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F1/ Part 1 > Gastro + Surgery > Flashcards

Gastro + Surgery Flashcards

1
Q

STOMATITIS

Causes

A

Inflammation of oral cavity

Non-infective: Crohn’s, Behcet’s, coeliac, normal population

Infective: herpetic, oral candidiasis (NB uncommon in DM)

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2
Q

Causes of glossitis

Different appearances

A

Stomatitis (various causes), deficiencies (esp B vitamins, folic acid)

Acute: tongue is beefy-red, raw, painful
Chronic: tongue appears moist and unduly clean

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3
Q

What is Chagas’ disease?

A

Infection by Trypanosoma cruzi - cause of secondary achalasia due to destruction of myenteric plexus
(S America)

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4
Q

Difference between urea breath test and CLO test?

A

CLO is invasive: you add biopsy to kit

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5
Q

Most commonly prescribed prophylaxis for gut surgery?

A

Co-amoxiclav

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6
Q

Define Zollinger-Ellison syndrome

A

A gastrin-secreting tumour of the pancreatic G cells, resulting in gastric gland hyperplasia and gastric hypersecretion
Common to have multiple peptic ulcers and diarrhoea

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7
Q

What is absorbed in the proximal small intestine and what is absorbed in the terminal ileum?

A

Proximal: iron, folate, calcium
Terminal: B12

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8
Q

Most common causes of UGIB

Other causes

A

PUD
Oesophageal varices

Other causes: oesophagitis, gastritis, malignancy, M-W tear, vascular malformation…

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9
Q

Risk factors for UGIB

A 
Alcohol abuse
Chronic renal failure
NSAIDs
Age
Low socio-economic class
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10
Q

Risk factors for re-bleeding following UGIB

A 
Age over 60
Presence of shock on admission
Coagulopathy
Pulsatile haemorrhage
Cardiovascular disease
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11
Q

Examination of UGIB

A

Signs of shock and blood loss: obs, postural hypotension, pallor, urine output…

Elicit cause:
stigmata of liver disease
signs of tumour
s/c emphysema (oesophageal perf)

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12
Q

Investigations for UGIB

A 
FBC (serially every 4-6 hours)
Cross-match (between 2-6 units)
Coagulation profile
LFTs
U&Es
Calcium (effect of blood transfusions)
Gastrin (rare gastrinomas)

ENDOSCOPY

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13
Q

Risk assessments in UGIB

A

Blatchford at first assessment

Rockall after endoscopy

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14
Q

Medication to give for suspected variceal bleeding

A

Terlipressin

Prophylactic abx

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15
Q

How to reconcile drug chart for bleeding patients

A

(Some hospitals say to give PPI for all UGIB, but better to wait til post-endoscopy)

Consider stopping all anticoag and antiplatelets during acute phase

Low-dose aspirin usually okay to continue later
Discuss with specialist risk/ benefits of clopi

SSRIs should be used with caution
CS will need careful concomitant PPI

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16
Q

Ix for rectal bleeding

A

FBC

Consider:
G&S
Ferritin and iron studies
Clotting studies
LFTs
Faecal calprotectin
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17
Q

M-W vs Boerhaave

A

M-W: tear at gastro-oesophageal jct

Boerhaave: transmural oesophageal rupture

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18
Q

Meds associated with GORD

A

NSAIDs
Doxycycline
Bisphosphonates

those affecting motility: TCAs, anticholinergics, nitrates, CCBs

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19
Q

What is the normal oesophageal histology? What happens in Barrett’s?

A

from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the stomach

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20
Q

Mx reflux (if no alarm symptoms)

A

PPI for one-month

Next: H2-receptor antagonist

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21
Q

Types of hiatus hernia (how common and definition)

A

Sliding (85-95%): gastro-esophageal jct slides up

Rolling (5-15%): jct remains in place but a part of stomach (or other organ) herniates up

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22
Q

Presentation of hiatus hernias

A

Asymptomatic
Dyspepsia/ GORD
Para-oesophageal may also present with chest pain, epigastric pain, fullness, sx of obstruction

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23
Q

Histological types of oesophageal cancer

A

SCC: alcohol + smoking,
AC: growing incidence - possibly more common in developed countries

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24
Q

Barrett’s oesophagus is a precursor of which ca?

A

AC

SCC associated with chronic inflammation and stasis, eg achalasia

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25
Q

Why does oesophageal ca present late?

A

Need obstruction of ~75% for ‘food sticking’

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26
Q

Difference between acute gastritis and acute erosive gastritis

A

Acute: almost always caused by drugs (aspirin) and alcohol - chemical exfoliation of surface epithelium

Acute erosive: partial loss of gastric mucosa - shock, severe burns, toxic substances

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27
Q

What is pernicious anaemia a risk factor for?

A

Carcinoma of stomach

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28
Q

What is reactive gastritis?

A

AKA reflux gastritis - duodenal contents into stomach

Caused by irritants: NSAIDs, alcohol, biliary reflux
or compromised motility

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29
Q

Causes of delayed gastric emptying.

Symptoms.

A

Mechanical: tumour, bezoar
Non-mechanical: gastroparesis

Asymptomatic or bloating, belching, N&V, weight loss…

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30
Q

Describe H.pylori

A

motile, Gram-negative spiral bacilli

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31
Q

PUD nearly always associated with

A

H.pylori

NSAIDs

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32
Q

Relationship between H.pylori and:
Gastric ca
GORD

A

Increased risk of gastric AC
Associated with gastric MALT-lymphoma

Potential inverse relationship with GORD

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33
Q

Recommended first-line treatment of H.pylori

A

7 days BD: PPI, 1g amox, 400 mg metronidazole

If allergic: 500 mg clarithromycin
(If recently already had clarith, use alternative)

If had only dyspepsia, no need to re-test
If has PUD, re-test in 6-8 weeks

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34
Q

Uses for probiotics/ lactobacilli

A

Reduce activity of H.pylori

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35
Q

Causes PUD

A 
H.pylori
NSAIDs
Steroids
Smoking 
Alcohol
Stress
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36
Q

Which ulcer better after eating?

A

Food worse for gastric

Better for duodenal

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37
Q

Investigations for dyspepsia

A

FBC
Testing for H.pylori
Endoscopy

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38
Q

Complications of PUD

A

Erosion > haematemesis/ melaena
Perforation > acute abdomen
Scarring > pyloric stenosis

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39
Q

Risk factors for gastric cancer

A 
Age
Men
Low socio-economic class
H.pylori
Smoking
Poor fruit diet/ high salt + preserved
Familial
Pernicious anaemia
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40
Q

Poor signs associated with gastric carcinoma

A 
Epigastric mass
Hepatomegaly
Jaundice
Ascites
Troisier's sign
Acanthosis nigricans
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41
Q

Definition of acute pancreatitis

A

Acute inflammation leading to release of exocrine enzymes/ autodigestion

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42
Q

Causes of acute pancreatitis

A

Gallstones (blocking bile duct)
Excess alcohol

Post-ERCP
Viral (Coxsackie, hep, mumps)
Metabolic (lots)
Ischaemia
Malignancy
IBD (maybe associated with mesalazine)
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43
Q

Symptoms and signs of acute pancreatitis

A

Sudden onset severe upper abdo pain with vomiting
(can radiate to back, can be peri-umbilical)
Pain tends to decrease over 72h

Looks unwell - possible jaundice
Hypoxaemia is characteristic
Tachycardia (dehydrated)
Mild pyrexia common (can be hypothermic)

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44
Q

Ix for acute pancreatitis

A

Serum lipase
FBC, U&Es, glucose, CRP, bone profile (hypocalcaemia), LFTs

AXR (eliminate other causes)
CXR (ARDs etc)

USS to visualise gallstones

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45
Q

Mx acute pancreatitis

A 
MILD:
IV Fluids
NBM
Pethidine or buprenorphine + IV benzos
(morphine can cause spasticity of sphincer of Oddi)
(NG only for severe vomiting)

SEVERE:
ITU/ HDU
IV abx if evidence necrosis

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46
Q

Complications of acute pancreatitis

A

Necrosis (rising CRP, confirmed by dynamic CT)
Infection/ abscess (requires surgery)
Ascitic fluid collection
Pseudo-cyst: pancreatic juice in wall of fibrous or granulation tissue - requires surgery (can rupture/ haemorrhage) - occurs ~4 weeks after

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47
Q

Systemic complications of acute pancreatitis

A 
Resp: 
pulm oedema
pleural effusions
consolidation
ARDs

Cardiovascular:
hypovolaemia
DIC

Renal: dysfunction due to hypovolaemia/ intravascular coagulation

Metabolic

GI:
haemorrhage
ileus

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48
Q

Presentation of chronic pancreatitis

A 
Abdo pain: typically epigastric, radiating to back
N&V
Decreased appetite
Steatorrhoea (exocrine dysfunction)
DM (endocrine dysfunction)
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49
Q

Why is chronic pancreatitis hard to diagnose?

A

Generalised symptoms
No dose-related link with alcohol
Amylase normal
Small-duct pancreatitis not easily seen on imaging

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50
Q

Tumour marker in pancreatic ca

A

CA19-9

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51
Q

Investigations for malabsorption

A 
FBC
CRP
Vit B12/ folate
Ferritin
Clotting (for vit K)
Serum albumin/ LFTs
Calcium
Coeliac screen
Mg

Consider:
stool sample
hydrogen breath test (bacterial overgrowth)

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52
Q

Where is gluten found?

A

Wheat, rye and barley

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53
Q

Prevalence of coeliac

A

1% in UK

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54
Q

Skin problem with coeliac

A

Dermatitis herpetiformis

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55
Q

Classical histological finding in coeliac

A

Subtotal villous atrophy

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56
Q

Types of diarrhoea

A

Osmotic: reduced absorption of electrolytes
Secretory
Rapid transit (stasis can also cause diarrhoea by facilitating bacterial overgrowth)

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57
Q

Histology of C.difficile

A

Gram positive rod

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58
Q

Mx Cdiff

A

Fluids & electrolytes

Metronidazole or vancomycin

Avoid anti-diarrhoeals

NOTIFIABLE

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59
Q

Extra-intestinal manifestations of Crohn’s

A

common

iritis, arthritis (sacroiliitis, ank spond) , erythema nodosum, pyoderma gangrenosum
clubbing

Similar UC

Basically steroids for everything

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60
Q

Common ages for Crohns

A

Young
And 50-70

Similar UC

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61
Q

When does Crohn’s require urgent admission

A 
Severe abdo pain
Severe diarrhoea (8+/day)
Bowel obstruction!
Systemically unwell
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62
Q

How to induce remission in Crohn’s

A

If first presentation/ one per year: GC (eg pred)
If not tolerated: 5-aminosalicylate (5-ASA)

If more:
azathioprine add-on
or others

*anti-diarrhoeals contra-indicated during relapse

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63
Q

How many Crohn’s require surgery?

A

50% within 10 years

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64
Q

Complications of Crohn’s

A

Bowel: strictures, fistulae, perfs, increased risk carcinoma

Osteoporosis (esp if on steroids)

Deficiencies..

Gallstones (usually oxalate)

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65
Q

Serological markers to differentiate Crohn’s and UC

A

p-ANCA UC

ASCA Crohns

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66
Q

Mx of UC relapse

A

Mesalazine - first choice

CS (no role in maintenance)

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67
Q

Triad of IBS

A

6 months:
abdo pain
bloating
change in bowel habit

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68
Q

Ix IBS

A 
FBC
CRP
Coeliac
CA 125
Faecal calprotectin
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69
Q

What is contained in an abdominal hernia?

A

Always contains portion of peritoneal sac - may contain viscera (usually small bowel)

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70
Q

Definition ileus

A

non-mechanical intestinal obstruction

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71
Q

Causes of small bowel obstruction

A

Adhesions, strangulated hernia, volvulus, malignancy (of caecum - small bowel malignancy rare)

72
Q

Causes of large bowel obstruction

A

Malignancy

73
Q

What does severe pain in bowel obstruction indicate

A

Ischaemia or perf

74
Q

Why may a person with bowel obstruction be dehydrated?

A

Water unabsorbed in bowel
Reduced oral intake
vomiting

75
Q

Ix bowel obstruction

A

Fluid chart

FBC, U&Es, G&S, cross-match, glucose

AXR

76
Q

Diverticulosis
Diverticular disease
Diverticulitis

A

Got em
Cause symptoms
Evidence of inflammation (eg systemic sx)

77
Q

Where does colorectal ca metastasise?

A

Liver

Lungs, brain, bone
these are unusual in absence of liver mets

78
Q

Which tumours require anterior resection?

A

Low sigmoid/ high rectum

79
Q

Biochemical jaundice vs clinical jaundice

A

Bili 25 +

35+ to see (in sclera, good light!)

80
Q

Signs of post-hepatic jaundice

A

Dark urine
Pale stools
Itching
Increased GGT and AP (damage to biliary tree)

81
Q

Signs of pre-hepatic jaundice

A 
Normal urine (unconjugated bili is insoluble)
Increased bili
82
Q

Signs of hepatic jaundice

A

(mixed)
increased clotting (lack of bile > malabsorption of lipids/ vit K
Increased ALT and AST

83
Q

Signs of liver disease

A 
Spider naevi
Palmar erythema
Gynaecomastia
Testicular atrophy
Flapping tremor
Splenomegaly
Finger clubbing
Ascites
Peripheral oedema
84
Q

False negatives for urinary bili

A

Rifampicin

Old urine

85
Q

Blood test for haemolysis

A

Lactate dehydrogenase is raised

86
Q

Vitamin K affects which clotting blood

A

Prolonged prothrombin time

87
Q

Signature serology for PBC

A

Antimitochondrial antibody

about 35% have ANAs

88
Q

Medication for pruritus

A

UDCA

can be used as prophylaxis for gallstones, eg post-bariatric surgery

89
Q

Why should HRT be avoided in PBC?

A

oestrogens promote cholestasis

90
Q

Most common type of biliary stone

A

Cholesterol (80%)

91
Q

Main difference between biliary colic and cholecystitis

A

inflammatory component: local peritonism, fever, raised WCC

92
Q

Bedside test for cholecystitis

A

Murphy’s sign

93
Q

Ix gallbladder disease

A

FBC
LFTs
Uss

94
Q

How does gallbladder empyema present?

A

Markedly toxic, markedly fever, leucocytosis

95
Q

What is gallstone ileus?

A

Occlusion of intestinal lumen by stone

96
Q

Pain relief for biliary colic/ cholescystitis

A

Morphine or pethidine parenterally
and/ or diclofenac suppository

Sometimes IV abx

97
Q

Why are ppl with Crohn’s predisposed to gallstones?

A

Malabsorption of bile salts from terminal ileum

98
Q

Why do ppl with haemolytic anaemias get gallstones?

A

Increase in billi

99
Q

Why may cholecystitis cause intercapsular pain?

A

T5-9 innervates gallbladder

Shoulder pain: C3-5 if inflammation irritates diaphragm

100
Q

What is Charcot’s triad?

A

jaundice
fever (usually with rigors)
RUQ pain

ascending cholangitis

101
Q

Levels of alcoholic liver disease

Equiv levels in non-alcoholic fatty liver disease

A

Hepatic steatosis
Alcoholic hepatitis
Alcoholic cirrhosis

NAFLD
NASH
Cirrhosis

102
Q

Why does alcohol excess cause fatty liver?

A

Metabolism of EtOH prioritised over lipid metabolism and it builds up in hepatocytes

103
Q

Risk factors for NAFLD

A

Obesity, DM, hyperlipidaemia

+ any hepatotoxin

104
Q

How to diagnose NASH

A

Biopsy

Or practically, based on EtOH intake

105
Q

What is the most common cause of deranged LFTs in developed countries?

A

NAFLD

106
Q

Blood tests suggestive of NAFLD

A

ALT mildly increased, relative to AST
Then reverses
(Up to 50% may have normal LFTs)

107
Q

Imaging of NAFLD

A

USS: hyper-echogenic bright image
CT: may be helpful to monitor
MRI: fatty infiltration + other liver disease

108
Q

Mx NAFLD

A

Weight loss, control of co-morbidities

Vit E

109
Q

Do ulcers require endoscopic follow-up?

A

Gastric: yes, at 8 weeks
Duodenal: only if symptoms recur (H.pylori breath test indicated)

110
Q

Mx autoimmune hepatitis

A

Prednisolone and azathioprine indedinitely - remission in 90% cases
May need liver transplant

Can present as mild or acute liver failure

111
Q

Presentation of acute Hep A

A

2-6 weeks incubation time
prodrome of mild-flu symptoms
can progress to icteric phase, with tender hepato-splemogegaly + lymphadenopathy
full recovery can take 6 months - complications v rare

112
Q

Presentation of acute hep B

A

Incubation 60-90 days
subclinical or flu-like prodrome
acute infection may include jaundice or liver failure (including decompensated or fatal fulminant failure…)

113
Q

How is chronic hep B divided?

A

Hep E antigen positive (higher rates of viral replication) or negative

114
Q

Presentation of chronic hep B

A

Can be indolent
sometimes low-grade symptoms
higher chances HCC or cirrhosis - if significant fibrosis or other risk factors will be offered HCC screening

115
Q

Presentation of hep C

A

acute: can present with jaundice
usually only presents in chronic state: at least 6 sub-types
usually non-specific symptoms

116
Q

Which viral hepatitis unusual?

A

Hep D requires presence of HBV to replicate

117
Q

How is Hep E transmitted?

A

Unlike others, the main resevoir is pigs/ contamination of water supplies
similar presentation as HAV

118
Q

Earliest neurological sign in Wilson’s

A

asymmetrical tremor

other neuro signs can be difficulty speaking, excess salivation, ataxia, personality changes
usually in 20s-30s

119
Q

Diagnosing Wilson’s

A

low caeroloplasmin + Kayser-Fleischer rings

can be treated! chelating agents and block Cu absorption

120
Q

Presentation haemochromatosis

A

usually in 40s-60s
non-specific initially
diabetes, bronzing of skin, hepatomegaly, arthropathy, impotence/ hypogonadism, cardiac disease (arrhythmias, cardiomyopathy), neuro or psych disturbance

121
Q

Causes of cirrhosis

A 
EtOH
Hep B
Hep C
Wilson's
Haemachromatosis
Drugs
Autoimmune hepatitis
Congestive heart failure or TR
others
122
Q

Classification of liver failure

A

Fulminant (within 8 weeks)
Late-onset (within 6 months)
Chronic (6 months+)

123
Q

Causes portal HTN

A

Prehepatic: blockage of portal vein, eg portal vein thrombosis
Hepatic, eg cirrhosis
Posthepatic: blockage in venous sx after liver, eg Budd-Chiari, severe R HF

124
Q

4 sites porto-systemic varices

A

Oesophageal
Rectal
Caput medusae
bare areas of GIT

125
Q

Aetiology HCC

A 
HBV or HCV
Alcoholism
haemachromotosis
metabolic sx
primary biliary cirrhosis
126
Q

Name ca biliary treee

A

cholangiocarcinoma

127
Q

Causes jaundice

A

Pre-hepatic: Gilbert’s, haemolytic anaemias

Hepatic: viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, drug-induced hep, decompensated cirrhosis

Post-hepatic: bile duct strictures, CBD stone, pancreatitis, tumours

128
Q

Causes of abnormal plts number in gastro disease

A

Low: portal HTN, hypersplenism
High: chronic GI blood loss, inflammatory disease

129
Q

How to read an AXR

A 
Patient details/ indications
Date 
Projection (usually AP)
Technical adequacy (hemidiaphragms to pubic symphysis)
Obvious abnormalities

BOWEL
Large from rectum (<6cm, except caecum), bowel wall thickness
Small (<3 cm), wall thickness

PRESENCE OF PNEUMOPERITONEUM (extra-luminal gas)

LIVER, GALLBLADDER, SPLEEN

URINARY TRACT

MAJOR VASCULATURE

SKELETON

IATROGENIC ABNORMALITIES (stents, clips etc.)

130
Q

How to differentiate small and large bowel markings?

A 
Haustra (partial) - large bowel
Valvulae conniventes (full width) - small bowel
131
Q

Only indications for AXR

A

acute abdo ?obstruction

acute exacerbation IBD ?megacolon

132
Q

Causes of pneumoperitoneum

A

Perf
recent laparotomy
intra-abdo infection with gas-causing bugs

133
Q

What is gallstone ileus?

A

Misnomer

Mechanical obstruction: will see dilated loops of small bowel, pneumobilia and a calcific entity at ileo-caecal valve

134
Q

Which organs does the MRCP look at?

A

Pancreas
Biliary tree
MRI scan

135
Q

What does ERCP look at?

A

Bile duct and pancreatic duct

good for gallstones and pancreatitis

136
Q

What does faecal elastase look for?

A

Pancreatic insufficiency
>200 diagnostic
<100 negative

137
Q

Which younger patients are eligible for bowel ca screening?

A

Familial adenomatous polyposis - other plyp diseases
Peutz-Jehgers
Strong family history
IBD affecting colon or rectum
acromegaly
people who have had bowel ca/ polyps in past

frequency depends on risk

138
Q

E&D for endoscopy

A

nothing for 6 hours

139
Q

E&D for sigmoidoscopy

A

fluids only 12h before procedure

140
Q

how far does sigmoidoscope go?

colonoscopy?

A

splenic flexure
usually no sedation needed

ileo-caecal valve
usually sedation

141
Q

alternatives to colonoscopy you might consider for older person

A

CT colonography

Ba swallow

142
Q

Which GORD mx shouldn’t be given with clopidogrel?

A

Omeprazole

reduces efficacy - other PPIs ok

143
Q

Which anti-emetics have prokinetic effects?

Side-effects?

A

D2 receptor antagonists: metaclopramide, domperidone

extra-pyramidal effects, esp children and YAs

144
Q

Which anti-emetic to be avoided in hepatic encephalopathy?

A

Cyclizine (sedating effects)

also avoid in BPH (anticholinergic effects)

145
Q

Which anti-emetics best with chemo/ GA?

A

5-HT3 anatagonists: ondansetron

not great with vertigo

146
Q

When to avoid bulk-forming laxatives?

A

In ileus - causes obstruction

147
Q

Indications for N-acetylcysteine

A

Paracetamol OD
prevent contrast nephropathy
mucolytic to decrease resp secretions

148
Q

FISTULA

A

abnormal communication between 2 epithelial surfaces

149
Q

SINUS

A

blind-ending track

150
Q

ULCER

A

abnormal area of discontinuity in an epithelial surface

151
Q

ABSCESS

A

cavity filled with pus

152
Q

Post-op bleeding
primary
reactive
secondary

A

during procedure
within 24h
7-10 days after op

153
Q

Abx prophylaxis for UGIB

A

co-amox (cipro if pen-allergic)

154
Q

Who gets sucralfate?

A

1g qds following banding

155
Q

Signs of acute flare IBD

A 
6+ motions in 24hrs and at least 1 of:
fever above 37.5
tachycardia above 90
inflamm markers up (CRP above 45)
Hb below 100
Albumin below 30
156
Q

Gastro causes of clubbing

A

IBD
Cirrhosis
Coeliac disease

157
Q

What is sialodenosis

A

Parotid enlargement - might see in EtOH excess

158
Q

What causes fetor hepaticus

A

hepatic failure - mercaptan accumulation

159
Q

extra-intestinal manifestations of IBD

A 
Clubbing
Eyes: episcleritis, conjunctivitis
Mouth: ulcers (esp Crohns)
Skin: EN, PG
Joints: seronegative spondyloarthropathy
PSC (esp Crohns)
160
Q

When might you hear a bruit in the liver?

A

TIPSS
HCC
AV malformation

161
Q

When might you have a pulsatile liver?

A

TR

162
Q

McBurney’s point

A

One-third between umbilicus and ASIS (appendicitis)

163
Q

Obturator sign

A

Pain upon internnal rotation of leg: appendicitis and pelvic abscess

Bend leg at knee and rotate towards midline

164
Q

Psoas sign

A

pain upon extending hip (straight leg pulled back)

appendicitis
psoas inflammation

165
Q

Rovsings’ sign

A

palpation of LLQ results in pain in RLQ

appendicitis

166
Q

What is dumping syndrome?

A

delivery of large amount hyperosmolar chyme into small bowel
following vagotomy and gastric drainage procedure
autonomic instability, abdo pain, diarrhoea

167
Q

Fitz-Hugh-Curtis sx

A

Perihepatic gonorrhea sx

168
Q

Plummer-Vinson sx

A 
oesophageal web
iron-deficiency anaemia
dusphagia
spoon shaped nails
atrophic tongue/ oral mucosa

typically elderly women
10% will develop SCC

169
Q

Short gut sx

A

<200 cm viable gut

170
Q

Most common indication for surgery in Crohns

A

SBO

171
Q

most common electrolyte deficiency causing ileus

A

hypokalaemia

172
Q

most common cause of free peritoneal air

A

Perforated PUD

173
Q

Primary
Secondary
Tertiary intention

A

Immediate closure in theatre
allowed to remain open and granulation tissue form (for dirty wounds)
delayed primary closure (with debridement)

174
Q

Which parts of GI tract are retroperitoneal?

A

most of duodenum
ascending colon
descending colon
pancreas

175
Q

Locations of:
foregut
midgut
hindgut

A

mouth to ampulla of vater
ampulla of vater to distal third of transverse colon
distal third transverse colon to anus

176
Q

Normal diameter CBD

A

< 4 mm until age 40 - then add 1 mm per decade

if gallbladder been removed: 8-10 mm

177
Q

Likely cause of high-output NG

A

In duodenum

F1/ Part 1 (13 decks)

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