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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
Cardinal features of intestinal obstruction?
Vomiting Colicky pain Constipation Distension
26
Small bowel causes of obstruction?
Adhesions | Hernias
27
Large bowel causes of obstruction?
Colon Constipation Diverticular stricture Volvulus (sigmoid, caecal)
28
Rare causes of bowel obstruction?
``` Crohns stricture Gallstone ileus Intussesception TB Foreign body ```
29
What is ileus?
Non-mechanical obstruction
30
What key 3 decisions/questions need to be asked in the case of bowel obstruction?
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
How might a small bowel obstruction present as opposed to a large bowel obstruction?
Vomiting occurs earlier, distension is less, and pain is higher in the abdomen. In large bowel obstruction pain is more constant.
32
What would an AXR show in small bowel obstruction?
Central gas shadows with vulvulae conniventes that completely cross the lumen and no gas in the large bowel.
33
What are vulvulae conniventes?
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
What will an AXR show in large bowel obstruction?
Peripheral gas shadows proximal to the blockage but not in the rectum unless you have doen a PR exam
35
How can we tell if a bowel obstruction is ileus?
There is no pain and bowel sounds are absent
36
What are the general principles of bowel obstruction?
Determine cause, site, speed of onset and completeness of obstruction
37
What forms of bowel obstruction require surgery?
Large bowel obstruction and strangulation
38
What is the immediate management/investigations in bowel obstruction?
``` NGT and IV fluids (drip and suck) Analgesia Blood tests AXR erect CXR Catheterise to monitor fluid status ```
39
Factors contributing to paralytic ileus?
``` Abdominal surgery Pancreatitis Spinal injury Hypokalaemia Hyponatraemia Uraemia Peritoneal sepsis Drugs (tricyclic antidepressants) ```
40
What is sigmoid volvulus?
This occurs when the bowel twists on its mesentery which can produce severe, rapid, strangulated obstruction
41
What is the definition of a hernia?
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
Hernias are irreducible when?
They cant be pushed back into the right place
43
What occurs witha femoral hernai?
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
Who is most likely to get a femoral hernia?
Women of middle age and elderly
45
Where can a femoral hernia be felt (anatomically)
Inferior and lateral to pubic tubercle
46
What is the difference between a direct and indirect inguinal hernia?
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
Conditions predisposing to inguinal hernia?
``` Males (8:1) Chronic cough Constipation Urinary obstruction heavy lifting ascites Past abdominal surgery ```
48
Where do inguinal hernias appear?
Above and medial to pubic tubercle
49
How common are indirect inguinal hernias?
80% | Can strangulate
50
How common are direct inguinal hernais
20% Reduce easily Rareky strangulate

3rd Year (18 decks)

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