Git

Front 1

Questions to ask specifically regarding the Sx of pain?

Back 1

Site, Radiation, Character and Pattern (eg Colicky?), Aggravating and Alleviating factors, Frequency and Duration

Front 2

Red Flag Q's for abdo complaint?

Back 2

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?

Front 3

Dx this common disorder:

Dull or burning episodic pain in epigastrium often at night waking the patient. Relieved somewhat by food and antacids

Back 3

Peptic or duodenal ulcer

Front 4

Dx this:

Chronic epigastric pain often radiating posteriorly with Nausea and Vom. Pain can be alleviated by sitting up and leaning forwards.

Back 4

Pancreatic pain

Front 5

Dx this GIT problem:

45yo man presents with 12hr Hx of Naus and chronic epigastric/RUQ pain radiating posteriorly. Afebrile, otherwise well.

Back 5

Biliary colic

Front 6

DDx for colicky pain in anterior abdomen?

Back 6

Cholecystitis

Bowel obstruction

Diverticulitis

Front 7

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?.

Back 7

DDx: Diverticulitis, Renal calculi, Bowel obstruction, Volvulus, Perf bowel, Viral colitis

Mgmt: Pain relief, hydration (IV), abdo CT, antibiotics, antiemetics, monitor vitals.

Front 8

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.

Back 8

GI Bleed from subcapsular hepatic tumour.

Front 9

What are the 3 physiological causes of diarrhoea and their symptomology?

Back 9

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.

Front 10

Causes of dysphagia?

Back 10

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

Front 11

Causes of constipation (generally)?

Back 11

Medications/drugs (eg opiates, Parasymp antags...)

hypothyroidism

hypercalcaemia

DM

Neurological - autonomic neuropathy, MS...

Obstruction - cancer/polyp, abscess, diverticulum, foetus

Front 12

3 causes of asterixes?

Back 12

Hyperbilirubinaemia

Hyperureamia

Hypercapnia

Front 13

Common DDx of RUQ pain?

Back 13

Cholecystitis

Biliary colic

Ascending cholangitis

Pancreatitis

gastric ulcer

choledocolithiasis (CBD stone)

Front 14

Investigations for RUQ pain?

Back 14

Bloods: FBC, UEC, LFTs, coags, CRP (the BS test), lipase (or amylase).

Imaging: CT abdo and/or U/S, CXR. If warranted - ERCP/MRCP

Front 15

Who is at risk of cholecystitis?

Hint: there is a mnemonic for this.

Back 15

The 5 F's.

Fat, 40, Female, Fertile and Fare

Front 16

Treatment for cholecystitis?

Back 16

Laproscopy - ERCP to determine patency and remove stone

Front 17

What symptoms would differentiate cholecystitis from ascending cholangitis (AC)?

Back 17

AC = significant fever which can result in bacteraemia/septicaemia resulting in unstable vitals, reduced GCS and med emergency... better call Tim!

Front 18

Mnemonic for causes of pancreatitis?

Back 18

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

Front 19

Management of pancreatitis?

Back 19

Pain relief and fluids. ERCP to remove stone if one present. That's all. Next stop Whipple's.

Front 20

DDx of appendicitis in:

A) children

B) elderly

C) females

D) General

Back 20

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),

Front 21

3 causes of Dupuytren's contracture?

Back 21

1. Alcoholism

2. Hereditary

3. Overuse Trauma

Front 22

Causes of hepatomegaly?

Back 22

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

Front 23

Presenting complaint of diverticulitis?

Back 23

Pain - constant and rhythmical

N and V

D and C

Fever (not always)

reduced appetite

distended abdo

tender, palpable mass sometimes

Front 24

Complications of diverticulitis?

Back 24

Abscess can form

Obstruction of bowel - narrowing due to inflam

Fistula formation - bladder or vagina to colon

Perf bowel - peritonitis

Front 25

DDx for diverticulitis?

Back 25

Ischamic bowel

Bowel obstruction

Cancer

Volvulus

IBD

Infective colitis

appendicitis

Bowel obstruction

Endometriosis

Adnexal pain

Ovarian cyst

Front 26

What is the pathophys of leuconychia in liver disease?

Back 26

Hypoalbuminaemia causing opacity of the nail bed

Front 27

Why do you check the parotid glands in a GIT exam?

Back 27

Alcoholism can cause parotid enlargement (parotiditis)

Front 28

2 symptoms of Wilson's disease?

Back 28

Kaiser-Fleischer rings in eyes (brown/green rings around cornea)

Blue Lunulae (nail root - most proximal part)

Front 29

Causes of Splenomegally?

Back 29

Cirrhosis of liver - portal HTN

Infection - CMV, malaria, EBV

Haematological - Leukaemia, Lymphoma, thalasaemia, sickle cell anaemia, AI haemolytic anaemia

Infiltration - Amyloidosis, Sarcoidosis

Abscess

Front 30

How do you differentiate between spleen and kidney on examination?

Back 30

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

Front 31

What are diff types of hernias and where do they occur?

Back 31

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

Front 32

Causes of Jaundice?

Back 32

Pre, Intra and Posthepatic.

Commonly:

Gallstones

Infectious hepatitis

Carcinoma head of pancreas

Haemolytic anaemia

Front 33

Intrahepatic causes of jaundice?

Back 33

PBC, PSC, infection, drugs, metabolic disorders, cirrhosis, HCV, HBV, neoplasm,

Front 34

Most common causes of GI bleed in

A) upper and B) lower GIT?

Back 34

A) Gastric ulcer, oesophageal varices, duodenal ulcer, gastritis, Mallory-Weiss

B) Diverticulitis (60%), anorectal conditions, angiodysplasia, IBD, cancer

Front 35

2 main types of gall bladder stones?

Back 35

Cholesterol and Pigment (bilirubin)