Year 3 - Exams > Abdominal > Flashcards

Abdominal Flashcards

(59 cards)

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1
Q

Ascites Ddx - exudate

A

(Protein > 30g/L)

  1. Infection (TB, pyogenic infection)
  2. Inflammation (pancreatitis)
  3. Malignancy (luminal, pancreas, liver, ovarian, lymphoma)
  4. Lymphoedema
  5. Hypothyroidism
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2
Q

Aetiology of ascites in CLD

A
  1. Portal HTN
  2. Hypoalbuminaemia
  3. Salt and water retention (RAAS Activation)
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3
Q

Gynaecomastia Ddx

A
  1. Physiological (puberty,elderly)
  2. Testicular failure
  3. Increased estrogen
  4. Drug-induced
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4
Q

Gynaecomastia - Testicular failure Ddx

A
  1. Klinefelter’s syndrome
  2. Viral orchitis/testicular trauma
  3. Haemodialysis
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5
Q

Gynaecomastia - increased oestrogen Ddx

A
  1. Chronic liver disease
  2. Thyrotoxicosis
  3. Oestrogen-secreting tumour
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6
Q

Gynaecomastia - Drug-induced Ddx

A

DISCO MTV

  1. Digoxin
  2. Isoniazid
  3. Spironalactone
  4. Cimetidine/calcium channel blocker
  5. Osteogens
  6. Methyldopa
  7. Tricyclics
  8. Verapamil
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7
Q

Hepatomegaly Ddx

A

BI INCH

  1. Biliary
  2. Infection
  3. Infiltrative
  4. Neoplastic
  5. Congestion (venous)
  6. Haematological
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8
Q

Hepatomegaly - infection Ddx

A
  1. Hepatitis*
  2. EBV*
  3. Malaria*
  4. Liver abscess
    * causes hepatosplenomegaly
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9
Q

Hepatomegaly - neoplasm Ddx

A
  1. Primary

2. Metastatic

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10
Q

Hepatomegaly - congestion (venous) Ddx

A
  1. RHF
  2. Tricuspid regurgitation
  3. Budd-Chiari syndrome
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11
Q

Hepatomegaly - haematological Ddx

A
  1. Lymphoma/leukaemia
  2. Myelofibrosis
  3. Sickle-cell anaemia
    All these cause hepatosplenomegaly
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12
Q

Hepatomegaly - infiltration Ddx

A
  1. Sarcoid/Amyloid*
  2. Haemochromotosis
  3. Fatty liver
    * causes hepatosplenomegaly
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13
Q

Hepatomegaly - biliary Ddx

A
  1. PBC

2. PSC

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14
Q

Splenomegaly - mild Ddx

A

GRIP

  1. Glandular fever
  2. RA (Felty’s syndrome)
  3. Infective Endocarditis
  4. Pernicious anaemia
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15
Q

Splenomegaly - moderate Ddx

A
  1. Lymphoma / leukaemia
  2. Portal hypertension
  3. Haemolytic anaemia
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16
Q

Splenomegaly - massive Ddx

A
  1. Malaria

2. Myeloproliferative (myelofibrosis, CML)

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17
Q

Smooth liver edge Ddx

A
  1. Venous congestion

2. Fatty infiltration

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18
Q

Knobbly liver edge Ddx

A
  1. Metastases

2. Cysts

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19
Q

Pulsating liver dx

A

TR

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20
Q

Tender liver edge Ddx

A
  1. Hepatitis

2. RHF

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21
Q

Liver bruit Ddx

A
  1. HCC
  2. AV malformation
  3. TIPSS
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22
Q

Peripheral IBD Signs

A
  1. Finger clubbing
  2. Mouth ulcers (especially crohn’s)
  3. Eyes - episcleritis, conjunctivitis
  4. Skin - erythema nodosum, pyoderma gangrenosum
  5. Joints - seronegative spondyloarthropathy
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23
Q

Pancreatitis - causes

A

GET SMASHED

  1. Gallstones
  2. Ethanol
  3. Trauma
  4. Steroids
  5. Mumps
  6. Autoimmune
  7. Scorpion envenomation
  8. Hyperlipidaemia/parathyroidism
  9. ERCP/surgey
  10. Drugs
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24
Q

Pancreatitis risk factors

Study These Flashcards
A
  1. Gallstones
  2. Ethanol
  3. FHx of pancreatitis
  4. High TGs
  5. Smoking
  6. CF
  7. Medications - some ABx and oestrogen
  8. Congenital - pancreas divisum
25
Biliary colic Ddx
1. Acute cholecystitis 2. Ascending cholangitis 3. Pancreatitis
26
Biliary colic investigations
1. LFT (raised ALP and bilirubin) 2. lipase/amylase normal (Ddx pancreatitis) 3. Urine normal 4. Gallbladder USS - 95% sensitive 5. CXR - normal
27
Biliary colic - management
1. Analgesia - paracetamol, NSAIDS, opioids 2. Antiemetics - omeprazole 3. Laparoscopic cholecystectomy (definitive) 4. Shockwave lithotripsy
28
Peptic ulcer disease - causes
1. NSAID usage - up to 20% in long term users 2. H. Pylori -90% 3. Acid induced 4. Chronic disease I.e. COPD, CF, CKD, cirrhosis
29
Peptic ulcer disease - risk factors
1. Aspirin, NSAIDs 2. Alcohol I.e. Gastritis 3. Smoking 4. Coffee 5. Corticosteroids
30
Duodenal vs. Gastric ulcer - history
Duodenal - Epigastric pain, relieved by antacids, ***nocturnal pain*** Gastric ulcer - Epigastric pain, relieved by antacids, *aggravated by food*, *may have anorexia*, *weight loss*, *N&V*
31
Peptic ulcer disease - red flags
1. Age > 50 2. Dysphagia 3. Early satiety 4. Vomiting 5. Jaundice 6. FHx of gastric cancer 7. Weight loss 8. GI bleed
32
Peptic ulcer disease - Ddx
1. Cholecystitis 2. Pancreatitis 3. Appendicitis 4. Gastric cancer 5. Ischemic bowel if elderly 6. IBD
33
Peptic ulcer disease - investigations
1. Trial of PPI 2. H. Pylori stool antigen 3. Gastroscopy if any red flags
34
Peptic ulcer disease - management
1. Stop NSAIDs 2. Start PPI 3. Treat H. Pylori (metronidazole, tetracycline. Bismuth, omeprazole)
35
Peptic ulcer disease - complications
1. Perforation | 2. Haemorrhage
36
AAA - risk factors
1. Smoking 2. FHx 3. Atherosclerosis 4. HTN 5. Age 6. Male
37
AAA - causes
1. 25% associated with atherosclerosis 2. Aortic dissection 3. Ehler's danlos syndrome
38
AAA - presentation
75% a symptomatic 1. Sudden onset back pain 2. Pulsatile mass 3. Hypotension
39
AAA - investigations
1. USS - sensitivity is 100% 2. CT if obese 3. Pre-op evaluation is done by CT/MRI angiogram
40
AAA - management + indication
Surgical repair 1. Pain 2. Asymptomatic & >5.4cm or enlarging
41
AAA - pre-op risk reduction
1. Stop smoking 2. Beta-blocker 3. COPD optimisation 4. Renal function optimisations
42
Types of Gallstone pathology
1. Biliary colic - transient cystic duct obstruction 2. Cholelithiasis - presence of gallstones 3. Cholecystitis - persistent cystic duct obstruction 4. Choledocholithiasis - stones in CBD 5. Ascending cholangitis - infection of the biliary tract due to bacteria ascending from duodenum
43
Gallstone - risk factors
1. Female, forty, fair skinned, FHx, fat 2. High calorie diet 3. Associated with obesity, DM, cirrhosis 4. HRT, oral contraceptive
44
Types of gallstones
1. Cholesterol | 2. Black pigment stones (bilirubin)
45
Gallstone Ddx
1. Hepatitis 2. Pancreatitis 3. Gastritis 4. Peptic ulcer disease 5. GORD 6. PID
46
Renal colic - risk factors
1. Age 2. Male 3. Congenital 4. Corticosteroids 5. Low urine volume
47
Renal colic - types of stones
1. Calcium oxalate 2. Calcium phosphate 3. Uric acid 4. Struvite 5. Cysteine
48
Renal colic - presentation
1. Sudden, severe abdominal pain 2. Unilateral flank pain (loin to groin) 3. N & V 4. Haematuria
49
Renal colic - Ddx
1. UTI | 2. Acute prostatitis
50
Renal colic - investigations
1. Non-Contrast CT Urogram (gold standard - 95% sensitivity + specificity) 2. Abdominal USS - good to rule out stones but not to find them 3. Intravenous pyelogram (good if CT not available and not pregnant) 4. MSU - haematuria 5. Urine culture 6. RFT - BUN, creatinine
51
Renal colic - management
1. Analgesia - NSAIDs are highly effective 2. Nifedipine or tamsulosin 3. Shock wave lithotripsy 4. Stent 5. Open surgery 6. Fluid - prevention
52
NSAIDs and AKI
1. Afferent arteriole constricts with NSAID use (pre-renal failure) 2. Interstitial nephritis 3. Need to monitor renal function Triple whammy: NSAID, diuretic, ACEi Monitor renal function
53
Splenomegaly - investigations
1. FBC 2. LFT 3. Echo (cardiac cause) 4. ESR - RA 5. ANA - SLE 6. Splenic USS 7. Abdominal CT 8. Gallium scan (lymphoma or infection)
54
Internal vs external haemorrhoids
Weakness of connective tissue in anorectal vessels Internal - above dentate line, painless External - below dentate line, may be painful
55
Haemorrhoids - causes
1. Constipation - straining 2. Diarrhoea 3. FHx 4. Obesity 5. Portal hypertension and ascites
56
Haemorrhoids - presentation
1. Itchiness 2. Rectal bleeding 3. Rectal pain 4. Prolapse
57
Haemorrhoids - examination
1. Inspect 2. PR exam 3. Anoscopy
58
Haemorrhoids - Ddx
1. Anal fissure 2. Abscess 3. Rectal fistula 4. Cancer 5. IBD 6. Skin tags 7. Rash
59
Ascites Ddx - transudate
(Protein < 30g/L) 1. CLD (75%) 2. CHF 3. Volume Overload 4. Hypoalbuminaemia 5. Constrictive pericarditis
Year 3 - Exams
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