Presentations in GI Flashcards
GI causes of epigastric pain
Duodenal/gastric ulcers, oesophagitis, ruptured AAA
Non-GI causes of epigastric pain
Pericarditis, MI, ASC, diabetic ketoacidosis
Causes of central abdominal pain
Bowel obstruction, early appendicitis, acute gastritis, acute pancreatitis, ruptured AAA, ischaemic bowel disease
GI causes of left upper quadrant pain
Splenic rupture, splenic artery aneurysm, sub-phrenic abscess, pathology from epigastric region - ulcer, acute pancreatitis, oesophagitis
Non-GI causes of left upper quadrant pain
Pneumonia, ACS, diabetic ketoacidosis
Differentials of left upper quadrant mass
Splenomegaly, Gi malignancy, ectopic kidney, transplanted kidney, incisional hernia, sebaceous cyst, lipoma
Normal pathopysiology of bilirubin
Bilirubin is the breakdown product of RBCs, it is a yellow/orange bile pigment which is excreted in urine or faeces.
What are the normal levels of bilirubin and urobilinogen present in urine
Bilirubin is absent, urobilinogen present
In disease what are the levels of bilirubin
Prehepatic absent, hepatic present, posthepatic present
In disease what are the levels of urobilinogen
Prehepatic increased, hepatic increased, posthepatic decreased or absent
What happens in pre hepatic jaundice
Results in unconjugated hyperbilirubinaemia, which is not water soluble so does not enter urine
Causes of post hepatic jaundice
PBS, PSC, gall stones, head of pancreas adenocarcinoma, cholangiocarcinoma, biliary atresia, some drugs such as steroids, sulfonylureas, nitrofurantoin, flucloxacillin, co-amoxiclav
Causes of post hepatic jaundice
Conjugation disorders - Gilberts, Crigler-Naajjar. Haemolysis - malaria or haemolytic anaemia. Drugs - contrasts or rifampicin
What happens in hepatic jaundice
Hepatocellular dysfunction resulting in conjugated hyperbilrubinaemia
Causes of hepatic jaundice
Viruses (Hep, CMV), alcohol, cirrhosis, abscess, malignancy, AIAD, Wilson’s, haemochromatosis, Budd-Chiari, Drugs (paracetemol, valproate, statins, halothane, TB antibiotics)
What happens in post-hepatic jaundice
Impaired excretion of conjugated bilirubin causes cholestasis.
Symptoms of post hepatic jaundice
Dark urine (water soluble) and pale stools (less reaches gut). Also pruritis
Causes of splenomegaly
Infections, cancer, portal hypertension, sickle cell, haemolytic anaemia, chronic inflammatory diseases
Symptoms of splenomegaly
Abdominal pain, decreased appetite, symptoms of cryptopenias, signs of underlying cause - fever, chills, night sweats
Treatment of splenomegaly
Treat underlying cause to avoid ruptured spleen - splenectomy
GI causes of RIF pain
Acute appendicitis, mesenteric addenitis, inflamed Merkles diverticulum, diverticulitis, IBD esp Crohns
Gynae causes of RIF pain
Ectopic pregnancy, ovarian torsion of cyst, PID
Male causes of RIF pain
Testicular torsion
Urological causes of RIF pain
Pyelonephritis, ureteric colic
GI causes of RUQ pain
Biliary colic, acute cholecystitis, ascending cholangitis, hepatic abscess, epigastric causes can also radiate such as ulcer, oesophagitis, acute pancreatitis
Non Gi causes of RUQ pain
ACS, right sided pneumonia, MI, diabetic ketoacidosis
Differentials for RUQ mass
Hepatomegaly, hepatic abscess, hepatic cyst, enlarged gall bladder, pancreatic cancer, right kidney, lipoma, sebaceous cyst
GI causes of LIF pain
Diverticulitis, IBD, IBS, constipation
Non GI causes of LIF pain
Pyelonephritis, renal stones
Specific male or female causes of LIF pain
Ectopic pregnancy, ovarian torsion, cyst, PID, testicular torsion
Differentials of mass in LIF
Faecal mass, cancer, diverticular abscess, undescended/ectopic testis, ovarian tumour, fibroid, transplanted kidney, ectopic kidney, lymphadenopathy, aneurysm of common/external iliac arteries, lipoma, sebaceous cyst
Urological causes of suprapubic pain
Cystitis, urinary retention
Specific male or female causes of suprapubic pain
Tseticular torsion, ectopic pregnancy, PID, ovarian torsion/cyst
Gi causes of suprapubic pain
Constipation, IBS, IBD, diverticulitis
Differentials of mass in suprapubic area
Urinary retention, bladder cancer, stone, bladder diverticulum, ovarian mass, fibroids, pregnancy, colorectal cancer, lipoma, sebaceous cyst
What is Grey Turner’s sign
Bruising along flanks indicating retroperitoneal bleeding, highly associated with acute pancreatitis
What is Cullen’s sign
Bruising around peri-umbilical area which is associated highly with pancreatitis
What is Rosving’s sign
Palpation in LIF produces pain on RIF due to appendicitis
What is Courvoiser’s sign
Painless, palpable gallbladder with jaundice
