Complications
Abdominal pain and AKI PAN
SLE
Microscopic polyarteritis
Wegener's
HSP
Cryoglobulins
TTP, HUS
AAA
DM
APCKD
Methanol
Ethylene glycol
Aspirin
Hypercalcaemia
Peritonitis
Abdominal pain and Neuropathy AIP
Lead poisoning
Arsenic poisoning
GB
PAN
DKA
Intra abdominal malig
Sarcoid
Alcohol abuse
Vasculidites eg PAN
Gold
Botulism
Internal malign & paraneoplastic
COELIAC ASSOC WITH T1DM
IgA def
IBD
Fibrosing alveolitis
PBC
DH
Thyroid disease
Infertility
Pleural thickening
Thoracic cage deficiency
Neuromuscular resp muscle disease
LEAD POISONING vs ACUTE INTERMITTENT PORPHYRIA Lead
Persisting Sx Anaemia common
Basophilic stippling Raised ALA
Raised coproporphyrin
AIP
Episodic Anaemia rare
No basophilic stipple Raised ALA Low or N coproporphyrin
RAISED INFLAMMATORY MARKERS & RIF MASS Crohn's TB need tissue dx to differentiate
SB lymphoma Yesinia Actinomycosis
POST-GASTRECTOMY Dumping
Diarrhoea
Wt loss
Biliary reflux
Anaemia (iron + B12)
Osteomalacia
Blind loop synd
Malignancy
MULTIPLE BOWEL NODULES Eosinophilia
Lymphoma
Lymphangiectasia
Metastasis (melanoma)
Mastocytosis
Polyposis
Peutz-jeghers (hamartomas)
Typhoid
Waldenstroms
Whipples
Yersinia
RETROPERITONEAL FIBROSIS Methysergide, methyldopa
?-blockers (no longer used)
Bromocriptine
Tumours (e.g Ca rectum/ovary)
Aortic aneurysm
Lymphoma
Idiopathic
Mx Stent ureters
Sub-Total Villous Atrophy Coeliac
Giardia
Lymphoma
Whipples
Hypogammaglobulinaemia
Lactose intolerance
Infective enteritis in kids
'Medical' Abdo pain DKA
Lead poisoning
AIP
HZV
Diptheria
Syphillis
Pneumonia
PE
SC
Mesenteric ischaemia
FMF
Hereditary angio-oedema
PERNICIOUS ANAEMIA Low Hb, high MCV
Low WCC, low Plat
Look for autoimmune clues e.g. thyroid, Addison's, MG, DM, etc
Infective Diarrhoea Non Bloody
B cereus* S aureus* Viruses
Protozoa (eg Giordia, cryptoporidia, microsporidosis) * preformed toxin
Bloody
Clostridia Campylobacter
Salmonella Shigella
Yersinia E-coli Vibrio
Gardner's Synd (AD) Premalignant colon polyps
Benign bone exostoses
Epidermal cysts
Dermoid tumour
Fibroma/neurofibromas
Fundocscopy : black spots
Congenital retinal pigment epithelium hypertrophy
Onset ~ 20 years
Coeliac - Non responders Compliance
Other dis (IBD, Giardia, bact overgrowth)
Small bowel lymphoma
Lactase def
Uncorrected nutritional def
Small bowel malabsorption synd usually folate def seen first
Massive Splenomegaly CML
Myeloprolif
CLL
Hairy cell leukaemia
Gaucheirs
Splenectomy Iatrogenic (Rx = HA, ITP, trauma)
UC
Coeliac
ET
Tropical sprue
Infection: capsulated bact (Pneumococcus, Haemophilus, Neisseria)
Parasites: p falciparum, babesiasis, copnocytophagia
Mx vaccine: Hib, Pneumococcus, Meningococcus, Prophylactic penicillin
Air in bowel wall Scleroderma
Polymyositis
Colitis
Bowel infarction
OGD
COPD
Primary Biliary Cirrhosis Cholestatic jaundice
Xanthelasma
Skin pigmentation
Clubbing
HS megaly
Osteoporosis & osteomalacia
RTA, autoimmune
High ALP/GGT
Normal ALT
Positive ANA M2
Ransom's Criteria: Acute Pancreatitis At admission and 48 hrs
>55 yrs WCC >15 Gluc >10 LDH >600 AST >60
Haematocrit drop > 10% Urea >16 PO2 <8 Calcium <2 )
Abumin <32 BE >-4
Dyspepsia requiring OGD Chronic GI blood loss
Unintentional wt loss
Dysphagia
Persistent vomiting
IDA
Epigastric mass
Suspicious Ba meal
Low B12 & Normal folate Malabsorption : terminal ileal disease (Crohn's, resection, TB)
XS utilisation of B12 in gut itself bact overgrowth
Structural abnormality of small bowel e.g. surgery, RXT, sclerosis, Crohn's, amyloid, diabetic auto-neuro
Ix SB meal, then CO2-breath test
Steatorrhoea & post-prandial DYSPEPSIA Mesenteric ischaemia
Chronic pancreatitis
Ca pancreas
ZE synd
Miscellaneous Coeliac: low risk small bowel lymphoma (gluten free diet); increased risk small bowel carcinoma
Coeliac = "Diarrhoea" + Hyposplenism on film = Target cells, HJ bodies, hypochronic
Isolated Gastric varices = TIPPSS
In coeliac: if low IgA, then Anti-Endomysial also likely NEG
Chronic pancreatitis: ERCP or CT abdo
Chylous ascites = lymphoma
Low Hb and low calcium (in absence of CKD) suggest malabsorption
Rheumatoid arthritis & liver disease = Methotrexate-induced cirrhosis
Serum ascites-albumin gradient >1.1 = portal-HTN
Watery diarrhoea & clubbing = small bowel lymphoma
Barium in small bowel & colon Fistula
Surgery
Prognosis in pancreatitis ABG
CT Abdo
Dilated intrahepatic ducts with normal CBD PSC
Obstruction @ porta-hepatis
Gray Turner's sign Haemorrhagic pancreatitis
AAA rupture
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