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stomach, pancreas, liver and gallbladder conditions Flashcards

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1
Q

what is appendicitis?

A

inflammation of the appendix

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2
Q

what are the s&s of appendicitis?

A

generalised pain around the umbilicus (moves to the R iliac fossa)
decreased appetite
fever, nausea, sweating

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3
Q

what aggravates the pain in appendicitis?

A

moving
coughing

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4
Q

what examination findings will you find in appendicitis?

A

tenderness of McBurney’s point
rosving’s sign (palpation of L iliac fossa causes pain in R iliac fossa)
guarding
rebound tenderness
auscultation: absent bowel sound

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5
Q

what is cholycistitis?

A

inflammation of the gallbladder

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6
Q

what is the cause of cholecystitis?

A

gallstones

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7
Q

what is biliary colic?

A

non-inflammatory damage of the gallbladder due to gallstones (no signs of fever)

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8
Q

what is the most common content of gallstones?

A

cholesterol

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9
Q

what are s&s of biliary colic?

A

R upper quadrant pain with possible referred pain to the interscapular region
pain persists for 15 min to 24 hrs
nausea and vomiting
US is diagnosis of choice

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10
Q

what are s&s of cholycistitis?

A

continuous epigastric or RUQ pain
vomiting, fever
local peritonism
gallbladder mass
+ve murphy’s sign

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11
Q

what are s&s of both cholecystitis and biliary colic?

A

r upper quadrant pain
pain worse with fatty meals
signs of fever (only in cholecystitis)

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12
Q

what examination findings will you find in cholecystitis and biliary colic?

A

murphy sign (hand under ribcage of patient, pt breaths in +ve when pain on R but not on L)

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13
Q

what are the risk factors for gallstones?

A

female
>40
obesity
high fat/ low fibre diet
decreased gallbladder motility
multiparity
diabetes
cystic fibrosis
prolonged fasting

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14
Q

what area can pain coming from the gallbladder be referred to?

A

the shoulder tip

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15
Q

what is are the functions of the liver?

A

immunity against infection
regulates blood clotting
factory for proteins and cholesterol
clears blood from toxins and processes drugs
excretes waste to bile
converts excess glucose to glycogen for storage
gluconeogenesis
excretes bile for fat digestion

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16
Q

what is hepatitis?

A

viral hepatitis or inflammation of the liver caused by any hepatitis viruses

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17
Q

how are hepatitis A and E transmitted?

A

via faecal or through the oral route and tend to lead to an acute disease

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18
Q

how are hepatitis B and D transmitted?

A

via blood or bodily fluids and can lead to chronic liver disease and cirrhosis

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19
Q

what is cirrhosis (non-alcohol fatty liver disease)?

A

fatty degeneration and scarring of the liver due to chronic irritation of toxins (eg drugs), alcohol or glucose

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20
Q

what are the s&s of cirrhosis?

A

pain in RUQ and back
jaundice ( conjugated bilirubin, seen in sclera)
ascites in abdomen and ankles (due to increased plasma protein production)
nodules/enlarged liver on palpation
nail clubbing
palmar erythemia
>5 spider naevi
gynaecomastia
+ve shifting dullness test

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21
Q

what are the possible causes of ascites?

A

cirrhosis
malignancy
heart failure
protein losing enteropathy
tuberculosis
pancreatitis

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22
Q

what is portal hypertension?

A

fibrosis and scarring of the liver lead to increased vascular resistance also called portal hypertension

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23
Q

what are the most common signs of liver failure?

A

jaundice
spider naevi
palmar erhythema
bruising
clubbing
hepatomegaly and a nodular liver
oedema/ascites
gynaecomastia

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24
Q

what is jaundice?

A

the yellow discolouration caused by bilirubin accumulation in the tissue

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25
what is coeliac disease?
allergic reaction to gluten
26
what are s&s of coeliac disease?
tiredness malaise weight loss diarrhoea steatorrhea (fats in faeces) abdominal distention and pain signs of anaemia may be present
27
what are patients with coeliac disease more at risk for?
peripheral neuropathies osteoporosis (poor Ca2+ and vit D absorption)
28
what investigation is done for coeliac disease?
endoscopy and bioscopy serology (IgA antibodies/tissue tranglutaminase (TTG)) bone density
29
what is diverticular disease?
conditions caused by diverticula (small pouches within the gut wall)
30
what are s&s of diverticular disease?
low abdominal pain (usually L iliac fossa) bloating and constipation nausea and vomiting possible rectal bleeding
31
what are exacerbating and relieving factors of diverticular disease?
exacerbated: eating relieving: defecation and flatus
32
what is diverticulosis?
diverticula without symptoms
33
what is diverticular disease?
diverticula with symptoms
34
what is diverticulitis?
inflamed diverticula (fever, tachycardia etc)
35
what are s&s of colorectal cancer?
bleeding from rectum passing mucus with faeces change in bowel habit (usually more frequently) feeling of not fully emptying rectum after passing faeces persistent abdominal pains anaemia weight loss abdominal mass
36
what is an ectopic pregnancy?
a pregnancy outside the uterus (usually fallopian tubes)
37
what are s&s of ectopic pregnancy?
pain on side of abdomen/groin vaginal bleeding diarrhoea and pain on defecation shoulder tip pain
38
what is endometriosis?
endometrial tissue (uterine lining) occurring in sites other than the uterus
39
what are the s&s of endometriosis?
period pain cyclical pelvic pain dyspareunia (pain during intercourse) LBP difficulty getting pregnant
40
what is the cause of GORD?
lower oesophageal sphincter does not close effectively (reflux of gastric acid or duodenal contents into the oesophagus)
41
what are risk factors for GORD?
obesity pregnancy smoking stress and anxiety hiatal hernia
42
what are s&s of gastro-oesophageal reflux (GORD)?
heart burn unpleasant taste in mouth bloating/nausea
43
what is the management for GORD?
reduction of causes eating smaller and more frequent meals anti-acids
44
what is a hiatal hernia?
upper stomach (fundus) herniates through the diaphragm, into the mediastinum
45
what are s&s of hiatal hernia?
mostly asymptomatic GORD (heart burn) difficulty or pain during swallowing
46
which two conditions does inflammatory bowel disease consist of?
ulcerative colitis Crohn's disease
47
what is ulcerative colitis?
inflammation of the rectum and colon
48
what is crohn's disease?
lifelong condition where parts of the digestive system become inflamed
49
what are s&s of IBD?
abdominal pain diarrhoea (possible with blood or mucus) fever/malaise/weight-loss increased need to empty bowel signs of anaemia clubbing abdominal tenderness/mass inflammatory skin lesions (erythema nodosum)
50
what are the diagnostic tests for IBD?
blood tests: FBC, ESR, CRP, irons studies and vit B12 and folate faecal calprotectin colonoscopy biopsy
51
what are the possible treatment options for IBD?
to reduce inflammation: - corticosteroids (prednisolone) - 5-aminosalicylate medicines (alternative for steroids) - immunosuppressants
52
what conditions are more common to occur in patients with IBD?
spondyloarthropathies ankylosing spondylitis reactive arthritis enteropahtic arthritis psoriatic arthritis juvenile arthritis
53
what are seronegative spondyloarthroptahies?
a group of inflammatory rheumatic diseases with predominant involvement of the axial and peripheral joints. they have a high incidence in HLA-B27 but have a negative rheumatoid factor test. they include: - AS - reactive arthritis - enteropathic arthritis - psoriatic arthritis - juvenile idiopathic arthritis
54
what is osteomalacia and what is the cause?
malabsorption of vit D due to excess parathormone causing defective bone mineralisation or 'softening' of the bone
55
what is irritable bowel syndrome (IBS)?
a relapsing functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. NICE guidelines consider a IBS diagnosis if abdominal pain is either relieved by defecation, or associated with altered bowel frequency or stool from and at least 2 of the following: - altered passage of stool - abdominal bloating, distension, or hardeness - symptoms are aggravated by eating - passage of mucus rectally
56
what are the main function of the kidneys?
1. regulate the composition of the blood by a process of filtration, reabsorption and secretion 2. help regulate the blood pressure (renin/angiotensin) 3. stimulate the making of red blood cells 4. maintain the body's calcium level (vit D activation)
57
what is the most common component of kidney stones?
calcium
58
what are s&s of kidney stones?
colicky abdominal pain loin to groin pain might mimic MSK pain nausea polyuria and dysuria haematuria (painful)
59
what is the management for kidney stones?
<4 mm: urinated larger stones are broken down with shockwave
60
what is pyelonephritis?
acute kidney infection
61
what is the most common cause of pyelonephritis?
urinary tract infection (UTI)
62
what are s&s of pyelonephritis?
same s&s of kidney stones pain in loin, suprapubic bone or back hematuria fever malaise cloudy and bad smelling urine
63
what are the key symptoms of kidney failure?
blood in urine (hematuria)--> painful: infection or stone --> no pain: tumour or polycystic disease nocturia dysuria (pain on urinating) hesitance in urination poor urinary stream incontinence fever, rigors nausea and vomiting
64
what are s&s of chronic kidney disease?
malaise fatigue increased frequency and urgency of urination nocturia, haematuria and dysuria cloudy and bad smelling urine hesitancy, poort stream, incontinence
65
what are risk factors for developing chronic kidney disease?
hypertension diabetes heart failure factory for proteins and cholesterol clears blood of toxins and processes drugs excretes waste via bile converts excess glucose to glycogen for storage gluconeogenesis excretes bile for fat digestion
66
what are possible consequences of chronic kidney failure?
osteomalacia and osteoporosis (kidneys don't activate vit D --> less bone absorption) anaemia oedema
67
what dietary recommendations are suitable for people with chronic liver disease?
low potassium (K+) diet
68
what is the normal function of the pancreas?
hormone production (Islets of Langerhans produce glucagon and insulin) digestive enzyme production (acinar cells)
69
what happens during active pancreatitis?
digestive enzymes becomes active and start to digest the pancreas itself
70
what are s&s of acute pancreatitis?
acute epigastric pain pain in upper back nausea and vomiting
71
what is commonly associated with acute pancreatitis?
gallstones
72
what is the cause of chronic pancreatitis?
chronic irritants (eg alcohol) causes scarring and inflammation of the pancreas
73
what are s&s of chronic pancreatitis?
epigastric and back pain malabsorption (weight loss, diabetes) pain is worse with eating pain is relieved by leaning forward
74
what are common findings for pancreatic cancer?
jaundice pain in epigastric and left upper quadrant area pain can radiate to the back metastasis early (usually to liver and peritoneal cavity) usually diagnosed late
75
what are s&s of benign prostate hyperplasia (prostate enlargement)?
poor stream hesitance in stream dribbling poor bladder emptying frequency increased urgency increased nocturia
76
what is the most common cancer type in males?
prostate cancer
77
what are s&s of prostate cancer?
bone pain or sciatica paraplegia secondary to spinal cord compression lymph node enlargement loin pain or anuria due to ureteric obstruction lethargy (wide-spread symptoms) weight loss
78
what is a peptic ulcer?
an ulcer in the stomach wall, due to chronic irritation (by HCl)
79
what are the possible pathological cause of peptic ulcers?
decreased mucosal protection increased acid production
80
which bacteria reduces mucosal lining and is therefor strongly associated with peptic ulcer?
H. pylori bacterio
81
which type of drugs reduce the mucosal lining and is strongly associated with peptic ulcers?
NSAIDs
82
what are s&s of peptic ulcer?
epigastric pain (may pass to Tx) worse during fasting wakes patient up at night improved with eating/antacids nausea bloating, distention, flatulence pain may be felt in the thoracic spine region of a posterior ulcers is present
83
what is the management for peptic ulcers?
triple therapy: 2x antibiotics + 1x protonpump inhibitor
84
what are the complications of peptic ulcer?
hematemesis (vomiting blood due to perforation of ulcer) malena blood in stool (black) anaemia perforation (may lead to severe peritonitis --> medical emergency)
85
what is dyspepsia?
indigestion
86
what is the pharmacological management for acid suppression?
H2 receptor blockers (cometidine, rantidine, famotidine, nizatidine) proton pump inhibitors (omeprazole, lansoprazole, pantoprazole)
87
what symptoms additional to dyspepsia should be urgently referred because they can indicate gastric cancer?
chronic gastrointestinal bleeding progressive dysphagia progressive unintentional weight loss persistent vomiting iron-deficiency anaemia epigastric mass
88
what are proton pump mechanism stimulators?
gastrin acetylcholine histamine

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