Gastroenterology (surgery) Flashcards
What bowel obstruction do adhesions and cancer likely cause?
Adhesions - small bowel
Cancer - large bowel
Bowel obstruction imaging
1) AXR
2) CT abdo pelvis
Small bowel obstruction management
1) Fluid resus, NG bowel decompression, analgesia
2) If peritonitic, strangulation - laparoscopic surgery
Large bowel obstruction management if sigmoid volvulus and caecal volvulus
SV: Decompression with sigmoidoscope, insert flatus tube
CV: laparotomy + right hemicolectomy
FIT cancer screening programme time
60-74
Every 2 years
Bowel cancer first 2 investigations
Sigmoidoscopy
Colonoscopy
What medication should be given for 28 days after bowel cancer sugery?
Heparin
Syndrome causing hamartomas, and risk of breast, ovarian, cervical, pancreatic and bowel tumours
Peutz-Jegher’s syndrome
Syndrome with right sided colonic, endometrial, and gastric tumours
Lynch syndrome
aka Hereditary non-polyposis colorectal cancer
Where are inguinal and femoral hernias found
Inguinal: above + medial to pubic tubercle
Femoral: below + lateral to puboc tibercle
Biggest risk factor for cholangiocarcinoma
PSC
Imaging for cholangiocarcinoma
1) Abdo USS
2) Abdo CT
3) ERCP (gold standard) + MRCP for staging
Cholangiocarcinoma management
Cholecystectomy or partial liver resection if intrahepatic
Chemo/radio
Liver transplant
Bacterium causing acute cholangitis
E. coli
Imaging for acute cholangitis
1) Abdo USS - dilated bile duct
2) ERCP - find cause and therapeutic if stone
Acute cholangitis management
1) IV abx (broad spectrum until blood culture results)
2) ERCP and stent
Condition with Murphy’s sign
Cholecystitis
Imaging for cholecystitis
Sepsis not suspected - abdo USS
Sepsis suspected - abdo CT
Cholecystitis management
Fluids
Analgesia
IV abx
Laparoscopic cholecystectomy within 1 week
Imaging in biliary colic
Abdo USS
MRCP if not detected
Biliary colic management
Elective laparoscopic cholecystectomy
Analgesia
2 causes of pre-hepatic jaundice
Haemolytic anaemia
Gilbert’s syndrome
3 mechanisms of hepatic jaundice
1) Hepatic cell dysfunction - can’t conjugate
2) Leakage of conjugated bile
3) Compression of biliary tree e.g. in cirrhosis
Mechanism of post-hepatic jaundice
Obstruction of bile ducts causing leakage of conjugated bile
