__Y6 Abdo Flashcards
Skip lesions
Crohn’s or UC?
Crohn’s
No inflammation past sub-mucosa
Crohn’s or UC?
UC
‘Cobblestone’ mucosa
Crohn’s or UC?
Crohn’s
Pseudopolyps
Crohn’s or UC?
UC
Rose thorn ulcers
Crohn’s or UC?
Crohn’s
Granulomas
Crohn’s or UC?
Crohn’s
Decreased goblet cells
UC
Increased Goblet cells
Crohn’s
Kantor’s string sign (strictures on Ba enema)
Crohn’s
Extra-intestinal manifestations of IBD
Erythema nordosum
Arthritis
Dermatitis herpatiformis
Intensely itchy, chronic papulovesicular blistering eruptions, usually distributed symmetrically on extensor surfaces
Coeliac disease
Hypersplenism vs splenomegaly
Hypersplenism is about function, not necessarily large, just hyper-functioning, +++ sequestration of cells
Causes of portal HTN
Pre-hepatic – portal vein thrombosis (↑risk in prothrombotic states)
Hepatic – cirrhosis (most common)
Post-hepatic – Budd-Chiari, R heart failure
What is Budd Chiari syndrome?
Occlusion of hepatic veins by thrombosis
Signs of liver decompensation
x5
Ascites Encephalopathy Hepatorenal syndrome (biochem sign) Variceal bleeding (Acute onset jaundice)
Child Pugh Score for cirrhosis mortality
Includes:
x5
Bilirubin Albumin INR Ascites Encephalopathy
Common causes of ESRF
PKD, diabetes, glomerulonephritis
Pfannenstiel incision
Transverse, convex, suprapubic
for C-sectons, abdo hysterectomy
Rutherford-Morrison incision
Hockey stick
Oblique, flank
Renal transplant
Lanz incision
Horizontal incision in IF
variation of Mc Burneys
open appendectomy
McBurney incision
Oblique, right iliac fossa
Open appendectomy
Kocher incision
Oblique, Right upper quadrant
For hepatobiliary surgery eg. open cholecystectomy
Abdo wall muscles and orientation
External oblique - hands on pockets
Internal oblique - perpendicular to ext ob
Transverse abdominal - horizontal/transverse
Why is the Arcuate line important?
Below arcuate line (just below umbilicus) there is no posterior rectus sheath
Enables immediate access to peritoneum
Transpyloric plane of Addison
1/2way between jugular notch and symphysis pubis
Supercristal plane
L4/5, bifurcation of aorta, umbilicus in lean pts
Discoloration of skin in pt with chronic pain due to prolonged exposure to hot water bottle?
Erythema ab igne
GI causes of clubbing (x5)
CUMPF
Chronic liver disease UC/Crohns Malignancy PBC Familial
Paramedian inscision
Historical
Vertical incision, next to midline
Wrongly thought it might be better than midline lap
Rooftop incision
Subcostal
For HPB and oesophageal-gastric cancers
Mercedes Benz added vertical scar (liver transplant and allows access to chest)
Indications for oblique and vertical inguinal incisions
Oblique bilateral inguinal incisions – hernias
Vertical inguinal vascular access scars – access arteries/veins
Laparostomy
Unable to close abdo as too ill
Once healed forms a permanent incisional hernia
HBsAg
Anti-HBs
Anti-HBc
HbeAg
HBsAg - implies current acute disease
Anti-HBs - implies immunity
Anti-HBc - implies previous infection (negative if vaccinated)
HBeAg - a marker of infectivity (results from breakdown of core ag)
Histology - villous atrophy, crypt hyperplasia, raised intraepithelial lymphocytes
Coeliac disease
Coeliac disease histology
Histology - villous atrophy, crypt hyperplasia, raised intraepithelial lymphocytes
Embryology of gut
Foregut - coeliac trunk
Midgut - supplied by the sup mesenteric artery
Hindgut - inf mesenteric artery
Branches of coeliac trunk
Splenic artery, hepatic artery, left gastric
Branches of superior mesenteric artery
Ileocolic artery, right colic, middle colic
Branches of inferior mesenteric artery
Left colic artery, sigmoid artery, superior rectal
What makes a healthy anastamosis?
Good technique (complete join, no holes), no tension, no sepsis, no cancer
Anterior resection vs APER
Based on how close pathology is to anal sphincter
If sphincter infiltrated or <1cm then sphincter must be sacrificed - do APER (with colostomy)
IF >1cm can make a join with a low anterior resection
How to examine spider naevi?
Found in distribution of the SVC
Blanch and watch them fill from the CENTER
> 5 significant
Signs of portal HTN
Splenomegaly
Ascites
Dilated veins on abdo
(haematemesis, malaena)
Causes of obstructive jaundice
Malignancy (liver, pancreas)
Gallstones
PBC
Cause of ascites (x6)
Portal HTN IVC/hepatic vein obstruction Constrictive pericarditis Ovarian malignancy Peritoneal secondaties Hypo-proteinaemia states - nephrotic syndrome, liver failure, malabsorption
Large mass in LUQ
How do you prove it’s spleen rather than kidney?
(x4)
Spleen has a notch
Cannot palpate above spleen
Spleen dull to percusion, kidney resonant due to overlying bowel
Kidney ballotable
Spleen moves to RIF, kidney moves down towards LIF
d
d
