stomach, pancreas, liver and gallbladder conditions Flashcards
what is appendicitis?
inflammation of the appendix
what are the s&s of appendicitis?
generalised pain around the umbilicus (moves to the R iliac fossa)
decreased appetite
fever, nausea, sweating
what aggravates the pain in appendicitis?
moving
coughing
what examination findings will you find in appendicitis?
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
what is cholycistitis?
inflammation of the gallbladder
what is the cause of cholecystitis?
gallstones
what is biliary colic?
non-inflammatory damage of the gallbladder due to gallstones (no signs of fever)
what is the most common content of gallstones?
cholesterol
what are s&s of biliary colic?
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
what are s&s of cholycistitis?
continuous epigastric or RUQ pain
vomiting, fever
local peritonism
gallbladder mass
+ve murphy’s sign
what are s&s of both cholecystitis and biliary colic?
r upper quadrant pain
pain worse with fatty meals
signs of fever (only in cholecystitis)
what examination findings will you find in cholecystitis and biliary colic?
murphy sign (hand under ribcage of patient, pt breaths in +ve when pain on R but not on L)
what are the risk factors for gallstones?
female
>40
obesity
high fat/ low fibre diet
decreased gallbladder motility
multiparity
diabetes
cystic fibrosis
prolonged fasting
what area can pain coming from the gallbladder be referred to?
the shoulder tip
what is are the functions of the liver?
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
what is hepatitis?
viral hepatitis or inflammation of the liver caused by any hepatitis viruses
how are hepatitis A and E transmitted?
via faecal or through the oral route and tend to lead to an acute disease
how are hepatitis B and D transmitted?
via blood or bodily fluids and can lead to chronic liver disease and cirrhosis
what is cirrhosis (non-alcohol fatty liver disease)?
fatty degeneration and scarring of the liver due to chronic irritation of toxins (eg drugs), alcohol or glucose
what are the s&s of cirrhosis?
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
what are the possible causes of ascites?
cirrhosis
malignancy
heart failure
protein losing enteropathy
tuberculosis
pancreatitis
what is portal hypertension?
fibrosis and scarring of the liver lead to increased vascular resistance also called portal hypertension
what are the most common signs of liver failure?
jaundice
spider naevi
palmar erhythema
bruising
clubbing
hepatomegaly and a nodular liver
oedema/ascites
gynaecomastia
what is jaundice?
the yellow discolouration caused by bilirubin accumulation in the tissue
what is coeliac disease?
allergic reaction to gluten
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
what are patients with coeliac disease more at risk for?
peripheral neuropathies
osteoporosis (poor Ca2+ and vit D absorption)
what investigation is done for coeliac disease?
endoscopy and bioscopy
serology (IgA antibodies/tissue tranglutaminase (TTG))
bone density
what is diverticular disease?
conditions caused by diverticula (small pouches within the gut wall)
what are s&s of diverticular disease?
low abdominal pain (usually L iliac fossa)
bloating and constipation
nausea and vomiting
possible rectal bleeding
what are exacerbating and relieving factors of diverticular disease?
exacerbated: eating
relieving: defecation and flatus
what is diverticulosis?
diverticula without symptoms
what is diverticular disease?
diverticula with symptoms
what is diverticulitis?
inflamed diverticula (fever, tachycardia etc)
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
what is an ectopic pregnancy?
a pregnancy outside the uterus (usually fallopian tubes)
what are s&s of ectopic pregnancy?
pain on side of abdomen/groin
vaginal bleeding
diarrhoea and pain on defecation
shoulder tip pain
what is endometriosis?
endometrial tissue (uterine lining) occurring in sites other than the uterus
what are the s&s of endometriosis?
period pain
cyclical pelvic pain
dyspareunia (pain during intercourse)
LBP
difficulty getting pregnant
what is the cause of GORD?
lower oesophageal sphincter does not close effectively (reflux of gastric acid or duodenal contents into the oesophagus)
what are risk factors for GORD?
obesity
pregnancy
smoking
stress and anxiety
hiatal hernia
what are s&s of gastro-oesophageal reflux (GORD)?
heart burn
unpleasant taste in mouth
bloating/nausea
what is the management for GORD?
reduction of causes
eating smaller and more frequent meals
anti-acids
what is a hiatal hernia?
upper stomach (fundus) herniates through the diaphragm, into the mediastinum
what are s&s of hiatal hernia?
mostly asymptomatic
GORD (heart burn)
difficulty or pain during swallowing
which two conditions does inflammatory bowel disease consist of?
ulcerative colitis
Crohn’s disease
what is ulcerative colitis?
inflammation of the rectum and colon
what is crohn’s disease?
lifelong condition where parts of the digestive system become inflamed
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)
what are the diagnostic tests for IBD?
blood tests: FBC, ESR, CRP, irons studies and vit B12 and folate
faecal calprotectin
colonoscopy
biopsy
what are the possible treatment options for IBD?
to reduce inflammation:
- corticosteroids (prednisolone)
- 5-aminosalicylate medicines (alternative for steroids)
- immunosuppressants
what conditions are more common to occur in patients with IBD?
spondyloarthropathies
ankylosing spondylitis
reactive arthritis
enteropahtic arthritis
psoriatic arthritis
juvenile arthritis
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
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
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
what are the main function of the kidneys?
- regulate the composition of the blood by a process of filtration, reabsorption and secretion
- help regulate the blood pressure (renin/angiotensin)
- stimulate the making of red blood cells
- maintain the body’s calcium level (vit D activation)
what is the most common component of kidney stones?
calcium
what are s&s of kidney stones?
colicky abdominal pain
loin to groin pain
might mimic MSK pain
nausea
polyuria and dysuria
haematuria (painful)
what is the management for kidney stones?
<4 mm: urinated
larger stones are broken down with shockwave
what is pyelonephritis?
acute kidney infection
what is the most common cause of pyelonephritis?
urinary tract infection (UTI)
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
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
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
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
what are possible consequences of chronic kidney failure?
osteomalacia and osteoporosis (kidneys don’t activate vit D –> less bone absorption)
anaemia
oedema
what dietary recommendations are suitable for people with chronic liver disease?
low potassium (K+) diet
what is the normal function of the pancreas?
hormone production (Islets of Langerhans produce glucagon and insulin)
digestive enzyme production (acinar cells)
what happens during active pancreatitis?
digestive enzymes becomes active and start to digest the pancreas itself
what are s&s of acute pancreatitis?
acute epigastric pain
pain in upper back
nausea and vomiting
what is commonly associated with acute pancreatitis?
gallstones
what is the cause of chronic pancreatitis?
chronic irritants (eg alcohol) causes scarring and inflammation of the pancreas
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
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
what are s&s of benign prostate hyperplasia (prostate enlargement)?
poor stream
hesitance in stream
dribbling
poor bladder emptying
frequency increased
urgency increased
nocturia
what is the most common cancer type in males?
prostate cancer
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
what is a peptic ulcer?
an ulcer in the stomach wall, due to chronic irritation (by HCl)
what are the possible pathological cause of peptic ulcers?
decreased mucosal protection
increased acid production
which bacteria reduces mucosal lining and is therefor strongly associated with peptic ulcer?
H. pylori bacterio
which type of drugs reduce the mucosal lining and is strongly associated with peptic ulcers?
NSAIDs
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
what is the management for peptic ulcers?
triple therapy:
2x antibiotics + 1x protonpump inhibitor
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)
what is dyspepsia?
indigestion
what is the pharmacological management for acid suppression?
H2 receptor blockers (cometidine, rantidine, famotidine, nizatidine)
proton pump inhibitors (omeprazole, lansoprazole, pantoprazole)
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
what are proton pump mechanism stimulators?
gastrin
acetylcholine
histamine
