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Year 3 > Block 32 Week 5 > Flashcards

Block 32 Week 5 Flashcards

1
Q

gastric cancer incidence?

A
  • more common in men
  • highest indicence in far east
  • > 90% are adenocarcinomas
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2
Q

RF for gastric cancer?

A
  • H. Pylori infection (secondary to inducing atrophic gastritis)
  • Excessive intake of salted food
  • Smoking
  • Pernicious anaemia
  • Menetrier’s disease
  • Gastric polyps
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3
Q

gastric cancer symptoms?

A
  • Usually presents late with symptoms of dyspepsia
  • Weight loss, anorexia, nausea
  • Upper GI bleed/anaemia
  • Maybe outflow obstruction if tumour near pylorus
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4
Q

gastric cancer - palpable?

A
  • Palpable epigastric mass
  • Virchow’s node – palpable lymph node in supraclavicular fossa
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5
Q

Blood tests for gastric cancer?

A
  • FBC - iron def anemia
  • LFT - evidence of mets
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6
Q

CT for gastric cancer?

A
  • staging
  • mets
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7
Q

Endoscopy for gastric cancer?

A
  • Visualisation for histology
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8
Q

BARRETS?

A
  • Prescence of columnar epithelium in LO
  • Results from long-standing acid reflux with metaplasia from squamous to columnar epithelium in the lower oesophagus
  • Its a premalignant condition for oesophageal adenocarcinoma – 30 fold increase in risk
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9
Q

Decision to treat?

A
  • the date a patient agrees a treatment plan, may not be the day consent is signed
  • Can change if the treatment plan changes and the patient needs to agree the change
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10
Q

symptoms of GOJ cancer?

A
  • Atypical upper abdominal pain.
  • Dyspepsia
  • Nausea and vomiting.
  • Anorexia.
  • Early satiety.
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11
Q

dysphagia in GOJ cancer?

A
  • Progressive dysphagia initially solids (bread)
  • The dysphagia may be accompanied by a steady, boring pain, which often signals mediastinal involvement & inoperability.
  • Obstruction (occurs when cancer is far advance)
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12
Q

Signs of GOJ cancer?

A
  • Anaemia.
  • Weight loss
  • Palpable mass (liver metastases)
  • Virchow’s node
  • Ascites
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13
Q

History for GOJ cancer?

A
  • B’s O
  • years of dysphagia
  • h pylori
  • prev gastric surgery
  • known perinicious anemia
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14
Q

CRC tumour markers?

A

CEA

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15
Q

Prostate cancer tumour marker?

A

PSA

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16
Q

CA125 tumour marker?

A

ovarian

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17
Q

pancreatic cancer tumour marker?

A

CA19.9

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18
Q

hepatocellular cancer tumour marker?

A

AFP -germ cell, ovary/ testis

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19
Q

Which sites are more commonly affected by CRC?

A

caecum and ascending colon most affected

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20
Q

LNs CRC spreads to?

A
  • spreads to local paracolic, para-aortic lymph nodes
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21
Q

gastric cancer risk factors?

A
  • H. Pylori increases HR to 4.5.
  • Smoked foods.
  • Tobacco, alcohol.
  • Pernicious anaemia, achlorhidria.
  • Blood group A.
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22
Q

gender and age inc risk for gastric cancer?

A
  • Male sex.
  • Age 50- 70 yrs.
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23
Q

pres of gastric cancer - other?

A
  • Anorexia.
  • Early satiety.
  • Nausea and vomiting.
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24
Q

diagnosis of gastric cancer?

A
  • virchows node
  • FBC: anaemia, plasma proteins: malnutrition.
  • Endoscopy biopsy, CT scan chest and abdomen.
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25
Q

hernias are generally caused by?

A

increased intra-abd pressure, weak or damaged tissues or comb of both

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26
Q

causes of increased abd pressure - cough?

A
  • Chronic cough:COPD, long-term smoking,bronchiectasis,cystic fibrosis
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27
Q

causes of inc abd pressure - abd distension?

A

pregnancy, ascites, peritoneal dialysis, obesity (ventral hernias)

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28
Q

causes of inc abd pressure - straining?

A

chronic constipation, prostatism, heavy lifting during work or exercise
* Kyphoscoliosis

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29
Q

weakened tissues leading to hernias?

A
  • Congenital defects:patent processus vaginalis, patent umbilical ring
  • Collagen disorders:Ehlers-Danlos syndrome, vitamin C deficiency, family history of hernias
  • Trauma:including surgery
  • Ageing
  • Chronic malnutrition
  • Long-term corticosteroid use
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30
Q

most common type of hernias?

A

inguinal hernias

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31
Q

inguinal hernia?

A
  • abnormal protrusionofabdominopelvic contents through thesuperficial inguinal ring into the groin.
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32
Q

Inguinal canal contents?

A
  • in men, the inguinal canal contains the spermatic cord to the testis and the round ligament in women
  • carries the illioinguinal nerve and genital branch of the genitofemoral nerve in both
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33
Q

direct inguinal hernia?

A
  • caused by a weakness in the posterior wall of the inguinal canal - Hesselbach’s triangle
  • abd contents (usually just fatty tissue, sometimes bowel) are forced directly through this defect into the inguinal canal
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34
Q

direct hernia enters through the

A

deep ring and exits via superficial

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35
Q

indirect inguinal hernia?

A
  • Instead of piercing the posterior wall, the abdominal contentsenter medial to the deep ring, pass along the length of the inguinal canal and exit via the superficial ring,
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36
Q

indirect inguinal hernia?

A
  • Instead of piercing the posterior wall, the abdominal contentsenter medial to the deep ring, pass along the length of the inguinal canal and exit via the superficial ring,
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37
Q

indirect vs direct inguinal hernias?

A
  • if you place your finger over the deep inguinal ring (just above the mid-point of the inguinal ligament), then you can control an indirect inguinal hernia which has been reduced.
  • If when youpress the deep ring, thehernia still protrudes, then the hernia is emerging via a defect in the posterior wall medial to this point and is, therefore, adirect hernia.
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38
Q

IH RFs?

A
  • IH are more common in men
  • incidence peaks at 70
  • low BMI RF for inguinal hernias
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39
Q

CFs of an inguinal hernia?

A
  • Patients often present with alump in the grointhat comes and goes and has slowly increased in size over time.
  • the lump may have popped out suddenly, for example after heavy lifting.
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40
Q

symptoms of an inguinal hernia?

A
  • symptomatic hernias present w groin pain or discomfort, espec after coughing, bending over or standing for long periods
  • pain/ altered sensation over scrotum or inner thigh due to compression of illioinguinal nerve
  • changes in bowel habit or US depending on hernia contents
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41
Q

inguinal hernias are often?

A

asymptomatic other than the lump

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42
Q

diagnosis of an inguinal hernia?

A
  • palpable swelling located above and medial to pubic tubercle
  • Larger hernias may extend down into thescrotum.
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43
Q

diagnostic uncertainty w hernias?

A
  • Where there is diagnostic uncertainty, anultrasound scanof the groin can help differentiate between other possible causes such as enlarged lymph nodes, fatty lumps, or vascular pathology.
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44
Q

femoral hernias?

A
  • less common type of hernia
  • freq present w bowel obstruction
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45
Q

what is a femoral hernia?

A
  • abnormal protrusion of abdominopelvic contentsthrough the femoral canalinto the medial upper thigh.
  • the femoral canal is a narrow space bordered by the lacunar ligament so they are at a high risk of obstruction or strangulation
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46
Q

who are femoral hernias more common in?

A
  • more common in women
  • incidence inc w age - higher risk over 50
  • low BMI - less fat in femoral canal
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47
Q

protective factors with femoral hernias?

A

laparoscopic inguinal hernia repair

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48
Q

Cfs of a femoral hernia?

A
  • lump in groin
  • sig prop present as an emergency w symptoms of bowel obstruction or strangulation
  • bowel can perforate
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49
Q

inguinal vs femoral hernias?

A
  • inguinal hernias are situated above and medial to the pubic tubercle
  • femoral hernias are located below and lateral to the pubic tubercle
  • Femoral hernias are usually quite small and are not always easily palpable, especially in overweight patients.
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50
Q

management of femoral hernias?

A
  • high risk of complications so always need to be repaired
  • laparscopic mesh repair the best method
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51
Q

obturator hernia?

A
  • very rare
  • An obturator hernia is an abnormal protrusion of abdominopelvic contents through theobturator foramenof the bony pelvis into the medial upper thigh.
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52
Q

RF for an obturator hernia?

A
  • ‘little old lady hernia’
  • mostly affect elderly multiparous women
  • more common in people who are v thin or have recently lost weight like femoral hernias
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53
Q

why does pregnancy increase risk of an obturator hernia?

A
  • changes to pelvis and pelvic floor in pregnancy means herniation is easier
  • sharp angles of female obturator foraman also mean structures herniate through it
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54
Q

how do obturator hernias present?

A
  • more than 90% present as an emergency w an acute abdomen and features of bowel obstuction/ strangulation
  • This usually occurs suddenly, but some patients may reportself-limiting episodes of subacute obstructionat home previously.
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55
Q

episodes of obstruction with obturator hernias?

A
  • These are characterised by attacks of colicky abdominal pain, bloating and nausea/vomiting which resolved within a few hours.
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56
Q

lump w obturator hernias?

A
  • deep position means there’s hardly ever a lump to feel
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57
Q

how can patients also present w obturator hernias?

A
  • patients can also present w pain and altered sensation along the inner thighdue tocompression of the obturator nerveby the hernia,
  • which is relieved by flexing the hip and worsened by internally rotating it - howship romberg sign
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58
Q

howship romberg sign?

A
  • pain that is relieved by flexing the hip and made worse by internally rotating it
  • obturator hernia
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59
Q

test for undifferentiated acute abdomen?

A
  • gold standard: CT abdo pelvis with portal venous contrast
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60
Q

management of obturator hernias?

A
  • generally require emergency surgery
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61
Q

umbilical hernia?

A
  • most common ventral hernia
  • An umbilical herniais an abnormal protrusion of intra-abdominal contents through a fascial defect in or around theumbilical ring.
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62
Q

RFs for umbilical hernias?

A
  • women especially during or after pregnancy
  • Down’s syndromeandBeckwith-Wiedemann syndromehave been associated with umbilical hernias in children.
  • chronically raised intra-abd pressure due to obesity or ascites
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63
Q

20% of ? patients develop umbilical hernias?

A
  • cirrhosis patients, secondary to ascites.
  • Umbilical hernias can be lethal to these patients, as they often develop large hernias containing bowel and do not have the physiological reserve to survive an acute complication.
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64
Q

CFs of umbilical hernias?

A
  • usually asymptomatic
  • symptomatic patients usually have a lump in their belly button
  • hernias containing bowel are at risk of obstruction or strangulation
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65
Q

umbilicus in umbilical hernias?

A
  • palpable swelling in or around umbilicus
  • The umbilicus itself may beeverted or distortedby the hernia. It is important to note the condition of theoverlying skin, which can become stretched and thin and may start to break down, posing a risk of infection.
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66
Q

management of umbilical hernias?

A
  • low risk of complications and can safely be managed conservatively
  • majority of symptomatic umbilical hernias should undergoopen repair with a meshto reduce the risk of recurrence.
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67
Q

complications of hernias?

A

obstruction and strangulation

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68
Q

obstruction from hernias signs?

A
  • abd pain
  • distension and vomiting may occur
  • hernia will tense tender and irreducible
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69
Q

strangulation from hernias?

A
  • become red and tender
  • irreducible
  • no impulse on cough
  • if contains bowel -> signs of obstruction
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70
Q

causes of RIF pain?

A
  • appendicitis
  • meckles divertiuculm
  • UTI
  • PID
  • Ectopic pregnancy
  • mesenteric lymphadenitis
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71
Q

Appendicitis pain?

A
  • acute appendicitis - pain origininally epigastric and then right lowe quadrant.
  • accompanied by nausea, vomiting, loss of appetite and low grade fever
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72
Q

meckle’s diverticulum?

A
  • meckles’s diverticulum - GI bleeding, intestinal obstruction (symptoms usually before age of 2)
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73
Q

PID?

A
  • PID - bilateral lower abd and pelvic pain - dull
  • fever, headache, lassitude
  • abn vaginal discharge
  • usually appear at the time and immediately after menstruation
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74
Q

mesenteric lympahdenitis?

A
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75
Q

peritonitis common causes?

A
  • most commonly caused by perforation of an abd viscera e.g. colon, appendix, GB
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76
Q

primary peritonitis?

A

spontaneous bacterial invasion of the peritoneal cavity. Also known as spontaneous bacterial peritonitis. Seen in patients with pre-existing ascites (mainly chronic liver disease)

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77
Q

secondary peritonitis?

A
  • Secondary: peritoneal infection due to loss of integrity of the gastrointestinal or urogenital tracts. This leads to contamination of the peritoneal space. This is the cause in perforation
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78
Q

tertiary peritonitis?

A
  • Tertiary: recurrent or persistent infection of the peritoneal cavity that typically occurs after secondary peritonitis.
  • Less well defined and usually seen in patients who are immunocompromised
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79
Q

localised peritonitis?

A
  • Localised: this refers to a focus of infection that is usually walled-off or contained by adjacent organs
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80
Q

generalised peritonitis?

A

also known as diffuse, this refers to an infection that has spread throughout the entire cavity

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81
Q

what can lead to SP - oesophagus perf?

A
  • Oesophagus: penetrating injury (trauma), rupture (Boerhaave syndrome), malignancy
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82
Q

what can lead to SP - stomach perf?

A
  • Stomach: malignancy, peptic ulcers
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83
Q

Pancreas issue leading to secondary peritonitis?

A

pancreatitis

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84
Q

hepatobiliary issues leading to secondary peritonitis?

A

gallstones, cholecystitis, malignancy

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85
Q

small intestine issues leading to secondary peritonitis?

A

ischaemic bowel, strangulated hernias

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86
Q

large intestine issues leadong to secondary peritonitis?

A

diverticulitis, colorectal cancer

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87
Q

localised infection to generalized peritonitis?

A

A localised infection may develop because the infection becomes walled-off or is contained by the positioning of adjacent organs. In this situation, an abscess may develop in an attempt to control the spread of infection. If the infection spreads throughout the peritoneal cavity this leads to generalised peritonitis

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88
Q

cfs of peritonitis?

A
  • cardinal feature: acute, severe abd pain
  • Peritonitis should be suspected in any patient with sudden onset, severe abdominal pain.
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89
Q

accompanying features of peritonitis?

A
  • Accompanying features are usually fever, nausea, vomiting, and systemic upset (e.g. tachycardia, hypotension). Patients may be extremely unwell with shock.
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90
Q

abd pain w peritonitis?

A
  • Abdominal pain is often dull and poorly localised initially due to inflammation of the visceral peritoneum.
  • As the parietal peritoneum becomes involved, pain becomes more severe, sharp, and localised
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91
Q

symptoms of peritonitis?

A
  • Abdominal pain: may be localised or generalised
  • Pain worse on movement: patients often described as wanting to stay rigid to prevent aggravating the inflammation
  • Abdominal distension
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92
Q

signs of peritonitis?

A
  • guarding
  • tendernerness
  • rigidity
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93
Q

guarding?

A

voluntary contraction of the abdominal muscles (to protect from the pain)

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94
Q

rigidity?

A
  • Rigidity: involuntary muscle contraction due to underlying inflammation
  • rebound tendernes
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95
Q

what else might you get with peritonitis?

A
  • absent/ reduced bowel sounds
  • inflammatory mass: may suggest abscess
  • features of septic shock
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96
Q

features of septic shock?

A
  • hypotension,
  • oliguria/anuria,
  • confusion,
  • mottled skin
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97
Q

what must be excluded with peritonitis?

A

make sure you check the hernial orifices in a patient with suspected peritonitis to exclude a strangulated hernia.

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98
Q

perforated stomch causes

A
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99
Q

benign causes of bowel obstruction?

A
  • volvulus
  • stricture
  • incarcerated hernia
  • tuberculosis
  • fecal impaction
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100
Q

malignant causes of bowel obstruction?

A
  • CRC
  • metastatic disease
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101
Q

causes of small bowel obstruction?

A

post op adhesions or hernia

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102
Q

causes of large bowel obstruction?

A

malignancy, diverticular disease, or volvulus

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103
Q

cardinal features of bowel obstruction?

A
  • abd pain
  • vomiting
  • abd distension
  • absolute constipation
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104
Q

abd pain in BO?

A

colicky or cramping in nature (secondary to the bowel peristalsis)

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105
Q

Vomiting in bowel obstruction?

A

occurring early in proximal obstruction and late in distal obstruction

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106
Q

absolute constipation in bowel obs?

A
  • Absolute constipation– occurring early in distal obstruction and late in proximal obstruction
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107
Q

SBO features?

A
  • early vomiting
  • billous and watery, little to no odour
  • pain is an early symptom, peri-umbilical
  • abd distention may be absent
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108
Q

what is almost always present w SBO?

A

anorexia

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109
Q

LBO?

A
  • small volumes, later vomiting
  • foul odour vomiting
  • localised, deep pain
  • often described as crampy
  • abd distention present
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110
Q

SBO vs LBO vomiting?

A

SBO: early vomiting, late vomiting in LBO

SBO: little odor, LBO - foul odour

111
Q

complications of stomas?

A
  • parastomal hernia - incisional hernia
  • stoma bleeding
  • skin irritation
  • necrosis
112
Q

where are colostomies found?

A
  • hallmark: found in left iliac fossa
113
Q

contents of colostomy bag?

A
  • Thecontentsof a colostomy bag should besolidor semisolidas the faeces have had time to travel through the colon, undergoingwater absorption.
114
Q

appearance of a colostomy?

A
  • Colostomies are positionedflush to the skin(i.e. no spout) because the enzymes present in large bowel contents areless alkaliand, therefore,less irritatingto the skin.
115
Q

ileostomy?

A
  • uses small bowel
  • typically located in RIF
116
Q

contents of an ileostomy?

A
  • Less water is absorbed in the small bowel, so the contents of the stoma bag tend to have aliquid or mushyconsistency.
117
Q

which type of stoma is spouted?

A

ileostomy to allow faces to drain w/o touching skin

118
Q

Outline how clinicians should act with others to control food poisoning and infective diarrhoea?

A
  • isolate the patient
  • accurate fluid balanxe management
  • onset of SIGHT acronym
119
Q

tests for constipation?

A
  • stool tests - calprotectin, FIT test
  • bloods - to exclude secondary causes or red flag features e.g. anaemia
  • thyroid function tests, HbA1c, renal profile
120
Q

management of constipation?

A
  • Lifestyle modifications - whole fruit, grains, vegges
  • First-line laxatives(osmotic, bulk-forming, softeners)
121
Q

second line laxatives for constipation?

A
  • Second-line laxatives(stimulants, suppositories and/or enemas)
122
Q

primary vs secondary causes of constipation?

123
Q

RF for iBS?

A
  • Female sex
  • Younger age
  • Stressful life events
  • Anxiety and/or depression
  • Gastrointestinal infection(post-infectious IBS)
  • Somatic symptoms(e.g. joint pain, migraine)
  • Endometriosis
  • Family history of mental illness
124
Q

abd pain of IBS?

A
  • often lower abd
  • typically cramping pain
  • pain is frequently related to defecation. May improve or worsen
  • food and stress may worsen symptoms
125
Q

Other GI features of IBS?

A
  • Bloating/Distention
  • Belching
  • Nausea
  • Others: IBS may overlap with other functional GI disorders
126
Q

Celiac disease?

A
  • 2x as common in womem
  • intolerance to prolamin proteins - wheat, barley and rye
127
Q

genetics of celiac?

128
Q

what inc risk of celiac disease?

A

recurrent rotavirus infections

129
Q

3 classifical features of coeliac disease?

A
  • Villous atrophy(reduced absorptive surface).
  • Crypt hyperplasia(increased cellular proliferation).
  • Inflammatory infiltration(increased IEL, influx of immune cells into lamina propria)
130
Q

CFs of celiac disease?

A
  • Patientsclassically present with gastrointestinal manifestations of malabsorption including bloating, abdominal pain, loose stools and steatorrhoea.
131
Q

symptoms of celiac disease?

A
  • Weight loss
  • Fatigue
  • Weakness
  • Abdominal pain
  • Bloating
  • Flatulence
  • Loose stools
  • Steatorrhoea
  • Failure to thrive(babies and young children)
132
Q

Signs of celiac disease?

A
  • Mouth ulcers
  • Angular stomatitis
  • Abdominal distension
  • Ecchymosis
  • Muscle wasting
  • Neuropathy
133
Q

EIM of celiac disease?

A
  • anaemia - mixed megaloblastic/ microcytic
  • osteoporosis
  • dermatitis herpetiformis
134
Q

achalasia?

A
  • Achalasia is a primary motility disorder of the oesophagus that is characterised byfailure to relax of the lower oesophageal sphincter.
  • cardinal symptom: dysphagia
135
Q

how do motor disorders like achalasia typically present?

A
  • Motility disorders, such as achalasia, typically present with dysphagia to both solids and liquids.
136
Q

how do cancers causing dysphagia present?

A

A physical obstruction (e.g. cancer) typically occurs with solids first and progresses to liquids as the narrowing becomes tighter.

137
Q

Symptoms of achalasia?

A
  • Dysphagia: solids and liquids
  • Regurgitation of undigested food
  • Vomiting
  • Difficulty belching(poor opening of upper oesophageal sphincter)
  • aspiration and heartburn
138
Q

aspiration w achalasia?

A

coughing and choking due to content passing into airways

139
Q

heartburn w achalasia?

A

irritation of the oesophagus due to uncleared food rather than reflux events through the LOS

140
Q

Gastric cancer RF

141
Q

SBO?

A
  • bilious vomiting of SBO (abd distented)
  • adhesions mostly cause SBOs
142
Q

Non bilous vomiting in obstructions proximal to?

A

ampulla of vater

143
Q

faceulent vomiting in obstructions in?

A

distal small gut obst, LBO, strangulation

144
Q

gallstone ileus?

A
  • gallstone ileus -> stone causes perforation passing from GB into duodenum
  • stops in the terminal ileum -> overflow and reflux -> pain and diarrhoea, scar tissue forms around the stone narrowing it
  • can get perforations from it
145
Q

Drug history in acute surgical abdomens?

A
  • AC - can lead to an intramural haematoma of the gut causing obs
  • espec elderly
146
Q

Acute abdomen - oral contraceptives?

A

rupture of hepatic adenomas

147
Q

acute abdomens - NSAIDS?

A

erosive gastritis and peptic ulcers

148
Q

anxious patient lying motionless - think?

A
  • acute appendicitis
  • peritonitis
149
Q

rolling in bed and restless ppt?

A

think colic

150
Q

patient writhing in pain?

A

writhing in pain: mesenteric ischemia (older patient w vascular history, soft abdomen)
very severe pain - out of proportion to clinical findings

151
Q

patient bending forwards =

A

chronic panc

152
Q

guarding and rigidity?

A
  • guarding = involuntary spasm of muscles during palpation
  • rigidity = when abd muscles are tense and board like -> peritonitis
153
Q

rosvings sign for appedicitis?

A

pain elicited in the right lower quadrant with palpation pressure in the left lower quadrant

154
Q

test for appendicitis?

A
  • test for appendictis - psoas test
  • obturator sign
155
Q

right renal angle pain, over 70 ->

A

consider AA

156
Q

Murphys sign for cholecystsitis?

A
  • asking the patient to take in and hold a deep breath while palpating the right subcostal area.
  • If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
157
Q

Large vs small bowel on scan?

A
  • can see whole circ = SBO
  • large bowel - can’t see full circle, just lines and is on the outsides
158
Q

pre-op assessments - history?

A
  • 2-4 weeks prior (elective)
  • history - surgeries, AC, allergies, identifying potential risks, FH - malignant hyperthermia
159
Q

pre-op assessment Ix?

A
  • bloods - FBC, platelets, WBC, U&Es - kidney function (opiods), LFT, clotting, group ans save +/- cross match
  • imaging - ecg, CXR (not routine), echo - aortic stenosis - limits cardiac output
  • other tests - swabs, spirometry, pregnancy test, urinanalysis, carotid doppler
160
Q

pre-op prep - aspiration risk?

A

1) nil by mouth for 6 hours before - aspiration risk

161
Q

preop prep - stop drugs?

A
  • CHOW
  • clopirodgrel stopped 7 days prior
  • other platelets like aspirin can continue
  • OC/ HRT/ 4 weeks prior
  • warfarin 5 days prior (INR less than 1.5) may need vit k if emergency operation
162
Q

pre-op prep - altering drugs

A
  • subcutaneous insulin -> variable rate insulin infusion
  • long term steroids -> switch to IV - consider inc dose
163
Q

pre-op prep - start drugs?

A
  • LMWH and or stockings
  • antibiotics prophylaxis
  • IV fluids
  • bowel products and blood products if needed
164
Q

informed consent?

A
  1. Nature of procedure
  2. risks of harm and benefits
  3. reasonable altns including harms and benefits
  4. assessment of ppt’s understanding
  5. must not be forced
  • must be written consent for operation and minor procedures
165
Q

blood transfusions?

A
  • group and save
  • valid for 3 months
  • identifying blood gr and saving it on the system
  • also identifies abn ab
166
Q

cross match?

A
  • lab provides blood products which have been checked to be compatible
  • can’t be done w/o group and save
  • Crossmatching involves physically mixing of patient’s blood with the donor’s blood, in order to see if any immune reaction occurs
167
Q

G&S and cross match samples?

A
  • take a G&S sample then take a cross match sample 1 hr later
168
Q

reactions from transfusions?

A
  • pyrexia
  • anaphylaxis
  • blood reactions
  • infective shock - bacteria from donor blood, can become septic and shock
169
Q

acute haemolytic reaction from transfusions?

A

fever, rigors, hbureia, blood hasn’t been properly crossmatched

170
Q

delayed infection from transfusion?

A
  • infection - non toxin producing bacteria
  • usually a day later
171
Q

G v H disease from transfusion?

A
  • G v H disease - rash on hands and feet first sign
  • generalised abd pain, enlarged liver, jaundice etc later
172
Q

iron overload?

A
  • iron overload - usually from regular/ multiple tranfusions
  • gets deposited in liver -> liver failure and raised liver enzymes
173
Q

what can be done to avoid G v H disease?

A
  • irradiated blood to avoid G v H disease - destroys all DNA in lymphocytes, safe to transfuse to IC patients
  • cancer patients, bone marrow malignancies, donated/ received bone marrow recently
174
Q

Indications for transfusions?

A
  • active bleeding
  • <70 hb in stable
  • <80 stable and ACS
  • chronic transfusion dependent anemia
  • radiotherapy - higher hb needed >100
175
Q

PVD RF?

A
  • older age - men more at risk
  • AF is a risk factor
  • fontaine’s and rutherfords classifications
176
Q

PVD - popliteal artery entrapment?

A
  • popliteal artery entrapment - young patients who may have normal pulses
177
Q

PVD - venous claudication?

A
  • venous claudication - (may turner syndrome) bursting pain on walking w previous history of DVT - compression of ilac vein by iliac artery
178
Q

PVD - burger’s disease?

A
  • burger’s disease - young males, heavy smokers, usually leads to digital ischeamia
179
Q

Ix of PVD?

A
  • APBI
  • arterial duplex scan
  • MR angiography - contrast enhanced
  • Ct angiography
180
Q

pharm for claudication?

A
  • pentoxifylline
  • cilostazol
  • naftidrofuryl
181
Q

procedures for claudication?

A
  • angioplasty - stenting
  • bypass grafting
182
Q

complications of PAD

A
  • Sepsis
  • major adverse cardiac events
  • major adverse limb events - amputations e.g.
183
Q

ALI?

A
  • surg emergency
  • sudden decrease in limb perfusion that threatens viability of the limb
  • 3 causes: thrombosis in situ, embolisation (E.g. from anyuerysm or prosthetic heart valve) and trauma
184
Q

rutherford classification of acute ischemia?

185
Q

painful white foot in ischemia?

A
  • painful white foot = reversible
  • 0-6 hs
186
Q

mottled skin in ischemia?

A
  • 6-12 hrs: mottled skin due to capillary pooling
  • blanches on digital pressure
187
Q

ALI Ix?

A
  • CT angiogram
  • lactate levels
  • bloods and blood gases
188
Q

ALI Tx?

A
  • high flow O2
  • IV heparin - bolus initially then infusion
189
Q

ALI of embolic cause management

A
  • embolectomy
  • intra-arterial thrombolysis - if the clot has had time to harden e.g alteplase
  • bypass surgery
190
Q

ALI of thrombotic cause management?

A
  • intra-arterial thrombolysis
  • angioplasty
  • bypass procedure
191
Q

referusion injury?

A
  • potassium and h+ builds up in the area of reduced perfusion
  • myoglobin -> rhabdo -> AKI and MOF
192
Q

compartment syndrome?

A
  • sudden rush of blood
  • caused by inc cap permeability and resultant oedema following reperfusion of the limb
  • inc in pressure
  • may impair blood flow or cause damage to the muscle directly - risk of ischemia again
193
Q

signs of CS?

A
  • disprop pain compared to signs - characteristic sign
  • paraesthesia
  • swelling
  • prolonged cap refill
194
Q

Raynaurd’s syndrome?

A
  • mostly affects women
  • usually bilateral - fingers affected more than toes
  • numbness, pain, tingling and throbbing
195
Q

what happens in raynaurds?

A
  • pallor -> cyanosis -> hyperaemia
  • vasospasm of artery, often triggered by cold
  • can be assoc w occupations - use of vibrating tools
196
Q

what worsens raynaurds?

A
  • worsened by smoking and BBs
197
Q

Management of raynaurds?

A
  • avoid cold
  • CCBs - vasodilators
  • sympatholytic agents - e.g. alpha blockers
  • chemical sympathectomy - blocking sympathetic chain usually stellate ganglion
198
Q

aneurysm =

A
  • abn dilatation of the lumen
199
Q

true anureysm?

A

wall of artery forms wall of A

200
Q

false anueurysm?

A
  • false - lumen of artery is in continuity with the space surrounded by compressed CT - false lumen
  • inner layer can block off an artery
201
Q

common areas of aneurysm?

A
  • AA
  • femoral arteries
  • circle of willis - assoc w subarachnoid haemorrhages
  • popliteal etc
202
Q

AAA?

A
  • > 65 most common
  • infections like syphilis and E coli
  • trauma
203
Q

Symptoms of AAA

A
  • tearing abd pain radiates to the back
  • hypotension
  • tachycardia
204
Q

Signs of AAA

A
  • pulsatile expansile mass in the abd
  • tenderness on deep palpation if impending rupture
205
Q

Ix of AAA?

A
  • US - screening
  • CT whole aortogram
206
Q

Management of venous ulcers?

A
  • raising leg and inc exercise
  • emollients for dry skin
  • compression therapy
  • endovenous ablation - surgery
207
Q

varicose veins?

A
  • incompetent valves
  • leading to tortous dilated veins
  • results in venous hypertension and superficial dilatation of veins
208
Q

varicose veins rF?

A
  • pregnancy
  • prolonged standing
  • Fhx
  • obesity
209
Q

VVs CFs?

A
  • visible veins
  • skin discoloration
  • pain,aching
  • swelling - after long periods of standing
  • oedema
  • ulcers
  • lipodermatosclrosis
  • varicose eczema or thrombophlebitis
210
Q

varicose veins Ix?

A
  • duplex US
  • CT venogram
211
Q

Tx of varicose veins?

A
  • compression
  • thermal ablation - burning to close the vein off
  • foam sclerotherapy - inflammatory resp closes off vein
  • vein ligation, stripping and avlsion
212
Q

CFs of DVTS?

A
  • pain and swelling in calf
  • redness
  • engorded superficial veins
  • signs of PE - breathlessness, pleuritic chest pain
213
Q

Ix of DVT?

A
  • Wells score
  • D dimer
  • Doppler US
214
Q

RF for DVTs?

A
  • Obesity
  • active cancer
  • smoking
  • age >60
  • pregnancy, HRT/ COCP
  • Fhx
  • clotting disorder
215
Q

preventon of DVTs?

A
  • stockings, encourage mobilisation, prophylatic LMWH for at risk patients
216
Q

management of DVTs?

A
  • anticoagulation - DOAC or warfarin (for 3 months)
  • thrombolysis/ thrombectomy
  • IVC FILTER - cancer patient
217
Q

Most common type of liver cancer?

218
Q

Diagnosis of HPB cancer?

A
  • bloods
  • tumour markers
  • imaging
  • histopathology
219
Q

GB cancer?

A
  • found incidentally at routine cholecystectomy
  • non-incidental - RUQ pain
  • palpable GB - hard
220
Q

biliary obstruction - signs?

A
  • obst jaundice
  • yellow sclera
  • dark urine + pale stools
  • pruitus
222
Q

constitutional symptoms of cancer?

A
  • fatigue
  • weight loss
  • anorexia
  • abd pain
  • night sweats
223
Q

4 features of obst jaundice?

A
  • dark urine
  • pruitus - itching
  • jaundice
  • clay coloured stools
224
Q

ascites from cancer means

A

the disease has metastised

225
Q

PC pain?

A

radiates to back - late symptom

226
Q

GB cancer - pain?

A
  • GB cancer is painless initially, becomes painful when it stretches capsule of liver
  • jaudiced patient with palpable GB = dilated biliary tract from tumour - distal to the duct
227
Q

which site does pancreatic cancer most commonly affect?

228
Q

CA19-9?

A

CA19-9: likely cholangiocarcinoma - pancreatic tumour marker

229
Q

AFP?

A

testicular tumours and liver

230
Q

Liver imaging?

A
  • triple phase CT
  • one arterial, one portal, one hepatic venous phase
231
Q

Oesophageal cancer?

A
  • 95% squamous cell or adenocarcinoma
  • SCC are sensitive to radiotherapy, adenos need chemo and surgery
232
Q

Oesophageal cancer RF?

A
  • smoking
  • Barrets oesophagus
  • obesity
  • nitrosamines - preservatives
  • hiatal hernia
  • FHx
  • alcohol
  • stasis
233
Q

Presentation of oesophageal cancer?

A
  • dysphagia - progressive - liquids to solids
  • regurgitation
  • retrosternal pain
  • haemoptysis
  • maleana
  • intractable hiccups
  • hoarseness
234
Q

Ix of OC?

A
  • OGD - endoscopy
  • barium swallow
  • CT chest and abdomen
  • PET-CT
235
Q

Gastric cancer?

A
  • 90% squamous or adenocarcinoma
  • 5th most common cancer, present late
  • most common pres anemia
236
Q

gastric cancer epidemiology?

237
Q

RF for gastric cancer?

A
  • BOG
  • obesity smoking
  • ETOH
  • H pylori
  • salt/ nitrosamines
238
Q

pres of gastric cancer?

A
  • dyspepsia in early disease
  • vomiting
  • gastric outlet obs - move epigastric will hear splash - succussion splash
  • anemia
239
Q

advanced gastric cancer symptoms?

A
  • early satiety
  • bloating
  • distension
240
Q

what should be given for variceal bleeding?

A

Prophylactic antibiotics should be given in addition to terlipressin in anyone with suspected variceal bleeding. The prophylactic antibiotics of choice are usually quinolones.

241
Q

Side effects of mesalazine?

A

Mesalazine, in particular, can cause agranulocytosis, which may present with sudden onset rigors, fever and sore throat.

242
Q

first line for constipation in IBS?

A

A bulk-forming laxative such as isphagula husk is the first-line recommended treatment

243
Q

omeprazole and ? interact

A

clopidogrel so use lansoprazole instead

244
Q

gastric carcinoma symptoms?

A
  • fatigue
  • weight loss
  • anemia
  • elevated urea
245
Q

gastric cancer and upper GI bleed?

A

Gastric cancer can present with an upper gastrointestinal (GI) bleed which would result in raised urea due to digestion of blood. The patient’s dark, foul-smelling stools are indicative of digested blood being passed in the stool.

246
Q

perf PUD -> Ix ?

A

erect chest XR

247
Q

Diarrhoea, fatigue, osteomalacia → ?

A

?coeliac disease

248
Q

iron def anemia vs anemia of chronic disease

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

249
Q

Metabolic ketoacidosis with normal or low glucose: think?

250
Q

CURB scoring?

A
  • Confusion = 1,
  • Urea > 7 mmol/L = 1,
  • Respiratory rate > 30 = 1,
  • Diastolic BP < 60 mmHg = 1,
  • Age > 65 = 1
251
Q

UC - patterns seen?

A
  • Proctitis - most common pattern
  • pseudopolyps
252
Q

What is the best thing to check for liver failure?

253
Q

What is useful in the management of crohns in patients who develop a perianal fistula?

A

Oral metronidazole

254
Q

renal cell carcinoma can metastaise to ?

A

to the lungs, causing ‘cannonball metastases, lesions like this can also be due to endometrial cancer

255
Q

what is the most common cause of exudative pleural effusion?

256
Q

transudate vs exudate pleural effusions?

A

transudate: less than 30g protein
exudate: more than 30g protein

257
Q

transudate pleural effusions examples?

A
  • hypoalbuminaemia - nephrotic syndrome
  • hypothyroidism
  • HF
258
Q

What is the most common cause of transudate pleural effusions?

259
Q

Causes of exudative pleural effusions?

A
  • pneumonia - most common
  • TB
  • RA
  • lung cancer
  • mesothelioma
  • pancreatitits
  • PE
260
Q

What is the most common causative agent of bronchiectasis?

A

haemophilus infleunza

261
Q

Mx of infective exacerbation of COPD?

A

first-line antibiotics are amoxicillin or clarithromycin or doxycycline

262
Q

Which ab should be avoided w long QT?

A

clarithromycin

263
Q

Tb can cause ? lymphadenopathy

264
Q

Young male smoker with symptoms similar to limb ischaemia - think?

A

Buerger’s disease

265
Q

DABS - ACS management?

A

He had an ACS, now he DABS

Dual antiplatelet therapy
Ace Inhibitor
Beta blocker
Statin

266
Q

What is normal in an athlete?

A

Mobitz type 1

267
Q

most common causes of AS in under 65s and over 65S?

A
  • younger patients < 65 years: bicuspid aortic valve
  • older patients > 65 years: calcification
268
Q

symptoms of AS?

A
  • slow rising pulse
  • dyspnoea on activity
  • systolic mumur
269
Q

What is a poor prognostic indicator of ACS?

A

low systolic BP -> cardiogenic shock -> poor prognostic indicator for ACS

270
Q

Becks triad?

A
  • cardiac tamponade
  • hypotension
  • raised JVP
  • muffled heart sounds
271
Q

what is the definitive management of cardiac tamponade?

A
  • pericardiocentesis—a procedure involving the drainage of fluid from the pericardial sac, thereby permitting normal cardiac contractions.
272
Q

management of paracetamol overdose?

A
  • staggered: NAC immediately
  • presents within an hour: activated charcoal
273
Q

lithim - tremor in chronic treatment vs in acute toxicity?

A

Lithium: fine tremor in chronic treatment, coarse tremor in acute toxicity

of COARSE lithium produces toxicity

Year 3 (45 decks)

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