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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
Q

Crohn’s dermatological manifestations

A

erythema nodosum

pyoderma gangrenosum

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26
Q

Crohn’s HPB and renal manifestations

A

gall stones
renal stones
cholangiocarcinoma

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27
Q

Crohn’s investigations

A 
Bloods: anaemia, hypoalbuminaemia, inflammation (^CRP ^WCC)
faecal calprotein 
colonoscopy + biopsy
CT abdo + pelvis
MRI
28
Q

Crohn’s management

A

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
Q

Crohn’s complications

A 
fistulae
strictures
recurrent perianal disease
GI malignancy 
osteoporosis 
malabsorption
gall stones 
renal stones
30
Q

alcoholic liver disease management

A

alcohol abstinence

disulfram

31
Q

non-alcoholic fatty liver disease management

A

lifestyle modifications (v caloric intake, ^ exercise)

32
Q

viral hepatitis management

A

acute = supportive / symptomatic
antiviral drugs = peginterferon alpha / entecavir
preventative = immunisation

33
Q

haemochromatosis management

A

therapeutic phlebotomy
iron chelation
dietary changes

34
Q

treatment for benign symptomatic peptic strictures

A

balloon dilation

PPI

35
Q

common complications of balloon dilation for peptic strictures

A

oesophageal perforation

36
Q

signs of oesophageal perforation

A

CP (mediastinitis)
SOB
surgical emphysema palpable in the neck

37
Q

oesophageal perforation post procedure imaging

A

CT with oral contrast

38
Q

immediate management of oesophageal varices

A

fluid resuscitation +/- blood transfusion
IV terlipressin (vasopressin analogue)
IV Abx
Refer to on-call endoscopy service

39
Q

bleeding varies surgical mangement

A

band ligation / sclerotherapy

40
Q

LT / non-acute varices management

A

non-selective beta blocker

41
Q

pre-hepatic jaundice blood results

A

^ bilirubin (unconjugated)
normal ALP / ALT
anaemia

42
Q

hepatic jaundice blood results

A

^ bilirubin (mixed)
^^ ALP
^ ALT

43
Q

post-hepatic jaundice blood results

A

^ bilrubin (conjugated)
^ ALP
^^ ALT

44
Q

assessments for a patient with jaundice

A

VTE assessment + INR

A to E assessment

45
Q

investigations for a patient with jaundice

A 
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
Q

immediate prescriptions for a patient with jaundice

A

IV fluids if dehydrated
Vitamin K if abnormal INR
TEDS (thromboembolism-deterrent stockings) + LMWH (slows liver necrosis + v risk of VTE)

47
Q

Courvoiser’s law

A

palpable gall bladder + painless jaundice is NOT (unlikely to be) gall stone pathology

48
Q

causes of post-hepatic jaundice

A

pancreatic carcinoma
cholangiocarcinoma
primary sclerosing cholangitis
cancer of ampulla of Vater

49
Q

H pylori management + MOA

A

amoxicillin beta lactam
clarithromycin X protein synthesis
lanzoprazole irreversibly block gastric proton pump of parietal cells

50
Q

2WW indications for OGD

A

new onset dysphagia

age > 55 with weight loss and dyspepsia / abdo pain / dyspepsia

51
Q

tumor marker for oesophageal ca

A

CEA

52
Q

vitamin deficiency associated with ^ alcohol intake

A

vitamin B

53
Q

drainage and feeding indications post gastric pull through

A

NBM for 5-7 days
jejenostomy feeding / parenteral feeding
thoracotomy tubes to X hyilarthorax / haemothorax

54
Q

pathophysiology of third space fluid accumulation in acute pancreatitis

A

acute pancreatitis > => inflammatory + vasoactive mediators
> vasoconstriction, microscopic intravascular coagulation, vascular injury
=> fluid accumulation in the third spaces

55
Q

acute pancreatitis complications

A

pancreatic pseudocyst

third space fluid accumulation > AKI / pleural effusion / ARDS

56
Q

L / R colonic cancer presentation

A

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
Q

risk factors for gallstones

A 
fat 
female
40s
fertile + pregnancy 
haemolytic anaemias => black gall stones
bowel resection (X terminal ileum) eg. Crohn's
rapid weight loss
58
Q

how are gall stones diagnosed

A

transabdominal USS

MRCP = gold standard

59
Q

what are the complications of actue pancreatitis

A

Systemic: ARDS, DIC, hypocalcaemia, hyperglycaemia
Pancreatic: pseudocyst, necrosis, chronic pancreatitis

60
Q

bruising in umbilicus sign

A

Cullen’s sign

indicates bleeding into intraperitoneal space, common in acute pancreatitis

61
Q

what is the gold standard imaging modality for ? bowel obstruction

A

CT WITH IV CONTRAST

62
Q

haematemesis, XS alcohol intake, stigmata of chronic liver disease
Pathophysiology:

A

CLD > portal hypertension > oesophageal varices > rupture => haematemesis

63
Q

scoring in acute pancreatitis

A

Glascow

64
Q

scoring in acute upper GI bleed

A

Rockall = morality (after endoscopy)

Glascow Blatchford = need for admission / blood transfusion / endoscopy

65
Q

oesophageal varices management

A

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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