial overgrowth Microscopic colitis – only see when take biopsy. Routinely take biopsy Thyrotoxicosis – increased sweating, tachy NSAIDs – can cause small bowel problems Addisons sometimes Gastrinoma – similar path to ZE
30
GI infections causing diarrhoea
short hx precipitating event - food, contact, travel associated feaures - fever, crampy abdo pain, vom dysentry if severe multiple stool samples needed to detect bacterial infection viral difficult to dx - electron microscopy Mx - rehydration and AB (ciprofloxacin)
31
clostridium difficile diarrhoea
can cause pseudomembranous colitis associated with AB use, wipe out normal microbiome and c diff take over - more in healthcare cause mortality, esp in elderly Mx - rehydration and AB (metronidazole or vancomycin) if resistant - faecal microbial transplantation colectomy if evidence of dilation or perforation
32
what is malabsorption
failure to absorb nutrients from the bowel * failure to secrete digestive enzymes - pancreatic disease * failure to absorb through the gut wall - mucosal disease * abnormal luminal env preventing absorption - structural abnormalities, surgery, stricture single or combined nutrient abnormality
33
clincal features of malabsorption
diarrhoea steatorrhea if fat absorption pale, bulky, offensive stools difficult to flush malabsorption w/o diarrhoea suggests intestinal cause wht loss lethargy, anorexia, abdo discomfort/bloating hypoalbuminaemia, hypocalcaemia, vitamin deficiencies
34
mx of malabsorption
document the malabsorption * stool sample for fat globules * 3 day faecal fat estimation * FBC - B12, folate, Fe, ferritin * clotting - PT (vit K def) * albumin, ca, phos, ALP establish site of amalabsorption establish underlying cause institute treatment
35
what malabsorption does pancreatitis/pancreatic cancer cause
fat ca B12
36
what malabsorption does coeliac disease cause
iron B12 folate fat ca
37
what malabsorption dose crohn's disease form
b12 bile salts
38
what malabsorption does infective/post-infective causes form
fat folate
39
what type of malabsorption does bacterial overgrowth form
combined
40
causes of malabsorption
biliary obstruction tropical sprue parasites short bowel resection - gastric, pancreatic, terminal ileal rare - CF, lymphoma, Whipple's, thyrotoxicosis, ZE, amyloidosis, mesenteric ischemia, mastocytosis
41
non-invasive tests to determine whether malabsorption is intestinal or pancreatic
faecal elastase - have to have moderately severe pancreatic malabsorption for it to be +ve CT scanning/ERCP trial of therapy tTG, anti-endomysial Ab, reticulin, gliadin Ab's
42
tests for intestinal causes of malabsorption
tissue transglutaminase - coeliac, specific IgA Ab - some people deficient so miss dx in these people becomes -ve on gluten free diet jejunal/distal duodenal biopsy gold standard dx for coeliac lactulose breath test - less commonly performed barium follow through/small bowel MRI - structural abnormality, crohn's jejunal diverticulosis - bacterial overgrowth crohn's - B12 def SeHCAT scan - assess bile salt malabsorption - high negative predictive value
43
what is lactulose breath test
give 50g of lactulose unabsorbed sugar fermented by bacteria to hydrogen - absorbed into circulation and exhaled 30mls end expiratory air is collected at 20 min intervals for 3hrs and analysed for hydrogen \>20ppm is abnormal and suggests bacterial overgrowth
44
commonest causes of malabsorption
chronic pancreatitis coeliac disease crohn's disease post-infective
45
what are IBD
chronic relapsing inflammatory disorders of teh GIT UC or crohn's also include - microscopic colitis, behcet's disease, systemic vasculitis need to distinguish from infections
46
microscopic colitis
common dont need surgery no risk of cancer
47
behcet's
recurrent oral and genital ulcer in gut in 20% cases in turkey and fertile crescent
48
ddx of UC
amoebic olitis
49
ddx of crohn's
yersinia TB
50
ddx of crohn's and UC
behcet's vasculitis
51
sx of inflammation in colon
bleeding mucus urgency diarrhoea *(constipation if just rectum involved)*
52
sx of small bowel inflammation
abdo pain wht loss tiredness/lethargy diarrhoea abdo mass *because of loop of matted bowel*
53
sx of perianal inflammation
anal pain leakage difficulty passing stool
54
extra-intestinal sx of IBD
arthrits - axial = ankylosing spondylitis, peripheral skin - erythema nodosum, pyoderma gangrenosum eyes - anterior uveitis, episcleritis/iritis liver - PSC, autoimmune hepatitis
55
pyoderma gangrenosum this is sterile
56
how do you dx active IBD
stool cultures inflammatory markers fecal calprotectin rectal biopsy bloods - malabsorption, Hb ddx * infection - amoebic, yersina/c diff * appendicitis * bacterial overgrowth * bile salt malabsorption
57
acute severe colitis
consequence of IBD or pseudomembranouse colitis from c diff systemically unwell diarrhoea truelove and witts criteria * BO \>6x/day * tachycardia * pyrexia \>37.5 * anaemia
58
problem with toxic megacolon
risk of perf = peritonitis = death
59
Mx of acute severe colitis
admit ACR is there colonic dilatation or evidence of perf = surgeons resus IV hydrocortisone IV AB monitor FBC, ESR and CRP dauily if no better at 3-4 days - infliximab if no better at 5-7 - colectomy if acute deterioration - colectomy
60
toxic megacolon
such substantial inflammation in colonic wall = failure of peristalsis – gas dilates = toxic megacolon

DPD (38 decks)

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