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3rd Year > Gastrointestinal conditions > Flashcards

Gastrointestinal conditions Flashcards

1
Q

4 lifestyle Causes of GORD

A 
Obesity 
smoking
alcohol 
big meals 
eating late
 tight clothes
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2
Q

Drugs that cause GORD

A

Tricyclic antidepressants, anticholinergics, nitrates and calcium channel blockers

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3
Q

Presentation of GORD

A

Heartburn
Retrosternal discomfort
Water Brash (excess salivation)
Odynophagia

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4
Q

Investigations in GORD

A 
Endoscopy
FBC (to exclude anaemia)
Barium swallow (to show hiatus hernia)
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5
Q

Non pharmaceutical treatment of GORD?

A 
Encourage raising the bed head 
Weight loss
Smoking cessation
Small regular meals
Avoid exacerbating factors
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6
Q

Drugs for GORD?

A

Antacids (gaviscon)

PPI (Lansoprazol)

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7
Q

Infectious causes of liver failure?

A

Viral hepatitis (B,C,CMV)
Yellow fever
Leptospirosis

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8
Q

Causes of liver disease?

A 
Infection
Paracetamol overdose
Alcohol
Primary biliary cirrhosis
haemochromatosis
autoimmune hepatitis
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9
Q

Signs of liver failure?

A

Jaundice
Hepatic encephalopathy
Liver flap

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10
Q

Risk factors for gallstones?

A 
Fair, fat, fertile, female, forty
Positive family history
Sudden weight loss
Diabetes
Oral contraception
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11
Q

How many patients with gallstones are asymptomatic at presentation?

A

70%

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12
Q

Explain biliary colic?

A

Sudden pain in epigastrium or RUQ
May radiate to back in the interscapular region
Contrary to its name it doesnt fluctuate
Often accompanied by nausea or vomiting

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13
Q

What is the best way to demonstrate gallstones?

A

Ultrasound

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14
Q

Risk factors for cholecystitis?

A 
Gallstones (95% patients)
Female gender
Increasing age
Obesity
Rapid weight loss
Pregnancy
Crohns disease
Hyperlipidaemia
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15
Q

How does cholecystitis present?

A 
Biliary colic
Jaundice (if stones move to CBD)
Murphys sign
Fever
Raised WCC
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16
Q

Management of gallbladder problems?

A

Antiobiotics if infective
Analgesia
Laparoscopic surgery

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17
Q

What is the most common surgical emergency?

A

Acute appendicitis

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18
Q

What age is the highest incidence of acute appendicitis?

A

10-20 years old

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19
Q

Symptoms of acute appendicitis?

A

Periumbilical colicky pain that moves to the RIF
Anorexia
Pain normally precedes vomiting
Constipation

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20
Q

What aggravates appendicitis pain?

A

Movement and coughing.

Patient may lie still with shallow breathing as deep breathing hurts

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21
Q

General signs of acute appendicitis?

A 
Tachycardia
Fever 37.5-38.5
Furred tongue
Lying still
Coughing hurts
Shallow breaths
Foetor (foul smell)
22
Q

Signs in the RIF in acute appendicitis?

A

Guarding
Rebound
Percussion tenderness
PR painful on right

23
Q

What is Rovsings sign?

A

Pain > RIL than LIF when the LIF is pressed

24
Q

Treatment for acute appendicitis?

A

Prompt appendicectomy

Antibiotics (Metronidazole and cefuroxime)

25
Q

Cardinal features of intestinal obstruction?

A

Vomiting
Colicky pain
Constipation
Distension

26
Q

Small bowel causes of obstruction?

A

Adhesions

Hernias

27
Q

Large bowel causes of obstruction?

A

Colon
Constipation
Diverticular stricture
Volvulus (sigmoid, caecal)

28
Q

Rare causes of bowel obstruction?

A 
Crohns stricture
Gallstone ileus
Intussesception
TB
Foreign body
29
Q

What is ileus?

A

Non-mechanical obstruction

30
Q

What key 3 decisions/questions need to be asked in the case of bowel obstruction?

A

Is it obstruction of the small or large bowel?
Is there an ileus or mechanical obstruction?
Is the obstructed bowel simple/closed loop/strangulated?

31
Q

How might a small bowel obstruction present as opposed to a large bowel obstruction?

A

Vomiting occurs earlier, distension is less, and pain is higher in the abdomen. In large bowel obstruction pain is more constant.

32
Q

What would an AXR show in small bowel obstruction?

A

Central gas shadows with vulvulae conniventes that completely cross the lumen and no gas in the large bowel.

33
Q

What are vulvulae conniventes?

A

The valvulae conniventes, also known as Kerckring folds or plicae circulares, are the mucosal folds of the small intestine, starting from the second part of the duodenum. They result in a classical appearance on abdominal radiography and barium studies.

34
Q

What will an AXR show in large bowel obstruction?

A

Peripheral gas shadows proximal to the blockage but not in the rectum unless you have doen a PR exam

35
Q

How can we tell if a bowel obstruction is ileus?

A

There is no pain and bowel sounds are absent

36
Q

What are the general principles of bowel obstruction?

A

Determine cause, site, speed of onset and completeness of obstruction

37
Q

What forms of bowel obstruction require surgery?

A

Large bowel obstruction and strangulation

38
Q

What is the immediate management/investigations in bowel obstruction?

A 
NGT and IV fluids (drip and suck)
Analgesia
Blood tests
AXR
erect CXR
Catheterise to monitor fluid status
39
Q

Factors contributing to paralytic ileus?

A 
Abdominal surgery
Pancreatitis
Spinal injury
Hypokalaemia
Hyponatraemia
Uraemia
Peritoneal sepsis
Drugs (tricyclic antidepressants)
40
Q

What is sigmoid volvulus?

A

This occurs when the bowel twists on its mesentery which can produce severe, rapid, strangulated obstruction

41
Q

What is the definition of a hernia?

A

The protrusion of a viscus or a part of a viscus through a defect of the walls of its containing cavity into an abnormal position

42
Q

Hernias are irreducible when?

A

They cant be pushed back into the right place

43
Q

What occurs witha femoral hernai?

A

Bowel enters the femoral canal as a mass in the upper medial thigh or above the inguinal ligament where it points down the leg.

44
Q

Who is most likely to get a femoral hernia?

A

Women of middle age and elderly

45
Q

Where can a femoral hernia be felt (anatomically)

A

Inferior and lateral to pubic tubercle

46
Q

What is the difference between a direct and indirect inguinal hernia?

A

Direct: push their way directly forward through posterior wall of inguinal canal into a defect in the abdominal wall

Indirect inguinal hernias pass through the internal ring and, if large, out through the external ring

47
Q

Conditions predisposing to inguinal hernia?

A 
Males (8:1)
Chronic cough
Constipation
Urinary obstruction
heavy lifting
ascites
Past abdominal surgery
48
Q

Where do inguinal hernias appear?

A

Above and medial to pubic tubercle

49
Q

How common are indirect inguinal hernias?

A

80%

Can strangulate

50
Q

How common are direct inguinal hernais

A

20%
Reduce easily
Rareky strangulate

3rd Year (18 decks)

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