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PACES > Abdo > Flashcards

Abdo Flashcards

1
Q

Achalasia Definition

A

Focal motility disorder due to degeneration of myenteric plexus of Auerbach

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2
Q

Achalasia Radiology findings

A

Proximal dilatation of the oesophagus with smooth distal tapering and characteristic Bird’s Beak

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3
Q

Achalasia Investigations

A

Barium swallow
Manometry (failure to relax and decreased peristalsis)
OGD to exclude oesophageal SCC

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4
Q

Achalasia Management

A

Medical: CCBs and Nitrates
Interventional: Botox and Endoscopic Balloon Dilatiation
Surgical: Heller’s Cardiomyotomy

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5
Q

Oesophageal Cancer Risk Factors

A 
GORD-->Barrett's
alcohol
smoking
Achalasia
Plummer-Vinson
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6
Q

Truelove and Witt Criteria for IBD Exacerbation

A 
'She Hasn't Even Finished Pooping!'
Stools >6 per day
Hb 30
Fever >37.8
Pulse Rate >90
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7
Q

UC Indications for Surgery

A

Acute:
Megacolon
Perforation
Severe GI bleed

Chronic:
Malignancy
Medical management failed
Maturation failure in children

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8
Q

Crohn’s Indications for Surgery

A

Acute:
Obstruction secondary to stricture
Perforation
Severe GI bleed

Chronic:
Peri-anal disease
Intra-abdominal abscess
Medical management failed
Fistulae (enterocutaneous)
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9
Q

Diverticulum Definition

A

Outpouching of tubular structure

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10
Q

Saint’s Triad

A

Diverticular Disease
Hiatus Hernia
Cholelithiasis

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11
Q

Hinchey Grading for Diverticulitis and Mx

A
  1. Small Pericolic Abscess
  2. Large Abscess extending to pelvis
    - -> NBM, antibiotics, fluids
  3. Purulent Peritonitis–> Washout
  4. Faecal Peritonitis–> Hartmann’s
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12
Q

Complications of Diverticular Disease

A

Luminal:
Obstruction

Mural:
Diverticulitis
ulceration
Perforation
Haemorrhage
Abscess

Extramural:
fistula (eg bladder)

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13
Q

Small Bowel Obstruction Causes

A

Commonest:
Adhesions
Hernias
Ileus

Also: Intraluminal, Mural, Extramural, Ileus

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14
Q

Large Bowel Obstruction Causes

A

Commonest:
Carcinoma
Diverticular Stricture
Volvulus

Also: Intraluminal, Mural, Extramural, Ileus

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15
Q

Glasgow Criteria for Pancreatitis

A 
PANCREAS
PaO2  55
Neutrophils >15
Calcium 16
Enzymes LDH>600, AST>200
Albumin 10

Mild=1, Moderate=2, Severe=3

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16
Q

Gallstone Complications

A 
In the gallbladder:
Biliary colic
Acute or chronic cholecystitis
Mucocele
Carcinoma

In the Common Bile Duct:
Obstructive Jaundice
Pancreatitis
Cholangitis

In the gut:
Gallstone ileus

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17
Q

Lap Cholecystectomy Indications

A

Cholecystitis
Biliary Colic
Gallbladder Cancer

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18
Q

Lap Chole Complications

A 
Conversion to open
Common Bile Duct Injur
Bile Leak
Retained Stones
Intra-abdominal haemorrhage
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19
Q

Jaundice after Lap Chole, Causes

A

Gallstone Retention
Biliary Sepsis
Thermal injury during op
Ligation to common hepatic or common bile duct

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20
Q

Polycystic Kidney Disease Genetics

A

Autosomal Dominant:
PKD1: Chr 16 coding for Polycystin 1
PKD2: Chr 4 coding for Polycystin 2

Autosomal Recessive:
rarer and presents in childhood

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21
Q

Polycystic Kidney Disease Complications

A

MISSHAPE

Mass
Infected Cysts
Systolic Murmur
Systolic BP elevated
Haematuria
Aneurysms predisposing to Subarachnoid Haemorrhage
Polyuria and Nocturia
Extrarenal cysts eg in Liver
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22
Q

Causes renal enlargement

A

PHONOS

PKD
Hypertrophy due to renal agenesis
Obstruction
Neoplasia
Occlusion secondary to renal vein thrombosis
Systemic disease eg DM or Amyloidosis
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23
Q

Haemodialysis Complications

A 
Failure
Ischaemia (Steal Syndrome)
Bleeding
Aneurysm
Taking blood no longer possible
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24
Q

Chronic Renal Failure Complications

A 
REACH-O
Renal Osteodystrophy
Electrolyte Abnormalities
Anaemia
Cardiovascular Problems
Hypertension
Oedema
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25
Q

5 Functions of the Kidney

A 
Excretion of Water Soluble Waste
Excretion of Water
Acid Base Homeostasis
Electrolyte Control
Endocrine: RAAS, EPO, Vit D
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26
Q

Renal Transplant Indications

A

Diabetic Nephropathy
Glomerulonephritis
Polycystic Kidney Disease
Hypertensive Nephropathy

27
Q

Renal Transplant Contraindications

A

Active Infection
Cancer
Severe Comorbidity
Failed Crossmatch

28
Q

Renal Transplant Immunosuppression

A

Pre-Op: Campath/ Alemtuzumab
Post-Op:
Short term Prednisolone
Long term Tacrolimus or Ciclosporin

29
Q

Renal Transplant Complications

A

Post Op Bleeding, Infection, Urinary Leaks, Graft Thrombosis
Rejection
Drug Toxicity
Graft vs Host Disease

30
Q

Ileus: Definition and Causes

A

Obstruction in the intestines due to absence of peristalsis.

Post-op
Pancreatitis
Peritonitis
Metabolic
Poisons
31
Q

Stoma complications

A

Early: HIPS
High output, haemorrhage
Ischaemia
Parastomal Abscess

Late: POSH
Prolapse
Obstruction
Stricture or Stenosis
Hernia
32
Q

Staging for Colorectal Cancer

A 
Duke's 
A= confined to bowel wall
B= through bowel wall but no lymph nodes
C= regional lymph nodes
D= distant mets
33
Q

P-POSSUM

A

Scoring system integrating patient’s physiological factors and operative factors to predict operative morbidity and mortality

34
Q

Sphincters of the Oesophagus

A

3 components:
LOS (4cm long)
Extrinsic sphincter
Physiologic sphincter

35
Q

Familial Adenomatous Polyposis

A

Autosomal dominant, APC gene on 5q21

Thousands Adenomatous by age 16, need prophylactic colectomy by 20 as 100% risk cancer by 40.

If J pouch need lifelong surveillance

Endoscopic screening for stomach and duodenal cancers too

36
Q

Colorectal cancer screening

A

60-75 years FOB testing every 2 years home testing kit. Positive samples=== colonoscopy

55-60 years = one off flexi sigmoidoscopy

37
Q

Bariatric surgery

A

Endoscopic balloon

Gastric banding

Sleeve gastrostomy

Roux en Y bypass– small gastric pouch connected to jejunum

Biliopancratic divesion

(Can be divided into restrictive and malabsorptive)

38
Q

Complications of bariatric surgery

A 
Immediate:
Anaesthetic complications (high ASA grade)
Damage to surrounding structures

Early:
Anastomotic leak–> peritonitis
Haemorrhage
VTE

Late:
Strictures
Nutritional deficiencies
Dumping syndrome (rapid gastric emptying)
Gallstones
39
Q

Type of cell type in colorectal cancer

A

Adenocarcinoma

40
Q

Causes for a liver transplant

A

Cirrhosis
Acute Liver Failure (Hep A or B, Paracetamol Overdose)
Malignancy
Autoimmune disease (Haemachromatosis, PBC)

41
Q

Immunosuppression regimen for liver transplant

A

Tacrolimus/Ciclosporin
Azathioprine
Prednisolone with or without withdrawal at 3 months

42
Q

Liver tumours

A

90% are Mets from Stomach, lung, colon, breast, uterus

90% of Primaries are Hepatocellular Carcinomas

43
Q

Causes + Mx of Hepatocellular Carcinoma

A

Viral Hepatitis
Cirrhosis
Exposure to Aflatoxins (Aspergillus)

Resect tumour (but 50% recur)
Chemo, percutaneous ablation and embolisation
44
Q

Presentation of PBC

A 
Intrahepatic bile duct destruction by chronic granulomatous inflammation leading to cirrhosis
PPBBCC+S
Pruritis
Pigmentation of face
Bone osteoporosis and osteomalacia
Big Organs (Hepatosplenomegaly)
Cirrhosis and coagulopathy
Cholesterol increase
Steatorhhoea
45
Q

Management of PBC

A

Symptomatic: pruritis (Cholestyramine), Diarrhoea, Osteoporosis
Specific: ADEK, Ursodeoxicholic acid
Liver transplant

46
Q

How do you prepare patient for a stoma?

A

Discussion of indications and complications

Liaison with Stoma Nurse to discuss siting

47
Q

Ileal conduit

A

Ureters attached to a portion of resected ileum which is exteriorised to form a spouted stoma

48
Q

Indiana pouch

A

Pouch created from 2 feet of resected ascending colon and portion of ileum which includes ileocaecal valve.

Ureters anastomosed to colonic end and ileal end exteriorised with valve

49
Q

Complications of a J pouch

A 
Mechanical: fistulae, strictures
Inflammation
Infection
Dysplasia or Neoplasia
Systemic: anemia or malnutrition
Recurrence
50
Q

Common surgeries for management of Crohns

A

Ileocaecectomy
Drainage of intra-abdominal abscesses
Stricturoplasty
Colonic de functioning for failed medical therapy

51
Q

Causes of post operative jaundice

A

Pre hepatic:
Haemolytic after a transfusion

Hepatic:
Halogenated anaesthetics
Sepsis
Intra or post operative hypotension

Post-hepatic:
Biliary injury

52
Q

Causes of ascites

A

Serum ascites albumin gradient>1.1g/dl = TRANSUDATE
Cirrhosis
Congestive cardiac Failure

SAAG

53
Q

Management of ascites

A

General:
Alcohol abstinence
Daily weights aiming for less than half kilo reduction
Fluid restriction to

54
Q

Indications for therapeutic paracentesis

A

Respiratory compromise
Pain or discomfort
Renal impairment

55
Q

Complications of therapeutic paracentesis

A

Severe hypovolaemia, replenish albumin

Spontaneous bacterial peritonitis

56
Q

Spontaneous bacterial peritonitis

A

Ascites and peritonitic abdomen.
Polymorphs>250. Common organisms e.coli, klebsiella and streps

Give tazocin until sensitivities known

57
Q

Differentials for gum Hypertrophy

A 
Familial 
AML
Drugs: Ciclosporin, Nifedipine, phenytoin
Scurvy
Pregnancy
58
Q

Side effects of Ciclosporin

A

Nephrotoxic
Gum Hypertrophy
Hypetrichosis
Liver dysfunction

59
Q

Side effects of Tacrolimus

A

Less nephrotoxic compared to Calcineurin
Diabetogenic
Peripheral neuropathy
Cardiomyopathy

60
Q

Complications of peritoneal dialysis

A 
Peritonitis
Exit site infection
Catheter malfunction
Obesity from glucose in dialysiate
Mechanical: hernias and back pain
61
Q

Complications of Haemodialysis

A

Diseauilibration syndrome( first time): rapid changes in plasma osmolarity lead to cerebral oedema
Fluid balance changes: blood pressure drop and pulmonary oedema
Electrolyte imbalances
Aluminium toxicity
Psychological factors

62
Q

What is an AV fistula?

A

Surgically created anastomosis between artery and a vein

63
Q

Medical management of UC

A

Induction:
5ASAs then prednisolone then Ciclosporin/Infliximab
Topical enemas or foams (5ASAs or Prednisolone)

Maintenance:
5ASA, then Azathioprine then Infliximab/Adalimumab

64
Q

Medical management Crohns

A

Induction:
If ileocaecal: budesonide. If colitis: sulfasalazine.
Then prednisolone, then methotrexate then Infliximab/Adalimumab

Maintenance:
Azathioprine, then Methotrexate, then Infliximab/Adalimumab

PACES (4 decks)

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