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35 Cards in this Set
- Front
- Back
Questions to ask specifically regarding the Sx of pain? |
Site, Radiation, Character and Pattern (eg Colicky?), Aggravating and Alleviating factors, Frequency and Duration |
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Red Flag Q's for abdo complaint? |
Any blood in vomit? Unintended Weight loss? Early satiety? Dysphagia? Does pain suggest an MI? - radiating to jaw/down L arm? Fevers/Rigors/Chills? Blood in stool - malena or hematochezia? Bowel habits changed? Hx of polyps or Ca? |
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Dx this common disorder: Dull or burning episodic pain in epigastrium often at night waking the patient. Relieved somewhat by food and antacids |
Peptic or duodenal ulcer |
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Dx this: Chronic epigastric pain often radiating posteriorly with Nausea and Vom. Pain can be alleviated by sitting up and leaning forwards. |
Pancreatic pain |
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Dx this GIT problem: 45yo man presents with 12hr Hx of Naus and chronic epigastric/RUQ pain radiating posteriorly. Afebrile, otherwise well. |
Biliary colic |
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DDx for colicky pain in anterior abdomen? |
Cholecystitis Bowel obstruction Diverticulitis |
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DDx and brief Mgmt for this case: 45yomale presented with 12hr chronic central abdo pain 6/10 with cyclical 8/10sharp pain. Paracetamol did little. Over time pain shifted to LLQ and into Lgroin. Afebrile, developed N/V after 24hr, no change bowel habits. Headache, ?Dehydrated?. |
DDx: Diverticulitis, Renal calculi, Bowel obstruction, Volvulus, Perf bowel, Viral colitis Mgmt: Pain relief, hydration (IV), abdo CT, antibiotics, antiemetics, monitor vitals. |
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Bloody hard Dx to crack: 87yofemale BIB ambo after waking at 3am to urinate and experienced 3 episodes ofintense sweating, feeling hot and nausea on a background of 4/7 constant upperabdo pain rated 7/10 which was alleviated by remaining supine. Pt reports nochest pain or symptoms of CVD, denies fever, wt loss, vomiting, UTI, loss ofappetite. Pt suffers from GORD. |
GI Bleed from subcapsular hepatic tumour. |
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What are the 3 physiological causes of diarrhoea and their symptomology? |
1. Secretory - lumen secretion>absorption. Often caused by infection (E. coli, Staph aureas, Cholera), hormonal imbalance (VIP-secreting tumour), adenoma. Sx = fasting doesn't stop diarrhoea, it just keeps on coming! 2. Osmotic - due to excess solute drag, eg lactose intolerance. Sx - fasting will stop D. 3. Increased intestinal mobility - IBD, thyrotoxicosis, anything increasing Ach/Parasymp activity. |
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Causes of dysphagia? |
Stricture of oesophagus Carcinoma of oesophagus Eosinophilic oesophagitits Foreign body Goitre - mass effect Mediastinal tumour - mass effect Achalasia Oesophageal spasm Scleroderma Cricopharyngeal dysfunction - Zenkers diverticulum Neurological disease |
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Causes of constipation (generally)? |
Medications/drugs (eg opiates, Parasymp antags...) hypothyroidism hypercalcaemia DM Neurological - autonomic neuropathy, MS... Obstruction - cancer/polyp, abscess, diverticulum, foetus |
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3 causes of asterixes? |
Hyperbilirubinaemia Hyperureamia Hypercapnia |
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Common DDx of RUQ pain? |
Cholecystitis Biliary colic Ascending cholangitis Pancreatitis gastric ulcer choledocolithiasis (CBD stone) |
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Investigations for RUQ pain? |
Bloods: FBC, UEC, LFTs, coags, CRP (the BS test), lipase (or amylase). Imaging: CT abdo and/or U/S, CXR. If warranted - ERCP/MRCP |
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Who is at risk of cholecystitis? Hint: there is a mnemonic for this. |
The 5 F's. Fat, 40, Female, Fertile and Fare |
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Treatment for cholecystitis? |
Laproscopy - ERCP to determine patency and remove stone |
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What symptoms would differentiate cholecystitis from ascending cholangitis (AC)? |
AC = significant fever which can result in bacteraemia/septicaemia resulting in unstable vitals, reduced GCS and med emergency... better call Tim! |
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Mnemonic for causes of pancreatitis? |
I - idiopathic G - gall stones E - EtOH T - trauma S - steroids M - mumps A - autoimmune S - scorpion venom H - hyperlipid, hyperparathyroid, hypothermia E - ERCP D - drugs |
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Management of pancreatitis? |
Pain relief and fluids. ERCP to remove stone if one present. That's all. Next stop Whipple's. |
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DDx of appendicitis in: A) children B) elderly C) females D) General |
A) Meckels diverticulitis, mesenteric adenitis B) diverticulitis, carcinoma, etc C) ruptured ovarian cyst, ectopic preg D) Mesenteric adenitis, infection (colitis, gastroenteritis), UTI, adnexal/gynae (ovarian cyst), |
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3 causes of Dupuytren's contracture? |
1. Alcoholism 2. Hereditary 3. Overuse Trauma |
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Causes of hepatomegaly? |
Congenital Acquired: T - trauma I - infection - fungal/bact/parasitic/viral M - metabolic - NASH, Wilsons, alpha1 anti-tryp... M - ? O - Other C - Cardiac K - neoplastic E - endocrine D - drugs |
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Presenting complaint of diverticulitis? |
Pain - constant and rhythmical N and V D and C Fever (not always) reduced appetite distended abdo tender, palpable mass sometimes |
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Complications of diverticulitis? |
Abscess can form Obstruction of bowel - narrowing due to inflam Fistula formation - bladder or vagina to colon Perf bowel - peritonitis |
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DDx for diverticulitis? |
Ischamic bowel Bowel obstruction Cancer Volvulus IBD Infective colitis appendicitis Bowel obstruction Endometriosis Adnexal pain Ovarian cyst |
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What is the pathophys of leuconychia in liver disease? |
Hypoalbuminaemia causing opacity of the nail bed |
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Why do you check the parotid glands in a GIT exam? |
Alcoholism can cause parotid enlargement (parotiditis) |
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2 symptoms of Wilson's disease? |
Kaiser-Fleischer rings in eyes (brown/green rings around cornea) Blue Lunulae (nail root - most proximal part) |
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Causes of Splenomegally? |
Cirrhosis of liver - portal HTN Infection - CMV, malaria, EBV Haematological - Leukaemia, Lymphoma, thalasaemia, sickle cell anaemia, AI haemolytic anaemia Infiltration - Amyloidosis, Sarcoidosis Abscess |
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How do you differentiate between spleen and kidney on examination? |
On percussion spleen is dull, kidney resonant as bowel sits over top of it. Cannot get over spleen due to ribs Spleen moves inferiorly with inspiration, kidney doesn't Spleen has a palpable notch |
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What are diff types of hernias and where do they occur? |
Indirect Inguinal - abdo viscera gets into the internal deep inguinal ring then protrudes through external inguinal ring on way toward testes. This ring starts LATERAL to Mid-Inguinal point. Hernia can strangulate. Direct Inguinal - into the external ring of inguinal canal through weakened wall (in area called Hasselbach's triangle). This ring is MEDIAL to MIP. Hernia rarely strangulates Umbilical (direct) Femoral - through the femoral canal. Often strangulate. Common in women Incisional hernia - post abdo surgery - repair with mesh |
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Causes of Jaundice? |
Pre, Intra and Posthepatic. Commonly: Gallstones Infectious hepatitis Carcinoma head of pancreas Haemolytic anaemia |
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Intrahepatic causes of jaundice? |
PBC, PSC, infection, drugs, metabolic disorders, cirrhosis, HCV, HBV, neoplasm, |
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Most common causes of GI bleed in A) upper and B) lower GIT? |
A) Gastric ulcer, oesophageal varices, duodenal ulcer, gastritis, Mallory-Weiss B) Diverticulitis (60%), anorectal conditions, angiodysplasia, IBD, cancer |
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2 main types of gall bladder stones? |
Cholesterol and Pigment (bilirubin) |