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Surgery Block > General - Small Bowel > Flashcards

General - Small Bowel Flashcards

1
Q

What is angiodysplasia?

A

Formation of arteriovenous malformations between blood vessels (most commonly in the caecum and ascending colon)

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2
Q

What is the most common cause for bleeding from the small bowel?

A

Angiodysplasia

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3
Q

What causes congenital angiodysplasia?

A
  • Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
  • Heyde’s syndrome
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4
Q

What is the pathophysiology of acquired angiodysplasia?

A
  1. Reduced submucosal venous drainage in the colon
  2. Dilated and tortuous veins arise
  3. Loss of pre-capillary sphincter competency
  4. Formation of AVM (characterised by small tuft of dilated vessels)
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5
Q

In which three ways will angiodysplasia typically present?

A
  1. Asymptomatic (incidental diagnosis)
  2. Painless occult PR bleeding
  3. Acute haemorrhage
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6
Q

What are the main DDx for painless GI bleeding?

A
  • Oesophageal varices
  • GI malignancy
  • Diverticular disease
  • Coagulopathies
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7
Q

What abnormality may be seen in blood tests for a patient with angiodysplasia?

A

Iron deficiency anaemia

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8
Q

What imaging modality is required for any case of GI bleeding?

A

OGD +/- colonoscopy

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9
Q

Why is wireless capsule endoscopy beneficial in angiodysplasia?

A

Identifies the bleed and can be stemmed by administration of therapeutic agents at endoscopy

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10
Q

What risk factors are associated with poor outcome in angiodysplasia?

A
  • Advancing age
  • Liver disease
  • Presentation with hypovolaemic shock
  • Current inpatient
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11
Q

What is first line management for angiodysplasia?

A

Endoscopy

- bleeding vessel is subjected to current and argon, or can use banding, sclerotherapy

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12
Q

What is mesenteric angiography?

A

Super-selective catheterisation and embolisation that has shown to be bleeding (by extravasation of contrast dye)

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13
Q

What is the surgical management for angiodysplasia?

A

Bowel resection

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14
Q

What indications are there for surgery in angiodysplasia?

A
  • Continuation of severe bleeding despite other management
  • Severe acute life threatening GI bleed
  • Multiple angiodysplastic lesions that cannot be treated medically
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15
Q

What does the term GEP-NETs refer to?

A

Gastroenteropancreatic neuroendocrine tumours - tumours arising from neuroendocrine cells in the tubular GI tract and pancreas with malignant potential

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16
Q

What is the WHO classification for GEP-NETs?

A
  1. Grade 1 - Well differentiated, mitotic count <2 per 10, ki index <3%
  2. Grade 2 - Well differentiated, mitotic count 2-20 per 10, ki index 3-20%
  3. Grade 3 - poorly differentiated, mitotic count >20 per 10, ki index >20%
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17
Q

What are the main risk factors for GEP-NETs?

A
  • MEN1
  • von Hippel-Lindau disease (VHL)
  • Neurofibromatosis 1
  • Tuberous sclerosis complex (TSC)
18
Q

What symptoms do patients with GEP-NETs often present with?

A
  • Vague abdo pain
  • N+V
  • Abdo distension
  • Features of bowel obstruction
  • Unintentional weight loss
  • Palpable abdominal mass
19
Q

What do well differentiated midgut NETs often present with?

A

Carcinoid syndrome

20
Q

What is carcinoid syndrome?

A

Metastasis of a carcinoid tumour causes oversecretion of bioactive mediators eg. serotonin, prostaglandins
–> causes symptoms of flushing, abdo pain, diarrhoea, wheezing, palpitations

21
Q

What specific lab tests should be done for a suspected GEP-NET in addition to routine bloods?

A
  • Chromogranin A

- 5-HIAA

22
Q

What imaging is indicated for GEP-NETs?

A

Small bowel NET –> CT enteroclysis

Gastric, duodenal, colorectal –> Endoscopy

23
Q

What investigation can be done to establish disease extent/if no primary is found for a GEP-NET?

A

Whole bodu somatostatin receptor scintigraphy (SSRS)

24
Q

What happens in a carcinoid crisis?

A

Severe hypotension due to overwhelming release of hormones

25
Q

What is the management for the subtypes of gastric NETs?

A

Type 1+2 –> endoscopic resection + annual surveillance

Type 3 –> gastrectomy with lymph node clearance

26
Q

What is the curative treatment for GEP-NETs?

A

Surgery - resection of the tumour and often regional lymph nodes

27
Q

What agent can be used as prophylaxis pre or intra operatively for carcinoid crisis?

A

Somatostatin analogues

28
Q

How can time between ingestion of food and development of symptoms be used to determine a likely causative agent of gastroenteritis?

A 
Hours = Bacterial toxins
Days = Viruses
Weeks = Bacteria
Months = Parasites
29
Q

What does travellers diarrhoea refer to?

A

> 3 loose stools commencing within 24hrs of foreign travel

30
Q

What is the difference between acute and chronic diarrhoea?

A

Acute <14 days

Chronic >14 days

31
Q

What are the main risk factors for gastroenteritis?

A
  • Poor food preparation
  • Immunocompromise
  • Poor personal hygiene
32
Q

What clinical features will patients with gastroenteritis typically present with?

A
  • Cramp like abdo pain
  • Diarrhoea (+/- blood/mucus)
  • Vomiting
  • Pyrexia
  • Night sweats
  • Weight loss
  • Dehydration
33
Q

When is a stool culture indicated in gastroenteritis?

A
  • Blood/mucus in stool
  • Immunocompromised
  • Severe/persistent
34
Q

How long should a patient be excluded from work for in gastroenteritis?

A

48hrs from last episode of vomiting or diarrhoea

35
Q

What viruses commonly cause gastroenteritis?

A
  • Norovirus
  • Rotavirus
  • Adenovirus
36
Q

What bacteria are common causes of gastroenteritis?

A
  • Campylobacter
  • E coli
  • Salmonella
  • Shigella
37
Q

What bacterial toxins commonly cause gastroenteritis?

A
  • Staphylococcus aureus
  • Bacillus cereus
  • Clostridium perfringes
  • Vibrio cholera
38
Q

What parasites are commonly indicated in travellers diarrhoea?

A
  • Cryptosporidium
  • Entamoeba histolytica
  • Giadria intestinalis
  • Schistosoma
39
Q

What pathogen is commonly indicated in hospital acquired gastroenteritis? How is it acquired?

A

Clostridium difficile

Typically following broad spectrum Abx

40
Q

What treatment is given for C. difficile infection?

A

IV fluid rehydration
PO Metronidazole
(Start vancomycin if severe/no improvement in 72hrs)

41
Q

How does C. difficile affect the bowel?

A

Production of exotoxins A+B –> inflammatory response in bowel –> inflammatory exudate on colonic mucosa –> severe bloody diarrhoea (–> potentially toxic megacolon)

42
Q

What are some non-infective causes of gastroenteritis?

A
  • Radiation colitis
  • IBD
  • Microscopic colitis
  • Chronic ischaemic colitis

Surgery Block (12 decks)

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