General Flashcards
List four differentials for right iliac fossa pain
acute appendicitis, meckel’s diverticulum, ectopic pregnancy, ruptured ovarian cyst, pelvic inflammatory disease, ureteric colic, torted testes
What is triple therapy for GI infections?
amox, met, and gent
Name four differentials for altered bowel habit
colonic carcinoma, IBS, IBD, metabolic, drugs
Which metabolic conditions can result in altered bowel habit?
hypothyroidism/hyper, hypocalcaemia
List four investigations for altered bowel habit
history + clinical exam bloods- U+Es, calcium, thyroid AXR colonoscopy contrast enema
What are the criteria for diagnosing IBS?
diagnosis of exclusion, no anatomical abnormality, investigations are normal
Define hernia
part of organ is displaced and protrudes through the wall of the cavity containing it
List four retroperitoneal organs
SAD PUCKER suprarenal/adrenal gland aorta/IVC duodenum pancreas (except tail) ureters colon (ascending and descending) kidneys oesophagus rectum
What is the golden rule when imaging an acute abdomen?
CT is always an appropriate investigations unless there is a biliary picture
How can the gut be divided embryologically? What is the blood supply of these areas?
foregut- coeliac axis
midgut- SMA
hindgut- IMA
Why is pain from parietal peritoneum localised?
The parietal peritoneum lines the internal surface of the abdominopelvic wall. It is derived from somatic mesoderm in the embryo.
It receives the same somatic nerve supply as the region of the abdominal wall that it lines; therefore, pain from the parietal peritoneum is well localised. Parietal peritoneum is sensitive to pressure, pain, laceration and temperature.
Why do you have non specific pain/poorly localised with visceral pain in the peritoneum?
The visceral peritoneum has the same autonomic nerve supply as the viscera it covers. Unlike the parietal peritoneum, pain from the visceral peritoneum is poorly localised and the visceral peritoneum is only sensitive to stretch and chemical irritation, therefore distension/severe muscular contraction.
Name two differentials for surgical causes of sudden onset pain
perforation (most commonly large bowel, then small bowel)
vascular event (e.g. strangulation) #
acute pancreatitis
((appendicitis and gallstones present with gradual increase in severity of pain)
Which surgical presentation is associated with crescendo-decrescendo pain?
colic
Where does pain from retroperitoneal organs refer to?
the back
gallstones pain referral to shoulder, phrenic nerve
Name two causes of tenesmus
acute proctitis
rectal cancers
gynae presentations
(always ask about tenesmus in a history!)
Is a 6 week history of loose or solid stools more concerning?
loose stools
What are the two feeding options and what are their indications?
TPN- paraenteral nutrition, gut is not working
enteral- gut is fine however unable to eat
What is a risk associated with Panproctocolectomy?
risk of damage to parasympathetic nerves, therefore risk of causing infertility in females
What is the risk of leaving rectal stump?
cancer, therefore perform pouch anastamosis or remove rectum + anus
Pain arising from diverticulitis is most likely to localise on which side?
the left side due to sigmoid interference
Which tests must you do in order to rule out an important presentation in anyone with epigastric pian?
troponin and ECG
Two causes of air in biliary tree?
ERCP and bowel obstruction
Which blood test is important for small bowel ischaemia?
lactate
