Term
| what are sister mary joseph nodes and in which condition might they be seen? |
|
Definition
this is periumbillical lymphadenopathy
it may be seen in cholangiocarcinoma |
|
|
Term
| exam question features of cholangiocarcinoma |
|
Definition
persistent biliary colic symptoms associated with nausea and weight loss
palpable mass in RUQ (courvoisiers law)
periumbilical lymphadenopathy (sister mary joseph nodes)
supraclavicular adenopathy (virchow node) may be seen |
|
|
Term
| which part of c diff causes psuedomembranous colitis? |
|
Definition
|
|
Term
|
Definition
raised white cell count is characteristic
diarrhoea
abdo pain
if severe; toxic megacolon may develop |
|
|
Term
| how long do you give po metronidazole for in c diff? |
|
Definition
|
|
Term
| which test do you use for test of cure after h pylori eradication? |
|
Definition
| carbon 13 urea breath test |
|
|
Term
| what is h pylori associated with? |
|
Definition
duodenal ulcers (strongest association)
gastric adenocarcinoma
atrophic gastritis |
|
|
Term
| h pylori eradication therapy? |
|
Definition
7 day course
PPI amoxicillin and clarithromycin
PPI metronidazole and clarithromycin |
|
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Term
|
Definition
ABC wide bore IV access x 2
platelet transfusion if actively bleeding and platelets are < 50 x 10^9
if fibrinogen is < 1g/litre of INR or APTT are > 1.5 normal then give FFP
prothrombin complex to pts who are taking warfarin and actively bleeding. |
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Term
pt is in a hypercoagulative state (antiphospholipid syndrome, polycythemia rubra vera, pregnancy, COCP) and presents with sudden onset, severe abdo pain ascites tender hepatomegaly what are you thinking?
triad of
abdominal pain
ascites
hepatomegaly |
|
Definition
|
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Term
| a nurse gets her Hep B immunisatisation. levels of what need to be checked 4 months later to ensure an adequate response? |
|
Definition
|
|
Term
who definition of diarrhoea
what is acute and chronic diarrhoea? |
|
Definition
diarrhoea: > 3 watery loose stools per day
acute diarrhoea < 14 days.
chronic > 14 days |
|
|
Term
| conditions causing acute diarrhoea |
|
Definition
| gastroenteritis diverticulitis overflow from constipation Abx therapy |
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|
Term
| conditions causing chronic diarrhoea |
|
Definition
|
|
Term
| you measure ca 125 marker in a woman who is 65 and presents with IBS like symptoms. this is because it is rare for IBS to present for the first time in this age. what must the ca 125 level be above for you to order an US of the abdomen? |
|
Definition
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|
Term
MEN type 1 - REMEMBER 3 Ps
also commonest presentation is hypercalcemia
also adrenal and thyroid problems
what does 3Ps stand for? |
|
Definition
parathyroid
pituitary
pancreas |
|
|
Term
MEN Type 11a
what are the organs involved? |
|
Definition
medullary thyroid cancer
phaeochromocytoma
pituitary |
|
|
Term
| what is considered a staggered OD? |
|
Definition
| if all the tablets have not been taken within 1 hour |
|
|
Term
|
Definition
excessive accumulation of fluid in the abdominal cavity
for fluid to be detectable there has to be at least 1500ml present |
|
|
Term
|
Definition
cirrhosis
malignancy: GI, colon, ovary
cancer of ovary ovarian:meigs syndrome
infections: TB
HF
nephrotic syndrome
pancreatitis |
|
|
Term
on palpation of a man with ascites you feel a firm nodule in his protruding umbilicus.
what is this and what is the cause? |
|
Definition
this is a sister mary joseph node
suggests peritoneal cancer originating from gastric, hepatic or pancreatic primaries |
|
|
Term
| at least 1500ml fluid must be present for shifting dullness in ascites but USS detects much less fluid. how much? |
|
Definition
|
|
Term
|
Definition
conservative: slat restriction <5.2g salt/day useful in cirrhosis but not if it is due to cancer.
medical: spirinolactone; can be increased to 400mg a day: measure K+ as can cause it to rise
surgical: paracentesis. if pt needs >3 taps a month then consider TIPSS |
|
|
Term
|
Definition
hyponatremia on diuretics (esp if loop ones are used)
SBP
hepatorenal syndrome |
|
|
Term
how would you diagnose SBP in ascites?
mx for SBP? |
|
Definition
do a paracentesis and SBP confirmed if
neutrophil count is >250 cell/ul
mx: IV cefotaxime |
|
|
Term
SA-AG >11g/L
likely causes? |
|
Definition
cirrhosis
cardiac failure
nephrotic syndrome |
|
|
Term
SA-AG < 11g/L
likely causes? |
|
Definition
|
|
Term
| what can withdrawal of 5 litres or more fluid from ascites cause? |
|
Definition
post paracentesis circulatory dysfunction
characterised by:
AKI
hyponatremia
increased plasma renin activity
if removing 5 litres or more ascitic fluid albumin should be replaced by infusion at 8g per litre of ascites removed. |
|
|
Term
benign ovarian tumour
pleural effusion
ascites
what syndrome am i? |
|
Definition
|
|
Term
| associations for sigmoid volvulus |
|
Definition
older pts
chronic constipation
chagas disease
neuro e.g. parkinson's disease, duchess muscular dystrophy
psychiatric disease: schizophrenia |
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|
Term
|
Definition
|
|
Term
| definition of hernia : learn off by heart |
|
Definition
| profusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. |
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|
Term
what type of hernia am i??
i protrude above and medial to pubic tubercle and strangulation is rare. more common in men |
|
Definition
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|
Term
what type of hernia am i?
i protrude below and lateral to pubic tubercle. i am more common in women especially multiparous women. in my type of hernias there is a high risk of obstruction and strangulation therefore surgical repair is required |
|
Definition
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|
Term
AKA lateral ventral hernia, seen in older people. it is rare
it is a hernia through the spigelian faschia. this is the apeuneurotic layer between the rectus abdominus muscle medially and the semilunar line laterally |
|
Definition
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|
Term
| i am a hernia that passes through the obturator foramen. i am more common in females and I tend to present with bowel obstruction |
|
Definition
|
|
Term
| i am a rare type of hernia where only the anti mesenteric border of the bowel herniates through the faschial defect |
|
Definition
|
|
Term
| which lymph nodes should you examine when an abdominal mass is present? |
|
Definition
supraclavicular
and inguinal lymph nodes |
|
|
Term
| excluding lesions of the abdominal wall. what is the Carnett's method? |
|
Definition
| ask the patient who is lying supine to do a straight leg raise |
|
|
Term
| in excluding lesions of the abdominal wall what is the valsalvas test? |
|
Definition
| ask the pt to do blowing movements with their mouth and see if any lumps appear in the abdomen |
|
|
Term
| what is Kamath's test. what is it used for? |
|
Definition
| you ask the pt to strain as if they are toiling and then you look for any abdominal wall lesions. you do the test when you are investigating abdominal wall lesions |
|
|
Term
|
Definition
diverticulitis
hernia
kidney abnormality or surgically implanted kidney
ovarian tumour
CRC
tumour in intra abdominal testicle |
|
|
Term
|
Definition
cholecystitis- very tender
cholangiocarcinoma - moderately tender and irregular shaped
hepatomegaly
liver cancer: firm lumpy mass |
|
|
Term
|
Definition
gastric carcinoma
pancreatic absence or pseudocysts
hepatomegaly |
|
|
Term
|
Definition
splenomegaly
pancreatic abscess or pseudocysts
gastric carcinoma
disorders of colon and kidney
neurofibroma (rare) |
|
|
Term
| Right Flank and left flank mass DDX |
|
Definition
hydronephrosis: smooth spongy mass
renal cell carcinoma: smooth, firm non tender mass |
|
|
Term
|
Definition
AAA if pulsating mass
tumour somewhere in the GI tract |
|
|
Term
|
Definition
appendix mass or abscess
Crohns disease (multiple tender sausage shaped masses)
hernia
ileoceacal mass caused by TB
intussuseption
kidney abnormality or transplanted kidney
ovarian tumour
tumour in intraabdominal testicle
actinomycosis
amoebic abscess |
|
|
Term
| oral facial abscesses with sulfur granules in sinus tract and RIF mass. what are you thinking? what might the person have had in the past? |
|
Definition
we thinking Actinomyces. gram positive anaerobic bacteria.
this is a commensal bacteria that becomes pathogenic when a mucosal barrier is breached
occur in people that have had appendicitis (65%) |
|
|
Term
|
Definition
distended bladder
neuroblastoma in children and infants
uteropelvic junction obstruction |
|
|
Term
pelvis mass DDX
NB: you shouldn't be able to palpate below the mass |
|
Definition
pregnancy
ovarian cysts if smooth round rubbery mass
ovarian tumour
uterine fibroids: round, lumpy mass or
malignancy |
|
|
Term
| what is gold standard ix in mesenteric schema? |
|
Definition
|
|
Term
| superior mesenteric artery occlusion is suspected and the consultant request a specific test, what is it? |
|
Definition
| multi detector computerised tomography with iV contrast enhancement (MDCT) |
|
|
Term
|
Definition
ABC
medical mx: papaverine to relieve vasopspasm or thrombolytics and heparin.
sx mx: angioplasty to superior mesenteric artery
embelectomy
aortomesenteric bypass and resection of bowel if gangrene develops. |
|
|
Term
| what is papaverine. what condition can it be given in to relieve vasospasm? |
|
Definition
vasodilating agent that works by relaxing smooth muscle
can be given in bowel schema to relieve vasospasm |
|
|
Term
| DDx fro small bowel obstruction |
|
Definition
crohns
cancer
mesenteric ischemia
diverticulitis
gastric cancer
other causes of acute abdomen
chronic pancreatitis or chronic pyelonephritis
pregnancy :ectopic |
|
|
Term
| what electrolyte imbalance might you see in ischemic colitis or mesenteric ischema? |
|
Definition
|
|
Term
| which type of inguinal hernia runs laterally to inferior epigastric vessels? |
|
Definition
|
|
Term
| which type of inguinal hernia runs medially to the inferior epigastric vessels? |
|
Definition
| direct hernia . this is more common in elderly and rare in children |
|
|
Term
| how would you differentiate between an inguinoscrotal hernia and a hydrocele by clinical exam? |
|
Definition
| you can get above a hydrocele but you cannot get above an inguinoscrotal hernia. |
|
|
Term
| which surgical hernia surgery is commonly used. it involves a piece of open weave polypropylene mesh? |
|
Definition
| The Lichtenstein technique |
|
|
Term
| complications of hernias and surgery |
|
Definition
reoccurance
infection
infarcted testes or ovary with atrophy
hydrocele
bladder injury
intestinal injury |
|
|
Term
| Ddx of tender groin lumps |
|
Definition
strangulated femoral hernia
psoas abscess
tender lymph nodes |
|
|
Term
| Ddx of painless groin lumps |
|
Definition
femoral artery aneurysm
saphena varix
femoral hernia
skin swellings: epidermal, sebaceous cysts
undescended testes |
|
|
Term
| which groin lumps are more prominent when the pt is standing? |
|
Definition
hernias
saphena varix and
varicoceles |
|
|
Term
| on which side are varicoceles more often located? what do they feel like? |
|
Definition
| they are more common on the left side and feel like a bag of worms. |
|
|
Term
| cremasteric reflex. how do you initiate it? in which condition might it be absent? |
|
Definition
lightly stroke the inner thigh, the testicle on that side should contract.
almost always absent in torsion of testes |
|
|
Term
| in which kind of hernia would you see a dome above the umbilicus when a pt lifts their head while lying on their back? |
|
Definition
|
|
Term
| what is a pantaloon hernia? |
|
Definition
| when an indirect and direct hernia occur together and are seen to straddle the inferior epigastric vessels |
|
|
Term
| lateral to medial we use the acronym NAVEL what does this stand for |
|
Definition
from the outside to the inside of the hip: lateral to medial
nerve
artery
vein
empty space
lymph |
|
|
Term
| conservative mx of hernias? |
|
Definition
wearing a truss: for those unfit for surgery
weightloss, stopping smoking as it reduces chronic cough, avoid heavy lifting |
|
|
Term
| most common hernia repair method? |
|
Definition
| Lichtenstein method with mesh repair |
|
|
Term
|
Definition
hernia
lipomas
lymph nodes
undescended testes
femoral aneurysm
saphena varix |
|
|
Term
| key questions to ask in groin lumps |
|
Definition
is there a cough impulse?
is it pulsatile and expansile?
are both testes intrascrotal?
any lesions in legs such as malignancy of infections? (look for lymph nodes)
is the lump soft, small and very superficial? (lipoma) |
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