Peer Teaching Flashcards
Risk factors of infective diarrhoea
Foreign travel
Poor hygiene
Overcrowding
New or different food
Causes of infective diarrhoea
Usually viral: rotavirus (children), norovirus, adenovirus
Sometimes bacterial: Campylobacter jejuni, E.coli, Salmonella, Shigella
Occasionally parasitic: Giardia lamblia, cryptosporidium
Antibiotics Associated (C diff): clindamycin, ciprofloxacin, coamoxiclav, cephalosporins
Presentation of infective diarrhoea
Blood suggests hernia
May also experience vomiting, fever, fatigue, headache and muscle pains
Diagnosis of infective diarrhoea
Stool culture
If chronic, consider sigmoidoscopy and bloods
Treatment of infective diarrhoea
Rehydration
Antibiotics
Antimotility (Loperamide)
Antiemetics (maybe)
What is a hernia
A protrusion of organ or tissue out of the body cavity that it normally lies
Causes of hernia
Muscle weakness (age, trauma) Body strain (constipation, heavy lifting, pregnancy, chronic cough)
What is an inguinal hernia
Protrusion of abdominal cavity contents through the inguinal canal
Describe Direct inguinal hernia
Bulge through weakened fascia of abdominal wall
Directly behind the superficial inguinal ring
Protrudes directly into the inguinal canal
MEDIAL to inferior epigastric vessels
Rarely enters the scrotum
In what patients is direct inguinal hernia common
Elderly men with weak abdominal muscles
Describe indirect inguinal hernia
Traverses inguinal canal
Same course as spermatic cord
Enter inguinal canal at deep inguinal ring (indirect)
LATERAL to inferior epigastric vessels
Can pass into the scrotum or labia majora
Where would you more likely see an indirect inguinal hernia
Male > female
Congenital, injury
What is a hiatus hernia
Part of the stomach herniates through the oesophageal hiatus of the diaphragm
Describe sliding hiatus hernia
Oesophageal-gastric junction slides through the hiatus and lies above the diaphragm
Symptom of sliding hiatus hernia
No symptoms other than reflux symptoms
Describe para-oesophageal hiatus hernia
Uncommon - gastric fundus rolls up through hiatus alongside the oesophagus, therefore the gastro-oesophageal junction remains below the diaphragm.
Treated via surgery.
Describe where pain is felt in appendicitis
Umbilicus to RIF
What is peritonitis
Inflammation of the peritoneum due to entry of blood, air, bacteria or GI contents (Faeces or bile)
Symptoms of peritonitis
Dull pain that becomes sharp
Pain worse on coughing or moving
Systemic symptoms and generally unwell
Causes of peritonitis
AEIOU P
A - Appendicitis: umbilicus to RIF pain
E - Ectopic Pregnancy: low abdo pain, sudden onset, tachycardia, low bp
I - Infection with TB:
O - Obstruction: colicky pain, history of abdominal surgery
U - Ulcer: epigastric pain radiating to shoulder
Peritoneal Dialysis
Investigations of peritonitis
Clinical examination: rigid and guarding, laying still
AXR: dilated bowel, flat fluid level, gas under diaphragm
Bloods: FBCs, U&Es, LFTs, clotting
Ascitic Tap: high neutrophil count
When would you suspect sepsis in peritonitis
If BP is low
What is pancreatitis
Pancreatic enzymes destroy the pancreas and possibly nearby blood vessels
Presentation of pancreatitis
Nausea and vomiting, epigastric pain radiating to the back (relieved by sitting forwards)
Cullens/Grey Turner’s
Tachycardia
Causes of pancreatitis
I GET SMASHED Idiopathic Gall stones Ethanol (alcohol) Trauma Steroids Mumps/malignancy Autoimmune Scorpion stings Hypercalcaemia/hypertriglyceridemia ERCP Drugs
Investigations of pancreatitis
High amylase, high lipase, AXR shows no psoas shadow (raised retroperitoneal fluid). CT chest/abdo
Management of pancreatitis
IV fluids and maintain electrolyte balance
Pain relief
May need bowel rest
Cause of ischaemic colitis
Low flow in inferior Mesenteric Artery
Presentation of ischaemic colitis
LLQ pain
Bloody diarrhoea
Diagnosis of ischaemic colitis
Colonoscopy
Cause of acute mesenteric ischaemia
Low flow in the Superior Mesenteric artery
Presentation of acute mesenteric ischaemia
Acute severe abdo pain, out of proportion with signs
Diagnosis of acute mesenteric ischaemia
Metabolic acidosis & high lactate
Often made on laparotomy
Management of acute mesenteric ischaemia and ischaemic colitis
Ischaemic colitis - conservative
Acute mesenteric ischaemia - Surgery to remove dead bowel
Fluid resus and antibiotics
