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General surgery Flashcards

1
Q

appendicitis -definition and pathophysiology?

A
  • inflammation of appendix
  • lymphoid hyperplasia / faecolith obstructs appendiceal lumen, gut orgs invade wall
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2
Q

appendicitis Px?

A
  • generalised abdo pain, migrates to McBurney’s in RIF
  • fever
  • anorexia
  • N+V
  • Rovsing’s
  • Guarding
  • rebound tenderness
  • percussion tenderness
  • Psoas sign (retrocaecal)
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3
Q

appendicitis DDx?

A

GI - obstruction, constipation, intussusception, diverticulitis, perf, Meckel’s diverticulum, mesenteric adenitis
Uro - torsion, renal calculi, UTI, pyelo
Gynae - ectopic, torsion, cyst rupture, acute salpingitis
Others - DKA, pneumonia

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4
Q

appendicitis Ix?

A
  • clinical dx
  • Bloods - raised CRP / WCC
  • urine pregnancy test
  • urine dip
  • CT abdo
  • USS - female pts (exclude gynae), children
  • diagnostic laparoscopy
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5
Q

appendicitis Mx?

A
  • appendicectomy - laparoscopic / open
  • IV abx
  • IV fluids
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6
Q

appendicitis Cx?

A
  • appendix rupture, peritonitis
  • appendix mass
  • appendix abscess
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7
Q

bowel obstruction?

A
  • blockage of flow of intestinal contents
  • SBO>LBO
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8
Q

bowel obstruction pathophysiology?

A
  • gas+faeces build up proximally -> vomiting, bowel dilatation
  • fluid not absorbed in colon - 3rd space loss - hypovolaemia
  • ischaemia, necrosis, perf
  • closed-loop obstruction - eg 2 points of adhesions, hernias, volvulus, LBO + competent ileocaecal valve
  • strangulated - blood supply compromised - pt more ill
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9
Q

causes of SBO?

A
  • adhesions
  • hernias
  • strictures, intussusception, paralytic ileus, pseudo-obstruction, Hirschsprung’s
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10
Q

causes of LBO?

A
  • malignancy
  • volvulus
  • strictures
  • diverticular disease
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11
Q

bowel obstruction Px? SBO vs LBO?

A
  • vomiting - green, bilious
  • abdo distension
  • diffuse abdo pain
  • constipation, no flatulence
  • tinkling bowel sounds
  • maybe colon cancer sx - PR bleed, weight loss, change in bowel habit

SBO vs LBO
SBO - vomiting early, distension less, pain higher
LBO - pain more constant, later vomiting (more faecal)

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12
Q

bowel obstruction Ix?

A
  • PR - no stool
  • examine hernial orifices
  • Bloods - FBC, U/E, G/S, LFTs, amylase, VBG (raised lactate - ischaemia, metabolic alkalosis - vomiting)
  • AXR - distended loops of bowel
  • Erect CXR - perf
  • Abdo CT + contrast
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13
Q

bowel obstruction Mx?

A
  • NBM
  • analgesia, antiemetic
  • IV fluids
  • NG tube (Ryles)
  • surgery - laparoscopy / laparotomy
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14
Q

paralytic ileus? causes Px, Ix, and Mx?

A
  • functional reduced motility of gut, common post-op

Causes
- bowel injury, surgery, peritonitis, electrolyte imbalance, meds

Px
- N+V, green bilious vomit
- abdo distension, pain
- constipation, no flatulence
- absent bowel sounds
- dehydration\
Ix
- bloods inc Mg, phos, FBC, U/E
- CT scan

Mx
- NBM / sips
- IV fluids
- NG tube if vomiting
- mobilise
- TPN if needed
- correct electrolytes / meds

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15
Q

pseudo obstruction?

A
  • functional obstruction of LI
  • XR - colon dilatation
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16
Q

volvulus?

A
  • torsion of colon around its mesenteric axis -> compromised blood supply + closed loop obstruction
  • sigmoid 80%, caecum 20%
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17
Q

volvulus Px?

A
  • as bowel obstruction
  • constipation, bloating, abdo pain, N+V etc
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18
Q

volvulus Ix?

A

AXR
- sigmoid - LBO + coffee bean sign
- caecal - SBO

CT with contrast

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19
Q

volvulus Mx?

A
  • NBM, IV fluids, NG tube

Sigmoid
- endoscopic decompression - rigid sigmoidoscopy
- surgical - Hartmann’s

Caecal
- surgical - right hemicolectomy / ileocaecal resection

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20
Q

hernia - definition and RFx?

A

protrusion of organ through weak point in cavity wall

RFs
- male, chronic cough, constipation, heavy lifting, ascites, past abdo surgery

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21
Q

hernia Px?

A
  • soft lump
  • Reducible
  • Cough impulse
  • Worsened on standing
  • Aching, pulling, dragging sensation
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22
Q

hernia Ix?

A
  • lump examination
  • USS
  • CT / MRI
  • Erect CXR if ?strangulation/perf
  • Bloods - VBG, FBC, U/E, G/S, LFTs, CRP etc
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23
Q

hernia Mx?

A

Conservative
- Truss

Surgical
- tension-free repair - mesh repair
- tension repair - suture muscles / tissues (rarely done)

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24
Q

hernia Cx?

A
  • large neck, lower risk of cx
  • incarceration - irreducible
  • obstruction - bowel obstruction
  • strangulation - irreducible + blood supply cut off - ischaemia, perf
  • Richter’s hernia - part of bowel wall herniates
  • Maydl’s hernia - 2 different loops of bowel in hernia
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25
inguinal hernia?
Protrusion of abdo contents through inguinal canal
26
indirect inguinal hernia?
- 80% - bowel herniates through inguinal canal - lateral to inferior epigastric artery
27
direct inguinal hernia?
- 20% - weakness in abdo wall at Hesselbach's triangle - medial to inferior epigastric artery
28
inguinal hernia Px?
- groin lump - medial + superior to pubic tubercle - disappears on pressure / lying down
29
inguinal hernia Mx?
- direct/indirect has no bearing on mx - tx medically fit patients, even if asym
30
femoral hernia - Px and Mx?
- herniation of abdo contents through femoral canal Px - lump in groin +/- pain - inferior + lateral to pubic tubercle - typically non-reducible Mx - surgical repair
31
incisional hernia?
- protrusion of bowel through incision site in abdo wall
32
umbilical hernia?
- protrusion of abdo contents through umbilicus
33
epigastric hernia?
hernia in epigastric region
34
[Spigelian hernia]
Hernia between lateral border of rectus abdominis and linea semilunaris - site of spigelian fascia (aponeurosis between muscles of abdo wall)
35
Diastasis recti
Widening of linea alba, between rectus abdominis muscle, leading to herniation of bowel
36
Obturator hernia
Abdo / pelvic contents herniate through obturator foramen - due to defect in pelvic floor
37
hiatus hernia - definition and RFs?
- herniation of abdo viscera through oesophageal aperture of diaphragm RFs - older, obesity, pregnancy, female, ascites
38
4 types of hiatus hernia?
Type 1 - sliding, 80%, stomach slides up, LOS less competent Type 2 - rolling, 20%, fundus rises into thorax, GOJ remains in abdo Type 3 - combination rolling / sliding Type 4 - large opening, additional abdo organs enter
39
hiatus hernia Px?
- dyspepsia - food reflux - burping, bloating - halitosis
40
hiatus hernia Ix?
- CXR, CT - endoscopy - barium swallow
41
hiatus hernia Mx?
- lose weight - PPIs - surgical repair - laparoscopic fundoplication (mainly rolling)
42
haemorrhoids - definition and RFs?
- enlarged anal vascular cushions RFs - constipation, straining, pregnancy, obesity, older age, weightlifting, chronic cough
43
haemorrhoid pathophysiology?
- anal cushions - specialised submucosal tissue with artery/vein connections - anus described as clockface Internal haemorrhoids - above dentate line - not painful External haemorrhoids - below dentate line, may see externally, painful Thrombosed - strangulation at base of haemorrhoid -> thrombosis Classification 1st degree – no prolapse 2nd degree – prolapse when straining, return on relaxing 3rd degree – prolapse when straining, no return on relaxing, can be pushed back 4th degree – prolapsed permanently
44
haemorrhoid Px?
- asym - painless, bright red bleeding - on toilet / tissue - sore / itchy anus - lump near anus - painful if thrombosed - anaemia sx - incontinence - 3/4th degree - thrombosed - purplish, painful, swollen lump
45
haemorrhoid Ix?
- examine, PR - proctoscopy - ?bloods - ?colonoscopy
46
haemorrhoid Mx?
Prevention - increase fibre, fluids, laxatives if needed Topical - anusol - anusol HC - germoloids cream - proctosedyl ointment Non-surgical - rubber band ligation - injection sclerotherapy - infra-red coagulation - bipolar diathermy Surgical - haemorrhoidal artery ligation - haemorrhoidectomy - stapled haemorrhoidopexy
47
anal fistula - definition and causes?
- abnormal connection between the epithelial surfaces of the anal canal + skin Causes - perianal sepsis, abscess, Crohn's, TB, diverticular disease, rectal carcinoma
48
anal fistula Px?
- pain - discharge - bloody / mucus - pruritis ani - swelling, red, abscess - bowel incontinence
49
anal fistula Ix?
- exam, PR - proctoscopy - scans - USS, CT/MRI
50
anal fistula Mx?
- surgical - fistulotomy - drain abscess
51
anal fissure - definition + causes?
- Tear in squamous-lined skin in lower anal canal, distal to dentate line - 90% posterior, (ant after childbirth) Causes - hard faeces, STIs, trauma, Crohn's, anal cancer
52
anal tissue Px?
- extreme pain, esp on defecation - passing shards of glass - bright red, rectal bleeding
53
anal fissure Ix?
- exam - PR if possible (pain)
54
anal fissure Mx?
- increase fibre + fluids, laxatives Medical - lidocaine ointment - GTN ointment - topical diltiazem - botox injection Surgical - sphincterotom
55
anorectal abscess?
- collection of pus in anal/rectal region - perianal abscess most commonly - E coli / S aureus - eg anal sex, DM, immunocompromised, IBD, malignancy
56
anorectal abscess Px?
painful swellings, tender - pus discharge
57
anorectal abscess Ix?
- PR, inspection - colonoscopy, bloods - US / CT / MRI
58
anorectal abscess Mx?
- surgical excision / drainage - abx
59
Pruritis ani
- perianal itching Mx - avoid scented products - use wet wipes over tissue - avoid scratching - ensure no faecal incontinence
60
Pilonidal disease - pathophysiology, Px and Mx?
- sinuses / cysts form at upper part of natal cleft of buttocks Patho - from hair getting trapped in pores - inflammation, abscess Px - pain, purulent discharge, fluctuant swelling Mx - asym - hygiene - sym - incision, drainage, excise pits
61
define diverticulum, diverticulosis, diverticular disease and diverticulitis
Diverticulum – outpouching of gut wall Diverticulosis – presence of diverticula Diverticular disease – symptomatic Diverticulitis – inflammation of diverticulum
62
Diverticular disease pathophysiology - including RFx
- most commonly sigmoid colon - increased pressure in lumen, mucosa herniates through gaps in circular muscle, forms pouches Diverticulitis - faeces obstructs neck of diverticulum, stagnation, bacteria grow, inflammation - perf, abscess, fistula, haemorrhage RFs - older age, low fibre diet, obesity, NSAIDs, smoking
63
Diverticular disease Px and Diverticulitis
Diverticular disease - left lower abdo pain - constipation, diarrhoea - rectal bleeding Diverticulitis - Left lower abdo pain - Fever - Diarrhoea - N+V - Rectal bleeding - Abscess – abdo mass
64
Diverticular disease and diverticulitis Ix?
Diverticular disease - colonoscopy - CT colonography - Barium enema Diverticulitis - Bloods - CT abdo + contrast - erect CXR (colonoscopy increases perf risk)
65
Mx of diverticular disease
- high fibre diet, wt loss - ispaghula husk (avoid stimulant laxatives) - mebeverine - surgical resection
66
Mx of diverticulitis
Community - uncomplicated - oral co-amox >5d - analgesia - clear fluid only until sx improve - 2d follow up Severe - admission - NBM - IV fluids - IV abx - analgesia - surgical resection
67
Diverticular disease Cx
- Perforation - Peritonitis - Abscess - Haemorrhage - Fistula - Ileus / obstruction
68
bowel ischaemia?
- intestinal ischaemia from lack of blood - foregut - coeliac artery - midgut - superior mesenteric artery - hindgut - inferior mesenteric artery
69
Acute mesenteric ischaemia
- rapid blockage of blood flow to gut - typically SMA, SI - thrombo/embolus, commonly AF - ischaemia -> necrosis, perf
70
Acute mesenteric ischaemia Px
- acute, non-specific abdo pain - disproportionate - shock, peritonitis, sepsis - fever - PR bleed
71
Acute mesenteric ischaemia Ix
- bloods - metabolic acidosis, raised lactate, WCC - contrast CT
72
Acute mesenteric ischaemia Mx
- surgery - laparotomy - bowel resection, thrombus removal (open/endo) - abx
73
Chronic mesenteric ischaemia - definition + RFx
- intestinal angina - reduced blood supply to gut from atherosclerotic blood vessels RFs - older age, FHx, smoking, DM, HTN, raised cholesterol, AF
74
Chronic mesenteric ischaemia Px
- central, colicky abdo pain after eating - wt loss - food avoidance - abdo bruit - PR bleed
75
Chronic mesenteric ischaemia Ix
- CT angio
76
Chronic mesenteric ischaemia Mx
- stop smoking - statins, antiplatelets - revascularisation - stent, endarterectomy, bypass
77
Ischaemic colitis - definition + causes
- acute transient drop in blood supply to large bowel - eg watershed areas - splenic flexure - leads to inflammation, ulceration, haemorrhage Causes - thromboembolism, reduced CO, drugs, vasculitis
78
Ischaemic colitis Px
- shock - abdo pain - rectal bleed
79
Ischaemic colitis Ix
- AXR - thumbprinting - abdo CT - colonoscopy + biopsy / barium enema
80
Ischaemic colitis Mx
- supportive - fluids, abx - surgery - resection
81
colorectal cancer
- cancer of colon/rectum - usually adenocarcinoma - majority distal colon - normal epithelium -> adenoma -> colorectal AC - spread through bowel wall, lymphatics, vessels, mets to liver, lung, brain
82
Colorectal cancer RFs
- Familial adenomatous polyposis (FAP) - Hereditary nonpolyposis colorectal cancer (HNPCC) - FHx - IBD - older - diet - red/processed meat, low fibre - obesity, sedentary - smoking, alcohol - colorectal polyps
83
Colorectal cancer Px
- change in bowel habit - diarrhoea, constipation, freq - wt loss - PR bleed - mucus - tenesmus - abdo pain - IDA - fatigue, weakness, SOB - abdo/rectal mass - intestinal obstruction
84
colorectal cancer screening
- 60-74yo - sent home FIT test to do every 2 yrs, colonoscopy if positive - Pts with FAP, HNPCC, IBD - colonoscopy at regular intervals
85
Colorectal cancer 2ww referral criteria
Do FIT test, then refer if positive with: - Abdo mass - Change in bowel habit - Iron deficiency anaemia - >40yo, abdo pain + unexplained wt loss - <50, rectal bleeding + abdo pain / wt loss - >50yo, unexplained rectal bleeding / abdo pain / wt loss - >60yo, change in bowel habit / anaemia
86
Colorectal cancer Ix
- FIT test - colonoscopy +/- biopsy - CT colonography - CT TAP - serum CEA - Bloods - FBC etc
87
Colorectal cancer staging
Dukes A – mucosa + part of muscle of bowel wall B – through muscle of wall C – lymph node involvement D – mets TNM Tumour, node, mets
88
Colorectal cancer Mx
- MDT - surgical resection - anastomosis/stoma - chemo - radio - palliative - Follow up - rpt CEA, CT TAP
89
Colorectal cancer operations
Caecal, ascending, proximal transverse colon - right hemicolectomy Distal transverse, descending colon - left heimcolecomy Sigmoid colon - high anterior resection Upper rectum - anterior resection (TME - total mesorectal excision) Low rectum - anterior resection (low TME) Anal verge - abdomino-perineal excision of rectum
90
Lower anterior resection syndrome
- after bowel resection, anastomosis between colon + rectum Px - urgency, freq of bowel movts - faecal incontinence - difficulty controlling flatulence
91
colonic polyps - RFs, Px, Ix, Mx
- abnormal tissue growth on colonic mucosa - adenoma - FAP / HNPCC RFs - FHx, >50yo, IBD, overweight, smoking Px - asym - rectal polyps / mass - PR bleed - diarrhoea, abdo pain, mucous, ?obstruction Ix - colonoscopy + biopsy - genetic testing - CT colonography Mx - remove during colonoscop
92
oesophageal cancer? types and RFs?
- cancer of oesophagus AC - most common in UK - in lower 1/3 - RFs - GORD, Barrett's (squamous epithelium -> simple columnar), smoking, obesity SCC - most common type in developing world - upper 2/3 - RFs - smoking, alcoho
93
Oesophageal cancer Px
- dysphagia, solids then liquids - anorexia - wt loss - vomiting - odynophagia - hoarseness - melaena - cough - lymphadenopathy - retrosternal chest pain
94
Oesophageal cancer Ix
- OGD - Endoscopic US? - CT TAP - Barium swallow
95
Oesophageal cancer Mx
- surgical resection (Ivor-Lewis oesophagectomy) - chemo
96
Benign oesophageal lesions (Px, Ix and Mx)
- benign growths in oesophagus, 1% all tumours, leiomyoma Px - asym - dysphagia - retrosternal pain - food regurg Ix - OGD - barium swallow - biopsy Mx - endoscopic / surgical resectio
97
gastric cancer - definition and RFs
- stomach cancer - adenocarcinoma - intestinal (well formed) / diffuse (worse) RFs - H pylori - atrophic gastritis - smoking - diet, blood group A
98
gastric cancer Px ?
- abdo pain - dyspepsia - wt loss - anorexia - N+V - dysphagia - UGIB - anaemia - lymphadenopathy - mets - bone, brain, liver, lung
99
gastric Ca Ix?
- OGD + biopsy - ?endoscopic USS - CT / MRI / PET
100
gastric Ca Mx?
- surgical - mucosal resection / partial/total gastrectomy - chemo
101
gastrectomy complications?
- dumping syndrome - wt loss, early satiety - IDA - osteoporosis, osteomalacia - B12 deficiency
102
SI tumours - RFs, Px, Ix and Mx
- rare, tend to be AC / non-Hodgkin's in ileum RFs - coeliac's, Crohn's Px - anaemia, mass, pain, diarrhoea, anorexia, wt loss Ix - endoscopy + biopsy - ?US - CT Mx - surgical resection - chemo / radio
103
pancreatic cancer? associated with?
- cancer of pancreas - mostly AC - 99% exocrine component - 60% at head, 25% body, 15% tail - early mets, poor prognosis Associations - older, smoking, DM, chronic pancreatitis, HNPCC, MEN, BRCA2, KRAS
104
Pancreatic cancer Px
- painless obstructive jaundice - pale stools, dark urine, pruritis - abdo mass - epigastric / hepatomegaly / gallbladder - anorexia, wt loss - epigastric pain - steatorrhoea, DM - back pain - migratory thrombophlebitis - lymphadenopathy
105
Pancreatic cancer referral
>40yo + jaundice - 2ww >60yo + wt loss + additional sx (below) - direct access CT abdo - Diarrhoea, back pain, abdo pain, N/V, constipation, new onset DM
106
Pancreatic cancer Ix
- BM - LFTs, CA 19-9 - MRCP / ERCP - trans-abdo USS - CT TAP - Biopsy - percutaneous / endoscopi
107
Pancreatic cancer Mx
Surgical - total / distal pancreatectomy - pylorus-preserving pancreaticoduodenectomy (PPPD) - Whipple's - pancreaticoduodenectomy - chemo - ERCP + stent
108
anal cancer - definition and RFx?
- malignancy in anal canal - 80% SCC - anal margin tumour - spread to inguinal lymph nodes - proximal tumours - spread to pelvic RFs - HPV 16/18, anal intercourse, MSM, HIV, cervical cancer/CIN, smoking
109
Anal cancer Px
- perianal pain, bleeding - palpable lesion - faecal incontinence
110
Anal cancer Ix
- T stage assessment - examine, DRE, anoscopic exam + biopsy, palpate nodes - CT / MRI / endo-anal USS / PET - test for eg HIV
111
Anal cancer Mx
- chemo / radio - surgical excision
112
stoma
- artificial opening of hollow organ - eg bypass distal structures - stoma bag to collect waste - stoma nurse follow up
113
Colostomy
- LI brought onto skin - solid stools - no spout, flatter to skin - LIF
114
ileostomy
- SI brought to skin - drains liquids, irritating to skin - spout -> tight-fitting bag - RIF
115
Gastrostomy
- artificial connection between stomach + abdo wall - provide feeds - PEG - percutaneous endoscopic gastrostomy
116
urostomy
- opening from urinary system onto skin - drain from kidney, bypass ureters, bladder, urethra - eg post-cystectomy - create ileal conduit - spout - RIF
117
End colostomy / ileostomy
- section of bowel removed, end part of proximal bowel brought to skin, end of distal bowel sutured up - can be reversed
118
Loop colostomy / ileostomy
- temporary stoma to allow distal bowel to heal - bowel partially opened - 2 openings at skin side-by-side
119
Stoma cx
- psychosocial - skin irritation - Parastomal hernia - Loss of bowel length - high output, dehydration, malnutrition - Constipation - Stenosis - Obstruction - Retraction - sinking into skin - Prolapse - Bleeding - Granulomas
120
Biliary colic
- Intermittent RUQ pain caused by gallstones passing through biliary tree
121
Gallstones causes
- cholesterol - bile pigment - calcium - eg haemolysis - biliary stasis
122
gallstone RFx?
- fair, fat, female, fertile (pregnant), forty - DM, Crohn's, rapid wt loss, cOCP
123
Biliary colic Px
- colicky RUQ pain, worse after eating fatty foods, radiation to R shoulder - N+V - no fever
124
Biliary colic Ix
- LFTs - raised ALP, if bilirubin raised, obstruction in CBD - AST/ALT normal - USS - MRCP - CT - maybe for pancreas
125
Biliary colic Mx
- elective laparoscopic cholecystectomy - ERCP - analgesia
126
Acute cholecystitis
- inflammation of gallbladder - secretion obstructed, increased secretion, distension, compromise vascular supply - 90% gallstones, 10% other (TPN, ill, hypoperfusion...)
127
Acute cholecystitis Px
- RUQ pain, shoulder - fever - Murphy's sign positive
128
Acute cholecystitis Ix
- LFTs - typically normal, may be deranged in Mirizzi syndrome (gallstone in distal cystic duct compressing on CBD) - raised CRP/WCC - USS - MRCP - consider HIDA scan
129
Acute cholecystitis Mx
- NBM - IV fluids - IV abx - ERCP - laparoscopic cholecystectomy - hot <72hrs / cold in 6-8wks
130
Acute cholecystitis cx
- sepsis - gallbladder empyema - gangrene / perf
131
Ascending cholangitis
- infection of biliary tree - E coli, klebsiella, enterococcus Causes - gallstones, ERCP - infection ascends up CBD from duodenum
132
Ascending cholangitis Px
Charcot's triad - RUQ pain - fever - jaundice Reynold's pentad - above plus .. - hypotension - confusion
133
Ascending cholangitis Ix
- bloods - deranged LFTs (ALP higher), raised bilirubin/CRP/WCC - USS - MRCP
134
Ascending cholangitis Mx
NBM - IV fluids - IV abx - ERCP - percutaneous transhepatic cholangiogram (PTC)
135
Cholangiocarcinoma
- cancer of bile ducts - majority AC - can be intra/extrahepatic, most commonly perihilar region (R+L hepatic ducts join to form CBD) RFs - PSC - liver flukes
136
Cholangiocarcinoma Px
- obstructive jaundice, pale stools, dark urine, itchy - biliary colic sx - wt loss, anorexia - palpable mass in RUQ with jaundice - periumbilical lymphadenopathy - left supraclavicular adenopathy - hepatomegaly
137
Cholangiocarcinoma Ix
- CA19-9 - raised ALP, bilirubin - CT / MRI - biopsy - MRCP
138
Cholangiocarcinoma Mx
- surgical resection - ERCP - chemo / radio
139
acute pancreatitis
- inflammation of pancreas - autodigestion of pancreatic tissue by enzymes -> necrosis
140
Acute pancreatitis causes
I GET SMASHED idiopathic gallstones ethanol trauma steroids mumps, coxsackie B autoimmune scorpion sting hyperlipidaemia, also Ca, hypothermia ERCP drugs - furosemide, thiazides, azathioprine
141
Acute pancreatitis Px
- severe epigastric pain, radiates to back - N+V - abdo tenderness - fever, tachycardia - Cullen's, Grey-Turner's sign - ischaemic retinopathy
142
Acute pancreatitis Ix
- bloods - FBC, U/E, LFT, Ca, ABG, amylase, CRP, ?lipase - USS - CT abdo - severity score - Glasgow, APACHE II, Ranson
143
Acute pancreatitis Mx
- A-E - IV fluids - analgesia - NBM if vomiting - Tx cause - ERCP, cholecystectomy... - Abx if infection - may need debridement
144
Acute pancreatitis Cx
- necrosis of pancreas - infection of necrosis - pancreatic abscess - peripancreatic fluid collections - pseudocysts - chronic pancreatitis - haemorrhage
145
chronic pancreatitis?
- chronic inflammation of pancreas - fibrosis, reduced function - alcohol most commonly, also CF, HHC, as acute
146
Chronic pancreatitis Px
- sx as acute, less intense, longer lasting - pain worse 15-30mins after meal - steatorrhoea - DM
147
Chronic pancreatitis Ix
- AXR - pancreatic calcification - CT - faecal elastase - assess exocrine function - secretin stimulation test - MRI / endoscopic USS
148
Chronic pancreatitis Mx
- stop smoking, alcohol - analgesia - creon - S/C insulin - ERCP + stent - strictures - surgery
149
Chronic pancreatitis Cx
- chronic pain - loss of pancreatic enzymes - lack of insulin - strictures - pseudocysts, abscesses
150
anastomotic leak? Px, Ix, Mx
- leak of luminal contents from surgical join Px - pt deteriorating / not progressing after surgery - 3-5d post-op - abdo pain - sepsis - prolonged ileus - peritonism Ix - Bloods - FBC, CRP, coag, ABG - CT with contrast Mx - NBM - broad spec IV abx - IV fluids - catheter - surgical intervention
151
Boerhaave's syndrome
- spontaneous rupture of oesophagus after repeated vomiting - rupture usually distal, on left side Px - sudden onset severe chest pain - subcut emphysema Ix - CT contrast swallow Mx - thoracotomy + lavage Cx - sepsis, mediastinitis
152
bariatric surgery options?
Primarily restrictive - laparoscopic gastric banding - sleeve gastrectomy - intrinsic gastric balloon Primarily malabsorptive - Biliopancreatic diversion with duodenal switch Mixed - Roux-en-Y gastric bypass surgery
153
Lowe GI bleed - causes, Px, Ix, Mx
- PR bleed from lower GI tract - eg colonic Causes - colitis, diverticular disease, cancer, haemorrhoids, angiodysplasia Px - bright/dark red bleed on PR Ix - examination, PR proctoscopy - CT angio Mx - A-E - blood resus - endoscopy - surgical - resection - Oakland score - for safe discharge post lower GI bleed

finals (19 decks)

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