COSTROENDEROLOGYAbdominal pain: medical causes

COSTROENDEROLOGYAbdominal pain: medical causes

Abdominal pain: medical causes

"ABDOMENAL PANE" [abdominal pain]:

Acute rheumatic fever
Blood [purpura, a/c hemolytic crisis]
DKA
cOllagen vascular disease
Migraine [abdominal migraine]
Epilepsy [abdominal epilepsy]
Nephron [uremia]
Abdominal angina
Lead
Porphyria
Arsenic
NSAID's
Enteric fever

Abdomen: inspection

5 S's:

Size
Shape
Scars
Skin lesions
Stoma

Bilirubin: common causes for increased levels

"HOT Liver":

Hemolysis
Obstruction
Tumor
Liver disease

Bowel components

"David Johnson Is American Cardiac Surgery Resident":

From proximal to distal:

Duodenum
Jejunum
Ileum
Appendix
Colon
Sigmoid
Rectum

Carcinoid syndrome: components

CARCinoid:

Cutaneous flushing
Asthmatic wheezing
Right sided valvular heart lesions
Cramping and diarrhea

Celiac sprue gluten sensitive enteropathy: gluten-containing grains

BROW:

Barley
Rye
Oats
Wheat

Flattened intestinal villi of celiac sprue are smooth, like an eyebrow.

Charcot's triad (gallstones)

"Charcot's Triad is 3 C's":

Color change (jaundice)
Colic (biliary) pain, aka RUQ pain
Chills and fever

Charcot's triad (gallstones)

"Charge a FEE":

Charcot's triad is:
Fever
Epigastric & RUQ pain
Emesis & nausea

Cholangitis: features

CHOLANGITITS:

Charcot's triad/ Conjugated bilirubin increase
Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3
Obstruction
Leukocytosis
Alkaline phosphatase increase
Neoplasms
Gallstones
Inflammatory bowel disease (ulcerative colitis)
Transaminase increase
Infection
Sclerosing

Cirrhosis: causes of hepatic cirrhosis

HEPATIC:

Hemochromatosis (primary)
Enzyme deficiency (alpha-1-anti-trypsin)
Post hepatic (infection + drug induced)
Alcoholic
Tyrosinosis
Indian childhood (galactosemia)
Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)

Cirrhosis: differential: common and rarer

Common causes are ABC:

Alcohol
B (Hepatitis)
C (Hepatitis)

*Rarer are also ABC:

Autoimmune
Biliary cirrhosis
Copper (Wilson's)

Constipation: causes

DOPED:

Drugs (e.g opiates)
Obstruction (e.g IBD, cancer)
Pain
Endocrine (e.g hypothyroid)
Depression

Crohn's disease: morphology, symptoms

CHRISTMAS:

Cobblestones
High temperature
Reduced lumen
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

Diabetic ketoacidosis: precipitating factors

5 I's:

Infection
Ischaemia (cardiac, mesenteric)
Infarction
Ignorance (poor control)
Intoxication (alcohol)

Digestive disorders: pH level

With vomiting both the pH and food come up.
With diarrhea both the pH and food go down.

Duodenum: lengths of parts

"Counting 1 to 4 but staggered":

1st part: 2 inches
2nd part: 3 inches
3rd part: 4 inches
4th part: 1 inch

Dry mouth: differential

"DRI":

2 of each:

Drugs/ Dehydration
Renal failure/ Radiotherapy
Immunological (Sjogren's)/ Intense emotions

Dysphagia: causes

MOON:

Mouth lesions
Obstruction
Oesophageal stricture
Neurological (eg stroke, Guillain-Barre, achalasia)

Dysphagia: differential

DISPHAGIA:

Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus
Intrinsic lesion
Scleroderma
Pharyngeal disorders/ Palsy-bulbar-MND
Achalasia
Heart: eft atrium enlargement
Goitre/ myesthenia Gravis/ mediastinal Glands
Infections
American trypanosomiasis (chagas disease)

Esophageal cancer: risk factors

ABCDEF:

Achalasia
Barret's esophagus
Corrosive esophagitis
Diverticuliis
Esophageal web
Familial

Gallstones: risk factors

5 F's:

Fat
Female
Family history
Fertile
Forty

GIT symptoms:

BAD ANAL SHIT:

Bleeding
Abdominal pain
Dysphagia
Abdominal bloating
Nausea & vomiting
Anorexia/ Appetite changes
Lethargy
Shits (diarrhea)
Heartburn
Increased bilirubin (jaundice)
Temperature (fever)

H. Pylori treatment regimen (rough guidelines)

"Please Make Tummy Better":

Proton pump inhibitor
Metronidazole
Tetracycline
Bismuth

Alternatively: TOMB:

Tetracycline
Omeprazole
Metronidazole
Bismuth

Haemochromatosis: definition, classic triad

"Iron man triathalon":

Iron man: deposition of iron in many body tissues.
Triathalon has 3 components, which match triad:
Swimming: Skin pigmentation
Biking: Bronze diabetes
Marathon: Micronodular pigment cirrhosis

Haemachromatosis : complications

"HaemoChromatosis Can Cause Deposits Anywhere":

Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy

Hepatic encephalopathy: precipitating factors

HEPATICS:

Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

Hepatic necrosis: drugs causing focal to massive necrosis

"Very Angry Hepatocytes":

Valproic acid
Acetaminophen
Halothane

Hepatocellular carcinoma: aetiology, features

ABC

Aflatoxins
Hep B
Cirrhosis

*Features:

AFP increased (classic marker)
Bile-producing (DDx from cholangiocarcinoma)
Commonest primary liver tumor

Hepatomegaly: 3 common causes, 3 rarer causes

Common are 3 C's:

Cirrhosis
Carcinoma
Cardiac failure

*Rarer are 3 C's:

Cholestasis
Cysts
Cellular infiltration

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause:

is DNA mismatch repair

DNA mismatch causes a bubble in the strand where the two nucleotides don't match.
This looks like the ensuing polyps that arise in the colon.

Inflammatory Bowel Disease: which has cobblestones

Crohn's has Cobblestones on endoscopy.

IBD: extraintestinal manifestations

A PIE SAC:

Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips

IBD: surgery indications

"I CHOP":

Infection
Carcinoma
Haemorrhage
Obstruction
Perforation

"Chop" convenient since surgery chops them open.

Ileus: causes

MD SPUGERS:

Mesenteric ischemia
Drugs (see below)
Surgical (post-op)
Peritonitis/ Pancreatitis (sentinnel loop)
Unresolved mechanical obstruction (eg mass, intussusception, blockage)
Gram negative sepsis
Electrolyte imbalance (eg hypokalemia)
Retroperitoneal bleed or hematoma
Spinal or pelvic fracture

Drugs are Aluminum hydroxide, Ba++, Ca carbonate, opiates, TCA, verapamil.

Left iliac fossa: causes of pain

SUPER CLOT:

Sigmoid diverticulitis
Uteric colic
PID
Ectopic pregnancy
Rectus sheath haematoma
Colorectal carcinoma
Left sided lower love pneumonia
Ovarian cyst (rupture, torture)
Threatened abortion/ Testicular torsion

Liver failure: decompensating chronic liver failure differential

HEPATICUS:

Haemorrhage
Electrolyte disturbance
Protein load/ Paracetamol
Alcohol binge
Trauma
Infection
Constipation
Uraemia
Sedatives/ Shunt/ Surgery

Liver failure (chronic): signs found on the arms

CLAPS:

Clubbing
Leukonychia
Asterixis
Palmar erythema
Scratch marks

Pancreatitis: causes

PANCREATITIS:

Posterior
Alcohol
Neoplasm
Cholelithiasis
Rx (lasix, AZT)
ERCP
Abdominal surgery
Trauma
Infection (mumps)
Triglycerides elevated
Idiopathic
Scorpion bite

Pancreatitis: criteria

PANCREAS:

PaO2 below 8
Age >55
Neutrophils: WCC >15
Calcium below 2
Renal: Urea >16
Enzymes: LDH >600; AST >200
Albumin below 32
Sugar: Glucose >10 (unless diabetic patient)

Pancreatitis: Ranson criteria for pancreatitis at admission

LEGAL:

Leukocytes > 16000
Enzyme AST > 250
Glucose > 200
Age > 55
LDH > 350

Pancreatitis: Ranson criteria for pancreatitis: initial 48 hours

"C & HOBBS" (Calvin and Hobbes):

Calcium < 8
Hct drop > 10%
Oxygen < 60 mm
BUN > 5
Base deficit > 4
Sequestration of fluid > 6L

Peptic ulcer: associated causative factors

SHAZAM:

Smoking
Hypercalcemia
Aspirin
Zollinger-Ellison
Acidity
MEN type I

These may work with H. pylori to promote ulceration, or may act alone.

Portal hypertension: features

ABCDE:

Ascites
Bleeding (haematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen

RLQ pain: differential

APPENDICITIS:

Appendicitis/ Abscess
PID/ Period
Pancreatitis
Ectopic/ Endometriosis
Neoplasia
Diverticulitis
Intussusception
Crohns Disease/ Cyst (ovarian)
IBD
Torsion (ovary)
Irritable Bowel Syndrome
Stones

Spleen: dimensions, weight, surface anatomy

"1,3,5,7,9,11":

Spleen dimensions are 1 inch x 3 inches x 5 inches.
Weight is 7 ounces.
It underlies ribs 9 through 11.

Splenomegaly: causes

CHICAGO:

Cancer
Hem, onc
Infection
Congestion (portal hypertension)
Autoimmune (RA, SLE)
Glycogen storage disorders
Other (amyloidosis)

Splenomegaly: causes

HICCUPS:

Haematological
Infective : Kala azar, malaria, enteric fever
Congestive: CCF, constrictive pericarditis, IVC thrombosis, Hepatic vein thrombosis, portal vein thrombosis and splenic vein thrombosis
Collagen diseases: SLE, Felty's syndrome
Unknown etiology: tropical splenomegaly
Primary malignacies (secondaries are rare)
Storage diseases: Gaucher's disease, Niemman Pick