Abdo Flashcards
Achalasia Definition
Focal motility disorder due to degeneration of myenteric plexus of Auerbach
Achalasia Radiology findings
Proximal dilatation of the oesophagus with smooth distal tapering and characteristic Bird’s Beak
Achalasia Investigations
Barium swallow
Manometry (failure to relax and decreased peristalsis)
OGD to exclude oesophageal SCC
Achalasia Management
Medical: CCBs and Nitrates
Interventional: Botox and Endoscopic Balloon Dilatiation
Surgical: Heller’s Cardiomyotomy
Oesophageal Cancer Risk Factors
GORD-->Barrett's alcohol smoking Achalasia Plummer-Vinson
Truelove and Witt Criteria for IBD Exacerbation
'She Hasn't Even Finished Pooping!' Stools >6 per day Hb 30 Fever >37.8 Pulse Rate >90
UC Indications for Surgery
Acute:
Megacolon
Perforation
Severe GI bleed
Chronic:
Malignancy
Medical management failed
Maturation failure in children
Crohn’s Indications for Surgery
Acute:
Obstruction secondary to stricture
Perforation
Severe GI bleed
Chronic: Peri-anal disease Intra-abdominal abscess Medical management failed Fistulae (enterocutaneous)
Diverticulum Definition
Outpouching of tubular structure
Saint’s Triad
Diverticular Disease
Hiatus Hernia
Cholelithiasis
Hinchey Grading for Diverticulitis and Mx
- Small Pericolic Abscess
- Large Abscess extending to pelvis
- -> NBM, antibiotics, fluids - Purulent Peritonitis–> Washout
- Faecal Peritonitis–> Hartmann’s
Complications of Diverticular Disease
Luminal:
Obstruction
Mural: Diverticulitis ulceration Perforation Haemorrhage Abscess
Extramural:
fistula (eg bladder)
Small Bowel Obstruction Causes
Commonest:
Adhesions
Hernias
Ileus
Also: Intraluminal, Mural, Extramural, Ileus
Large Bowel Obstruction Causes
Commonest:
Carcinoma
Diverticular Stricture
Volvulus
Also: Intraluminal, Mural, Extramural, Ileus
Glasgow Criteria for Pancreatitis
PANCREAS PaO2 55 Neutrophils >15 Calcium 16 Enzymes LDH>600, AST>200 Albumin 10
Mild=1, Moderate=2, Severe=3
Gallstone Complications
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
Lap Cholecystectomy Indications
Cholecystitis
Biliary Colic
Gallbladder Cancer
Lap Chole Complications
Conversion to open Common Bile Duct Injur Bile Leak Retained Stones Intra-abdominal haemorrhage
Jaundice after Lap Chole, Causes
Gallstone Retention
Biliary Sepsis
Thermal injury during op
Ligation to common hepatic or common bile duct
Polycystic Kidney Disease Genetics
Autosomal Dominant:
PKD1: Chr 16 coding for Polycystin 1
PKD2: Chr 4 coding for Polycystin 2
Autosomal Recessive:
rarer and presents in childhood
Polycystic Kidney Disease Complications
MISSHAPE
Mass Infected Cysts Systolic Murmur Systolic BP elevated Haematuria Aneurysms predisposing to Subarachnoid Haemorrhage Polyuria and Nocturia Extrarenal cysts eg in Liver
Causes renal enlargement
PHONOS
PKD Hypertrophy due to renal agenesis Obstruction Neoplasia Occlusion secondary to renal vein thrombosis Systemic disease eg DM or Amyloidosis
Haemodialysis Complications
Failure Ischaemia (Steal Syndrome) Bleeding Aneurysm Taking blood no longer possible
Chronic Renal Failure Complications
REACH-O Renal Osteodystrophy Electrolyte Abnormalities Anaemia Cardiovascular Problems Hypertension Oedema
5 Functions of the Kidney
Excretion of Water Soluble Waste Excretion of Water Acid Base Homeostasis Electrolyte Control Endocrine: RAAS, EPO, Vit D
Renal Transplant Indications
Diabetic Nephropathy
Glomerulonephritis
Polycystic Kidney Disease
Hypertensive Nephropathy
Renal Transplant Contraindications
Active Infection
Cancer
Severe Comorbidity
Failed Crossmatch
Renal Transplant Immunosuppression
Pre-Op: Campath/ Alemtuzumab
Post-Op:
Short term Prednisolone
Long term Tacrolimus or Ciclosporin
Renal Transplant Complications
Post Op Bleeding, Infection, Urinary Leaks, Graft Thrombosis
Rejection
Drug Toxicity
Graft vs Host Disease
Ileus: Definition and Causes
Obstruction in the intestines due to absence of peristalsis.
Post-op Pancreatitis Peritonitis Metabolic Poisons
Stoma complications
Early: HIPS
High output, haemorrhage
Ischaemia
Parastomal Abscess
Late: POSH Prolapse Obstruction Stricture or Stenosis Hernia
Staging for Colorectal Cancer
Duke's A= confined to bowel wall B= through bowel wall but no lymph nodes C= regional lymph nodes D= distant mets
P-POSSUM
Scoring system integrating patient’s physiological factors and operative factors to predict operative morbidity and mortality
Sphincters of the Oesophagus
3 components:
LOS (4cm long)
Extrinsic sphincter
Physiologic sphincter
Familial Adenomatous Polyposis
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
Colorectal cancer screening
60-75 years FOB testing every 2 years home testing kit. Positive samples=== colonoscopy
55-60 years = one off flexi sigmoidoscopy
Bariatric surgery
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)
Complications of bariatric surgery
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
Type of cell type in colorectal cancer
Adenocarcinoma
Causes for a liver transplant
Cirrhosis
Acute Liver Failure (Hep A or B, Paracetamol Overdose)
Malignancy
Autoimmune disease (Haemachromatosis, PBC)
Immunosuppression regimen for liver transplant
Tacrolimus/Ciclosporin
Azathioprine
Prednisolone with or without withdrawal at 3 months
Liver tumours
90% are Mets from Stomach, lung, colon, breast, uterus
90% of Primaries are Hepatocellular Carcinomas
Causes + Mx of Hepatocellular Carcinoma
Viral Hepatitis
Cirrhosis
Exposure to Aflatoxins (Aspergillus)
Resect tumour (but 50% recur) Chemo, percutaneous ablation and embolisation
Presentation of PBC
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
Management of PBC
Symptomatic: pruritis (Cholestyramine), Diarrhoea, Osteoporosis
Specific: ADEK, Ursodeoxicholic acid
Liver transplant
How do you prepare patient for a stoma?
Discussion of indications and complications
Liaison with Stoma Nurse to discuss siting
Ileal conduit
Ureters attached to a portion of resected ileum which is exteriorised to form a spouted stoma
Indiana pouch
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
Complications of a J pouch
Mechanical: fistulae, strictures Inflammation Infection Dysplasia or Neoplasia Systemic: anemia or malnutrition Recurrence
Common surgeries for management of Crohns
Ileocaecectomy
Drainage of intra-abdominal abscesses
Stricturoplasty
Colonic de functioning for failed medical therapy
Causes of post operative jaundice
Pre hepatic:
Haemolytic after a transfusion
Hepatic:
Halogenated anaesthetics
Sepsis
Intra or post operative hypotension
Post-hepatic:
Biliary injury
Causes of ascites
Serum ascites albumin gradient>1.1g/dl = TRANSUDATE
Cirrhosis
Congestive cardiac Failure
SAAG
Management of ascites
General:
Alcohol abstinence
Daily weights aiming for less than half kilo reduction
Fluid restriction to
Indications for therapeutic paracentesis
Respiratory compromise
Pain or discomfort
Renal impairment
Complications of therapeutic paracentesis
Severe hypovolaemia, replenish albumin
Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis
Ascites and peritonitic abdomen.
Polymorphs>250. Common organisms e.coli, klebsiella and streps
Give tazocin until sensitivities known
Differentials for gum Hypertrophy
Familial AML Drugs: Ciclosporin, Nifedipine, phenytoin Scurvy Pregnancy
Side effects of Ciclosporin
Nephrotoxic
Gum Hypertrophy
Hypetrichosis
Liver dysfunction
Side effects of Tacrolimus
Less nephrotoxic compared to Calcineurin
Diabetogenic
Peripheral neuropathy
Cardiomyopathy
Complications of peritoneal dialysis
Peritonitis Exit site infection Catheter malfunction Obesity from glucose in dialysiate Mechanical: hernias and back pain
Complications of Haemodialysis
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
What is an AV fistula?
Surgically created anastomosis between artery and a vein
Medical management of UC
Induction:
5ASAs then prednisolone then Ciclosporin/Infliximab
Topical enemas or foams (5ASAs or Prednisolone)
Maintenance:
5ASA, then Azathioprine then Infliximab/Adalimumab
Medical management Crohns
Induction:
If ileocaecal: budesonide. If colitis: sulfasalazine.
Then prednisolone, then methotrexate then Infliximab/Adalimumab
Maintenance:
Azathioprine, then Methotrexate, then Infliximab/Adalimumab
