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MedEd Lectures > Acute GI > Flashcards

Acute GI Flashcards

1
Q

What are the classical presentation of appendicitis

A
  1. young patient
  2. Acute onset
  3. umbilical pain that moves to the right iliac fossa
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2
Q

What are the signs of appendicitis

A
  1. Rovsing’s sign:
    palpation of the LIF causes more pain in the RIF
  2. Cope’s sign: pain of passive flexion and internal rotation of the hip
  3. Psoas sign: pain on extending hip
  4. Rebound tenderness: sign of peritonitis
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3
Q

What are the investigations for appendicitis

A
  1. Bloods - leukocytosis + raised CRP
  2. USS
  3. CT - very sensitive but takes time
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4
Q

What is the treatment of appendicitis

A

appendectomy

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5
Q

What is the surgical scar left after an appendectomy

A

McBurney’s incision

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6
Q

What are the antibiotics that are used as prophylaxis in appendicectomy

A
  1. metronidazole

2. cefuroxime

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7
Q

What are the complications of appendicitis

A
  1. peroforation
  2. appendix mass - inflamed appendix becomes covered in omentum and forms a mass
  3. appendix abscess
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8
Q

A nervous 16-year-old college student attends the local A&E department with her boyfriend, complaining of an episode of sudden onset right-sided pain in her abdomen. Physical examination of the patient is unremarkable except from a small scar located near the inguinal ligament. What is the most appropriate first line investigation in this case?

USS of the abdomen
𝞫-hCG test
Full blood count
CT scan of the abdomen
No investigations, immediate surgery
A

𝞫-hCG test

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9
Q

A 26-year-old professional rugby player presents to the A&E department with abdominal pain in the umbilical area. On initial inspection, the gentleman is feverish with a temperature of 38C and a BP of 115/90. The admitting doctor suspects a diagnosis of appendicitis from the history and performs an abdominal physical examination and passively extends the gentleman’s right hip which elicits pain. Which eponymous sign of appendicitis is being demonstrated here and what does it represent?

Cope’s sign, and a retrocaecal appendix

Psoas sign, and a retrocaecal appendix

Psoas sign, and an appendix located next to obturator externus

Rovsing’s sign, and a retrocaecal appendix

Rovsing’s sign, and an appendix located next to obturator externus

A

Psoas sign, and a retrocaecal appendix

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10
Q

What is diverticulosis

A

presence of diverticulae outpouching of the colonic mucosa and submucosa throughout the large bowel

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11
Q

What is diverticular disease

A

the complications of diverticulosis

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12
Q

What is diverticulitis

A

acute inflammation and infection of diverticulae

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13
Q

What are the common presentation for diverticular disease

A
  1. bloody stool
  2. LIF pain
  3. fever
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14
Q

On general inspection, the patient is absolutely still, what does that suggest

A

peritonitis

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15
Q

What are the investigations for acute diverticular disease

A
  1. CT

2. Flexible sigmoidoscopy +/- colonoscopy

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16
Q

What are the investigations for chronic diverticular disease

A
  1. barium enema

2. Flexible sigmoidoscopy +/- colonoscopy

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17
Q

What is the management for acute diverticulosis

A
  1. IV hydration

2. bowel rest

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18
Q

What is the management of diverticular disease

A
  1. soluble high fibre diet

2. anti-inflammatories (mesalazine)

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19
Q

Diverticular disease: What is recommended if a patient has recurrent attacks or complication

A

Surgery
Hartmann’s
primary anastomosis

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20
Q

What is Hartmann’s procedure

A

removal of the diseased bowel and end-colostomy formation with a anorectal stump
This is used when primary anastomosis (immediate joining) is not possible

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21
Q

What are the complications of diverticular disease

A
  1. diverticulitis
  2. faecal peritonitis
  3. fistula
  4. peri-colic abscess
  5. colonic obstruction
  6. perforation
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22
Q

A feverish 56-year-old woman attends her GP complaining of a sudden appearance of bloody stools. She adds that she has experienced a few episodes of bloody stools before but did not seek medical attention and apart from a fever, she has had no other constitutional symptoms. The GP notes that the patient’s diet is particularly low in fibre and on physical examination, tenderness is found on pressure to the LIF. A DRE shows fresh blood upon removal of a gloved finger. What is the most likely diagnosis?

Angiodysplasia
Diverticulosis
Diverticulitis
Mallory-Weiss tear
Gastroenteritis
A

Diverticulitis

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23
Q

What are constitutional symptoms

A 
FLAWSV
Fever 
Lethargy 
Appetite changes
Weight loss 
Night sweats
Vomiting & nausea
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24
Q

A feverish 65-year-old is brought to the local A&E department by her daughter. She complains about nausea, LIF pain and vomiting. The attending doctor takes a full history and performs an abdominal examination and subsequently makes a diagnosis of acute diverticulitis with some associated signs of peritonism. A erect AXR is taken which shows some air under the diaphragm. What is the most appropriate surgical procedure?

Hartmann’s procedure
Primary anastomosis
Colectomy and end-ileostomy formation
Delorme’s procedure 
Whipple’s procedure
A

Hartmann’s procedure

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25
Q

What are the risk factors for hernia

A
  1. age
  2. obesity
  3. constipation
  4. chronic cough
  5. heavy lifting (gym)
26
Q

What are the classical presentation of a hernia

A
  1. lump in groin
  2. groin pain
  3. vomiting
  4. scrotal swelling
27
Q

What are the features of femoral hernia

A 
lateral & inferior to pubic tubercle 
More common in females
more commonly strangulated 
surgery recommended 
Older patients
28
Q

What are the features of inguinal hernia

A 
superior and medial to pubic tubercle 
common is males
less commonly strangulated 
can be treated without surgery 
younger patients
29
Q

What are signs of a strangulate hernias

A 
tender
red
colicky abdominal
distension
vomiting
30
Q

How do you determine the difference between the a direct and indirect inguinal hernia

A
  1. reduce the hernia
  2. place finger over deep inguinal ring (just above the midpoint of the inguinal ligament)
  3. Ask the patient to cough and if the hernia re-appear, it cannot be an indirect hernia
31
Q

What is the first investigation for hernias

A

USS

32
Q

A 26-year-old bodybuilder attends the local day-surgical clinic upon referral from his GP due to a groin lump. The general surgical registrar suspects a hernia and so performs a simple test to ascertain the type of hernia to determine the most appropriate management. The doctor reduces the hernia and then places their finger over the deep inguinal ring. The patient is asked to cough and the hernia does not reappear. What is the most likely type of hernia?

Femoral hernia
Direct inguinal hernia
Indirect inguinal hernia
Spigelian hernia
Hiatus hernia
A

Indirect inguinal hernia

33
Q

What is the classical presentation of pancreatitis

A
  1. epigastric pain
  2. pain relieved by sitting forward
  3. pain radiates to the back
  4. pain worst on movement
34
Q

What are the causes of pancreatitis

A 
I GET SMASHED 
Idiopathic 
Gallstones
Ethanol 
Trauma 
Steroids 
Mumps
Autoimmune disease 
Scorpion sting 
Hypertriglyceride + hypercalcaemia 
ERCP
Drugs (thiazides)
35
Q

What are the signs of pancreatitis

A
  1. epigastric tenderness
  2. fever
  3. shock, tachycardia, tachypnoea
  4. reduced bowel sounds
  5. Cullens sign
  6. Grey Turner’s
    5 + 6 are signs of retroperitoneal bleeding
36
Q

What are the investigations fr pancreatitis

A
  1. amylase
  2. USS - gall stones?
  3. Erect CXR & AXR - pleural effusion?
  4. CT to exclude other causes
37
Q

How does the amylase present in chronic pancreatitis

A

normal

38
Q

What scoring system is used to measure the severity of pancreatitis

A

Modified Glasgow Score

>3 = severe

39
Q

How can the modified Glasgow score be used to measure the severity of pancreatitis

A 
PANCREAS 
P = PaO2 = <7.9kPa
A = age = >55y/o
N = neutrophils = >15x10 9/L
C = calcium = <2mmol/L
R = renal function = urea >16mmol/L
E = enzymes = LDH > 6000U/L or AST >200U/L
A = albumin = <32g/L
S = sugar = >10mmol
40
Q

What is the management for acute pancreatitis

A
  1. NBM
  2. Drip and suck
  3. Catheter and NG tube if vomiting
  4. analgesia + glucose control
  5. surgical = ERCP
41
Q

What are the risk factors for chronic pancreatitis

A
  1. GET SMASHED

2. mostly alcohol related 70%

42
Q

What is the classical presentation of chronic bronchitis

A
  1. recurrent epigastric pain
  2. pain relieved by sitting forward
  3. Weight loss, bloating, steatorrhoea
  4. pain worse on movement
43
Q

What are the signs of chronic pancreatitis

A
  1. epigastric tenderness

2. Cullen’s + Grey Turner’s

44
Q

What are the investigations for chronic pancreatitis

A
  1. serum amylase is normal
  2. raise fecal elastase
  3. AXR pancreatic calcification
  4. ERCP/MRCP = early: duct dilation, late = duct strictures
45
Q 
Which of the following may be raised in chronic pancreatitis?
Amylase
Calcium
Faecal elastase
Albumin
Haematocrit
A

Faecal elastase

46
Q 
Which of the following is not a cause of acute pancreatitis?
Mumps
Hypocalcaemia
Thiazide drugs
Trinidad scorpion bite
Steroids
A

Hypocalcaemia

47
Q

What are the risk factors for intestinal obstruction

A
  1. Malignancy
  2. hernia hx
  3. surgery hx
48
Q

What is the classical presentation of intestinal obstruction

A
  1. diffuse pain
  2. constipation
  3. vomiting
  4. abdominal distention
49
Q

What can be seen on general examination of a patient with intestinal obstruction

A
  1. abdominal distention

2. pyrexia, sweating (potential perforation or infarction)

50
Q

What can be heard on auscultation in a patient with intestinal obstruction

A
  1. high pitched tinkering bowel sounds

2. absent bowel sounds

51
Q

What causes bowel obstruction

A
  1. strangulated hernia
  2. volvulus
  3. inssuscepiton
52
Q

How do you diagnose intestinal bowel obstruction

A

Plain AXR and CT

normal bowel follows 3/6/9 rule

53
Q

What is the treatment for intestinal obstruction

A

medical treatment: Drip and suck

Surgical treatment: laparotomy

54
Q

An overweight 65-year-old woman visits her general practitioner with discomfort in her right groin. On examination, the suggestion of a reducible groin lump is noted. She is routinely referred to the surgical outpatient clinic with a possible diagnosis of inguinal hernia. However, two weeks later and before her surgical appointment, she again visits her general practitioner, this time with vomiting, diarrhoea, and colicky abdominal pain. What is the next most appropriate management step?

Administer antibiotics
Give IV fluids
Insert an NG tube
Give IV fluids and insert an NG tube
Administer an enema
A

Give IV fluids and insert an NG tube

55
Q

what is intestinal ischaemia

A

impaired blood transfusion to the intestine, resulting in ischaemia of the bowel wall. Also known as acute mesenteric ischaemia.
It can be acute and chronic

56
Q

What are the risk factors for intestinal ischaemia

A
  1. old age
  2. cardiovascular disease
  3. AF
  4. hypotensive state
    such as car accidents
57
Q

What is the presenting symptoms of acute intestinal ischaemia

A

Triad

  1. sudden onset diffuse pain
  2. shock signs
  3. normal exam
58
Q

What are the investigations for intestinal ischaemia

A
  1. AXR - perforation, megacolon
  2. Angiography - show blockages
  3. ECG - look for MI or AF
59
Q

What are the risk factors for chronic intestinal ischaemia

A
  1. old age
  2. cardiovascular disease
  3. heart failure
60
Q

What are the presenting symptoms of chronic intestinal ischaemia

A
  1. intermittent claudication
  2. post-prandial pain (after eating)
  3. PR bleeding
  4. weight loss
61
Q

What are the investigation for chronic intestinal ischaemia

A
  1. blood on DRE
  2. normal abdominal exam
  3. weight loss o inspection
  4. AXR
  5. angiography - show blockages
  6. ECG - look for MI or AF
62
Q

A 70-year-old gentleman presents to the A&E department with sudden-onset severe diffuse abdominal pain. Observations are taken in the ambulance which show an irregularly irregular pulse rate of 130 and a blood pressure of 76/60mmHg. An abdominal X-ray is performed as soon as possible which shows the Rigler sign and the physician diagnoses an acute form of mesenteric ischaemia with perforation. What is the most likely cause for the acute onset of the mesenteric ischaemia?

Atherosclerotic disease
Embolism
Thrombosis
Polycythaemia vera
Idiopathic
A

Embolism

MedEd Lectures (15 decks)

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