Gastroenterology Flashcards
What extra vaccines do you need for coeliac?
Pneumococcal
Hib
Flu
- same as splenectomy
Risks of coeliac
Osteoporosis
Vit D deficiency
Cancer - lymphoma
Anaemia
Where does the inguinal ligament run?
ASIS to pubic tubercule
Where does the inguinal canal run?
ASIS to pubis symphisis
What are the contents of the inguinal canal?
Spermatic cord/Round ligament
Ilioinguinal nerve
What are the borders of the inguinal canal?
MALT
Muscle - internal oblique
Aponeurosis (ext oblique)
Ligament (inguinal ligament)
Tendon (transversalis tendon)
Where is the midinguinal point?
Halfway between ASIS to pubic symphisis
Where is the midpoint of the inguinal ligament?
Midpoint between origins of inguinal ligament (ASIS to pubic tubercle) = deep inguinal ring
Direct inguinal hernia
through external inguinal ring
if reduced, can’t be controlled by pressing over deep inguinal ring
Indirect inguinal hernia
herniated contents run in inguinal canal
can run right down into scrotum - inguino-scrotal hernia
due to failure of proc
Inguinal vs femoral hernia
femoral - below and lateral to pubic tubercule
direct inguinal - above and medial
indirect - anywhere between deep inguinal and scrotum
Differentials for hernias
Psoas abcess Femoral neurofibroma (hard, painful, lateral to femoral artery)
Features of a colostomy
LIF
solid faeces
flush with skin
Features of an ileostomy
RIF
liquid faeces
spouted (to protect skin from enzymes)
Features of a urostomy
RIF
urine
flush with skin
What is a end colostomy ad what is it for?
all of distal bowel removed w/ proximal end brought to surface
e.g for resection of low rectal tumours, Hartmann
What a loop colostomy and what is it for?
two made in central part of large bowel and brought to surface
e.g to protect distal anastamosis while bowel structures heal
reversed after 6w
What is a barrel colostomy and what is it for?
segment of bowel removed and both ends brought to surface
e.g for sigmoid volvulus
What is an end ileostomy and what is it for?
who colon removed
e.g UC, FAP Hirschsprungs
What is an ileal conduit and what is it for?
urostomy when short segment of ileum removed to act as bladder
e.g after cystectomy
What are the early complications of a stoma?
high output (dehydration, hypokalaemia), retraction, bowel obstruction, ischaemia of stoma
What are the late complications of a stoma?
parastomal hernia, prolapse, fistulae, psychological, dermatits
Stoma care
stoma nurse
empty via tap when 2/3 full, irrigated with water, change 2-4 days/whenever full
diet: lots of full, low fibre to begin with
avoid foods that cause blockage or flatulence
can wear in shower
Cuases of hepatosplenomegaly
Viral hepatits
Mono
CMV
Haematology; leukaemia, sickle cell, lymphoma
Risk factors for Dupetryns
Trauma/ occupational Genetics Smoking/alcohol hypercholesterolaemia anticonvulsants
Questions to ask in Dupetryns
How it affects life?
What job they did?
Can you put your hand flat on table?
Feet or Willy?
Crohns Barium Enema features
Cobblestone Transverse stripes Kantors string sign Ulcers Patrial obstruction
Inducing remission in UC
rectal aminosalicylates or steroids if distal
oral salicyates if no response __>
oral pred
IV steroids (1st line if severe)
Causes of ascites
Cirrhosis Hypoalbuminaemia Peritoneal mets Hepatic vein thrombosis TB Ovarian Ca
Acute Pancreatitis Managemet
IV fluids
NBM (enteral fluids)
Analgesia
ABx
Causes of Bowel Obstruction
Adhesions
Hernias
Tumours
(Gallstones, Crohns, diverticulitis)
Symptoms of bowel obstruction
Pain
Vomiting
DIstention
Absolute Constipation
Volvulus
Loop of bowel twisted on mesentery Idiopathic/due to faecal loading Sudden severe abdo pain w/ distention Unrelieved by opiates Obstruction then ileus then peritonitis
Coffee Bean Sign
sigmoid volvulus
Acute Pancreatitis Management
FBC, LFTs, U+Es, bHCG amylase, lipase BM ABG ECG - rule out MI CXR - pneumoperitoneum USS - pancreas CT - pancreas later
