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Y3 Clinical Case Revision > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Peptic Ulcer Disease causes

A

imbalance of protective mucus secretion and acid production

  • NSAIDs
  • H pylori
  • ZES
  • gastric bypass surgery
  • physiological stress
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2
Q

H pylori features and actions

A

Gram -ve
spiral shaped bacillus
found in mucous layer of duodenal / gastric ulcers
=> cytokine / interleukin driven inflammatory response
^ gastric acid secretion > => histamine > + parietal cells
> damage of surface glycoproteins
> - bicarbonate production

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3
Q

ZES triad

A

severe peptic ulcer disease
gastric acid hypersecretion
gastrinoma

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4
Q

PUD investigations

A

Bedside: H pylori urease breath test
Bloods: anaemia
Imaging: OGD (visualise and biopsy), CXR if sus of perforation

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5
Q

PUD Conservative Management

A

lifestyle advice inc

  • diet
  • exercise
  • alcohol
  • smoking
  • weight loss

NSAID / corticosteroid use
PPI Px

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6
Q

PUD surgical management indications

A

severe / relapsing disease

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7
Q

PUD surgical management options

A

partial gastrectomy

selective vagotomy

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8
Q

PUD complications

A

perforation
haemorrhage
pyloric stenosis

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9
Q

NSAID mechanism of gastric ulceration

A
  • prostaglandin secretion
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10
Q

ZES most commonly associated condition

A

Multiple endocrine neoplasia syndrome

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11
Q

ZES investigation / definitive diagnosis

A

fasting gastrin levels

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12
Q

H pylori investigations / definitive diagnosis

A

carbon-13 urease breath test
stool antigen test
CLO test

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13
Q

blood vessel most likely involve in cases of posterior duodenal ulcer > upper GI bleeding

A

gastroduodenal artery

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14
Q

common site of ulceration

A

lesser curvature of proximal stomach

first section of the duodenum

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15
Q

most common causes for GI perforation

A

PUD

sigmoid diverticulum

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16
Q

acute abdomen investigations

A

A-E assessment, urinalysis, (ECG)
Routine baseline bloods + G+S (^WCC, ^ CRP common in perforation)
CXR (pneumoperitoneum), AXR / CT abdo

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17
Q

perforation management

A 
early resuscitation
broad spectrum Abx 
NBM + NG tube 
IV fluids
analgesia
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18
Q

peptic ulcer perforation surgical management

A

omental patch

+ thorough washout

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19
Q

perforated diverticula surgical management

A

resection - Hartmann’s procedure

+ thorough washout

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20
Q

perforation complications

A

haemorrhage

infection - peritonitis / sepsis

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21
Q

Crohn’s pathology features

A 
non-caseating granulomatosis
mouth to anus 
skip lesions
cobblestone appearance 
transmural inflammation 
relapsing, remitting disease
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22
Q

Crohn’s clinical features

A 
aphthous ulcers 
peri-anal fissures + fistulas 
colicky abdominal pain
diarrhoea +/- mucous / blood 
malnutrition / anorexia
malaise, low grade fever
peaks: 15-30 and 60-75 years
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23
Q

Crohn’s risk factors

A

family
smoking
white ethnicity
appendectomy

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24
Q

Crohn’s MSK manifestations

A

metabolic bone disease

enteropathic disease

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25
Crohn's dermatological manifestations
erythema nodosum | pyoderma gangrenosum
26
Crohn's HPB and renal manifestations
gall stones renal stones cholangiocarcinoma
27
Crohn's investigations
``` Bloods: anaemia, hypoalbuminaemia, inflammation (^CRP ^WCC) faecal calprotein colonoscopy + biopsy CT abdo + pelvis MRI ```
28
Crohn's management
smoking cessation ACUTE = oral corticosteroids + azathioprine REMISSION = azathioprine / rituximab Surgical = ileocaecal resection, SB / LB resection, stricturoplasty, perianal disease repair (abcess drainage / fissure lay down, fistulae repair)
29
Crohn's complications
``` fistulae strictures recurrent perianal disease GI malignancy osteoporosis malabsorption gall stones renal stones ```
30
alcoholic liver disease management
alcohol abstinence | disulfram
31
non-alcoholic fatty liver disease management
lifestyle modifications (v caloric intake, ^ exercise)
32
viral hepatitis management
acute = supportive / symptomatic antiviral drugs = peginterferon alpha / entecavir preventative = immunisation
33
haemochromatosis management
therapeutic phlebotomy iron chelation dietary changes
34
treatment for benign symptomatic peptic strictures
balloon dilation | PPI
35
common complications of balloon dilation for peptic strictures
oesophageal perforation
36
signs of oesophageal perforation
CP (mediastinitis) SOB surgical emphysema palpable in the neck
37
oesophageal perforation post procedure imaging
CT with oral contrast
38
immediate management of oesophageal varices
fluid resuscitation +/- blood transfusion IV terlipressin (vasopressin analogue) IV Abx Refer to on-call endoscopy service
39
bleeding varies surgical mangement
band ligation / sclerotherapy
40
LT / non-acute varices management
non-selective beta blocker
41
pre-hepatic jaundice blood results
^ bilirubin (unconjugated) normal ALP / ALT anaemia
42
hepatic jaundice blood results
^ bilirubin (mixed) ^^ ALP ^ ALT
43
post-hepatic jaundice blood results
^ bilrubin (conjugated) ^ ALP ^^ ALT
44
assessments for a patient with jaundice
VTE assessment + INR | A to E assessment
45
investigations for a patient with jaundice
``` abdo examination + full set of obs urinalysis INR bloods - LFTs, coagulations, TGs liver screen - haemachromatosis, autoimmune liver disease, hepatitis liver USS Abdo CT (!!! renal impairment) ```
46
immediate prescriptions for a patient with jaundice
IV fluids if dehydrated Vitamin K if abnormal INR TEDS (thromboembolism-deterrent stockings) + LMWH (slows liver necrosis + v risk of VTE)
47
Courvoiser's law
palpable gall bladder + painless jaundice is NOT (unlikely to be) gall stone pathology
48
causes of post-hepatic jaundice
pancreatic carcinoma cholangiocarcinoma primary sclerosing cholangitis cancer of ampulla of Vater
49
H pylori management + MOA
amoxicillin beta lactam clarithromycin X protein synthesis lanzoprazole irreversibly block gastric proton pump of parietal cells
50
2WW indications for OGD
new onset dysphagia | age > 55 with weight loss and dyspepsia / abdo pain / dyspepsia
51
tumor marker for oesophageal ca
CEA
52
vitamin deficiency associated with ^ alcohol intake
vitamin B
53
drainage and feeding indications post gastric pull through
NBM for 5-7 days jejenostomy feeding / parenteral feeding thoracotomy tubes to X hyilarthorax / haemothorax
54
pathophysiology of third space fluid accumulation in acute pancreatitis
acute pancreatitis > => inflammatory + vasoactive mediators > vasoconstriction, microscopic intravascular coagulation, vascular injury => fluid accumulation in the third spaces
55
acute pancreatitis complications
pancreatic pseudocyst | third space fluid accumulation > AKI / pleural effusion / ARDS
56
L / R colonic cancer presentation
L sided = earlier presentation, may present with bowel obstruction ie. fresh rectal bleeding, tenesmus, mass: DRE / left iliac fossa R sided = later presentation, iron def anaemia + vague abdominal pain + occult bleeding + R sided abdo mass Nb. stool in R = semi-liquid and will not present with obstructive picture
57
risk factors for gallstones
``` fat female 40s fertile + pregnancy haemolytic anaemias => black gall stones bowel resection (X terminal ileum) eg. Crohn's rapid weight loss ```
58
how are gall stones diagnosed
transabdominal USS | MRCP = gold standard
59
what are the complications of actue pancreatitis
Systemic: ARDS, DIC, hypocalcaemia, hyperglycaemia Pancreatic: pseudocyst, necrosis, chronic pancreatitis
60
bruising in umbilicus sign
Cullen's sign | indicates bleeding into intraperitoneal space, common in acute pancreatitis
61
what is the gold standard imaging modality for ? bowel obstruction
CT WITH IV CONTRAST
62
haematemesis, XS alcohol intake, stigmata of chronic liver disease Pathophysiology:
CLD > portal hypertension > oesophageal varices > rupture => haematemesis
63
scoring in acute pancreatitis
Glascow
64
scoring in acute upper GI bleed
Rockall = morality (after endoscopy) | Glascow Blatchford = need for admission / blood transfusion / endoscopy
65
oesophageal varices management
major haemorrhage pathway + resuscitation urgent gastro referral + endoscopy IV terlipressin IV omeprazole IV Abx eg. co-amoxiclav Surgical: adrenaline injection, cautery, endoscopic banding, balloon tamponade consider TIPS (Transjugular intrahepatic portosystemic shunt)

Y3 Clinical Case Revision (17 decks)

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