Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPE > Abdo Surg > Flashcards

Abdo Surg Flashcards

1
Q

What activates the pancreatic enzymes? What are they called?

What acts to prevent early activation?

A

Zymogens
Enterokinase activates trypsinogen to trypsin which in turn activates chemotrypsinogen, pancratic prolipase, pancreatic proamylase and proelastase
Alpha 1 antitrypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Other than enzymes what is another major compent of pancreatic secretion? What controls it?

A

Bicarbonate

Controlled by secretin released from the terminal jejunum in response to low ph and also by cck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What hormones decrease pancreatic secretions post meal?

A

Somatostatin and pancreatic polypeptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main endocrine pancreas cells? What do they secrete?

A 
Beta - insulin
Alpha - glucagon
PP - pancreatic polypeptide 
D - somatostatin 
Enterochromaffin - seratonin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Test for exocrine pancreas function

A

Faecal elastase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Imaging of the pancreas and what its looking for

A

AXR - calcification of chronic pancreatitis
USS - masses and inflammation
Spiral CT - gold standard
MRCP - pancreatic ducts and biliary tree for gallstones
Endoscopic USS - distal stones id, needle biopsy
ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definition of acute pancreatitis?

A

Acute onset inflammation of the pancreas on the background of a normal pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of acute pancreatitis?

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune 
Scorpions 
Hypothermia, hypercalcaemia, hyperlipidaemia 
ERCP
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs can result in acute pancreatitis?

A

Steroids
Azothioprine
Oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of chronic pancreatitis apart from getsmashed?

A

CF
Idiopathic
Alpha 1 antitrypsin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S+S of acute pancreatitis ?

A 
Epigastric pain, spreads to back, relieved by sitting forward 
N+V 
Tenderness to guarding 
Normal vital signs to shock and fever
Cullens and grey turners signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Blood test changes in acute pancreatitis

A

Serum amylase >3x normal

CRP raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pitfall of serum amylase

A

Goes down after several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Investigations to do in acute pancreatitis

A 
Bloods - FBC, UE, LFTs, amylase, CRP, calcium 
ABG
AXR and CXR erect
USS
Spiral CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Scoring systems that can be used in chronic pancreatitis

A

Glasgow
EWS
APACHE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the glasgow score for pancreatits? Interpret it

A 
PO2 55
Neutrophillia WCC >15
Ca 16
Enyzmes LDH >600
Albumin 10
Sugar >10

3 or more within 48 hours suggests severe - consider HDU/ITU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DDx for acute pancreatitis

A 
Perforated ulcer
Mesenteric infarction
MI
AAA
Cholecystits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is an issue with pancreatitis, perforated ulcer and mesenteric infarction all presenting in a similar manner?

A

All also cause raised amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of acute pancreatitis?

A 
Iv fluids and electrolytes
Catheter for fluid balance
Analgesia
Antiemetics
Nutrition with NG or NI tube 
Alcohol withdrawal prophylaxis 
ABX consideration if severe 
Precipitating cause once settled 
Consideration to HDU, ITU and central line monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Complications of acute pancreatitis

A 
Shock - organ failure (ARDS, AKI), DIC
Sepsis - infection of necrotic areas 
Haemorrhage
Pulmonary insufficiency (oedema, pain, R-L shunting) 
Fistula 
Pseudocyst 
Stricture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an issue if a pancreatic pseudocyst forms post acute pancreatitis?

A

Full of digestive enzymes so can damage structures and cause bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment for infected necrotic areas of pancrease post acute pancreatitis?

A

Remove area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why does calcification occur in chronic pancreatitis?

A

Enzyme activity leads to protein precipitation in ducts leading to calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Presentation of chronic pancreatitis?

A 
Chronic epigastric pain - eased with heat and leaning forwards, can radiate to back.  Fluctuates 
Erythema ab igni from hot waterbottle 
Anorexia and weight loss
Diabetes
Malabsorption and steatorrheoa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Amylase and lipase levels in chronic pancreatitis?

A

usually normal!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tests to run in suspected chronic pancreatitis?

A 
Faecal elastase 
Abdo xray for calcification 
MRCP for duct dilation 
USS
Contrast spiral CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of chronic pancreatits

A 
Abstain from alcohol
Nsaids and opiates
Coeliac nerve block 
Pancreatic enzyme supplementation (creon) 
Vitamin supplementation 
Diabetes control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Complications of chronic pancreatitis?

A 
Pancreatic pseudocyst 
DM
Biliary obstruction
Splenic vein thrombosis 
Pancreatic carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Risk factors for pancreatic cancer

A

Smoking
Pancreatitis
Napthalamine
Genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Types of gallstones?

A

Cholesterol
Pigment
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Formation of cholesterol gallstones?

A

Cholesterol supersaturation - excess cholesterol or insufficient bile salts (e.g. Chrones disease preventing reabsorption in ilium)
Gall bladder stasis
Nidus for stone formation - e.g. Infection, lipoproteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Presentations of gallstones?

A 
Asymptomatic
Biliary colic
Acute cholecystitis 
Acute cholangitis 
Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Cause and Presentation of biliary colic

A

Temporary obstruction of cystic or common bile duct by gallstone
Abrupt onset and offset
Severe constant pain epigastrium to RUQ
Nausea and vomiting
Generally lasts several hours, usually evening to morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Cause and Presentation of acute cholecystitis

A

Blockage of the cystic duct causing gallbladder distension, inflammation and secondary infection
Similar onset to biliary colic but prolonged and progressive
Localises to RUQ with peritonism +/- mass
Pyrexia
Murphy’s sign positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What blood tests would be raised in acute cholecystitis but not biliary colic?

A

WCC
CRP
Marginal LFT increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What test is most useful in gallstone disease? What may it show?

A

Abdo USS
gallstones!
thickened wall and shrunken gall bladder in cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What bloods should be done in all gallstone based diseases acutely?

A 
Fbc
U+e
Lft
Amylase 
Alp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How should acute cholecystitis be managed?

A

Analgesia
IV coamoxiclav
Lap chole a few days later once settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of biliary colic

A

Analgesia

Elective lap chole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Complications of lap chole?

A

Biliary leak from cystic duct
Damage to bile duct
Ascending cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is and presentation of acute cholangitis

A

Stone in CBD
Biliary colic, fever and jaundice - charcots triad
Episodic and fluctuating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Investigation of acute cholangitis

A

Bloods - FBC, CRP (increased), LFTs (transient mild increase), amylase (mild increase), increased prothrombin time (decreased vit. k absorption!)
USS - dilation of intrahepatic ducts
MRCP or spiral CT
ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Alternative treatments for gallstones and their issues

A

Ursodeoxycholic acid - increased risk of small stones entering bile duct, stones reform when stopped
Lithotripsy - increased risk of small stones entering bile duct
Percutanious drainage of gall bladder - high rate of reoccurence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Complications of gallstones

A

Empyema / gangrene - perforation - peritonitis
Pancreatitis
Fistula into duodenum - gallstone ilius
Compression of cbd by gallstone within bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Treatment of gallstone cholangitis

A

Ercp
Abx
Cholesystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Red flags for malignant cause of obstructive jaundice

A

Very high bilirubin (as nothing can pass whilst stones can bob)
Jaundice and palpable gallbladder (in stones it shrinks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

A patient has his gallbladder removed due to stones and presents a month later with ruq pain. Possible causes?

A

Functional large bowel disease
Retained cbd stone
Hypertension of sphincter of oddi (look for raised lfts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A gallbladder is removed due to acute cholocystitis. It has no gallstones. What is wrong?

A

Non calculous cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Other than gallstones another cause of cholangitis?

S+S

A 
Primary sclerosing cholangitis 
Pruritis 
Fatigue 
Cholangitis 
Cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Associated diseases with primary sclerosing cholangitis?

A

IBD (75%)

Cholangiocarcinoma (15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Treatment for primary sclerosing cholangitis

A

Liver transplantation
Ursodeoxycholic acid
Colestyramine for pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Malignancy risks in primary sclerosing cholangitis

A

Hepatic
Colorectal
Cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Positive bloods in primary sclerosing cholangitis

A 
ANA
ANCA
Alk phos
Bilirubin
Hypergammaglobulinaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What triggers exocrine release from the pancreas?

A

Neurological stimuli of the vagus
Gastric stretch stimuli of the vagus
Intestinal lipids causing cck release from apud cells and stimuli of the vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Presentation of ischemic colitis

A

LIF pain and PR bleeding
+/- diarrhoea
Distended tender abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Xray changes in ischemic colitis

A

Thumb printing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Treatment for ischemic colitis

A

Symptomatic

Urgent surgery if gangrene or perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Presentation of diverticular disease?

A

Asymptomatic
LIF pain
Erratic bowels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Complication of chronic diverticular disease

A

Bowel narrowing with constipation and severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Treatment of uncomplicated symptomatic diverticular disease

A

High fibre diet
Mebevarine if required
Consideration to bulk forming laxative if constipated
High water intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Presentation of acute diverticulitis

A

LIF pain
Fever
Constipation
Tenderness, guarding and rigidity in LIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

CT findings in acute diverticulitis

A

Colon wall thickening
Diverticula
Abscesses

63
Q

Treatment of acute diverticulitis

A

Pain relief
Outpatient - oral cephalosporin, oral metranidazole,
Inpatient - bowel rest, iv fluids, abx as above but iv

64
Q

Complications of diverticular disease

A 
Haemorrhage
Perforation
Stricture 
Fistula 
Obstruction
65
Q

Symptoms of appendicitis

A

Pain
N+V
Anorexia
Diarrhoea

66
Q

Differentials of acute appendicitis

A

Mesenteric adenitis
Inflamed meckels diverticulum
Acute terminal ileitis

67
Q

Specific signs of appendicitis

A

Rovsing sign - LLQ palpation causes RLQ pain
Psoas sign - pain on right hip flexion against resistance
Obturator sign - pain on internal and external rotation of right hip

68
Q

Causes of small bowel obstruction

A 
Adhesions
Hernia 
Chrones
Intussusception
Extrinsic cancer
69
Q

Causes of large bowel obstruction

A

Cancer
Sigmoid volvulus
Diverticular disease

70
Q

Features of small bowel obstruction

A 
Vomiting 
Pain in paroxysms 
Constipation
No flatulance 
Distended abdomen
71
Q

How does large bowel obstruction present differently to a small bowel obstruction?

A

Less vomiting

Increased time between pain

72
Q

Management of bowel obstruction

A 
Resucitation 
NG tube
Fluids
Catheter 
Watchful waiting or surgery.
73
Q

What sort of bowel obstruction often resolves itself?

A

Adhesions

74
Q

Indications for surgery in bowel obstruction

A

No adhesive cause suspected
Worsening pain
Raised temp, pulse

75
Q

How can a sigmoid volvulus be. Managed?

A

Pass a ridid sigmoidoscope to. Straighten

76
Q

What HAS to be examined in a case of bowel obstruction

A

Hernial orifices

77
Q

Characteristic anal fissure pain?

A

Pain through defication with stinging post defication

78
Q

Physical examination findings with anal fissure?

A

Fissure usually posterior

Sentinel pile

79
Q

What group of patients may have an anterior anal fissure

A

Post partum women

80
Q

Bowel changes in someone with an anal fissure?

A

Constipation

Diarrhoea due to water overflow around constipation

81
Q

Differential diagnosis of anal fissure? When should the main one be considered?

A

Low lying carcinoma of anus
Abnormal appearance, failed first line treatment treatment, systemic illness

Also - crohns,

82
Q

What are chronic anal fissures? What is a common causative mechanism? Why may acute fissures persist?

A

> 2 months duration
Vigerous wiping
Spasm of sphincter decreases blood supply decreasing healing

83
Q

Conservative treatments for anal fissures

A

Fluids
High fibre
Salt baths
Wash/dab rather than wipe

84
Q

Medical treatments for anal fissures

A

Fibrogel

Nitrates or calcium channel antagonists

85
Q

Surgical treatments for anal fissures

Mechanism?

A

Botox injection
Incision to the sphincter
Relaxes pressure aiding healing

86
Q

Physiological function of haemarrhoidal veins?

A

Stop flatulance

87
Q

Presentation of haemarrhoids

A

Bright red rectal bleeding
Pruritus
Discharge

88
Q

Haemorrhoid stages

A

1 - internal
2 - prolapse on defication, spontaniously reduce
3 - prolapse on defication, reduced manually
4 - constant prolapse

89
Q

Conservative treatment of haemarrhoids

A

Fibre

Fluids

90
Q

Symptomatic treatment of haemorrhoids

A

Anusol

91
Q

Surgical treatment of haemorrhoids

A

Haemorrhoidal banding
Injection sclerotherapy
Haemorrhoidal artery ligation
Open haemorrhodectomy

92
Q

Complication of haemorrhoids
Presentation
Treatment

A

Thrombosed pile
Very painful, discoloured, swollen
Ice pack and laxatives to reduce oedema, then as normal

93
Q

Definition of a sinus

A

Blind ended cavity

94
Q

Definition of fistula

A

Abnormal connection between two epithelial lined surfaces

95
Q

Definition. Of an abscess

A

Pus filled cavity lined with pyogenic membrane

96
Q

How do anal fistulas form?

A

From abscess that open at both ends

97
Q

Types of cleanliness in surgery?

A

Clean - no where near internal organs
Clean contaminated - internal organ puncture no leak
Contaminated - internal organ leak
Dirty - gross contamination

98
Q

Presentation of an anal abscess?

Signs of chronicity?

A

Tender perianal lump, systemic upset and fever

Chronic with discharge, anal pain

99
Q

Treatment of perianal abscess

A

Lay open and wash

100
Q

If you suspect an anal fistula what examinations?

A

MRI
EUA
Fistulography - squirt in dye and look inside, define path with wires

101
Q

A fistula presents in an emergency - management

A

Rigid sig
Drain and wash
Culture
Pack

102
Q

Ways to lay open chronic anal fistula

A

Cut in surgery

Insert a wire loop under tension that slowly cheesewires through to surface

103
Q

How do rectal cancers present?

A

Fresh blood
Pain
Tenesmus
Discharge

104
Q

How do left sided colon cancers present?

A

Mixed blood

Change in bowel habits

105
Q

How do transverse and right sided colon cancers present?

A

Weight loss
Anaemia
Mass
Small bowel obstruction

106
Q

2WW criteria for lower gi symptoms?

A

All ages - mass, +v occult blood
>40 - weight loss and abdo pain
50 - pr bleed
>60 - iron deficiency anaemia or change in bowels

107
Q

What examinations should be done on someone arriving on a 2ww pathway initially in clinic?

A

Pr
Sigmoidoscopy
Bloods

108
Q

Alternatives to colonoscopy in looking for suspected bowel cancer. Disadvantages?

A

Flexi sig - only sees so far
Barium enema - still needs bowel prep, misses small, still needs biopsy, misses rectum
CT abdo/pelvis - may miss small, still needs biopsy, radiation

109
Q

Tumour seen and biopsied in the bowel. What next?

A

Staging ct chest abdo pelvis

If rectal add mri pelvis for direct spread

110
Q

What is the advantage of a short course of preop chemo in bowel cancer?

A

Reduces risk of reocurrance

111
Q

What is the advantage of long course pre op chemo in bowel cancer

A

Reduces reoccurence and makes a locally advanced tumour more operable

112
Q

Elective operations for bowel cancer?

A 
R hemicolectomy 
Extended right hemicolectomy 
Anterior resection 
Abdominal peroneal resection
TEMS
113
Q

What is a tems proceedure for bowel cancer?

A

Transanal endoscopic microsurgery

114
Q

What emergency procedure can be performed for bowel cancer? Indications? What is it?

A

Hartmanns - obstruction, perforation

Resection of sigmoid colon and rectum with colostomy formation and closure of rectal stump.

115
Q

Staging for bowel cancer?

A 
Dukes
A - confined to wall
B - through the wall
C - involves lymph nodes
D - widespread mets
116
Q

Late complications of stomas

A 
Obstruction
Dermatitis
Prolapse
Parastomal hernia 
Fistula
117
Q

Early complications of stoma

A 
Haemorrhage
Ischemia 
High output
Adhesions
Retraction
118
Q

Term for a stoma that rests an anastemosis or distal bowel?

A

Defuctioning

119
Q

Post stoma what may happen at the anus?

A

Mucus production

120
Q

Risk factors for gastric cancer?

A 
Age
Asian
Poor
FHx
High fat diet
Preserved foods
Smoking 
H pylori
121
Q

What weird risk factor for gastric cancer is there?

A

Blood group A

122
Q

Pre malignant conditions for gastric cancer

A 
Polyps
Gastritis
Atrophic gastritis 
Ulcer
Gastric surgery
123
Q

Complications of parenteral nutrition

A

Feed - fluid overload, electrolyte imbalance, liver damage, refeeding syndrome
Line - infection, pneumothorax, vascular injury, thrombosis

124
Q

Types of entral nutrition

A 
Oral
Nasogastric
Nasojejunal
Gastrostomy 
Jejunostomy
125
Q

Advantage of nj feeding over ng

A

Risk of reflux or delayed gastric emptying mitigated

126
Q

Advantage of gastostomy feeding over ng or nj

A

Hidden so less embaressment

Longer lasting

127
Q

Assessment scores for upper gi bleed?

A

Blachford

Rockall

128
Q

Indications for a platelet transfusion in upper gi bleed

A

Active bleeding or unstable with platelets less than 50x10^9

129
Q

What should be done in a upper gi bleed with INR >1.5 or APPT 1.5x normal?

A

Ffp

If fribrinogen remains low offer cryoprecipitate

130
Q

What drugs should be given to suspected oesophageal variceal bleeding (assuming normal hb and clotting)

A

Terlipressin
Prophylactic antibiotics
Consideration to PPI

131
Q

Surgical/endocopical proceedures for bleeding oesophageal varicies

A

Band ligation

TIPS

132
Q

What does the blachford score look at in upper gi bleed?

A 
Hb
Blood urea
Systolic pressure
Pulse
Melena 
Syncope
Hepatic hx
Heart failure hx
133
Q

Complications of peritonitis

A

Sepsis
Abscess
Electrolyte disturbance

134
Q

At what age are people screened for AAA?

A

65

135
Q

What is the treatment threshold for AAA?

A

> 5.5cm

136
Q

AAA risk factors

A

Non-modifiable : age, male, FHx

Modifiable : smoking, atherosclerosis, hypertension

137
Q

What surgery requires antibiotic prophylaxis?

A

Clean with prothesis or implant
Clean contaminated
Contaminated

138
Q

Management of non urgent dyspepsia?

A

Review predisposing meds (bisphosphonates, nsaids, corticosteroids, nitrates, calcium antagonists)
H pylori breath test +/- eradication
4 week full dose PPI trial
If symptoms return post successful 4 weeks start low dose PPI

139
Q

What is achalasia?

A

Failure of peristalsis and of relaxation of the LOS

140
Q

Symptoms of achalasia

A

Gradual onset dysphagia
Regurgitation
Heartburn

141
Q

Diagnosis of achelasia

A

Barium swallow

Endoscopy

142
Q

Treatment of achelasia

A

Nitrates
Balloon dilation
Botox
Surgery

143
Q

Complications of achalasia

A

Oesophageal cancer
Aspiration pneumonia
Weight loss

144
Q

Types of hiatus hernia

A

1 - sliding, goj above diaphragm
2 - paraoesophageal, goj normal, fundus herniates next to oesophagus
3 - mixed 1 +2
4 - structures other than stomach also herniate

145
Q

Three types of bowel ischemia

A

Acute mesenteric
Chronic mesenteric
Ischemic colitis

146
Q

Pathophysiology and presentation of acute mesenteric ischemia

A

SMA thrombosis or embolism OR mesenteric venous thrombosis
Effects small bowel
Illness out of proportion with clinical signs
C/O acute abdo pain in RIF or umbilicus
O/E no abdo signs and shocked

147
Q

Tests in acute mesenteric ischaemia

A

Bloods - relative polycythemia due to plasma loss, raised WCC, metabolic acidosis
Imaging - arteriography, ct angiography

148
Q

Treatment of acute mesenteric ischaemia

A 
Fluids
Gentamycin and metronidazole 
Heparin 
Local infiltration of thrombolytics 
Surgical removal of necrotic bowel
149
Q

Pathophysiology and presentation of chronic mesenteric ischemia

A

Atheroma combined with low flow state (e.g. Heart failure)

C/O pain following eating (gut angina), weight loss (as eating hurts) +/- pr bleeding, malabsorption and nausea/vomiting

150
Q

Tests for chronic mesenteric ischaemia

A

Ct angiography

151
Q

Treatment for chronic mesenteric ischemia

A

Consider surgery due to risk of acute infarction

Potential for stenting

152
Q

Pathology and presentation of ischemic colitis

A

Low flow in the IMA

LIF pain, bloody diarrhoea

153
Q

Diagnosis of ischemic colitis

A

Colonoscopy with biopsy

Barium enema shows thumb printing

154
Q

Treatment of ischaemic colitis

A

Fluid replacement
Antibiotics
Surgery if gangrene (peritonitis and shock)

IPE (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions