Gen Surg - Others Flashcards

haemorrhoids anal fissures anal fistula upper GIB dysphagia & odynophagia GERD barrett's oesophagus hiatal hernia

1
Q

what are haemorrhoids

A

normal vascular and CT columns that exist in the anal canal — there are 3 in total

split into internal and external haemorrhoids — internal = above dentate line; external = below dentate line
internal = can bleed or prolapse
external = can thrombose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what causes haemorrhoids

A

poor dietary habits
constipation — prolonged straining
increased intra-abdominal P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 4 degree of internal haemorrhoids

A

1st degree: bleeds only
2nd degree: prolapses BUT reduces spontaneously
3rd degree: prolapses BUT has to be manually reduced
4th degree: permanently prolapsed — may strangulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does thrombosed external haemorrhoids present + how to manage

A

presentation : acute excruciating pain

Tx: surgical evacuation of haemorrhoid + excision of skin overlying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how would u manage internal haemorrhoids that is bleeding/prolapsed

A

conservative Tx
secondary prevention
only evacuate when the natural desire to do so arises
minimise straining or lingering
increased dietary fibre
increased physical activity
sitz baths — warm water + 3x a day
(to clean perineum)

medical Tx
laxatives — stool softeners or bulking agents
topical analgesia + steroids
injection sclerotherapy —- for 1st or 2nd degree
rubber band ligation —- for 2nd degree
trans-anal haemorrhoidal dearterialisation — for 2nd & 3rd degree

surgical Tx = haemorrhoidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are anal fissures

A

longitudinal split of the anoderm in the distal anal canal — extending from the anal verge proximally — towards (but not extending beyond) the dentate line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what causes anal fissures

A

primary causes = local trauma
passage of hard stool
prolonged diarrhoea
vaginal delivery
anal sex

secondary causes
IBD — eg. CD
granulomatous diseases — eg. extrapulmonary TB, sarcoidosis
malignancy — eg. squamous cell anal ca, leukaemia
communicable diseases — eg. HIV, syphillis, chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what defines acute or chronic anal fissure

A

acute = <6 wks of onset
chronic = >6wks of onset OR certain features
eg. fibrosis, fibrotic edges, perianal skin tag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do anal fissures present

A

pain — exacerbated by defecation
+/- bleeding
+/- perianal skin tags
+/- puritus ani

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to manage anal fissures

A

conservative Tx = prevention
healthy bowel habits
high fibre diet
adequate fluids

medical Tx
laxatives
warm sitz baths — ie local wound care
analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is an anal fistula

A

fistula: chronic abnormal connection between 2 epithelial-lined surfaces
anal fistula is when a fistula forms between the anus and an adjacent structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what can cause anal fistulas

A

anorectal abscess —- ruptures or is drained
CD
lymphogranuloma venereum
radiation proctitis
rectal foreign bodies
primary perianal actinomycosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how would an anal fistula present

A

symptoms (Hx)
intermittent rectal pain
chronic purulent discharge
pustule-like lesion in the peri-anal or buttock area
intermittent + malodorous perianal drainage & pruritus

signs (exam)
perianal skin — excoriated + inflamed
induration just below skin
proctosigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what classification used for anal fistulas

A

park’s classification
intersphincteric
trans-sphincteric
extrasphincteric
suprasphincteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of anal fistulas

A

EUA examination under anaesthesia

options
fistulotomy
fistulectomy
seton insertion
advancement flap
plus and glues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of upper GIB

A

peptic ulcers 36%
oesophagitis 24%
gastritis 22%
varices 11%

17
Q

risk factors for upper GIB

A

chronic liver disease
alcohol
smoking
NSAIDs
vomiting
steroids
PUD

18
Q

Ix for upper GIB

A

bloods
FBC
U&E
GXM if severe
coag profile
ABG + lactate

OGD

CT angiogram

19
Q

scoring system for upper GIB

A

Glasgow Blatchford scoring system
predicts need for intervention in upper GIB

20
Q

management of upper GIB

A

IV PPI bolus/transfusion

if stable = GI endoscopy in 24 hrs

if unstable = urgent endoscopy
stop haemorrhage via haemostatic clips, adrenaline injections, haemostatic powder

if massive haemorrhage = ABCDs
2 large bore 14-16G IV cannulas
transfuse IV crystalloids, if severe = unmatched O -ve blood initially —- matched blood once available
activate massive transfusion protocol
balanced transfusion — 1:1:1 RCC, FFP, platelets
reverse any anticoags + correct any underlying coag deficits

if suspected variceal bleeding = IV terlipression + octreotide
+/- Sengstaken-Blakemore tube (in ED setting)
OGD for variceal banding
+/- TIPS Transjugular intrahepatic portosystemic shunt

21
Q

what is dysphagia and odynophagia and what are their DDx

A

dysphagia: difficulty swallowing
odynophagia: painful swallowing

DDx

intraluminal
foreign body
food bolus
oesophageal webs

intramural
lump — benign vs malignant
GERD
oesophagitis
dysmotility disorders
scleroderma
stricture
eosinophilic oesophagitis
neuro
hiatal hernia
volvulus

extraluminal
lymphadenopathy
goitre
pharyngeal pouch
haematoma

others
oesophageal rupture
Mallory-Weiss tear
oesophageal ulcers

22
Q

what is GERD

A

it is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications

23
Q

risk factors of GERD

A

causes of increased intra-abdominal P
obesity
pregnancy

causes of loss of anti-reflux mechanisms
alcohol
smoking
fam Hx
DM
hiatal hernia
oesophageal dysmotility
gastric dysfunction
meds

24
Q

Ix for GERD

A

urease breath test — for H.pylori

Upper GI Endoscopy

contrast swallow

ambulatory pH and impedence monitoring

oesophageal manometry

25
management of GERD
conservative Tx lifestyle --- reduce alcohol, smoking cessation, weight loss review meds causing dyspepsia -- eg. NSAIDs medical Tx PPIs ---- if ineffective = add H2 antagonist metoclopramide/domperidone ---prokinetic agent Tx of H.pylori if present surgical Tx = laparoscopic Nissen (360 degrees) fundoplication
26
what is Barrett's oesophagus
when the normal squamous epithelial lining of the distal oesophagus changes to metaplastic columnar epithelium
27
risk factors of barrett's oesophagus
smoking alcohol obesity white male >50 y/o
28
management of barrett's oesophagus
high dose PPI --- symptom control aspirin -- reduces progression to high grade dysplasia monitoring: surveillance endoscopy
29
what is a hiatal hernia
the displacement of part or all of the stomach through the oesophageal hiatus
30
what types of upper GI hernias are there
type 1: sliding hiatal hernia 2-3: para-oesophageal hernia --- incl rolling hernia 4: intrathoracic herniation of abdominal viscera
31
presentation of hiatal hernia
asymptomatic 50% symptomatic (Hx) epigastric or chest pain heartburn, regurgitation post-prandial fullness dysphagia iron deficiency anaemia
32
Ix for suspected hiatal hernia
CXR contrast swallow CT TAP oesophageal manometry --- to guide choice of fundoplication note: NO OGD!!!
33
management of hiatal hernias
conservative Tx = weight loss, smoking cessation, alcohol reduction medical Tx PPIs domperidone --- prokinetic agent surgical Tx indication: symptomatic most common = laparoscopic transabdominal repair if emergency presentation of gastric volvulus =NG tube decompression failure = urgent surgical repair
34
complications of hiatal hernia
GERD anaemia gastric outlet obstruction gastric volvulus gastric ischaemia