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DPD > medical causes of abdominal pain > Flashcards

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
Q

bristol stool chart

A
26
Q

mechanisms of diarrhoea

A

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
Q

what is overflow diarrhoea

A

become so constipated that they get overflow diarrhoea – liquid squeeze around the constipated stool

28
Q

what is dysentry

A

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
Q

causes of diarrhoea

A

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
Q

GI infections causing diarrhoea

A

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
Q

clostridium difficile diarrhoea

A

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
Q

what is malabsorption

A

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
Q

clincal features of malabsorption

A

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
Q

mx of malabsorption

A

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
Q

what malabsorption does pancreatitis/pancreatic cancer cause

A

fat

ca

B12

36
Q

what malabsorption does coeliac disease cause

A

iron

B12

folate

fat

ca

37
Q

what malabsorption dose crohn’s disease form

A

b12

bile salts

38
Q

what malabsorption does infective/post-infective causes form

A

fat

folate

39
Q

what type of malabsorption does bacterial overgrowth form

A

combined

40
Q

causes of malabsorption

A

biliary obstruction

tropical sprue

parasites

short bowel

resection - gastric, pancreatic, terminal ileal

rare - CF, lymphoma, Whipple’s, thyrotoxicosis, ZE, amyloidosis, mesenteric ischemia, mastocytosis

41
Q

non-invasive tests to determine whether malabsorption is intestinal or pancreatic

A

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
Q

tests for intestinal causes of malabsorption

A

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
Q

what is lactulose breath test

A

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
Q

commonest causes of malabsorption

A

chronic pancreatitis

coeliac disease

crohn’s disease

post-infective

45
Q

what are IBD

A

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
Q

microscopic colitis

A

common

dont need surgery

no risk of cancer

47
Q

behcet’s

A

recurrent oral and genital ulcer

in gut in 20% cases

in turkey and fertile crescent

48
Q

ddx of UC

A

amoebic olitis

49
Q

ddx of crohn’s

A

yersinia

TB

50
Q

ddx of crohn’s and UC

A

behcet’s

vasculitis

51
Q

sx of inflammation in colon

A

bleeding

mucus

urgency

diarrhoea (constipation if just rectum involved)

52
Q

sx of small bowel inflammation

A

abdo pain

wht loss

tiredness/lethargy

diarrhoea

abdo mass because of loop of matted bowel

53
Q

sx of perianal inflammation

A

anal pain

leakage

difficulty passing stool

54
Q

extra-intestinal sx of IBD

A

arthrits - axial = ankylosing spondylitis, peripheral

skin - erythema nodosum, pyoderma gangrenosum

eyes - anterior uveitis, episcleritis/iritis

liver - PSC, autoimmune hepatitis

55
Q
A

pyoderma gangrenosum

this is sterile

56
Q

how do you dx active IBD

A

stool cultures

inflammatory markers

fecal calprotectin

rectal biopsy

bloods - malabsorption, Hb

ddx

  • infection - amoebic, yersina/c diff
  • appendicitis
  • bacterial overgrowth
  • bile salt malabsorption
57
Q

acute severe colitis

A

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
Q

problem with toxic megacolon

A

risk of perf

= peritonitis

= death

59
Q

Mx of acute severe colitis

A

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
Q

toxic megacolon

A

such substantial inflammation in colonic wall = failure of peristalsis – gas dilates = toxic megacolon

DPD (38 decks)

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