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CSI Y2 > CSI 17 > Flashcards

CSI 17 Flashcards

1
Q

When is laparoscopy used in assessment of an acute abdomen?

A

After the history, examination and investigations

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2
Q

What does the algorithm AIR stand for?

A

Appendicitis inflammatory response

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3
Q

For which groups of patients may acute abdominal pain present abnormally?

A

Immunocompromised (old) patients

Pregnant women

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4
Q

Why may acute abdominal problems present atypically in elderly patients?

A

They have more comorbidities
They have decreased immune function
Central and peripheral nervous systems are affected by ageing (peripheral nervous system decline may lead to altered perception of pain and temp)
Conditions like dementia may restrict their ability to communicate

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5
Q

Why may acute abdominal problems present atypically in pregnant patients?

A

It may be difficult to localise the pain
The baby displaces a lot of organs so pain may not be where expected for a certain organ
Obtaining radiographs has a risk

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6
Q

What are some common differentials of acute abdomen?

A 
Intestinal obstruction
Peritonitis secondary to infection
Haemorrhage 
Ischaemia 
Contamination of GI contents
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7
Q

What is the most common cause of a GI obstruction?

A

Adhesions

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8
Q

What are other causes of GI obstruction?

A

Incarceration of hernia
Volvulus
Gallstones
Intussusception

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9
Q

What are causes of inflammation in the GI tract?

A 
Cholecystitis
Appendicitis
Acute pancreatitis
Diverticulitis
UC/Chrohn's
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10
Q

What can perforation be a complication of?

A

Duodenal and gastric ulcers

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11
Q

What types of perforation result in oesophageal laceration and GI haemorrhage?

A 
Oesophageal perforation (Boerhaave's syndorme)
Mallory Weiss tear
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12
Q

What do you have to rule out in young women with an acute abdomen?

A

Ectopic pregnancy

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13
Q

What are risk factors and points in the history that indicate acute cholangitis?

A

History of pain
Worse after eating
High weight

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14
Q

What are risk factors and points in the history that indicate hernia?

A

Acute pain
Vomitting
High weight

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15
Q

What are risk factors and points in the history that indicate gastric ulcer?

A

Pain
Nausea and vomitting
Worse after eating

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16
Q

What commonly causes acute viral hepatitis?

A

Paracetamol overdose

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17
Q

What type of pain does biliary colic present with?

A

Colicky

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18
Q

Where is pain for biliary colic situated?

A

RUQ

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19
Q

What shows up on bloods for biliary colic?

A

Nothing

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20
Q

What happens in biliary colic?

A

Stone is stuck in duct and causes gallbladder muscle spasms which results in pain

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21
Q

How long does biliary colic last?

A

6 hours or less

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22
Q

What is biliary colic triggered by and why?

A

Fatty foods, when they are eaten there is cholecystokinin release which causes the gallbladder to contract

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23
Q

What type of pain does acute cholecystitis present with?

A

Severe and constant

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24
Q

Where is pain for acute cholecystitis situated?

A

RUQ

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25
Q

What sign is present with acute cholecystitis? Describe it

A

Murphy’s sign (hand is put under the right rib cage and the patient will complain of pain on inhalation, if the same is done on the left hand side the won’t complain of pain)

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26
Q

What will WCC and CRP be in someone with acute cholecystitis? Why?

A

Raised due to inflammation

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27
Q

What will temp be in someone with acute cholecystitis?

A

High

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28
Q

What cardiac sign may be present in someone with acute choelscystitis?

A

Tachycardia

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29
Q

What will LFTs be in someone with acute cholecystitis?

A

Normal, ALP may be raised

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30
Q

What will LFTs be in someone with ascending cholangitis?

A

Deranged

SGOT, bilirubin and ALP will be high

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31
Q

What triad is used to identify ascending cholangitis?

A

Charcot’s traid

32
Q

What are the components of Charcot’s triad?

A

Fever, jaundice and abdominal pain

33
Q

What happens to biliary outflow in ascending cholangitis?

A

There is outflow obstruction and infection

34
Q

What sign asides from Murphy’s may patients with ascending cholangitis display?

A

Rigors

35
Q

What is the primary imaging for RUQ pain?

A

Ultrasound

36
Q

What are the 2 types of gallstones?

A

Cholesterol and pigment

37
Q

What are most gallstones made of?

A

Cholesterol (70%)

38
Q

What are pigment gallstones made of?

A

Bilirubin breakdown products (due to increased bile pigment production)

39
Q

Why do pigment gallstones arise?

A

In conditions where theres high RBC breakdown or higher risk eg haemolytic anaemia

40
Q

Why aren’t x rays useful in imaging for gallstones?

A

99% of the time stones don’t show up on them

41
Q

What are some risk factors for gallstones?

A 
Obesity
Haemolytic anaemia
Hyperlipidaemia 
Crohn's 
Female
Pregnant
Being on the OCP
42
Q

Why does being on the OCP increase risk of gallstones?

A

There are higher levels of oestrogen which increases biliary production

43
Q

Asides from risk factors, what else must you remember can cause gallstones?

A

Medications

44
Q

What are the main complications of gallstones?

A

Gallstone ileus

Cancer of the gallbladder

45
Q

What is cancer of the gallbladder called?

A

Cholangiocarcinoma

46
Q

Where does pain radiate to in ascending cholangitis?

A

The back

47
Q

How can you differentiate a stone that is causing acute pancreatitis?

A

Test for amylase and lipase, they will be high

48
Q

Define ileus

A

A lack of peristalsis

49
Q

Where does a gallstone become stuck to cause gallstone ileus?

A

Ileocaecal valve

50
Q

What symptoms does small bowel obstruction cause?

A

Vomiting and severe pain

51
Q

What happens over time before gallstone ileus can happen?

A

The gallbladder becomes inflammed, is eroded and a duodenal fistula forms to eventually allow impaction where the small bowel meets the large bowel

52
Q

What is the surgical treatment for gallstones?

A

Laparoscopic cholecystectomy

53
Q

What is needed to gain valid consent for surgery?

A 
Capacity on the patient's behalf 
Knowledge of the procedure
Explaining the diagnosis 
Explaining the treatment options
Explain the purpose of the procedure
Explain the risks
54
Q

What are some general complications for any surgery?

A

Infection
Bleeding
Scarring

55
Q

What are some systemic complications that can occur after a lap cole?

A 
Bad reactions to anasthesia
Hypoxia 
Clotting (DVTs and PE)
Septicaemia
Cutting a nerve
Cutting the bowel
Cutting the bile duct
Cutting the vein or artery
56
Q

What are long term complications of a lap cole?

A

Adhesions

Lack of healing

57
Q

How will adhesions manifest clinically?

A

Intermittent bowel obstruction

Pain

58
Q

What are the 2 main ways to classify surgical complications?

A

General vs specific

Early vs late

59
Q

What are some specific complications of a lap coli?

A

Damage to surrounding organs eg liver
Bile duct injury
Risk of converting to an open procedure

60
Q

What are early complications of a lap cole?

A

Wound infection

61
Q

What are late complications of a lap cole?

A

Hernia

Scar not healing properly

62
Q

What do most gallstones consist of?

A

Cholesterol
Bile pigments
Calcium salts
Glycoproteins

63
Q

What do brown gallstones indicate?

A

Infection of the biliary tract

64
Q

What do black gallstones indicate?

A

Calcium bilirubinate

65
Q

What conditions is calcium bilirubinate found in?

A

Haemolytic anaemia

Ineffective haematopoiesis in cystic fibrosis

66
Q

What are the 3 mechanisms of formation of cholesterol gall bladder stones?

A

Cholesterol supersaturation
Gallbladder hypomotility
Kinetic factors

67
Q

How soluble is cholesterol?

A

Slightly soluble in aqueous media

68
Q

Where is cholesterol made soluble?

A

In bile

69
Q

When does precipitation of cholesterol occur?

A

When its solubility exceeds the cholesterol saturation index

70
Q

At what ratio do cholesterol crystals occur?

A

Low phospholipid: cholesterol ratio

Also at low phospholipid and high bile conc

71
Q

When are microcrystals flushed out?

A

During post prandial contractions of the gallbladder

72
Q

In what patients is impaired motility seen?

A

Diabetics and rapid weight loss

73
Q

What can increase lipid conc?

A

Decreased emptying of the gallbladder

74
Q

What modulates formation of microcrystals?

A

Kinetic protein factors

75
Q

What is a crystallisation promoting protein?

A

Mucin

CSI Y2 (3 decks)

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