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Phase 4 Question Knowledge > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Appenditis

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 patho

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

Bowel obstruction causes

A

SBO

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

LBO

  • malignancy
  • volvulus
  • strictures
  • diverticular disease
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10
Q

Bowel obstruction Px

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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11
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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12
Q

Bowel obstruction Mx

A
  • NBM
  • analgesia, antiemetic
  • IV fluids
  • NG tube (Ryles)
  • surgery - laparoscopy / laparotomy
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13
Q

Paralytic ileus

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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14
Q

Pseudo-obstruction

A
  • functional obstruction of LI
  • XR - colon dilatation
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15
Q

Volvulus

A
  • torsion of colon around its mesenteric axis -> compromised blood supply + closed loop obstruction
  • sigmoid 80%, caecum 20%
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16
Q

Volvulus Px

A
  • as bowel obstruction
  • constipation, bloating, abdo pain, N+V etc
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17
Q

Volvulus Ix

A

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

CT with contrast

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18
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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19
Q

Hernia

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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20
Q

Hernia Px

A
  • soft lump
  • Reducible
  • Cough impulse
  • Worsened on standing
  • Aching, pulling, dragging sensation
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21
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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22
Q

Hernia Mx

A

Conservative

  • Truss

Surgical

  • tension-free repair - mesh repair
  • tension repair - suture muscles / tissues (rarely done)
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23
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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24
Q

Inguinal hernia

A

Protrusion of abdo contents through inguinal canal….

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25
Indirect inguinal hernia
- 80% - bowel herniates through inguinal canal - lateral to inferior epigastric artery
26
Direct inguinal hernia
- 20% - weakness in abdo wall at Hesselbach's triangle - medial to inferior epigastric artery
27
Inguinal hernia Px
- groin lump - medial + superior to pubic tubercle - disappears on pressure / lying down
28
Inguinal hernia Mx
- direct/indirect has no bearing on mx - tx medically fit patients, even if asym
29
Femoral hernia
- herniation of abdo contents through femoral canal Px - lump in groin +/- pain - inferior + lateral to pubic tubercle - typically non-reducible Mx - surgical repair
30
Incisional hernia
- protrusion of bowel through incision site in abdo wall
31
Umbilical hernia
- protrusion of abdo contents through umbilicus
32
Epigastric hernia
hernia in epigastric region
33
Spigelian hernia
Hernia between lateral border of rectus abdominis and linea semilunaris - site of spigelian fascia (aponeurosis between muscles of abdo wall)
34
Diastasis recti
Widening of linea alba, between rectus abdominis muscle, leading to herniation of bowel
35
Obturator hernia
Abdo / pelvic contents herniate through obturator foramen - due to defect in pelvic floor
36
Hiatus hernia
- herniation of abdo viscera through oesophageal aperture of diaphragm RFs - older, obesity, pregnancy, female, ascites
37
Hiatus hernia types
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
38
Hiatus hernia Px
- dyspepsia - food reflux - burping, bloating - halitosis
39
Hiatus hernia Ix
- CXR, CT - endoscopy - barium swallow
40
Hiatus hernia Mx
- lose weight - PPIs - surgical repair - laparoscopic fundoplication (mainly rolling)
41
Haemorrhoids
- enlarged anal vascular cushions RFs - constipation, straining, pregnancy, obesity, older age, weightlifting, chronic cough
42
Haemorrhoids patho
- 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
43
Haemorrhoids 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
44
Haemorrhoids Ix
- examine, PR - proctoscopy - ?bloods - ?colonoscopy
45
Haemorrhoids 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
46
Anal fistula
- abnormal connection between the epithelial surfaces of the anal canal + skin Causes - perianal sepsis, abscess, Crohn's, TB, diverticular disease, rectal carcinoma
47
Anal fistula Px
- pain - discharge - bloody / mucus - pruritis ani - swelling, red, abscess - bowel incontinence
48
Anal fistula Ix
- exam, PR - proctoscopy - scans - USS, CT/MRI
49
Anal fistula Mx
- surgical - fistulotomy - drain abscess
50
Anal fissure
- 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
51
Anal fissure Px
- extreme pain, esp on defecation - passing shards of glass - bright red, rectal bleeding
52
Anal fissure Ix
- exam - PR if possible (pain)
53
Anal fissure Mx
- increase fibre + fluids, laxatives Medical - lidocaine ointment - GTN ointment - topical diltiazem - botox injection Surgical - sphincterotomy
54
Anorectal abscess
- collection of pus in anal/rectal region - perianal abscess most commonly - E coli / S aureus - eg anal sex, DM, immunocompromised, IBD, malignancy
55
Anorectal abscess Px
- painful swellings, tender - pus discharge
56
Anorectal abscess Ix
- PR, inspection - colonoscopy, bloods - US / CT / MRI
57
Anorectal abscess Mx
- surgical excision / drainage - abx
58
Pruritis ani
- perianal itching Mx - avoid scented products - use wet wipes over tissue - avoid scratching - ensure no faecal incontinence
59
Pilonidal disease
- 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
60
Diverticular disease
Diverticulum – outpouching of gut wall Diverticulosis – presence of diverticula Diverticular disease – symptomatic Diverticulitis – inflammation of diverticulum
61
Diverticular disease patho
- 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
62
Diverticular disease Px
Diverticular disease - left lower abdo pain - constipation, diarrhoea - rectal bleeding Diverticulitis - Left lower abdo pain - Fever - Diarrhoea - N+V - Rectal bleeding - Abscess – abdo mass
63
Diverticular disease Ix
Diverticular disease - colonoscopy - CT colonography - Barium enema Diverticulitis - Bloods - CT abdo + contrast - erect CXR (colonoscopy increases perf risk)
64
Diverticular disease Mx
Diverticular disease - high fibre diet, wt loss - ispaghula husk (avoid stimulant laxatives) - mebeverine - surgical resection 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
65
Diverticular disease Cx
- Perforation - Peritonitis - Abscess - Haemorrhage - Fistula - Ileus / obstruction
66
Bowel ischaemia
- intestinal ischaemia from lack of blood - foregut - coeliac artery - midgut - superior mesenteric artery - hindgut - inferior mesenteric artery
67
Acute mesenteric ischaemia
- rapid blockage of blood flow to gut - typically SMA, SI - thrombo/embolus, commonly AF - ischaemia -> necrosis, perf
68
Acute mesenteric ischaemia Px
- acute, non-specific abdo pain - disproportionate - shock, peritonitis, sepsis - fever - PR bleed
69
Acute mesenteric ischaemia Ix
- bloods - metabolic acidosis, raised lactate, WCC - contrast CT
70
Acute mesenteric ischaemia Mx
- surgery - laparotomy - bowel resection, thrombus removal (open/endo) - abx
71
Chronic mesenteric ischaemia
- intestinal angina - reduced blood supply to gut from atherosclerotic blood vessels RFs - older age, FHx, smoking, DM, HTN, raised cholesterol, AF
72
Chronic mesenteric ischaemia Px
- central, colicky abdo pain after eating - wt loss - food avoidance - abdo bruit - PR bleed
73
Chronic mesenteric ischaemia Ix
- CT angio
74
Chronic mesenteric ischaemia Mx
- stop smoking - statins, antiplatelets - revascularisation - stent, endarterectomy, bypass
75
Ischaemic colitis
- 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
76
Ischaemic colitis Px
- shock - abdo pain - rectal bleed
77
Ischaemic colitis Ix
- AXR - thumbprinting - abdo CT - colonoscopy + biopsy / barium enema
78
Ischaemic colitis Mx
- supportive - fluids, abx - surgery - resection
79
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
80
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
81
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
82
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
83
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
84
Colorectal cancer Ix
- FIT test - colonoscopy +/- biopsy - CT colonography - CT TAP - serum CEA - Bloods - FBC etc
85
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
86
Colorectal cancer Mx
- MDT - surgical resection - anastomosis/stoma - chemo - radio - palliative - Follow up - rpt CEA, CT TAP
87
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
88
Lower anterior resection syndrome
- after bowel resection, anastomosis between colon + rectum Px - urgency, freq of bowel movts - faecal incontinence - difficulty controlling flatulence
89
Colonic polyps
- 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 colonoscopy
90
Oesophageal cancer
- 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, alcohol...
91
Oesophageal cancer Px
- dysphagia, solids then liquids - anorexia - wt loss - vomiting - odynophagia - hoarseness - melaena - cough - lymphadenopathy - retrosternal chest pain
92
Oesophageal cancer Ix
- OGD - Endoscopic US? - CT TAP - Barium swallow
93
Oesophageal cancer Mx
- surgical resection (Ivor-Lewis oesophagectomy) - chemo
94
Benign oesophageal lesions
- benign growths in oesophagus, 1% all tumours, leiomyoma Px - asym - dysphagia - retrosternal pain - food regurg Ix - OGD - barium swallow - biopsy Mx - endoscopic / surgical resection
95
Gastric cancer
- stomach cancer - adenocarcinoma - intestinal (well formed) / diffuse (worse) RFs - H pylori - atrophic gastritis - smoking - diet, blood group A
96
Gastric cancer Px
- abdo pain - dyspepsia - wt loss - anorexia - N+V - dysphagia - UGIB - anaemia - lymphadenopathy - mets - bone, brain, liver, lung
97
Gastric cancer Ix
- OGD + biopsy - ?endoscopic USS - CT / MRI / PET
98
Gastric cancer mx
- surgical - mucosal resection / partial/total gastrectomy - chemo
99
Gastrectomy cx
- dumping syndrome - wt loss, early satiety - IDA - osteoporosis, osteomalacia - B12 deficiency
100
SI tumours
- 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
101
Pancreatic cancer
- 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
102
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
103
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
104
Pancreatic cancer Ix
- BM - LFTs, CA 19-9 - MRCP / ERCP - trans-abdo USS - CT TAP - Biopsy - percutaneous / endoscopic
105
Pancreatic cancer Mx
Surgical - total / distal pancreatectomy - pylorus-preserving pancreaticoduodenectomy (PPPD) - Whipple's - pancreaticoduodenectomy - chemo - ERCP + stent
106
Anal cancer
- 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
107
Anal cancer Px
- perianal pain, bleeding - palpable lesion - faecal incontinence
108
Anal cancer Ix
- T stage assessment - examine, DRE, anoscopic exam + biopsy, palpate nodes - CT / MRI / endo-anal USS / PET - test for eg HIV
109
Anal cancer Mx
- chemo / radio - surgical excision
110
Stoma
- artificial opening of hollow organ - eg bypass distal structures - stoma bag to collect waste - stoma nurse follow up
111
Colostomy
- LI brought onto skin - solid stools - no spout, flatter to skin - LIF
112
Ileostomy
- SI brought to skin - drains liquids, irritating to skin - spout -> tight-fitting bag - RIF
113
Gastrostomy
- artificial connection between stomach + abdo wall - provide feeds - PEG - percutaneous endoscopic gastrostomy
114
Urostomy
- opening from urinary system onto skin - drain from kidney, bypass ureters, bladder, urethra - eg post-cystectomy - create ileal conduit - spout - RIF
115
End colostomy / ileostomy
- section of bowel removed, end part of proximal bowel brought to skin, end of distal bowel sutured up - can be reversed
116
Loop colostomy / ileostomy
- temporary stoma to allow distal bowel to heal - bowel partially opened - 2 openings at skin side-by-side
117
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
118
Biliary colic
- Intermittent RUQ pain caused by gallstones passing through biliary tree
119
Gallstones causes
- cholesterol - bile pigment - calcium - eg haemolysis - biliary stasis
120
Gallstones RFs
- fair, fat, female, fertile (pregnant), forty - DM, Crohn's, rapid wt loss, cOCP
121
Biliary colic Px
- colicky RUQ pain, worse after eating fatty foods, radiation to R shoulder - N+V - no fever
122
Biliary colic Ix
- LFTs - raised ALP, if bilirubin raised, obstruction in CBD - AST/ALT normal - USS - MRCP - CT - maybe for pancreas
123
Biliary colic Mx
- elective laparoscopic cholecystectomy - ERCP - analgesia
124
Acute cholecystitis
- inflammation of gallbladder - secretion obstructed, increased secretion, distension, compromise vascular supply - 90% gallstones, 10% other (TPN, ill, hypoperfusion...)
125
Acute cholecystitis Px
- RUQ pain, shoulder - fever - Murphy's sign positive
126
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
127
Acute cholecystitis Mx
- NBM - IV fluids - IV abx - ERCP - laparoscopic cholecystectomy - hot <72hrs / cold in 6-8wks
128
Acute cholecystitis cx
- sepsis - gallbladder empyema - gangrene / perf
129
Ascending cholangitis
- infection of biliary tree - E coli, klebsiella, enterococcus Causes - gallstones, ERCP - infection ascends up CBD from duodenum
130
Ascending cholangitis Px
Charcot's triad - RUQ pain - fever - jaundice Reynold's pentad - hypotension - confusion
131
Ascending cholangitis Ix
- bloods - deranged LFTs (ALP higher), raised bilirubin/CRP/WCC - USS - MRCP
132
Ascending cholangitis Mx
- NBM - IV fluids - IV abx - ERCP - percutaneous transhepatic cholangiogram (PTC)
133
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
134
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
135
Cholangiocarcinoma Ix
- CA19-9 - raised ALP, bilirubin - CT / MRI - biopsy - MRCP
136
Cholangiocarcinoma Mx
- surgical resection - ERCP - chemo / radio
137
Acute pancreatitis
- inflammation of pancreas - autodigestion of pancreatic tissue by enzymes -> necrosis
138
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....
139
Acute pancreatitis Px
- severe epigastric pain, radiates to back - N+V - abdo tenderness - fever, tachycardia - Cullen's, Grey-Turner's sign - ischaemic retinopathy
140
Acute pancreatitis Ix
- bloods - FBC, U/E, LFT, Ca, ABG, amylase, CRP, ?lipase - USS - CT abdo - severity score - Glasgow, APACHE II, Ranson
141
Acute pancreatitis Mx
- A-E - IV fluids - analgesia - NBM if vomiting - Tx cause - ERCP, cholecystectomy... - Abx if infection - may need debridement
142
Acute pancreatitis Cx
- necrosis of pancreas - infection of necrosis - pancreatic abscess - peripancreatic fluid collections - pseudocysts - chronic pancreatitis - haemorrhage
143
Chronic pancreatitis
- chronic inflammation of pancreas - fibrosis, reduced function - alcohol most commonly, also CF, HHC, as acute
144
Chronic pancreatitis Px
- sx as acute, less intense, longer lasting - pain worse 15-30mins after meal - steatorrhoea - DM
145
Chronic pancreatitis Ix
- AXR - pancreatic calcification - CT - faecal elastase - assess exocrine function - secretin stimulation test - MRI / endoscopic USS
146
Chronic pancreatitis Mx
- stop smoking, alcohol - analgesia - creon - S/C insulin - ERCP + stent - strictures - surgery
147
Chronic pancreatitis Cx
- chronic pain - loss of pancreatic enzymes - lack of insulin - strictures - pseudocysts, abscesses
148
Anastomotic leak
- 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
149
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
150
Bariatric surgery
Primarily restrictive - laparoscopic gastric banding - sleeve gastrectomy - intrinsic gastric balloon Primarily malabsorptive - Biliopancreatic diversion with duodenal switch Mixed - Roux-en-Y gastric bypass surgery
151
Lower GI bleed
- 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

Phase 4 Question Knowledge (36 decks)

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