Gastroenterology Flashcards
What part of the gut does the appendix originate from?
The midgut. It is supported by the meso-appendix that supplies its vasculature.
What is the most common cause of appendicitis?
Direct luminal obstruction e.g. faecolith (poo stone), lymphoid hyperplasia, impacted stool, Ca (rare)
What is the nerve supply of the appendix?
T10 - like umbilicus.
Where is McBurney’s point?
1/3 distance from ASIS to umbilicus, most likely region for appendix pain
What are the emergency differentials to acute appendicitis?
Mesenteric adenitis (Hx of sore throat) - usually viral lymphadenopathy, provide reassurance Meckel's diverticulitis (children) Torsion or rupture of ovarian (young female)
How do you manage an appendicular abscess?
Treat with antibiotics to reduce inflammation, then perform appendicectomy in 6-8 weeks electively - this has been shown to increase recovery time
What causes thumbprinting?
Large bowel wall thickening/ oedema in association with an infective or inflammatory process i.e. colitis
What is the mechanism of infliximab? When is it used?
TNF alpha inhibitor. It is used in the treatment for IBD, both UC and Crohn’s.
What is Calot’s triangle?
The cystohepatic triangle. It is bordered by the common hepatic duct medially, cystic duct laterally and inferior edge of the liver superiorly.
Where is the ampulla of Vater, what does it delineate?
In the second part of the duodenum. It separates the foregut and the midgut.
Where is the separation between the midgut and hindgut?
2/3 along the way of the transverse colon
What are the three branches of the coeliac trunk?
The coeliac trunk gives rise to the common hepatic, left gastric and splenic arteries.
What are some risk factors for developing gallstones?
5Fs = fat, female, 40s, fertile, fair
Bariatric surgery/ sudden weight loss
Age
Diabetes
Family history
Oral contraception/ pregnancy
Anaemia (haemolytic)
Malabsorption (terminal ileitis/ ileal resection)
What are different types of gall stones and what are radiolucent?
Cholesterol stones (80%) - radiolucent
Bilirubin/ black pigment stones - radiolucent
Mixed stones - mostly radiolucent, some radiopaque if calcium
Brown pigment stones - E. coli and Klebsiella
How do gallstones present?
70% asymptomatic
If symptomatic, 50% present with biliary colic (e.g. post-prandial - cholecystokinin stimulates GB constraction after fatty food)
Acute cholecystitis, chronic cholecystitis, obstructive jaundice, pancreatitis
