- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
76 Cards in this Set
- Front
- Back
|
Shifting abdominal pain is typical of what?
|
Appendicitis
|
|
Why is visceral pain (distension, inflammation, ischaemia) usually midline?
|
Embryologically, internal organs develop midline, therefore pain is referred midline
|
|
What are the three segments of the abdomen that correspond to pain in the foregut, midgut and hindgut?
|
They are the epigastric, umbilical and hypogastric areas
|
|
Where would pain from a single kidney refer to?
|
As they are paired and retroperitoneal, kidneys would present ipsilaterally and to the back (as opposed to midline, intraperiotoneal structures such as the pancreas, which present in the front, umbilical area)
|
|
How does parietal pain present?
|
As it is innervated by somatic nerves, it is localized to the same site on the abdominal wall, and is accompanied by reflexive guarding. Rebound tenderness is also present
|
|
Where does pain from testicles refer to?
|
Testicles are innervated by T10, so will refer to the abdomen
|
|
Where does the biliary tree radiate pain to? Stomach?
|
Biliary tree radiates to back and shoulder blades. Stomach to back.
|
|
Six abdominal signs that are indication for surgery?
|
6 indications: a - Generalized peritonitis; b - Increasing local tenderness, c - Suspected ischaemia, d - Tense/progressive distension, e - Deteriorating clinical signs, f - Pneumoperitoneum
|
|
What are the top three causes of acute abdominal pain in the world?
|
(1 - 34%) non-specific; (2 - 28%) appendicitis; (3 - 10%) cholecystitis
|
|
How does appendicitis typically present?
|
Prodromal symptoms last hours to days, with vague peri-umbilical pain. This then shifts to the right iliac fossa. Is accompanied by anorexia, nausea and possibly constipation/diarrhoea/dysurea. Commonly flushed, pyrexic, tachycardic and will be guarded to touch.
|
|
What patients are gallstones commonly seen in?
|
(Remember the 4 F's) Fair, Fat Females in their Forties.
|
|
How does biliary colic present?
|
Severe pain in the RUQ of the abdomen, which radiates to back. Tender/guarded, and will experience N/V.
|
|
What is the term used for removal of the gallbladder?
|
Cholecystectomy.
|
|
What causes acute cholecystitis?
|
Inflammation due to persistent impaction of a stone.
|
|
How does acute cholecystitis present?
|
As persistent, radiating pain from right hypochondrium to the back, exacerbated by moving. Positive Murphy's sign.
|
|
What is Murphy's sign?
|
Pain is experienced while applying pressure under the right costal margin, while patient exhales.
|
|
What are the 4 cardinal signs of a bowel obstruction?
|
Vomiting; pain; constipation; distension
|
|
How does pancreatitis present?
|
Severe, constant epigastric pain, radiating to the back. Relieved by sitting forward. May have systemic upset, vomiting and jaundice. Grey-Turner's and/or Cullen's sign.
|
|
What is Cullen's sign?
|
Cullen's - edema and bruising around the umbilicus
|
|
What is Grey-Turner's sign?
|
Grey-Turner's - bruising of the flanks
|
|
What is management of pancreatitis?
|
Primarily supportive and conservative. Wait for it to settle down.
|
|
How does diverticulitis present?
|
As left-sided appendicitis: nausea and pyrexia, with pain in LIF. Bowel habits may be affected.
|
|
How many drugs is the average resident of a care facility taking concurrently?
|
Seven drugs
|
|
How many hospital admissions each year, in Australia, due to inappropriate usage of drugs?
|
45,000 admissions
|
|
What is the 'triple whammy' and what does it contribute to?
|
The triple whammy = ACE-I + diuretic + NSAID. This contributes to acute renal failure within 5 days in 50% of persons
|
|
Drugs with what type of activity contribute to Parkinson's Disease-like features
|
Drugs with anticholinergic activity
|
|
Why is biliary colic a misnomer?
|
as the pain is not 'colicky'; rather it is constant
|
|
What is the timing of pain with biliary colic like?
|
Sudden onset, brief in duration, and infrequent
|
|
What are associated symptoms of biliary colic?
|
Patients will feel restless, and may sweat, and experience nausea and vomiting
|
|
What is the name for an inflamed biliary tree?
|
Cholangitis
|
|
What is the typical presentation of pancreatitis?
|
Constant severe pain, through to ones back. Patients will try to remain still and seek relief by leaning forward.
|
|
What extra signs will you see in pancreatic cancer, in addition to those you see with pancreatitis?
|
Anorexia and weight loss; steatorrhea; jaundice; diabetes
|
|
Where is pain seen prior to inflammation, in appendicitis?
|
In the peri-umbilical area
|
|
What is the term for painful passage of food?
|
Odynophagia
|
|
What is the term for smelly, black stool?
|
Melaena
|
|
What is the term for frank blood (bright red) in stool?
|
Haematochezia
|
|
For GI bleeding, what test can be performed to determine if it is upper or lower GIT?
|
Urea:creatinine ratio
|
|
How many times per day must loose, watery stool be passed to be considered 'diarrhoea'?
|
Three or more times per day
|
|
In elderly patients, what should one consider if the presenting complaint is diarrhoea?
|
One should consider if it is possibly faecal incontinence
|
|
What are the three main types of jaundice?
|
(1) haemolytic; (2) hepatocellular; (3); cholestatic/obstructive
|
|
What frequency does US operate at?
|
2-15MHz
|
|
How are large, smooth surfaces described on U/S imaging?
|
Specular
|
|
What two common substances will reflect all of the ultrasound?
|
Bone and air
|
|
What is the benefit of a higher frequency probe? Lower frequency?
|
Higher frequency probes allow greater resolution, and are used for shallower depths; lower frequency probes have greater penetrance, but offer poorer resolution
|
|
What is the pneumonic for colour Doppler?
|
BART = blue away; red towards
|
|
What are the main safety concerns with ultrasound? And when are these worth considering?
|
The generation of heat in tissue may accelerate metabolic processes, and cavitation of small bubbles may send shock waves through tissue. Worth considering for Doppler, as B-mode is safe
|
|
What preparation do patients need to be mindful of for abdominal imaging? Pelvic?
|
For abdominals, patients need to fast for 6 hours, and are only allowed sips of water. For pelvic, only 500ml of fluid are allowed in the hour beforehand.
|
|
Why does salivary amylase only have a short duration to act upon carbohydrates?
|
It is deactivated by the acidic environment of the stomach
|
|
What pancreatic enzyme activates the rest of the digestive enzymes?
|
Trypsin activates the rest (the 'trip-wire')
|
|
What is the pH at the gastric cell surface, below the mucus layer?
|
pH Between 5-7 (unless luminal pH falls below 1.4)
|
|
What about the lumenal pH in the stomach?
|
pH between 1-6.
|
|
What is the section of the duodenum that has a low pH?
|
The duodenal bulb
|
|
How does the mucus protect the underlying cells from pepsin and acid?
|
The hydrophobic phospholipids repel them
|
|
Mucus production by gastric cells is stimulated by what two signaling molecules?
|
PGE2 (on EP1 receptors) and EGF
|
|
What neutralizes acid, in the duodenum, and what stimulates its release?
|
Bicarbonate (HCO3-), stimulated by PGE2 on EP3 receptors
|
|
What is the process of 'restitution'? What is a common environmental inhibitor of this process?
|
Replacement of damaged mucosal cells by migration of new cells along the basement membrane. This is inhibited by smoking (via antagonism of EGF)
|
|
Describe two processes stimulated by cholinergic activity in the stomach.
|
Gastric mucus secretion; PS ganglions release acetylcholine and stimulate parietal cells to secrete acid
|
|
How is the pH regulated within the epithelial cells, since they act as the second line defence against pH?
|
Regulated by Na+/H+ exchange and Na+/HCO3- cotransport
|
|
Is Cox-1 constitutively expressed? Cox-2?
|
Cox-1 is constitutive. Cox-2 is inducible
|
|
What are the three main stimulators of acid secretion from parietal cells?
|
Gastrin (from G-cells); Acetylcholine (from PS ganglion); Histamine (from H-cells)
|
|
What is the molecule released from D-cells, which inhibits acid secretion? What nerve controls its release?
|
Somatostatin, controlled by the vagus nerve
|
|
On imaging, what will be seen in the pancreas if there is acute inflammation? Chronic inflammation?
|
Acute - swelling; Chronic - shrinkage
|
|
What is the normal appearance of adrenals, in the transverse view?
|
Appear as a 'bird in flight'
|
|
The peritoneum is not normally visible. What changes make it seen?
|
If it contains gas (post-op, rupture of bowel) or fluid (inflammed, malignancy)
|
|
What appears bright on T1-weighted MRIs? T2?
|
T1 - fat is bright; water is dark. T2 - water is bright; fat is dark
|
|
What's the difference between erosion and an ulcer?
|
An ulcer penetrates through the mucosal layer, while an erosion does not
|
|
What is the most common type of peptic ulcer
|
A duodenal ulcer, originating from H pylori
|
|
What percent of (gastric and/or duodenal) ulcers is attributable to stress?
|
Less than 5%.
|
|
True or false: non-NSAID/non-H pylori ulcers are on the rise.
|
True!
|
|
Which of the following has a strong correlation with ulcer formation: alcohol, smoking, stress.
|
Smoking. Alcohol and stress have very low association.
|
|
What are the three conditions associated with peptic ulcer disease?
|
COPD, cirrhosis of the liver, CKD
|
|
The most common presenting complaint for peptic ulcer disease is?
|
Dyspepsia between meals (though only 20% of these complaints have an ulcer), which is relieved by eating
|
|
Do peptic ulcers disrupt sleep?
|
Yes.
|
|
What breathe test is performed to detect H. Pylori?
|
The urea breath test
|
|
How much does the presence of H pylori increase the risk of ulcer? How about usage of NSAIDs?
|
Both increase the risk by 20x. Combined, they increase the risk by 60x.
|
|
What investigations does one perform to rule out Zollinger-Ellison (ZE) syndrome?
|
Measurement of serum gastrin levels (tumours secrete high levels of gastrin)
|
