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PBLs > Week 15 - Abdomen > Flashcards

Week 15 - Abdomen Flashcards

1
Q

what are some causes of acute abdomen?

A

blood loss
obstructions
haematologic disorders
infection
perforation
toxins
blood flow blockage
endocrine and metabolic disorder

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2
Q

what is a mallory-weiss tear?

A

split in the inner layer of the oesophagus

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3
Q

what is cholecystitis?

A

inflammation of the gallbladder when a gallstone blocks bile from exiting

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4
Q

what are the most common causes of acute pancreatitis?

A

alcohol
gallstones

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5
Q

what is boerhaaves syndrome?

A

spontaneous rupture of the oesophagus that occurs during intense straining

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6
Q

what is buergers disease?

A

blood vessels in their legs, arms, feet and hands get inflamed, making it hard for blood to travel through.

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7
Q

what is uraemia?

A

buildup of toxins in the blood. Occurring when the kidneys stop filtering toxins out through urine

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8
Q

what is addisons disease?

A

adrenal glands don’t produce enough cortisol and aldosterone

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9
Q

what is acute intermittent porphyria?

A

porphyria is a deficiency in an enzyme that your body needs to make heme

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10
Q

what is the presentation of acute cholecystitis?

A

fever
guarding
positive Murphy’s sign (abrupt stopping of inspiration when the palpating hand meets the inflamed gallbladder descending with the liver from behind the subcostal margin on the right side -
but not on the left side).
Increased WBC and CRP.

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11
Q

what investigations are done when you suspect acute cholecystitis?

A

ultrasound of gallbladder and biliary ducts

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12
Q

what is murphys sign? when is it positive?

A

abrupt stopping of inspiration when the palpating hand meets the inflamed gallbladder descending with the liver from behind the subcostal margin on the right side -
but not on the left side

acute cholecystitis

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13
Q

what is cholangitis?

A

infection of the biliary tree

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14
Q

what is the presentation of cholangitis?

A

triad of:
- fevers
- right upper quadrant pain
- jaundice

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15
Q

what does a triad of: fevers, RUQ pain and jaundice suggest?

A

cholangitis

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16
Q

what is the presentation of a duodenal ulcer?

A

epigastric pain, dull or burning discomfort, typically relieved by food, nocturnal pain.

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17
Q

what type of ulcer has pain that is relieved by eating food?

A

duodenal ulcer

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18
Q

how is a duodenal ulcer investigated?

A

OGD, barium meal and pH study (Helicobacter pylori often present in mucosa or by serology).

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19
Q

what is the presentation of gallstone colic (with no acute inflammation or infection)?

A

jaundice
biliary colic
pain in epigastrium or RUQ radiating to right lower scapula.
No fever or increased WBC.

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20
Q

what is suggested by: jaundice, biliary colic, pain in epigastrium or RUQ radiating to right lower scapula. No fever or increased WBC?

A

gallstone colic (with no acute inflammation/infection)

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21
Q

what is the presentation of gastric carcinoma?

A

marked anorexia
fullness
pain
Troisier’s sign (a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa).

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22
Q

what is troisiers sign? what is it positive in?

A

a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa

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23
Q

what is suggested by these symptoms: marked anorexia, fullness, pain, Troisier’s sign (a Virchow’s node, i.e., large lymph node in the left supraclavicular fossa)?

A

gastric carcinoma

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24
Q

how do you investigate gallstone colic?

A

ultrasound of gallbladder and biliary ducts

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25
Q

what is the presentation of a gastric ulcer?

A

epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain.

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26
Q

what is suggested by these symptoms: epigastric pain, dull or burning discomfort, typically exacerbated by food, nocturnal pain?

A

gastric ulcer

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27
Q

which type of ulcer is exacerbated by eating food?

A

gastric ulcer

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28
Q

what is the presentation of gastritis?

A

epigastric pain, dull or burning discomfort, nocturnal pain.

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29
Q

what investigations are done in suspected gastric ulcer?

A

OGD, barium meal and pH study

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30
Q

what is suggested by these symptoms; epigastric pain, dull or burning discomfort, nocturnal pain?

A

gastritis

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31
Q

what investigations are done in gastritis?

A

OGD, barium meal and pH study.

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32
Q

what is the presentation of a hiatus hernia?

A

heartburn, worsens with stooping or lying, relieved by antacids.

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33
Q

what is suggested by these symptoms: heartburn, worsens with stooping or lying, relieved by antacids?

A

hiatus hernia

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34
Q

what investigations are done in a hiatus hernia?

A

OGD, barium meal

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35
Q

what is the presentation of oesophagitis?

A

retrosternal pain, heartburn.

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36
Q

what is suggested by these symptoms: retrosternal pain, heartburn?

A

oesophagitis

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37
Q

how is oesophagitis investigated?

A

OGD

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38
Q

what is the presentation of pancreatitis?

A

pain radiating straight through to the back, better on sitting up or leaning forward.

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39
Q

how is pancreatitis investigated?

A

increased serum amylase, CT pancreas.

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40
Q

what are the differentials for pain in the RUQ?

A

cholecystitis
pyelonephritis
ureteric colic
hepatitis
pneumonia

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41
Q

what are the differentials for LUQ pain?

A

gastric ulcer
pyelonephritis
ureteric colic
pneumonia

42
Q

what are the differentials for RLQ pain?

A

appendicitis
ureteric colic
inguinal hernia
IBD
UTI
gynaecological
testicular torsion

43
Q

what are the differentials for LLQ pain?

A

diverticulitis
ureteric colic
inguinal hernia
IBD
UTI
gynaecological
testicular torsion

44
Q

what region is the gallbladder found?

A

right hypochondrial

45
Q

where in the peritoneam does the gallbladder lie?

A

intraperitoneal

46
Q

what is the function of the gallbladder?

A

concentrate and store bile which is produced by the liver

47
Q

what is bile released in response to?

A

cholecystokinin

48
Q

what are the 3 parts of the gallbladder?

A

Fundus – the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line.
Body – the largest part of the gallbladder. It lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum.
Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree. The neck contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis.

49
Q

what duct leaves the gallbladder carrying bile?

A

cystic

50
Q

what duct is formed by the joining of the cystic and common hepatic ducts?

A

common bile duct

51
Q

What ducts join to form the common bile duct?

A

cystic
common hepatic

52
Q

what ducts join to form the hepatopancreatic ampulla?

A

common bile
pancreatic

53
Q

what regulates the major duodenal papilla?

A

sphincter of oddi

54
Q

what are the 5 parts of the pancreas?

A

ucinate process
head
neck
body
tail

55
Q

which is the only part of the pancreas that is intraperitoneal?

A

tail

56
Q

what vessels travels under the neck of the pancreas?

A

superior mesinteric vessels

57
Q

what arteries supply the pancreas?

A

pancreatic branches of the splenic artery

58
Q

what is the venous drainage of the pancreas?

A

Venous drainage of the head of the pancreas is into the superior mesenteric branches of the hepatic portal vein.
The pancreatic veins draining the rest of the pancreas do so via the splenic vein.

59
Q

what pneumonic gives the causes of pancreatitis?

A

I GET SMASHED
· Idiopathic
· Gallstones
· Ethanol (alcohol consumption)
· Trauma
· Steroids
· Mumps
· Autoimmune
· Scorpion sting
· Hyperlipidaemia
· ERCP
Drugs (furosemide, thiazide diuretics and azathioprine)

60
Q

what factors indicate severe pancreatitis?

A

· Severe epigastric pain radiating through to the back
· Associated vomiting
· Abdominal tenderness
Systemically unwell (low-grade fever, tachycardia)

61
Q

what score is used to assess the severity of pancreatitis? list out the points

A

glasgow score
PANCREAS
pao2 <8
age >55
neutrophils >15
calcium <2
uRea >16
enzymes (LDH>600, AST/ALT>200)
alnumin <32
sugar >10

0 - 1 mild
2 moderate
>3 severe

62
Q

what is the management of pancreatitis?

A

· Initial resuscitation (ABCDE approach)
· IV fluids
· Nil by mouth
· Analgesia
· Careful monitoring
· Treatment of gallstones in gallstone pancreatitis (ERCP/cholecystectomy)
· Abx - if infection present
Treatment of complications (endoscopic or percutaneous drainage of large collections)

63
Q

what are the complications of pancreatitis?

A

· Necrosis of the pancreas
· Infection in a necrotic area
· Abscess formation
· Acute peripancreatic fluid collections
· Pseudocysts - can develop 4 weeks after acute pancreatitis
Chronic pancreatitis

64
Q

what are the 2 types of gallstones?

A
  • Cholesterol stones are made of hardened cholesterol and comprise 80% of all gallstones.
    Pigment stones are small dark stones made of bilirubin - pigment stones can be subdivided into brown and black pigment stones.
65
Q

what are the risk factors for gallstones?

A

Risk Factors are the 5 Fs
* Fat
* Female
* Forty
* Fertile
Family History

66
Q

what is obstructed in cholecystitis?

A

opening of cystic duct by a stone

67
Q

what is obstructed in cholangitis?

A

common bile duct .: no bile can travel at all

68
Q

what factors can make a patient higher risk for surgery?

A

obesity = harder to safely administer anaesthesia
age = anaesthesia side effects
smoking
sleep apnoea
diabetes = stress of surgery increases blood sugar, fasting may lead to hypoglycaemia

69
Q

what factors make anaesthesia riskier?

A
  • Allergies to anaesthesia or a history of adverse reactions to anaesthesia
    • Diabetes
    • Heart disease (angina, valve disease, heart failure, or a previous heart attack)
    • High BP
    • Kidney problems
    • Lung conditions (asthma and COPD)
    • Stroke
      Seizures
70
Q

what are common adverse effects of general anaesthesia?

A

N+V
sore throat
shock
bleeding
wound infection
DVT/PE
lung problems
urinary retention

71
Q

what are some significant risks of general anaesthesia?

A
  • Accidental awareness (waking during the anaesthetic)
    • Aspiration
    • Dental injury, mainly when the laryngoscope is used for intubation
    • Anaphylaxis
    • Cardiovascular events (e.g., myocardial infarction, stroke and arrhythmias)
    • Malignant hyperthermia (rare)
    • Death
72
Q

what is malignant hyperthermia?

A

Increased body temperature (hyperthermia)
Increased carbon dioxide production
Tachycardia
Muscle rigidity
Acidosis
Hyperkalaemia

hypermetabolic response to anaesthesia

73
Q

how is malignant hyperthermia treated?

A

dantrolene
interrupts the muscle rigidity and hypermetabolism by interfering with the movement of calcium ions in skeletal muscle.

74
Q

how do you perform a nutritional assessment?

A

ABCDE
Anthropemetry = measurements for different components of the body
Biochemistry = blood tests
Clinical = symptoms theyre feeling and comorbidities
Diet = energy, fluid and dietary requirements
Environment = social and physical factors

75
Q

what is rapid sequence induction/intubation?

A

used to gain control over the airway as quickly and safely as possible where a patient is intubated in an emergency scenario and detailed pre-planning is not possible.

It is also used in non-emergency situations where the airway needs to be secured quickly to avoid aspiration, such as in patients with gastro-oesophageal reflux or pregnancy.

76
Q

what is the triad of general anaesthesia?

A

hypnosis = used to make the patient unconscious. They can be either given intravenously or by inhalation.

muscle relaxation = block the neuromuscular junction from working. Acetylcholine (the neurotransmitter) is released by the axon but is blocked from stimulating a response from the muscle. Muscle relaxants are given to relax and paralyse the muscles. This makes intubation and surgery easier.

analgesia

77
Q

what are the options for IV and inhaled hypnotic agents in general anaesthesia?

A

Intravenous options for a general anaesthetic include:
* Propofol (the most commonly used)
* Ketamine
* Thiopental sodium (less common)
* Etomidate (rarely used)

Inhaled options for a general anaesthetic include:
* Sevoflurane (the most commonly used)
* Desflurane (less favourable as bad for the environment)
* Isoflurane (very rarely used)
* Nitrous oxide (combined with other anaesthetic medications – may be used for gas induction in children)

78
Q

what are the 2 categories of muscle relaxants used in general anaesthesia?

A
  • Depolarising (e.g., suxamethonium)
    Non-depolarising (e.g., rocuronium and atracurium)
79
Q

what types of nutritional support techniques are there?

A
  1. Food fortification- adding nutrients to food
    1. Total enteral tube feeding- NG tube
  2. Parenteral nutrition- Delivery of nutrition into the blood stream
80
Q

what are the indications for food fortification?

A
  1. intake of nutrient is below desirable level
  2. food is still consumed in quantities that will make a significant contribution to diet
81
Q

what are the indications for total enteral tube feeding?

A

patient who cannot tolerate adequate oral intake to meet metabolic demand

82
Q

what are the indications for pareteral nutrition?

A

patients that have condition that impairs food intake, nutrient digestion or absorbtion
e.g. short bowel syndorme, GI fistula, bowel obstruction, acute pancreatitis

83
Q

when is GGT commonly raised?

A

after drinking alcohol

84
Q

what do investigations show in pre-hepatic jaundice?

A

LFTs normal
bilirubin high

85
Q

what are some types of prehepatic jaundice?

A

gilberts syndrome
haemolytic anaemia

86
Q

what do investigations show in hepatic jaundice?

A

ALT and AST high
released from breakdown of liver cells

87
Q

what are some causes of hepatic jaundice?

A

viral hepatitis
EBV
CMV
autoimmune
drug toxicity
alcohol
hereditary diseases

88
Q

what do investigations show in post hepatic jaundice?

A

GGT and ALP raised
obstructive jaudice

89
Q

what are some causes of post hepatic jaundice?

A

gall stones
anything obstructing the biliary tree e.g cancers, pancreatic cancer
biliary sclerosis

90
Q

how do you assess for alcohol withdrawal?

A

CAGE questionairre
CIWA score to assess for symptoms

91
Q

what type of bacteria is h.pylori?

A

gram -ve
rod shaped

92
Q

what is the treatment for h.pylori?

A

2 antibiotics and a PPI

93
Q

what drug is used in refeeding syndrome?

A

pabrinex

94
Q

what is the first line therapy for ulcerative colitis?

A

IV hydrocortisone

95
Q

what are some risk factors for GORD?

A

alcohol
poor diet
stress
obesity

96
Q

what factors require urgent upper GI investigation?

A

malena
coffee ground vomit
dysphagia
weight loss
>55

97
Q

what are the treatments for GORD?

A

PPI
antacids
H2 antagonist
lifestyle advice

98
Q

what are some complications for GORD?

A

barrets oesophagus
oesophageal adenocarcinoma
strictures
aspiration

99
Q

what investigations should be done in a paracetemol overdose?

A

paracetemol levels
LFTS (would increase transaminases - hepatic jaundice)
renal function
abg
clotting factors
albumin
glucose

100
Q

what is the initial treatment for a paracetamol overdose?

A

activated charcoal

PBLs (19 decks)

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