Abdominal

Question 1

75 year old man
• Epigastric pain
• Back pain
• High HR
• Low BP - haemodynamically compromised

Diagnosis?

Answer 1

Ruptured aortic aneurysm

Question 2

Classic test in chronic pancreatitis?

Answer 2

Normal amylase

Faecal elastase

Question 3

What endocrine disorder can someone with chronic pancreatitis present with?

Answer 3

Diabetes - loss of pancreatic endocrine function

Question 4

What is mesenteric adenitis, in whom does it present and where in the body?

Answer 4

• Inflamed mesenteric lymph nodes
• Children
• RIF

Question 5

What does the superior mesenteric artery supply?

Answer 5

• Small intestine
• Ascending (right) colon
• 2/3 of transverse colon

Question 6

What does the inferior mesenteric artery supply?

Answer 6

Descending (left) colon

Question 7

65 year old man
• AAA repair 2 days ago
• Diffuse abdominal pain
• High HR
• High RR

What is likely to be seen on a blood test?

Answer 7

High amylase

Seen in any cause of acute abdominal pathology

Question 8

Neutrophil count consistent with SBP?

Answer 8

Ascites neut ≥ 250 cells/mm^3

Question 9

Causes of transudative ascites (with SAAG)?

Answer 9

• Cirrhosis (> 11)
• Cardiac failure (> 11)
• Budd-Chiari syndrome - portal vein thrombosis (> 11)
• Nephrotic syndrome (< 11)

Question 10

Causes of exudative ascites (with SAAG)?

Answer 10

• Malignancy
• Infection e.g. TB

< 11

Question 11

Cause of pale stool in jaundice?

Answer 11

Low stercobilinogen

• Obstructive, post-hepatic jaundice
• No conjugated bilirubin / urobilinogen for bacteria to turn brown

Question 12

Syndrome with mild pre-hepatic jaundice caused by unconjucated bilirubin?

Answer 12

Gilbert’s syndrome

haemolysis is also pre-hepatic

Question 13

Cause of dark urine in jaundice?

Answer 13

Conjugated bilirubin leaking out of hepatocytes

hepatic jaundice

Question 14

Which enzyme conjugates bilirubin?

Answer 14

Glucuronyltransferase

Question 15

Symptom of hepatic jaundice?

Answer 15

Dark urine

Question 16

Symptoms of post-hepatic jaundice?

Answer 16

Dark urine and pale stool

Question 17

3 causes of post-hepatic jaundice?

Answer 17

• Gallstones in common bile duct
• Stricture
• Cancer of head of pancreas

Question 18

• Painless jaundice
• Weight loss
• Dark urine
• Pale stool

Which 2 things would you expect to see elevated in a blood test?

Answer 18

• ALP - raised in obstruction

* CA19-9

Question 19

Causes of bloody diarrhoea (5)

Answer 19

• Infective colitis (Campylobacter, Haemorrhagic E. coli, Entamoeba histolytica, Salmonella, Shigella)
• Inflammatory colitis - young, extra-GI manifestations
• Ischaemic colitis - elderly
• Diverticulitis
• Malignancy

Question 20

What blood tests would be abnormal in ischaemic bowel problems?

Answer 20

• Lactate

* CK

Question 21

What is a feature of inflammation on AXR?

Answer 21

Thumb printing - thick haustral folds

Question 22

What is a feature of UC in barium enema?

Answer 22

Lead pipe colon - featureless abdomen

Question 23

Diameter in toxic megacolon?

Answer 23

> 6cm

Question 24

Management of acute GI bleed, and what would you add in a variceal bleed?

Answer 24

• ABC
• IV access
• Fluids
• G&S, X-match blood
• OGD

Variceal:
+ ABx
+ Terlipressin

Question 25

Which LFTs go up in hepatocyte damage?

Answer 25

AST and ALT

Question 26

AST and ALT in paracetamol overdose and in alcoholic hepatitis?

Answer 26

* PO - in 1000s | * Alcoholic hepatitis - AST:ALT = 2:1

Question 27

Treatment for acute abdomen?

Answer 27

* NBM * IV fluids * Analgesia * Anti-emetics * ABx * Monitor vitals + urine output

Question 28

Patient presents with (jaundice has) ABNORMAL LFTs. What is the next investigation and why?

Answer 28

Abdominal USS - after fast • Better visualisation of gallstones in a distended gallbladder

Question 29

Patient presents with dyphagia and weight loss. What is the next investgation?

Answer 29

OGD + biopsy

Question 30

Patient presents with PR bleed and weight loss. What is the next investigation?

Answer 30

Colonoscopy

Question 31

Treatment for ascites?

Answer 31

* Spironolactone ± furosemide * Sodium restriction * Fluid restriction if hyponatraemia * Monitor weight daily * Therapeutic paracentesis

Question 32

Treatment for encephalopathy, what do you avoid and what do you need to treat/exclude?

Answer 32

* Lactulose * Phosphate enemas * Avoid sedatives * Treat infections and exclude GI bleed - high protein meal for bacteria

Question 33

Features of a pelvic abscess e.g. post-appendectomy ?

Answer 33

* Pain * Fever * Sweats * Mucus diarrhoea

Question 34

Patient who has just had surgery presents with: • diffuse abdominal tenderness • guarding • hypotensive/tachycardic Cause?

Answer 34

Anastomotic leak | peritonitis

Question 35

Treatment of perianal abscess?

Answer 35

Incision and drainage

Question 36

Presentation and treatment of anal fissure?

Answer 36

* Rectal pain (on defaecation) * Stool coated with blood * Advice - fluids, fibre * GTN cream

Question 37

Presentation of IBS and what do you not see and what should you particularly exclude?

Answer 37

* Recurrent abdominal pain * Bloating * Relieved with defecation * Change in frequency and form of stool * No PR bleeds, no anaemia, no weight loss, no nocturnal symptoms * Exclude Coeliac disease

Question 38

Treatment of IBS?

Answer 38

Diet and lifestyle modification Symptomatic treatment • Pain - anti-spasmodics • Constipation - laxatives • Diarrhoea - anti-diarrhoeals