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PACES Y6 > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Indications for renal replacement therapy

A

Uraemia
Resistant hyperkalaemia
Pulmonary oedema with oliguria (resistant)
Drug toxicity e.g. lithium
Resistant metabolic acidosis
End-stage renal failure eGFR<15

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2
Q

Which medications do you monitor following a renal transplant and how?

A

Calcineurin inhibitor e.g. cyclosporin and tacrolimus - monitor for HTN, hyperglycaemia (CVD risks), renal function

Corticosteroids - diabetes, osteoporosis

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3
Q

Different abdominal regions

A

Right hypochondriac, epigastric, left hypochondriac
Right lumbar, umbilical, left lumbar
Right iliac, hypogastric/suprapubic, left iliac

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4
Q

Different abdominal scars and their indications

A

Kocher (right upper) - cholecystectomy
Rooftop (whole upper) - oesophagectomy, pancreatic surgery

Midline - bowel resection, bariatric, hysterectomy in woman
Paramedian (less bleeding, less pain, more complications, longer recover) - retroperitoneal space e.g. adrenalectomy, lumbar spine surgery
Pararectal - colectomy
Periumbilical - laparoscopic e.g. access liver, gallbladder, stomach

Transverse - gallbladder, spleen, pancreas
Pfannenstiel - c-section, hysterectomy

Gridiron (diagonal) - appendicectomy, less cosmetically acceptable
Lanz (transverse) - appendicectomy

Rutherford-Morrison incision - adrenalectomy
Hockey-stick incision - renal transplant

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5
Q

Where is McBurney’s point and what does it show?

A

1/3 from ASIS to umbilicus

Appendix location

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6
Q

Signs of liver failure

A

Stable
- Spider naevi
- Dupuytren’s contracture
- Gynaecomastia
- Palmar erythema

Decompensation
- Splenomegaly
- Ascites
- Encephalopathy
- Varices
- Failed liver function e.g. poor clotting

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7
Q

Cause of haematomas on abdomen

A

Insulin injections
Blood clotting disorders
Blood thinning medication
Trauma
Surgery

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8
Q

What is an ileo-anal pouch and when is it used?

A

Ileum is connecting to an anus in a way that mimics the function of the large intestine
Allows patient to store and eliminate faeces more naturally
Used in IBD and cancer colectomy

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9
Q

Types of surgery for IBD

A

Colectomy
Proctocolectomy (colon and rectum)

Ileostomy
Ileal pouch-anal anastomosis

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10
Q

Post-op management of abdominal surgery

A

Pain e.g. opioids, NSAIDs
Fluids
Antibiotics
Nutrition
Mobilise early
Monitor for complications e.g. fever, vomiting

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11
Q

How is the mucosa different in the different types of stomas?

A

Ileostomy - thinner, smoother
Colostomy - thicker, more convoluted (haustral folds)

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12
Q

What is gallstone ileus and how is it different to paralytic ileus?

A

Gallstone ileus - gallstone pases to small intestine causing blockage, tinkling sounds (treat with surgery)

Paralytic ileus - reduced intestinal contractions, no sounds, caused by surgery, medications (opioids), infections (treat with cholinergics and electrolytes collecting any imbalances)

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13
Q

Causes of splenomegaly

A

Sickle cell disease
Malignancy: lymphoma, leukaemia
Liver disease: portal hypertension
Infections: EBV, malaria

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14
Q

Causes of hepatomegaly

A

Hepatic: hepatitis, cirrhosis, fatty liver, hepatocarcinoma
Congestive heart failure
Medication: methotrexate

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15
Q

How is a urostomy formed and why would it be formed?

A

Ileum removed to create channel from ureters out through abdominal wall

Done in bladder cancer, neurogenic bladder, incontinence

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16
Q

When is a nephrostomy done?

A

Large kidney stone
Cancer blocking ureter
Stricture in ureter
Trauma to ureter
UTI not responding to other treatments

17
Q

Management of a hernia (inguinal, femoral, parastomal)

A

Inguinal (superior, medial) - mesh repair, hernia truss if unfit for surgery (support)
Femoral (inferior, lateral) - laparoscopic repair
Parastomal - conservative (supportive belt), surgical reinforcement, monitoring

18
Q

Causes of pain following surgery

A

Normal inflammation
Infection
Nerve damage
Muscle spasm
Adhesions

19
Q

Peripheral signs of IBD

A

Uveitis
Erythema nodosum
Arthritis

20
Q

Management of IBD

A

Ulcerative colitis
Induce remission: topical/oral mesalazine
Maintain remission: topical/oral mesalazine
Severe colitis: IV steroids

Crohn’s disease
Induce remission: glucocorticoids
Maintain remission: glucocorticoids

21
Q

Manegement of cholecystitis

A

Fluids
Analgesia
IV abx
Laparoscopic cholecystectomy within 1 week

22
Q

Management of acute cholangitis

A

1) IV abx (broad spectrum until blood culture results)
2) ERCP and stent

23
Q

What is a Hartmann’s procedure, abdomino-perineal resection, and anterior resection, and the end results i.e. stomas, end-pouch, anastomosis

A

Hartmann’s procedure: Emergency sigmoid colectomy in obstruction, tumour perforation, diverticulitis. End colostomy that may be reversed (50% patients).

Abdominal-perineal resection: Sigmoid to anus removed. Rectal cancer <4cm from anal verge. Single lumen (loop) colostomy.

Anterior resection: Sigmoid to rectum removed. Rectal cancer >4cm from anal verge. Colorectal anastomosis covered by temporary loop ileostomy, as rectal blood supply is poor.

24
Q

When is a loop ileostomy formed compared to an end ileostomy?

A

Loop ileostomy made to protect distal anastomosis, usually reversed but permanent if complications/not candidate for reversal.

End ileostomy if colon removed, or colon is healing from disease. Can be temporary, or permanent if colon removed completely/ other reasons.

25
Q

Is there a stoma in the hemicolectomies?

A

None usually

26
Q

RIF pain causes. Investigation, management of key ddx

A

Appendicitis
Ectopic
Kidney stones
Constipation

Raised CRP with hx + examination enough
Can see high neutrophils
USS in females if pelvic organ pathology suspected

Appendicectomy
Prophylactic IV abx
Abdominal lavage if perforated

27
Q

LIF pain causes. Investigation, management of key ddx

A

Diverticulitis
Ectopic
Kidney stones
Constipation

CT - best modality
Avoid colonoscopy due to perforation

Oral abx, liquid diet, analgesia
Admit for IV abx if symptoms don’t settle

PACES Y6 (6 decks)

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