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4th year passmedicine by topic > Appendicitis/ Bowel Disease > Flashcards

Appendicitis/ Bowel Disease Flashcards

1
Q

most common acute abdominal condition requiring surgery.

A

Acute appendicitis

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2
Q

Acute appendicitis can occur at any age but is most common in young people aged 10-20 years.

A

true

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3
Q

Acute appendicitis patients often report the pain being worse on

A

worse on coughing or going over speed bumps. Children typically can’t hop on the right leg due to the pain.

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4
Q

Acute appendicitis Abdominal pain is seen where?

A

peri-umbilical abdominal pain

radiating to the right iliac fossa (RIF)

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5
Q

Acute appendicitis mild pyrexia is common

A

true

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6
Q

Acute appendicitis o/e

A

generalised peritonitis - rebound and percussion tenderness, guarding and rigidity

psoas sign: pain on extending hip if retrocaecal appendix

Rovsing’s sign (palpation in the LIF causes pain in the RIF) is now thought to be of limited value

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7
Q

pelvic abscess o/e

A

digital rectal examination may reveal boggy sensation if pelvic abscess is present, or even right-sided tenderness with a pelvic appendix

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8
Q

Acute appendicitis diagnosis?

Bloods

A

neutrophil-predominant leucocytosis is seen in 80-90%

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9
Q

Acute appendicitis diagnosis?

Urinalysis

A

urinalysis may show mild leucocytosis but no nitrites

exclude pregnancy in women, renal colic and urinary tract infection

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10
Q

there are no definite rules on the use of imaging and its use is often determined by the patient’s gender, age, body habitus and the likelihood of appendicitis

A

true

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11
Q

imaging and acute appendicitis

A

Clincial diagnosis - thin males

US - females query pelvic pathology

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12
Q

Mx acute appencititis

A

laparoscopic appendicectomy

prophylactic intravenous antibiotics

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13
Q

patients with perforated appendicitis (typical around 15-20%) require

A

copious abdominal lavage.

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14
Q

appendicitis - be wary in the older patients who may have either an underlying caecal malignancy or perforated sigmoid diverticular disease.

A

true

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15
Q

Angiodysplasia is

A

vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia.

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16
Q

Angiodysplasia is assoc with

A

aortic stenosis

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17
Q

Angiodysplasia is generally seen in

A

elderly patients

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18
Q

Angiodysplasia diagnosis

A

colonoscopy

mesenteric angiography if acutely bleeding

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19
Q

Angiodysplasia mx

A

endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used

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20
Q

Clostridium difficile is a

A

Gram positive rod

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21
Q

Clostridium difficile produces exo/endotoxin

A

exotoxin

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22
Q

Clostridium difficile roduces an exotoxin which causes intestinal damage leading to a syndrome called

A

pseudomembranous colitis

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23
Q

Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics
which abs?

A

Clindamycin

cephalosporins

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24
Q

Leading cause of Clostridium difficile.

A

Second and third generation cephalosporins

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25
Q

C diff Other than antibiotics, risk factors include:

A

PPIs

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26
Q

C diff Features

A

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop

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27
Q

C diff

severity scale?

A

Mild: Normal WCC

Moderate: ↑ WCC ( < 15 x 109/L)
Typically 3-5 loose stools per day

Severe: ↑ WCC ( > 15 x 109/L)
or an acutely ↑ creatinine (> 50% above baseline)
or a temperature > 38.5°C
or evidence of severe colitis(abdominal or radiological signs)

life-threatening: Hypotension
Partial or complete ileus
Toxic megacolon, or CT evidence of severe disease

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28
Q

Clostridium difficile Diagnosis?

A

is made by detecting Clostridium difficile toxin (CDT) in the stool

Clostridium difficile antigen positivity only shows exposure to the bacteria, rather than current infection

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29
Q

Management C Diff?

A

first-line therapy is oral metronidazole for 10-14 days

if severe or not responding to metronidazole then oral vancomycin may be used

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30
Q

patients who are not responding , particularly those with multiple co-morbidities c diff?

A

fidaxomicin

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31
Q

C Diff for life-threatening infections?

A

combination of oral vancomycin and intravenous metronidazole should be used

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32
Q

It is currently thought there are three types of colon cancer:

A

sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis (FAP, <1%

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33
Q

Most common form of inherited colon cancer.

A

HNPCC

34
Q

HNPCC, an autosomal dominant condition

A

True

35
Q

Around 90% of patients develop cancers, often of the proximal colon

A

true

36
Q

Colorectal Ca most common genes involved

A

MSH2 (60% of cases)

MLH1 (30%)

37
Q

Patients with HNPCC are also at a higher risk of other cancers, with what cancer being the next most common association, after colon cancer.

A

endometrial

38
Q

Colorectal ca

The Amsterdam criteria are sometimes used to aid diagnosis:

A

at least 3 family members with colon cancer

the cases span at least two generations

at least one case diagnosed before the age of 50 years

39
Q

what is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years.

A

FAP

40
Q

FAP is what?

A

mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.

41
Q

A variant of FAP called Gardner’s syndrome can also feature

A

osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin

42
Q

Diverticulosis is an extremely common disorder characterised by multiple outpouchings of the bowel wall, most commonly in

A

sigmoid colon.

43
Q

Risk factors diverticulosis

A

increasing age

low-fibre diet

44
Q

Diverticulosis sx

A

painful diverticular disease: altered bowel habit, colicky left sided abdominal pain.

45
Q

diverticulosis high fibre diet is usually recommended to minimise symptoms

A

true

46
Q

One of the diverticular become infected. The classical presentation is:

A

left iliac fossa pain and tenderness
anorexia, nausea and vomiting
diarrhoea
features of infection (pyrexia, raised WBC and CRP)

47
Q

Diverticulitis mx

A

mild attacks can be treated with oral antibiotics
more significant episodes are managed in hospital. Patients are made nil by mouth, intravenous fluids and intravenous antibiotics (typical a cephalosporin + metronidazole) are given

48
Q

Complications of diverticulitis include:

A

abscess formation
peritonitis
obstruction
perforation

49
Q

Ischaemia to the lower gastrointestinal tract can result in a variety of clinical conditions. Whilst there is no standard classification it can be useful to separate cases into 3 main conditions

A

acute mesenteric ischaemia
chronic mesenteric ischaemia
ischaemic colitis

50
Q

bowel ischaemia Common predisposing factors

A

increasing age
atrial fibrillation - particularly for mesenteric ischaemia
other causes of emboli: endocarditis, malignancy
cardiovascular disease risk factors: smoking, hypertension, diabetes
cocaine: ischaemic colitis is sometimes seen in young patients following cocaine use

51
Q

bowel ischaemia bloods typically show

A

elevated white blood cell count associated with a lactic acidosis

52
Q

bowel ischaemia diagnosis

A

CT

53
Q

Ischaemic colitis describes

A

acute but transient compromise in the blood flow to the large bowel.

54
Q

Ischaemic colitis more likely to occur in

A

‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

55
Q

Ischaemic colitis Investigations

A

‘thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage

56
Q

Metabolic alkalosis - Causes

A 
vomiting / aspiration (e.g. peptic ulcer leading to pyloric stenos, nasogastric suction)
diuretics
liquorice, carbenoxolone
hypokalaemia
primary hyperaldosteronism
Cushing's syndrome
Bartter's syndrome
57
Q

Molecular biology techniques

A

Southern blotting Detects DNA

Northern blotting Detects RNA

SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)

58
Q

Molecular biology techniques Western blotting detects?

A

Detects proteins
Uses gel electrophoresis to separate native proteins by 3-D structure
Examples include the confirmatory HIV test

59
Q

Molecular biology techniques - what is ELISA

A

a type of biochemical assay used to detect antigens and antibodies
a colour changing enzyme is attached to the antibody if looking for an antigen and to an antigen if looking for an antibody
the sample therefore changes colour if the antigen or antibody is detected
an example includes the initial HIV test

60
Q

Peutz-Jeghers syndrome is

A

autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract

61
Q

Peutz-Jeghers is assoc with freckles

A

true

pigmented freckles on the lips, face, palms and soles

62
Q

PJS he polyps themselves don’t have malignant potential, around 50% of patients will have died from another gastrointestinal tract cancer by the age of 60 years.

A

true

63
Q

PJS responsible gene

A

LKB1 or STK11

64
Q

Peutz-Jeghers syndrome mx

A

conservative unless complications develop

65
Q

Small bowel bacterial overgrowth syndrome (SBBOS) is

A

disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.

66
Q

SBBOS risk factors

A

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

67
Q

SBBOS many of the features overlap with irritable bowel syndrome

A

true

68
Q

SBBOS diagnosis

A

hydrogen breath test

clinicians may sometimes give a course of antibiotics as a diagnostic trial

69
Q

SBBOS mx

A

correction of underlying disorder

antibiotic therapy: rifaximin

70
Q

Spontaneous bacterial peritonitis

Diagnosis

A

paracentesis: neutrophil count > 250 cells/ul

71
Q

Spontaneous bacterial peritonitis most common organism found on ascitic fluid culture is

A

E. coli

72
Q

Spontaneous bacterial peritonitis

Antibiotic prophylaxis should be given to patients with ascites if:

A

patients who have had an episode of SBP

patients with fluid protein <15 g/l and
either Child-Pugh score of at least 9 or hepatorenal syndrome

73
Q

Spontaneous bacterial peritonitis which abs

A

oral ciprofloxacin or norfloxacin

74
Q

Villous adenomas are

A

colonic polyps with the potential for malignant transformation. They characteristically secrete large amounts of mucous, potentially resulting in electrolyte disturbances.

75
Q

Villous adenomas are mostly asymptomatic

A

true

76
Q

Villous Adenoma - The vast majority are asymptomatic. Possible features:

A

non-specific lower gastrointestinal symptoms
secretory diarrhoea may occur
microcytic anaemia
hypokalaemia

77
Q

Whipple’s disease is

A

are multi-system disorder caused by Tropheryma whippelii infection

78
Q

Whipple’s disease is more common in?

A

more common in those who are HLA-B27 positive and in middle-aged men.

79
Q

Whipples disease symptoms

A

malabsorption: diarrhoea, weight loss
large-joint arthralgia
lymphadenopathy
skin: hyperpigmentation and photosensitivity
pleurisy, pericarditis
neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus

80
Q

Whipple’s disease diagnosis?

A

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

81
Q

Whipple’s disease mx guidelines vary

A

true
guidelines vary: oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin

4th year passmedicine by topic (96 decks)

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