23 June UGI tut Flashcards
Commonest cause of fistulas?
Local inflammation - diverticulitis, Crohn’s, pancreatitis
Malignancy
Iatrogenic injury
Types of Fistulas?
Entero-enteric fistulas
Enterocutaneous
Enterovesical
Rectovaginal
Cholecystoenteric
Choledochoduodenal
Pancreatic
Vesicovaginal / Ureterovaginal
Define pancreatic pseudocysts
Encapsulated collection of pancreatic fluid that develops 4 weeks after acute attack of pancreatitis (both acute and chronic pancreatitis).
Physiology of pancreatic pseudocysts
Pancreatic secretions leak from damaged ducts → inflammatory reaction of surrounding tissue → encapsulation of secretions by granulation tissue
Clinical features of pancreatic pseudocyst?
Often asymptomatic.
Painless abdominal mass
Pressure effects
Gold standard for pancreas pathos?
ERCP
Treatment for pancreatic pseudocysts?
Conservative - asymptomatic patients
First-line treatment = endoscopic drainage
Percutaneous drainage
Surgical drainage
Types of anterior abdominal wall hernia?
Umbilical
Epigastric
Incisional
Parastomal hernia
Define abdominal wall hernia
PRotrusion of intra-abdominal contents through congenital or acquired weakness/defect in abdominal wall.
Classified by anterior wall, lateral wall, groin, or pelvis
What can raise risk of abdominal wall hernia?
Physiological states that raise intra-abdominal pressure
Ascites, pregnancy, obesity, chronic cough, intra-abdominal tumours
What necessitates emergency surgery for abdominal hernias?
Obstructed or strangulated hernias e.g. ischemic hernia
What is strangulated hernia?
Contents of hernial sac (e.g. omentum, bowel) have become ischemic due to compromised vascular supply
What is uncomplicated inguinal hernia?
Completely reducible and unassociated with signs of bowel obstruction or strangulation
what is Complicated inguinal hernia?
Irreducible or associated with mechanical bowel obstruction or strangulation
Hasselbach triangle borders?
Medial = rectus abdominis
Lateral = Inferior Epigastric vessels
Inferior = Inguinal ligament
