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Gastroenterology & General Surgery Flashcards

1
Q

Acute abdomen

  1. Presentation
  2. Organ rupture - causes
  3. Peritonitis - causes
  4. Local peritonitis - causes
  5. Colic - description
A
  1. Acute tenderness, guarding, rigidity, absence of bowel sounds, septic (sweating, pale, weak pulse, shallow breath)
  2. Spleen, aorta, ectopic pregnancy
  3. Perforation (ulcer, diverticulum, appendix, bowel, gallbladder)
  4. Diverticulitis, cholecystitis, salpingitis
  5. Regularly waxing/waning, muscular spasm in hollow viscus (gut, ureter, uterus, bile duct, gallbladder)
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2
Q

Abdominal pain

  1. History - associated symptoms
  2. Bloods
  3. Bedside tests
  4. Imaging
A
  1. Vomiting, haematemesis, eating/drinking, swallowing, stools (loose/blood), urine (frequency/urgency/blood), vaginal discharge, menstruation, FEVER, weight loss, night sweats
  2. FBC, U+;E, LFTs, glucose, CRP, amylase
  3. Urine dip - glucose, infection, pregnancy
  4. CXR (perforation), USS abdomen, CT
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3
Q

Abdominal examination - to complete

A 
Hernial orifices
External genitalia
PR
Urine dip
Stool sample if feel appropriate
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4
Q

Appendicitis

  1. Symptoms
  2. McBurney’s point - significance and location
  3. Rovsings sign - how to elicit and significance
  4. Other differentials (4)
  5. Bedside tests
  6. Blood tests
  7. Imaging
  8. Definitive management
  9. Other management
A
  1. Periumbilical pain moving to LIF, tachycardia, fever, peritonism, vomiting, constipation
  2. Most common location for base of appendix (where it attaches to the caecum). 2/3 of the way from the umbilicus to the right ASIS
  3. Press on RIF and pain in the LIF. Can be present in appendicitis
  4. Ectopic pregnancy (RULE OUT), ovarian cyst (torsion/rupture), meckel’s diverticulitis, mesenteric adenitis
  5. Urine dip, BM, pregnancy test, BP, palpable RIF mass
  6. FBC, U+E, CRP - leucocytes + CRP raised
  7. USS abdomen, CT if diagnosis unclear
  8. Appendectomy
  9. Antibiotics - metronidazole, cefuroxime
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5
Q

Diarrhoea

Causes

  1. GI
  2. Systemic
  3. Drugs
  4. Infective
  5. Important history questions
  6. Significant findings requiring follow up

Differentials

  1. Bloody
  2. Mucus
  3. Frank pus
  4. Explosive
  5. Steatorrhoea

Investigations

  1. Bedside
  2. Blood
  3. Non-bedside
  4. Imaging
  5. Management

C difficile

  1. Diagnosis
  2. Complication
  3. Acute management
  4. Recurrent management
A
  1. Infection, malignancy, IBD, IBS, malabsorption
  2. Endocrine, anxiety, bacterial overgrowth
  3. Laxatives, antibiotics, SSRIs, metformin
  4. E.coli, shigella, salmonella, campylobacter
  5. Acute/chronic, travel, diet change, contact with D+V, fever, pain
  6. Anaemia, weight loss, nocturnal diarrhoea
  7. Infective, IBD, colorectal cancer, polyps
  8. IBS, colorectal cancer, polyps
  9. IBD, diverticulitis, fistula/abscess
  10. Cholera, giardia, rotavirus
  11. Pancreatic insufficiency, biliary obstruction
12. PR (overflow due to constipation)
Urine dip and culture
Stool sample - viral / bacterial / occult blood
13. FBC, U+E, LFTs, CRP, TFTs
14. GI Endoscopy
15. AXR, abdominal ultrasound
  1. Treat the cause, rehydrate, slow bowel movements (?) - opioids / stop medication
  2. Two stage: 1. Rapid screening/PCR for C.diff protein, 2. Specific ELISA for toxins
  3. Toxic megacolon
  4. Stop causative antibiotic, metronidazole (mild), vancomycin (severe)
  5. Fidaxomicin PO
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6
Q

Nausea + Vomiting

Causes

  1. GI
  2. Metabolic
  3. Neurological
  4. Cardiovascular
  5. Drugs

Timing

  1. Morning
  2. 1 hour post-food
  3. Relieves pain
  4. Preceded by loud gurgling
A
  1. Infection (pancreatitis, pyelonephritis, gastroenteritis, cholecystitis), obstruction, inflammation
  2. DKA, hypercalacaemia, hyponatraemia, Addison’s disease, pregnancy
  3. Head trauma, tumour, motion sickness, Meniere’s
  4. MI
  5. Opioids, antibiotics, chemotherapy, alcohol
  6. Pregnancy, raised ICP
  7. Gastric stasis/gastroparesis (DM)
  8. Peptic ulcer
  9. GI obstruction
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7
Q

Bowel cancer - guidelines for suspicion

A

40+ with unexplained weight loss and abdominal pain or

50+ with unexplained rectal bleeding or

60+ over with:
Iron-deficiency anaemia
Changes in their bowel habit
Tests show occult blood in their faeces

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8
Q

Colorectal carcinoma / bowel cancer

  1. Commonest type
  2. Predisposing factors
  3. Genes responsible
  4. Right-sided presentation
  5. Left-sided presentation
  6. Examination signs
  7. Blood tests
  8. Further tests
  9. Staging (Duke’s)
  10. Screening
  11. Test if FH of FAP
A
  1. Adenocarcinoma
  2. Polyps, IBD, genetic, diet (low fibre, red meat), alcohol, smoking, previous cancer
  3. FAP, HNPCC
  4. Diarrhoea, weight loss, anaemia, RIF mass, abdominal pain - often late presenting
  5. Constipation, bleeding, PR bleed/mucus, tenesmus
  6. Abdominal mass, hepatomegaly (metastases), rectal mass, IDA signs
  7. FBC (looking for IDA), LFTs, U+E, CEA (monitor progress)
  8. Colonoscopy, barium swallow, imaging (MR/endorectal US)
  9. 1 (to muscularis), 2 (to suberosa), 3 (nodes involved), 4 (distant spread)
  10. 55 -one-off flexible sigmoidoscopy, 60-74 - home-testing (FOB/FIT) for occult blood every 2 years
  11. DNA at 16
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9
Q

Oesophageal cancer

  1. Type (commonest and BO-associated)
  2. Virus associated with commonest type
  3. Symptoms
  4. Signs
  5. Common metastasis
  6. Tests
  7. Non-metastasis treatment
  8. Metastasised treatment
  9. Urgent 2ww referral criteria
  10. Non-urgent referral criteria
A
  1. Squamous cell carcinoma, adenocarcinoma
  2. EBV
  3. Fatigue, increasing dysphagia, odynophagia, hoarseness, vomiting, haematemesis, cough
  4. Weight loss, anaemia, hepatomegaly, lymphadenopathy, ascites
  5. Liver
  6. FBC, LFTs, upper GI endoscopy, barium swallow, further imaging for staging
  7. Oesophageal resection
  8. Palliative
  9. Dysphagia or 55+ and weight loss + one of upper abdominal pain, reflux or dyspepsia
  10. Haematemesis, or 55+ and other upper GI symptoms
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10
Q

Gastro-oesophageal reflux disease (GORD)

  1. Causes
  2. Symptoms
  3. Tests
  4. Conservative management
  5. Medical management
  6. Surgical management (when severe and refractory)
  7. Surgical complications

Barrett’s Oesophagus

  1. Cause
  2. Location
  3. Histological changes
  4. Significance
  5. Management - no dysplasia
  6. Management - low grade dysplasia
  7. Management - moderate/high grade dysplasia
A
  1. LOS hypotension, hiatus hernia, oeseophageal dysmotility (e.g. systemic sclerosis), obesity, gastric acid hypersecretion, smoking, alcohol, pregnancy
  2. Heartburn, belching, acid brash, water brash, odynophagia, nocturnal asthma, chronic cough, laryngitis
  3. Endoscopy if dysphagia / >55 + ALARMS symptoms / treatment refractory dyspepsia
  4. Weight loss, stop smoking, small/regular meals, reduce hot drinks/alcohol/citrus/fizzy drinks/spicy. Avoid eating 3 hours before bed and raise bed head
  5. Antacids or alginates (Gaviscon) for symptom relief, and PPI. Add H2 blocker/double PPI dose if refractory
  6. Fundoplication
  7. Dysphagia, ‘gas bloat’ syndrome, new diarrhoea
  8. Chronic GORD
  9. Lower oesophagus
  10. Stratified squamous to simple columnar with interspersed goblet cells (dysplasia)
  11. Oesophageal adenocarcinoma more likely
  12. High dose PPI
  13. Endoscopic radiofrequency ablation
  14. Oesophagectomy or endoscopic ablation/mucosal resection
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11
Q

Gastric Carcinoma

  1. Commonest type
  2. Risk factors
  3. Symptoms
  4. Signs
  5. Blood tests
  6. Gold-standard investigations
  7. Management if localised
  8. Management if metastatic

Gastrectomy

  1. Physical complications (+ causes)
  2. If raised amylase and abdominal pain
  3. Metabolic complications
A
  1. Adenocarcinoma
  2. H. pylori, smoking, poor diet, blood group A, chronic gastritis, pernicious anaemia, adenomatous polyps
  3. B symptoms, N+V, abdominal pain, dyspepsia, dysphagia (oesophageal obstruction), upper GI bleed
  4. Palpable epigastric mass, Virchow’s node (left supraclavicular)
  5. FBC, LFTs (metastases)
  6. Upper GI endoscopy, barium swallow
  7. Resection / gastrectomy
  8. Palliative, stents if obstructions
  9. Abdominal fullness (eat little/often), afferent loop syndrome (upper abdominal pain, bilious vomit), diarrhoea (codeine), gastric tumour, increased amylase
  10. Consider afferent loop obstruction
  11. Dumping syndrome (post-prandial sweating/fainting - eat less sugar/more pectin/take acarbose), weight loss, bacterial overgrowth/malabsorption (blind loop syndrome), anaemia, osteomalacia
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12
Q

Pancreatic cancer

  1. Commonest type
  2. Risk factors
  3. Symptoms
  4. Signs
  5. Rarer features
  6. Blood tests
  7. Further investigations
  8. Management options

Carcinoid tumours

  1. Origin
  2. Common sites
  3. Carcinoid syndrome
  4. Cardiac involvement - which side
  5. Management

Carcinoid crisis

  1. Cause
  2. Symptoms
  3. Management
A
  1. Ductal adenocarcinoma
  2. Smoking, DM, pancreatitis, KRAS2 gene mutation
  3. Usually painless, abdominal mass, weight loss, non-specific back pain
  4. Painless progressive obstructive jaundice (HoP tumour) and non-tender palpable gallbladder (Courvoisier’s law), if tail then pancreatitis pain symptoms
  5. Thrombophlebitis migrans, high Ca2+, marantic endocarditis, portal HTN (splenic vein thrombosis), nephrosis (renal vein metastases)
  6. FBC, LFTs
  7. USS, CT, ERCP
  8. Surgical (Whipple’s procedure), palliative (stenting, pain relief)
  9. Enterochromaffin cell from neural crest; produce 5HT
  10. Appendix, ileum, rectum
  11. Implies hepatic involvement; bronchoconstriction, flushing, RUQ pain, endocrine abnormality, diarrhoea
  12. Octreotide (somatostatin analogue), loperamide
  13. Right - tricuspid insufficiency + pulmonary stenosis
  14. Tumour outgrows vessel supply or handled too much perioperatively, tumour mediators flow out
  15. Life threatening vasodilation, hypotension, tachycardia, bronchoconstriction, hyperglycaemia
  16. Octreotide, supportive, fluid balance (central line)
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13
Q

Constipation

  1. Medical causes
  2. Surgical causes
  3. Drug causes
  4. Important questions
  5. Examination
  6. Blood tests
  7. Imaging
  8. Conservative management
  9. Medical management
  10. Laxative - types and examples (4, ‘BOSS’)
  11. When not to use stimulants
  12. What to use if pain e.g. fissure
  13. Other useful use for osmotic laxative
A
  1. Diverticulitis, IBD, IBS, Coeliac, immobility, dehydration, raised calcium/phosphate, Parkinson’s disease, pregnancy, hypothyroidism
  2. Appendicitis, malignancy, obstruction, ischaemic bowel
  3. Anti-cholinergics, opiates, iron, calcium channel blockers (e.g. amlodipine, nifedipine, verapamil, diltiazem)
  4. Normal bowel habit - how many stools per day (? <3 per week) and for how long, overflow diarrhoea, melaena, pain, diet, new medications, red flags (fever, weight loss, night sweats), foreign travel, flatus/mucus
  5. Abdominal and PR
  6. FBC (haematinics e.g. B12/folate), U+E, LFTs, TFTs
  7. USS, AXR, CT (extreme)
  8. Exercise, fibre
  9. Laxatives, enema
  10. Bulking (methylcellulose), Osmotic (lactulose), Softer (docusate), Stimulants (senna)
  11. Intestinal obstruction, acute colitis
  12. Softening
  13. Hepatic encephalopathy
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14
Q

Acute pancreatitis - causes

A

I - idiopathic

G - gallstones
E - ethanol
T - trauma

S - steroids
M - mumps
A - autoimmune
S - scorpion venom
H - High: lipid, calcium, parathyroid
E - ERCP
D - drugs: furosemide, azathioprine, thiazides, tetracycline, statins, oestrogen
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15
Q

Acute pancreatitis

  1. Definition
  2. Causes
  3. Symptoms
  4. Signs
  5. Criteria for clinical outcome, score for ITU
  6. Specific blood tests (and results)
  7. Other bloods (and results)
  8. Imaging
  9. Management
  10. Early complications
  11. Late (>1 weeks) complications
A
  1. Acute inflammation of the pancreas by autodigestion
  2. I GET SMASHED
  3. N+V, abdominal pain radiating to back and relieved by sitting forward
  4. Grey turner’s sign (flank bruising), cullen’s sign (umbilical bruising), tachycardia, fever, shock, ileus, rigid abdomen
  5. Glasgow score, >3
  6. Amylase (>1000/may be normal), lipase (more specific, especially in alcohol, rise earlier/falls later)
  7. FBC (raised WBC), U+E, LFTs (if raised ALT, gallstones), raised glucose, urea, CRP, decreased albumin and calcium
  8. CT (1st line for severity), AXR (no psoas shadow from retroperitoneal fluid, sentinel loop of proximal jejunum from ileus), CXR (perforation), USS (if gallstones/raised AST), ERCP (if LFTs worsen)
  9. Supportive - O2, fluids, analgesics, anti-emetics, insulin, antibiotics 5-7 days, PPI, regular monitoring
  10. Shock, ARDS, renal failure, DIC, low Ca2+, high BM
  11. Pancreatic necrosis/pseudocyst (fever, mass, persistent high amylase/LFT), abscess, bleeding, thrombosis, fistulae
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16
Q

Chronic pancreatitis

  1. Definition
  2. Causes
  3. Clinical features
  4. Bloods
  5. Imaging
  6. Management
  7. Diet advice if exocrine insufficiency
  8. Complications
A
  1. Irreversible inflammation +/ fibrosis
  2. Alcohol, high calcium/PTH/lipids, biliary disease, cystic fibrosis
  3. Jaundice, abdominal pain (radiates to back, improves on sitting forward/hot water bottles), bloating, steatorrhoea (loose, greasy, foul-smelling), weight loss
  4. LFTs (abnormal if coexisting liver disease / compression of the intra-pancreatic bile duct), NOT serum amylase
  5. CXR, USS/CT (pancreatic calcifications)
  6. Lifestyle (stop drinking/smoking), analgesia, screening for diabetes/osteoporosis, pancreatin (lipase, amylase, protease) with all food if exocrine insufficiency
  7. Food distributed between 3 meals + 2-3 snacks / day. Avoid legumes (peas, beans, lentils) and high-fibre as difficult to digest. Reduced fat diets not recommended
  8. Pseudocysts, DM, biliary obstruction, local arterial aneurysm, splenic vein thrombosis, gastric varices, pancreatic carcinoma
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17
Q

Dyspepsia

  1. Definition
  2. Local causes
  3. Systemic causes
  4. Drug causes
  5. Important symptoms ‘ALARMS’
  6. Other symptoms
  7. Investigations (under or over 55)
  8. Peptic ulcers - cause
  9. Duodenal - relation to eating/antacids
  10. Gastric - commonest patient cohort
  11. Relation to eating
  12. Conservative management
  13. Antacids - types and examples
A
  1. Indigestion
  2. GORD, H. pylori, gastritis, gastric/duodenal ulcer, hiatus hernia
  3. Infection, alcohol, smoking
  4. NSAIDs, steroids, bisphosphonates
  5. Anaemia (ID), Loss of weight, Anorexia, Recent/progressive onset, Malaena/haematemesis, Swallowing difficulty
  6. Epigastric, related to hunger/food, fullness after meals, heartburn, tender epigastrium
  7. Under 55 needs urea breath test, add OGD if 55+
  8. Layer breakdown (steroids, NSAIDs, H. pylori), increased acid (ZES gastrinoma, stress, alcohol, caffeine, smoking, spicy food)
  9. Better after eating, relieved by antacids
  10. Elderly, on lesser curve
  11. Worse when eating, relieved by antacids
  12. Weight loss, stop smoking, less drinking/hot drinks
  13. PPI (lanzoprazole, omeprazole), H2 blocker (ranitidine)
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18
Q

Dysphagia

  1. Intraluminal causes
  2. Extraluminal causes
  3. Systemic causes
  4. Important questions
  5. 1st line investigation
  6. Further imaging

Achalasia

  1. Causes
  2. Symptoms/signs
  3. Most important diagnostic test + finding
  4. Other imaging + finding
  5. Management
A
  1. Inflammation (oesophagitis), malignancy
  2. Stricture, malignancy, achalasia (solids and liquids), goitre, vascular obstruction
  3. Parkinson’s, myasthaenia gravis, scleroderma, bulbar palsy, motor neurone disease
  4. Solids/liquids (both from start motility disorder, solids 1st worsening stricture), difficult to start swallowing (bulbar palsy), odynophagia (ulceration/spasm), intemittent (spasm) / continuous (stricture), bulge/gurgle when drinking (pharyngeal pouch), B symptoms
  5. Endoscopy
  6. Barium swallow, CT
  7. LOS fails to relax (myenteric plexus degeneration) -
  8. Liquids as well as solids, heartburn, regurgitation
  9. Manometry - high LOS tone, doesn’t relax if swallow 10. Barium swallow - dilated tapering oesophagus ‘bird’s beak’
  10. Endoscopic balloon dilatation/Heller’s cardiomyotomy then PPI
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19
Q

Biliary medicine - definitions

  1. Cholelithiasis
  2. Choledocholithiasis
  3. Cholecystitis
  4. Biliary colic
  5. Cholestasis
  6. Cholangitis
A
  1. Gallstones in gallbladder
  2. Gallstones passed into biliary tree
  3. Inflammation of the gallbladder
  4. Intermittent RUQ pain from gallstones irritating bile ducts
  5. Blockage to bile flow
  6. Infection + obstruction of the biliary system
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20
Q

Gallstones

  1. Types
  2. Percentage that are radio-opaque
  3. Factors increasing incidence
  4. Main precipitant for mixed stones
  5. 5 Fs of gallstone disease
  6. Courvoisier’s law
  7. Gallbladder size vs obstructed biliary tree
  8. Commonest presentation
  9. Cause of obstructive jaundice due to gallstones
  10. Imaging
  11. Asymptomatic management
  12. Medical management
  13. Surgical management
  14. Management if inoperable but symptomatic
A
  1. Cholesterol (large, solitary), pigment (small/irregular, from haemolysis)
  2. 10% seen on x-ray
  3. Overweight, pregnancy, diuretics, smoking
  4. Infection
  5. Fat, female, fertile, forty, fair
  6. Not gallstones if presenting with enlarged palpable gallbladder and painless obstructive jaundice - pancreatic cancer until proven otherwise
  7. Smaller (larger in biliary tree obstruction)
  8. 80% asymptomatic
  9. Choledocholithiasis
  10. USS first line, MRCP if no stones on USS but there is bile duct dilatation / raised bilirubin
  11. Conservative
  12. Medical: pain relief, anti-emetics, antibiotics if infection
  13. If symptomatic/complications: cholecystectomy
  14. ERCP / lithotripsy (US shock waves)
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21
Q

Cholecystitis

Acute

  1. Main cause
  2. Presentation
  3. Signs
  4. Blood tests
  5. USS findings
  6. Medical management
  7. Surgical management

Chronic

  1. Definition
  2. Presentation
A
  1. Gallstones impaction in neck of gallbladder
  2. Feverish, unwell, RUQ pain radiating to shoulder, taking shallow breaths, N+V, dyspepsia (no jaundice) - inflammatory component differs from simple biliary colic
  3. Fever, tachycardia, tachypnoea, Murphy’s sign (patient stops inspiring deeply on palpation of RUQ as gallbladder moves down to costal margin)
  4. FBC, U+E, LFTs, CRP, amylase, maybe culture
  5. Thickened gallbladder wall, stones / sludge within, fluid around, dilated bile ducts
  6. NBM, fluids, antibiotics (cover gram positive and negative) anti-emetic, analgesia
  7. Cholecystectomy - if severe / complications within 72 hours, up to 1 week if not
  8. Chronic inflammation/colic
  9. ‘Flatulent dyspepsia’, fat intolerance, vague pain, distension
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22
Q

Cholangitis

  1. Definition
  2. Causes
  3. Charcot’s triad
  4. Common presentation
  5. Management
A
  1. Inflammation of bile duct
  2. Infection, iatrogenic (past stent), obstruction
  3. Jaundice, fever/rigors, RUQ pain (only present in 25%)
  4. Sepsis
  5. ABCDE, + ERCP to retrieve stone
23
Q

Gallbladder cancer

  1. Commonest type
  2. Risk factors
  3. Presentation
  4. Blood markers
  5. Management
A
  1. Adenocarcinoma, then squamous cell
  2. Chronic gallstones, congenital malformation, older, FH, obese
  3. Late - weight loss, jaundice, RUQ mass
  4. CEA, CA 19-9
  5. Cholecystectomy, sometimes chemotherapy / radiotherapy
24
Q

Gastroenteritis - general

  1. Vomiting causing organisms
  2. Watery diarrhoea causing organisms
  3. Dysentery (inflammation) causing organisms
  4. Risk factors
  5. Symptoms within 4 hours - which infection
  6. Symptoms within 12-48 hours - which infection
  7. Treatment
A
  1. Staph aureus, bacillus cereus (rice)
  2. Cholera, E. coli (enterotoxigenic)
  3. E. coli (enterohaemorrhagic), shigella, salmonella, campylobacter (traveller)
  4. Young/old, immunosuppressed, travellers
  5. Food poisoning
  6. Toxin-producing / cell invaders
  7. Most resolve on own - fluids, anti-emetics, rehydration, antibiotics if systemically unwell/immunocompromised)
25
Q

Upper GI bleed

  1. Classification
  2. Oesophageal causes
  3. Gastric causes
  4. Drug causes
  5. Important questions to ask
  6. Presentation
A
  1. Mouth to 2nd part of duodenum
  2. Oesophagitis, mallory-weiss tear, malignancy, varices
  3. Gastritis, ulcer, malignancy
  4. NSAIDs, aspirin, steroids, thrombolytics, anticoagulants
  5. Past GI bleed, dyspepsia/known ulcers, liver disease, varices, dysphagia, vomiting, weight loss
  6. Haematemesis, coffee-ground vomit, malaena, haemodynamic instability, symptoms suggesting ulcer (epigastric pain, dyspepsia) or varices (jaundice, ascites)
26
Q

Lower GI bleed

  1. Classification
  2. Small + large bowel causes
  3. Rectal/anal causes
  4. Rectal bleeding - initial investigations
A
  1. 2nd part of duodenum to anus
  2. Malignancy, IBD, diverticulitis, ulcer, polyps
  3. Malignancy, fissure, haemorrhoid, fistula, IBD
  4. PR, procto-sigmoidoscopy (+ colonoscopy if change in bowel habit/IBD symptoms)
27
Q

GI bleed - general

  1. Associated symptoms
  2. PMH questions
  3. Causative medications
  4. Bedside tests
  5. Blood tests
  6. Imaging
  7. Score to determine risk of bleed at initial presentation
  8. Score used pre-endoscopy to determine risk of rebleeding/overall mortality
  9. Management - general (ABATED + other)
  10. Management - variceal
  11. Lifestyle advice post-bleed
  12. Treatment if high risk of re-bleeding
A
  1. Weight loss, vomiting, signs of chronic liver disease/anaemia
  2. Binge drinking, liver decompensation
  3. Anticoagulants, antiplatelets, steroids, NSAIDs, alcohol
  4. BP (lying and standing), PR, monitor urine output
  5. FBC (Hb down), U+E (urea up), haematinics, LFT, clotting, group + save, ABG
  6. CXR (look for perforation), maybe barium swallow / endoscopy
  7. Glasgow-Blatchford
  8. Rockall (pre and post-endoscopy)
  9. ABCDE
    Bloods (Hb, urea, coagulation, LFTs, crossmatch 2 units)
    Access (2x large bore cannulae)
    Transfuse
    Endoscopy (when stable, within 24 hours)
    Drugs - stop anticoagulants/NSAIDS
    Other - interventional radiology to identify bleeding point, medical (antibiotics, PPI, H. pylori), surgery (if failure to stop), correct clotting (vit K, FFP, platelets)
  10. Terlipressin (maximum 5 days), banding or TIPS if oesophageal, endoscopic N-butyl-2-cyanoacrylate injection or TIPS if gastric, Sengstaken-Blakemore tube
  11. Avoid NSAIDs, reduce alcohol
  12. PPI infusion, B blockade (1/2 prevention if variceal)
28
Q

Hernia - general

  1. Risk factors
  2. Irreducible - definition
  3. Obstructed - definition
  4. Incarcerated - definition
  5. Strangulated - definition
  6. Surgical management
  7. Periumbilical hernia - presentation, risk factors
  8. Umbilical hernia - presentation
  9. Epigastric hernia - pass through what
  10. Spigelian hernia - pass through what
  11. Richter’s hernia - involve what

Hiatus hernia

  1. Sliding - cause
  2. Rolling/paraoesophageal - cause
  3. Management
  4. Paediatric - umbilical hernia cause
  5. Paediatric - indirect inguinal hernia cause
A
  1. Obesity, previous surgery, coughing, straining (chronic constipation)
  2. Contents cannot be pushed back into place
  3. Bowel contents cannot pass
  4. Hernial contents fixed due to adhesions, surgical emergency
  5. Ischaemia of the bowel contents of the hernia, surgical emergency
  6. Mesh or suture to secure
  7. Umbilicus is a semicircle, obesity/ascites
  8. Mass bulges directly from umbilicus
  9. Linea alba above umbilicus
  10. Linea semilunaris at lateral edge of rectus sheath, below/lateral to umbilicus
  11. Bowel wall only, not whole lumen
  12. GOJ slides into chest, LOS looser, reflux common
  13. GOJ remains in abdomen (intact so less reflux), but stomach slides into chest; common in obese women
  14. Weight loss, treat GORD, surgery if refractory/severe
  15. Transversalis fascia defect
  16. Patient processus vaginalis
29
Q

Femoral and Inguinal Hernias

  1. Femoral hernia location to pubic tubercle
  2. Inguinal hernia location to pubic tubercle
  3. Strangulation commoner in which ^ and why
  4. Femoral hernia presentation
  5. Femoral hernia management
  6. Indirect inguinal hernia passes through
  7. Direct inguinal hernia passes through
  8. Strangulation commoner in which ^
  9. Inguinal ligament runs from
  10. Determine whether direct or indirect
  11. Inguinal canal - contents (male)
  12. Inguinal canal - alternative contents (female)
A
  1. Inferolaterally
  2. Superomedially
  3. Femoral, because of sharp lacunar ligament
  4. Tender swelling in upper medial thigh, often irreducible
  5. Urgent surgery, likely to strangulate
  6. Deep and superficial inguinal ring
  7. Just superficial inguinal ring
  8. Indirect
  9. ASIS to pubic tubercle, deep ring at mid point, superficial just superomedial to pubic tubercle
  10. Direct reduced when lying down, indirect restrained when pressure over deep ring when lying down
  11. Fascia, spermatic cord (vas deferens, arteries to vas/cremaster/testes), ilioinguinal nerve
  12. Uterus round ligament
30
Q

AXR

  1. Small bowel appearance
  2. Large bowel appearance
A
  1. Valvulae conniventes span the whole lumen, also more central
  2. Haustra don’t cross whole lumen, also more peripheral
31
Q

Small bowel obstruction

  1. Causes in lumen
  2. Causes in wall
  3. Causes outside the bowel
  4. Typical presentation
  5. Examinations
  6. Blood tests
  7. Imaging
  8. Management
A
  1. Polyp, intussusception, gallstone, faeces
  2. Tumour, Crohn’s, infarction, stricture
  3. Intussusception, adhesions, volvulus
  4. ‘Early vomiting, late constipation’. Cramping/colicky central abdominal pain, bilious vomiting, some distention, increased ‘tinkling’ bowel sounds
  5. Abdominal exam, hernial orifices, PR
  6. FBC, U+E, CRP, amylase
  7. Erect CXR, AXR
  8. Mostly conservative ‘drip and suck’; surgery if ischaemic bowel / incarcerated hernia
32
Q

Large bowel obstruction

  1. Causes in lumen
  2. Causes in wall
  3. Causes outside the bowel
  4. Typical presentation
  5. Imaging
  6. Medical management
  7. Surgical management
A
  1. Polyp, mass
  2. Diverticulitis, Crohn’s, mass, impacted faeces
  3. Volvulus, adhesions
  4. ‘Early constipation, late vomiting’, colicky pain, distended abdomen (more than in SBO)
  5. Erect CXR, AXR
  6. Drip and suck, water-soluble enema
  7. Emergency if ischaemic, stenting
33
Q

Other obstruction causes

Volvulus

  1. Definition
  2. Commonest location (2)
  3. Presentation
  4. AXR finding
  5. Imaging to confirm
  6. Management - sigmoid, no peritonitis
  7. Management - surgical
  8. Paralytic ileus - definition
  9. Contributing factors
  10. Specific examination finding
  11. Acute pseudo-obstruction - aka
  12. Predisposing factors
  13. Management
A
  1. Twisting of bowel around mesenteric attachment
  2. Sigmoid colon (anticlockwise), then caecal (clockwise)
  3. Colicky abdominal pain, distention, constipation
  4. Coffee bean sign (dilated, twisted sigmoid colon)
  5. CT to confirm / rule out other pathology
  6. Endoscopic decompression
  7. Hartmann’s (sigmoid), right hemicolectomy (caecal)
  8. Adynamic bowel due to absence of normal peristaltic contractions
  9. Abdominal surgery, localised peritonitis, spinal injury, low Na+/K+, urea, drugs (TCAs)
  10. ‘Sluggish’ bowel sounds
  11. Ogilvie’s syndrome
  12. Puerperium, pelvic surgery, trauma, cardiorespiratory / neurological disorders
  13. Neostigmine, colonoscopic decompression
34
Q

Crohn’s disease

  1. Lesions present
  2. Extent of inflammation at cellular level
  3. Bleeding
  4. Associated disease
  5. Smoking
  6. Classic presentation
  7. Mild-moderate into remission treatment
  8. Severe into remission treatment
  9. Maintaining remission - management
  10. Indications for surgery
A
  1. Skip - entire length of GI tract (terminal ileum worst)
  2. Transmural
  3. Less common
  4. Ankylosing spondylitis
  5. Makes it worse
  6. Non-bloody diarrhoea, RIF/suprapubic pain, weight loss, fever, malaise, mouth ulcers
  7. Prednisolone 1st line, 5-ASA 2nd line
  8. IV hydrocortisone, fluid rehydration
  9. Azathioprine 1st line, methotrexate 2nd line
  10. Failure of medical therapy, intestinal obstruction, perforation
35
Q

Ulcerative Colitis

  1. Lesions location
  2. Histopathology
  3. Bleeding
  4. ‘Cure’
  5. Precipitate
  6. Linked gene
  7. Type of mediated response
  8. Linked liver condition
  9. Smoking
  10. Severe colitis presentation
  11. Severe AXR findings
  12. Inducing remission in mild/moderate flare
  13. Inducing remission in severe flare
  14. Maintaining remission
  15. Surgical management
  16. Complications
A
  1. Continuous - rectum upwards
  2. Mucosal lesions; hyperaemic/haemorrhagic colonic mucosa, punctate ulcers to lamina propia (not transmural)
  3. More common
  4. Colectomy of affected region
  5. Infection, stress
  6. HLA-B27
  7. T helper - type 2
  8. Primary sclerosing cholangitis
  9. Protective
  10. Fever, weight loss, haemodynamic compromise, abdominal distention
  11. Loss of colonic markings - ‘lead pipe’ picture
  12. Aminosalicylate (PR, PO if extensive)
  13. IV hydrocortisone with hydration
  14. 5-Aminosalicylate (e.g. mesalazine), immunosuppressants (2+/year then immunomodulation)
  15. Colectomy / ileostomy (done in 20%)
  16. Perforation, bleeding, toxic megacolon, malignancy
36
Q

Inflammatory bowel disease

  1. Extra-intestinal manifestations
  2. Imaging
  3. Colonic surveillance
  4. Prognosis
  5. Blood tests
  6. Bedside tests
A
  1. Uveitis, joint arthritis, erythema nodosum on shins, pyoderma gangrenosum on legs, clubbing, primary sclerosing cholangitis leading to sclerosis
  2. Endoscopy (gold-standard), barium swallow, CT/MR
  3. 10 years after 1st diagnosis, repeat depending on risk
  4. Lifelong remitting and relapsing
  5. FBC, U+E, CRP (active inflammation)/ESR, LFTs
  6. Stool sample, faecal calprotectin (high)
37
Q

Irritable bowel syndrome

  1. Classification
  2. Trigger
  3. Symptoms
  4. Bloods to exclude other causes
  5. Other tests to exclude other causes
  6. Diagnostic criteria
  7. Diarrhoea IBS - medical treatment
  8. Constipation IBS - medical treatment
A
  1. Diarrhoea and constipation
  2. Stress, post-infectious
  3. Bloating, pain, feeling of not emptying bowel, nausea, anxiety/depression
  4. FBC, U+E, CRP, haematinics, TFTs, coeliac serology, Ca-125
  5. Stool culture, faecal calprotectin (low), urinalysis, USS
  6. Recurrent abdominal pain/discomfort with 2+ of (relief by defecation, altered stool form/ bowel frequency)
  7. Immodium
  8. Gentle laxatives, antispasmodics
38
Q

Malabsorption

  1. Causes
  2. Features
  3. Bloods if suspected
  4. Other tests if suspected
  5. Imaging
A
  1. Digestive enzyme failure, inflammation, structural abnormality (resections, diverticulae), pancreatic disease, cystic fibrosis, coeliac disease, malignancy, pancreas disease
  2. Diarrhoea, weight loss, failure to thrive, lethargy, flatus, ascites, oedema, abdominal pain, distention, vitamin deficiencies
  3. FBC, iron studies, LFTs, clotting, coeliac serology
  4. Faecal calprotectin, faecal appearance and fat collection over 3 days, faecal elastase (pancreatic exocrine insufficiency)
  5. Endoscopy
39
Q

Splenomegaly

  1. Massive - causes
  2. Normal - causes

Associated symptoms - differentials

  1. Fever
  2. Lymphadenopathy
  3. Purpura
  4. Arthritis
  5. Ascites
  6. Murmur
  7. Anaemia
  8. Weight loss + CNS signs
A
  1. Chronic myeloid leukaemia, malaria, myelofibrosis
  2. Sickle-cell thalassaemia, rheumatoid arthritis, haemolytic anaemia, chronic lymphocytic leukaemia, infectious mononucleosis
  3. Infection (malaria/TB/EMV/CMV/HIV), sarcoid, malignancy
  4. Glandular fever, leukaemia, lymphoma, Sjogren’s
  5. Septicaemia, DIC, amyloid, meningococcaemia
  6. Sjogren’s, RA, SLE, lyme disease, vasculitis/Behcets
  7. Carcinoma, portal HTN
  8. IE, rheumatic fever, amyloid
  9. Sickle cell, thalassaemia, leukaemia, pernicious anaemia
  10. Lymphoma, TB, paraproteinaemia
40
Q

Mouth disease - causes

  1. Leucoplakia
  2. Aphthous ulcers (+ management)
  3. Candidiasis (+ management)
  4. Cheilitis (angular stomatitis)
  5. Gingivitis
  6. Microstomia
  7. Oral pigmentation
  8. Blue gum line
  9. Furred/dry tongue
  10. Glossitis
  11. Macgroglossia
  12. Tongue cancer
A
  1. Pre-malignant, e.g. oral hairy in EBV HIV
  2. Crohn’s, coeliac, behcet’s, infections. Give tetracycline/antimicrobial mouth wash e.g. chlorhexidine, with topical steroid gel (triamcinolone); tablet if severe
  3. Buccal mucosa, can be removed. Give nystatin/fluconazole.
  4. Mouth corner fissure from dentures, candidiasis, IDA/B2 deficiency
  5. Poor oral hygiene, drugs (phenytoin, ciclosporin, nifedipine), pregnancy, vit C deficiency, AML
  6. Burns, epidermolysis bullosa, systemic sclerosis
  7. Peutz-Jegher’s (perioral brown), Addison’s, melanoma, SS/osler-weber-rendu (telangiectasia),
  8. Lead poisoning
  9. Dehydration, drugs, radiotherapy, Crohn’s, Sjogren’s
  10. Iron, folate, B12 deficiencies
  11. Myxoedema, acromegaly, amyloid
  12. Raised ulcer with firm edges, RF include smoking/alcohol
41
Q

Anti-emetics

Dopamine (D2) receptor antagonists

  1. Examples
  2. Side effects
  3. Contraindications

Serotonin (5HT3) receptor antagonist

  1. Example
  2. Side effect
  3. Contraindications

Antihistamines (H1 receptor)

  1. Example
  2. Side effects
A
  1. Prochlorperazine, domperidone*, metoclopramide
  2. Hyperprolactinaemia, extra-pyramidal syndrome
  3. Parkinson’s disease (can give domperidone), potential obstruction (metoclopramide has prokinetic properties)
  4. Ondansetron
  5. Prolonged QT (Torsades), serotonin syndrome
  6. Prolonged QT syndrome, severe liver disease
  7. Cyclizine
  8. Anticholinergic effects, drowsiness
42
Q

Coeliac disease

  1. Cause
  2. Associations
  3. Presentation
  4. Bloods
  5. Antibodies found
  6. Invasive test and findings
  7. Management
  8. Complications
  9. Increased risk of which malignancies
A
  1. T cell response to gluten (wheat, barley, rye, oats)
  2. HLA DQ2 (95%) / DQ8 (5%), autoimmune disease, dermatitis herpetiformis
  3. Steatorrhoea, diarrhoea, abdominal pain, bloating, N+V, aphthous ulcers, angular stomatitis, weight loss, fatigue, failure to thrive, osteomalacia
  4. Low Hb/B12/ferritin/folate, raised RCDW
  5. Anti transglutaminase 1st line, which is IgA type
  6. Duodenal biopsy whilst eating gluten; shows subtotal villous atrophy, high intra-epithelial WBCs, crypt hyperplasia
  7. Lifelong gluten free diet
  8. Anaemia, dermatitis herpetiformis, osteopoenia/osteoporosis, neuropathies
  9. GI T cell lymphoma, gastric/oeseophageal/colorectal
43
Q

Nutritional disorders

  1. Scurvy - deficiency, signs, management
  2. Beriberi - deficiency, signs
  3. Pellagra - deficiency, signs, causes
  4. Xerophthalmia - deficiency, signs
  5. Fat-soluble vitamins (so deficiency if malabsorption)

Absorption location, signs of deficiency

  1. B2
  2. B12
  3. Folic acid
A
  1. Vitamin C. Listlessness, anorexia, halitosis, gingivitis, bleeding, weakness. Change diet, give ascorbic acid
  2. Vitamin B1. Wet (HF + oedema), dry (neuropathy)
  3. Nicotinic acid. Diarrhoea, dementia, dermatitis, from carcinoid syndrome/isoniazid
  4. Vitamin A. Blindness (cloudy/bitot spots on conjunctiva)
  5. A, D (rickets, osteomalacia), E (haemolysis, neuro), K (bleeding)
  6. Proximal small intestine. Angular stomatitis + cheilitis
  7. Terminal ileum. Macrocytic anaemia, glossitis, neuropathy
  8. Jejunum. Macrocytic anaemia
44
Q

Post-operative complications

  1. Pyrexia - commonest causes within 48 hours
  2. Pyrexia - bloods to send
  3. Oliguria - commonest cause
  4. Oliguria - output to aim for
  5. Primary haemorrhage - definition + management
  6. Reactive haemorrhage - causes + management
  7. Secondary haemorrhage - cause + timing
A
  1. Atelectesis (physio), tissue damage, or blood transfusions
  2. FBC, U+E, CRP, cultures, +/- CRP
  3. Too little replacement of lost fluid
  4. > 30ml/hour
  5. Continuous bleeding, starting during surgery; replace blood loss
  6. Haemostasis restarts when BP rises; replace blood + explore wound
  7. Infection; 1-2 weeks post-op
45
Q

Specific post-op complications

  1. Laparotomy - early (+ sign)
  2. Laparotomy - late (+ management)
  3. Biliary - early
  4. Biliary - late
  5. Aortic
  6. Colonic - early
  7. Colonic - late
  8. Small bowel
  9. Splenectomy
A
  1. Wound breakdown, serous pink discharge)
  2. Incisional hernia, mesh
  3. Bile duct injury, cholangitis, bile leak, haemobilia, pancreatitis
  4. Bile duct stricture, post-cholecystectomy syndrome
  5. Gut ischaemia, renal failure, trauma to ureters or anterior spinal artery, aorto-enteric fistula
  6. Sepsis, ileus, fistula, anastomotic leak
  7. Adhesional obstruction
  8. Short gut syndrome (diarrhoea + malabsorption) - vitamin deficiency, hyperoxaluria (renal stones), bile salt depletion (gallstones)
  9. Acute gastric dilatation, thrombocytosis, sepsis (give pre-op HiB/meningococcal/pnemococcal vaccines + lifelong penicillin)
46
Q

Abdominal masses - differentials

  1. History and examination
  2. Right iliac fossa
  3. Distension (6 Fs)
  4. Ascites without portal HTN
  5. Ascites with portal HTN
  6. Left upper quadrant
A
  1. Site, size, shape, surface, pulsatile, mobile, nodes (supraclavicular and inguinal), ballotable
  2. Appendix mass/abscess, caecal carcinoma, Crohn’s, intussusception, kidney malformation
  3. Flatus, fat, fluid, foetus, faeces, f’ing big tumour
  4. Malignancy, TB, low albumin, CCF, pericarditis, pancreatitis
  5. Cirrhosis, IVC/portal vein thrombosis, Budd-Chiari
  6. Spleen, stomach, kidney, colon, pancreas
47
Q

Bowel ischaemia

  1. Consider if 2 signs

Acute mesenteric

  1. Bowel part and artery involved
  2. Causes
  3. Presentation (triad)
  4. Bloods
  5. Imaging
  6. Complications (2)
  7. Management

Chronic mesenteric

  1. Presentation (triad)
  2. Other symptoms
  3. Cause
  4. Imaging
  5. Management

Chronic colonic

  1. Cause
  2. Presentation
  3. Gold standard investigation
  4. Management
A
  1. AF and abdominal pain
  2. Small bowel, superior mesenteric artery (duodenum to 1st half of transverse colon)
  3. Thrombosis/embolism (AF), low-flow state, trauma, vasculitis, radiotherapy, strangulation (volvulus/hernia)
  4. Acute/severe abdominal pain (constant, central/RIF), no/minimal abdominal signs, rapid hypovolaemia/shock
  5. Raised Hb (plasma loss), raised WCC, metabolic acidosis (lactate), moderately raised plasma amylase
  6. AXR (‘gasless abdomen’)
  7. Septic peritonitis, SIRS/multi organ failure
  8. Fluid resuscitation, antibiotics, LMWH
  9. Severe/colicky post-prandial pain (gut claudication), weight loss, upper abdominal bruit
  10. PR bleeding, malabsorption, N+V
  11. Low flow state (atheromatic disease in all three mesenteric arteries) - celiac (stomach, biliary, pancreas, liver), inferior (2ns half of transverse colon to rectum)
  12. CT angiography/contrast-enhanced MR angiography
  13. Percutaneous transluminal angioplasty + stent
  14. Low flow in inferior mesenteric artery
  15. Lower left abdominal pain, bloody diarrhoea
  16. Lower GI endoscopy
  17. Conservative - fluid replacement, antibiotics
48
Q

Oesophageal rupture

  1. Iatrogrenic causes (85-90%)
  2. Other causes
  3. What causes Boerhaave syndrome
  4. Differential diagnosis
  5. Clinical features
  6. Complications (2), less likely in which
  7. Management
A
  1. Endoscopy, biopsy, dilatation
  2. Trauma, carcinoma, Boerhaave syndrome, corrosive ingestion
  3. Repeated violent vomiting
  4. Pneumothorax
  5. Odynophagia, tachypnoea, dyspnoea, fever, shock, surgical emphysema
  6. Mediastinitis, sepsis, less likely in iatrogenic causes
  7. NG tube, PPI, ABX, surgery if severe
49
Q

Obesity

  1. Definition
  2. Type more associated with co-morbidity
  3. Risk factors
  4. Bloods
  5. Female calorie intake for weight loss
  6. Male calorie intake for weight loss
  7. Conservative management
  8. Pharmacological management
  9. When to consider surgical therapy
A
  1. BMI >32 kg/m2
  2. Central
  3. Hypothyroidism, hypercortisolism, age >40, peri/post-menopause
  4. FBC, cholesterol, TFT
  5. 1000 - 1200 p/d
  6. 1200 - 1500 p/d
  7. Combined diet and exercise
  8. Orlistat (combine with above)
  9. BMI >40 or >35 with obesity-related comorbidities
50
Q

Diverticular disease

  1. Diverticulum - definition
  2. Diverticulosis - definition
  3. Commonest location
  4. Diverticular disease - definition/features
  5. Management
  6. Diverticulitis - definition
  7. Features
  8. Mild management
  9. Severe management
  10. Complications
  11. Diagnosis
A
  1. Gut wall outpouching at perforating artery entry sites
  2. Presence of diverticula without symptoms
  3. Sigmoid colon
  4. Altered bowel habit/left colic relieved by defecation, nausea, flatulence
  5. Antispasmodics e.g. meberevine
  6. Diverticular inflammation
  7. Features above plus pyrexia, raised WCC/ESR/CRP, tender colon, peritonism
  8. Bowel rest (fluids only) + antibiotics
  9. Admit - analgesia, NBM, IV fluids/ABX
  10. Abscess (pericolic/mesenteric/pelvic) generalised peritonitis (purulent/faecal), perforation (ileus, peritonism, shock), fistulae, post-infective sigmoid stricture
  11. CT abdomen (1st line for acute diverticulitis)
51
Q

Gastroenteritis - other

  1. Viral - causes (3)
  2. E.coli - spread (3)
  3. Salmonella - spread (2)
  4. Campylobacter (traveller’s diarrhoea) - spread (3)
  5. ABX choice (2) (also for)
  6. Bacillus cereus - appearance
  7. Spread
  8. Also causes
  9. Yersinia - appearance
  10. Think this if
  11. Giardia lamblia - management
  12. Isolation - until
  13. Complications
A
  1. Rotavirus, norovirus, adenovirus (subacute diarrhoea)
  2. Infected faeces, unwashed salads, water
  3. Raw eggs, raw poultry
  4. Raw poultry, untreated water, unpasteurised milk
  5. Azithromycin, ciprofloxacin (also for shigella)
  6. Gram positive rod
  7. Leftover fried rice (sick soon after- cereulide toxin)
  8. Infective endocarditis in IVDUs (staph. most common)
  9. Gram negative bacillus
  10. Children with lymphadenopathy and GI symptoms
  11. Metronidazole (diagnose with stool microscopy)
  12. 48 hours after symptoms completely resolved
  13. Lactose intolerance, IBS, reactive arthritis, GBS
52
Q

H. Pylori

  1. Type of bacteria
  2. Why it is damaging
  3. Test - indication
  4. Do not test within
  5. Test - outpatient
  6. Important question to ask
  7. Test - mid-endoscopy
  8. Eradication treatment
  9. If large, do what
A
  1. Gram negative aerobe
  2. Produced ammonia to neutralise acid; this damages epithelial cells
  3. If <55, or if >55 after 4 weeks of unsuccessful lifestyle dyspepsia management
  4. 4 weeks of ABX or 2 weeks of PPI

5 C-urea breath test/stool antigen

  1. Had eradication before or not
  2. Rapid urease test (CLO test)
  3. Triple therapy: PPI + 2 ABX (Amoxicillin/metronidazole + clarithromycin) for 7 days
  4. Continue PPI for 21 more days
53
Q

Haemorrhoid

  1. External - origin, risk
  2. Internal - origin, symptom
  3. Internal grading - degrees (1-4)
  4. Symptoms/signs
  5. Management
  6. Thrombosed haemorrhoid - cause
  7. Presentation
  8. Management
  9. Other differentials (3)
A
  1. Below dentate line; painful, prone to thrombosis
  2. Above dentate line; painless
  3. 1st: no prolapse
    2nd: prolapse when straining, returns on relaxing
    3rd: prolapse when straining, push back to return
    4th: prolapsed permanently
  4. Asymptomatic, constipation, painless bright red bleeding (on toilet paper or dripping), sore/itchy anus, feeling a lump around/in anus
5. Soften stools - increase fibre/fluid intake
Topical local anaesthetic/steroid/anusol
Bind ligation (outpatient), surgery if severe/resistant
  1. Strangulation at haemorrhoid base, causing thrombosis
  2. PR too painful, purple, very tender swollen lumps around anus
  3. Consider excision if present within 72 hours; if not then stool softeners/ice/analgesia + resolves in 10 days
  4. Fissure, cancer, IBD
54
Q

Colorectal carcinoma - curative resections

  1. Management - general
  2. Caecum / right colon
  3. Transverse segment
  4. Descending colon
  5. Sigmoid colon
  6. Rectum
  7. Low rectum
  8. Follow-up
A
  1. Radiotherapy (pre-operative rectal, palliative colon), surgery, adjuvant chemotherapy in stage 3/4
  2. Right hemicolectomy
  3. Extended right hemicolectomy
  4. Left hemicolectomy
  5. Sigmoid colectomy
  6. Anterior resection
  7. Abdomino-perineal resection, permanent colostomy
  8. CT TAP - 1 and 2/3 years
    Colonoscopy - 1 and 5 years
    CEA - 6 monthly for 3 years

Medical School (28 decks)

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