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Surgery - DONE > GENERAL SURGERY > Flashcards

GENERAL SURGERY Flashcards

1
Q

What is the ‘acute abdomen’

A

Sudden onset of severe abdominal pain of less than 24 hrs duration

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2
Q

What can cause an acute abdomen?

A

Ruptured AAA

Ruptured Ectopic pregnancy

Peritonitis (perforation of abdominal viscus) = rigid abdomen

Ischaemic bowel (pain out of proportion to clinical sign)

Gastric ulcer

Pancreatitis

MI

Small / large bowel obstruction

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3
Q

What are the investigations for an acute abdomen?

A
  • Urine dipstick (signs of infection)
  • Pregnancy test
  • ABG (bleeding / septic patients - lactate signs of tissue hypoperfusion)
  • Routine bloods: FBC, U&Es, LFTs, CRP, amylase
  • Serum calcium (pancreatitis)
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4
Q

What Amylase level is required for a diagnosis of pancreatitis?

A

3x the upper limit

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5
Q

What is the imaging in acute abdomen?

A
  • ECG
  • Ultrasound: KUB - renal tract pathology, biliary tree and liver - gallstones
  • CXR for bowel perforation
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6
Q

What is the general management of the acute abdo?

A
  • IV access
  • NBM
  • Analgesia
  • Antiemetic
  • Imaging
  • VTE prophylaxis
  • Urine dip
  • Bloods
  • Urinary catheter
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7
Q

What is Barrett’s oesophagus?

A

Metaplasia from stratified squamous epithelium to simple columnar epithelium

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8
Q

Is metaplasia reversible?

A

Yes

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9
Q

What typically causes Barretts oesophagus?

A

GORD

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10
Q

What are the risk factors for Barrett’s?

A

Being Caucasian

>50 y/o

Smoking

Male

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11
Q

What are the presenting features of Barrett’s?

A

Retrosternal chest pain

Belching

Chronic cough

REMEMBER TO CHECK RED FLAGS

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12
Q

What are investigations for Barrett’s oesophagus?

A

Histological diagnosis

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13
Q

What is the management of Barretts?

A

High dose PPI

NSAIDs stopped

Lifestyle advice

Regular follow up endoscopy

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14
Q

What type of cell is in the upper third and lower third of the oesophagus respectively?

A

Upper = Skeletal

Lower = Smooth muscle

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15
Q

What are the differentials for oesophageal motility disorders?

A

GORD

Malignancy

Achalasia

Oesophageal spasm

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16
Q

What is achalasia?

A

Failure of relaxation of the LOS (pathophysiology poorly understood)

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17
Q

What are the symptoms of achalasia?

A

Regurgitation of food

Chest pain

Weight loss

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18
Q

What is the investigation in achalasia?

A

Endoscopy

Oesophageal manometry

Barium swallow - birds beak appearance

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19
Q

What is the management of achalasia?

A

Sleeping with many pillows (stops regurg)

Chew food thoroughly

Botox injections at LOS (only effective for a few months)

Surgical endoscopic ballon dilatation

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20
Q

What is diffuse oesophageal spasm?

A

Multifocal high amplitude contractions of the oesophagus

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21
Q

How does diffuse oesophageal spasm present?

A

Severe dysphagia to both solids and liquids

Central chest pain

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22
Q

How is diffuse oesophageal spasm diagnosed?

A

Manometry (simultaneous and ineffective contractions of oesophagus)

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23
Q

What is the management of DOS?

A

Nitrates / CCBs (relax muscles)

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24
Q

What is Boerhaave’s syndrome?

A

Oesophageal perforation ​

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25
Q

Why is oesophageal rupture an emergency?

A

Leakage of stomach contents into mediastinum triggers an inflammatory response - leading to death

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26
Q

What are the causes of oesophageal rupture?

A

Iatrogenic (endoscopy)

Severe forceful vomiting

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27
Q

How does an oesophageal rupture present?

A

Sudden retrosternal chest pain

Respiratory distress

Subcutaneous emphysema

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28
Q

What are the investigations for an oesophageal rupture?

A

Routine bloods

G&S

CXR

CT chest abdo pelvis with contract to demonstrate air

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29
Q

What is the management of oesophageal rupture?

A

Fluid resus

High flow oxygen

Abx

Surgery

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30
Q

What are Mallory-Weiss tears?

A

Laceration in oesophageal mucosa usually due to forceful vomiting

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31
Q

What is the management of Mallory-Weiss tear?

A

As in other upper GI bleeds

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32
Q

What is the most common form of gastric cancer?

A

Adenocarcinoma

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33
Q

What are the risk factors for gastric cancer?

A

H. Pylori infection

Increasing age

Smoking

Alcohol consumption

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34
Q

What time of bacteria is H. Pylori?

A

G neg helical bacterium

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35
Q

How does H. Pylori exert its effect?

A

Produces urease enzyme breaking down urea into CO2 and ammonium

Ammonium neutralises the stomach acid

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36
Q

What are the symptoms of gastric cancer?

A

Dyspepsia (indigestion)

Dysphagia

Early satiety

Vomiting

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37
Q

What is Troisiers sign?

A

Presence of a palpable left supraclavicular node

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38
Q

What are the differentials to consider with dyspepsia?

A

Gastric cancer

Peptic ulcer disease

GORD

Gallstones

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39
Q

What is the imaging of choice in gastric cancer?

A

Upper GI endoscopy: direct visualisation

Biopsy’s sent for: Histology, CLO test (pylori)

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40
Q

What happens in GORD?

A

Excessive relaxation of LOS allowing reflux of acidic gastric contents

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41
Q

What are the risk factors for GORD?

A

Age

Obesity

Male gender

Alcohol

Smoking

Caffeinated drinks

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42
Q

What are the symptoms of GORD?

A

Burning retrosternal pain after meals

Relieved by antacids

Cough

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43
Q

What are the red flags for dyspepsia?

A

Weight loss

Early satiety

Malaise

Loss of appetite

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44
Q

How is GORD diagnosed?

A

Good history, resolution of symptoms after PPI

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45
Q

When do NICE suggest endoscopy for upper GI symptoms?

A

>55 years old with weight loss, dyspepsia or reflux

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46
Q

What are the management options for GORD?

A

Avoid precipitating food, weight loss, smoking cessation

PPIs

Surgery (fundoplication)

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47
Q

What are the complications of GORD?

A

Aspiration pneumonia

Barrett’s oesophagus

Oesophageal cancer

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48
Q

What is a hiatus hernia?

A

Herniation of part of abdomen into thorax via oesophageal hiatus (usually the stomach, can be small bowel, mesentery etc)

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49
Q

What are some risk factors for hiatus hernia?

A

Age

Repetitive coughing

Pregnancy

Obesity

Ascites

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50
Q

What are the presenting features of a hiatus hernia?

A

Reflux symptoms

Vomiting

Weight loss

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51
Q

What is the gold standard investigation for hiatus hernia?

A

Oesophagogastroduodenoscopy is the gold standard

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52
Q

What is the management of hiatus hernia?

A

PPI (first thing)

Weight loss, early meals small, smaller portions

Surgery

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53
Q

What are some complications of hiatus hernia?

A

GASTRIC VOLVULUS - Borchardt’s triad - stomach twists on itself (severe epigastric pain, retching without vomiting, inability to pass NG tube)

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54
Q

Where are peptic ulcers commonly seen?

A

Lesser curvature of proximal stomach

First part of the duodenum

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55
Q

What causes peptic ulcers?

A

H.Pylori infection

NSAID use

Previous gastric bypass surgery

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56
Q

How do patients with peptic ulcers present?

A

Epigastric or retrosternal pain

Early satiety

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57
Q

What is the triad in Zollinger-Ellison syndrome?

A

Triad of:

Severe peptic ulcer disease

Gastric acid hypersecretion

Gastrinoma

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58
Q

What are the investigations for peptic ulcer disease?

A

FBC (for anaemia)

H. Pylori testing

Ongoing symptoms despite treatment - OGD

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59
Q

What is the management for peptic ulcer disease?

A

Lifestyle advise: smoking cessation, weight loss, reduction in alcohol

PPI

Triple therapy if H. Pylori

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60
Q

What is the triple therapy for H. Pylori?

A

PPI

Oral amoxicillin

Clarythomycin/metronidazole

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61
Q

What type of hernia occurs in the upper midline through fibres of the linea alba, typically in men?

A

Epigastric hernia

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62
Q

What are risk factors for epigastric hernia?

A

Obesity

Pregnancy

Ascites

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63
Q

What other kind of hernia can occur in the abdomen?

A

Paraumbilical hernia

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64
Q

When else is serum amylase raised?

A

Ectopic pregnancy

DKA

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65
Q

What is angiodysplasia?

A

Arteriovenous malformation between previously healthy blood vessels normally in caecum

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66
Q

What are the main features of angiodysplasia?

A

Rectal bleeding and anaemia

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67
Q

What are the differentials for lower GI bleeding?

A

GI malignancy

Diverticular disease

Coagulopathies

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68
Q

What blood tests for lower GI bleed?

A

FBC (haemantics for iron deficiency)

U&Es

LFTs

Clotting profile

G&S

Cross match

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69
Q

What is the treatment for angiodysplasia?

A

Bed rest and IV fluid and tranexamic acid

Surgery (resection)

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70
Q

Why are femoral hernias worrying?

A

High rate of strangulation

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71
Q

What are the contents of the femoral canal?

A

Lymph vessels

Lymph nodes

Loose connective tissue

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72
Q

What are the risk factors for femoral hernia?

A

Female

Pregnancy

Raised intra-abdominal pressure

Increasing age

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73
Q

How to tell the difference between a femoral hernia and inguinal hernia?

A

Femoral = inferno-lateral to the pubic tubercle

Inguinal = supero-medial to pubic tubercle

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74
Q

How can a femoral hernia be imaged?

A

Ultrasound: operator dependent

CT abdo-pelvis

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75
Q

How is a femoral hernia managed?

A

Surgically

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76
Q

What is gastroenteritis?

A

Inflammation of GI tract

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77
Q

What is the most common cause of gastroenteritis?

A

Viral infection

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78
Q

What information does the timing of onset give you as to the cause of gastroenteritis?

A

Bacterial toxin = hours

Virus = days

Bacteria = weeks

Parasites = months

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79
Q

What is diarrhoea?

A

3/ more loose stool per day

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80
Q

What is acute diarrhoea?

A

< 14 days

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81
Q

What is dysentery

A

Gastroenteritis characterised by loose stools with blood and mucus

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82
Q

What are some risk factors for gastroenteritis?

A

Poor food prep

Poor personal hygiene

Immunocompromised

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83
Q

How does gastroenteritis present?

A

Cramp-like abdominal pain

Diarrhoea

Vomiting

Night sweats

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84
Q

What should be covered in the history?

A

Bowel movements (blood stained, watery?)

Affected family / friends?

Recent travel abroad?

Recent use of abx?

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85
Q

What is the management of gastroenteritis?

A

Rehydration

Education to prevent future episodes

Exclusion from work 24 hours

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86
Q

Is food poisoning a notifiable disease?

A

YES

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87
Q

What are some infective causes of gastroenteritis?

A

Viruses: norovirus, rotavirus

Bacteria: campylobacter, E.coli, salmonella, shigella

Bacterial toxins: Staph aureus, bacillus cereus

Parasites: Schistosoma, cryptosporidum

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88
Q

How long does norovirus last?

A

1-3 days of watery diarrhoea

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89
Q

What type of bacteria is campylobacter?

A

G. Neg bacillus (from chicken, eggs or milk)

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90
Q

What complication can campylobacter infection result in?

A

Reactive arthritis

Guillan Barre syndrome

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91
Q

Where does Cambylobacter, E. Coli, Salmonella and Shigella all come from?

A

Contaminated foodstuff

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92
Q

What kind of organism is C. Diff?

A

Gram positive

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93
Q

What is the worrying complication of a C. Diff infection?

A

Toxic megacolon

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94
Q

How does a C. Diff infection present?

A

Severe bloody diarrhoea

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95
Q

What are some important causes of dysentery?

A

Campylobacter

Shigella

Salmonella

Norovirus

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96
Q

What is a direct inguinal hernia?

A

Bowel enters through ‘Hesselbach’s’ triangle

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97
Q

What is an indirect inguinal hernia?

A

Bowel enters the inguinal canal via deep inguinal ring

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98
Q

How can direct and indirect hernias be differentiated?

A

Indirect: lateral to the vessels

Direct: medial to the vessels

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99
Q

What are the risk factors for inguinal hernias?

A

Male

Increasing age

Raised intra-abdominal pressure: Chronic cough, heavy lifting

Obesity

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100
Q

What are the differentials for lump in the groin?

A

Femoral / inguinal hernia

Inguinal lymphadenopathy

Lipoma

Groin abscess

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101
Q

How is an inguinal hernia diagnosed?

A

Clinical diagnosis

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102
Q

What is the risk associated with inguinal hernias?

A

Strangulation (bowel ischaemia)

Incarcerated hernia (cant return to normal position)

Obstruction (bowel obstruction)

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103
Q

What are some post op complications of hernia repair?

A

Pain, bruising

Recurrence

Damage to vas deferens (leading to sub-fertility)

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104
Q

What is appendicitis caused by?

A

Luminal obstruction:

Faecolith (stoney faeces)

Lymphoid hyperplasia

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105
Q

What are the risk factors for appendicitis?

A

FH

Caucasian

Seasonal presentation (summer)

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106
Q

What are the features of appendicitis?

A

Abdo pain

Peri-umbilical (migrating to RIF)

Vomiting

Anorexia

Nausea

Tachycardia

Tachypnoeic

Pyrexial

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107
Q

Where is McBurney’s point (where the pain is felt in appendicitis)?

A

2/3 way between umbilicus and ASIS

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108
Q

What ‘signs’ are elicited in appendicitis?

A

Rovsing’s sign (RIF pain on palpagtion of LIF)

Psoas sign (RIF pain with extension of the right hip

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109
Q

What are the differentials for Lower Right Quadrant pain?

A

Gynaecological (ovarian cyst rupture, ectopic pregnancy, PID)

Renal (ureteric stones, UTI, pyelonephritis)

GI (Diverticular disease, IBD)

Urological (testicular torsion, epididymo-orchitis)

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110
Q

What are the investigations for RIF pain?

A

Urinalysis (renal/urological cause)

Pregnancy test (or serum b-HCG)

FBC and CRP

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111
Q

How is appendicitis diagnosed?

A

Usually a clinical diagnosis

Ultrasound can be useful (also rules out gynae problems)

112
Q

What is the definitive treatment of appendicitis?

A

Laparoscopic appendicectomy

113
Q

What are the complications of acute appendicitis?

A

Perforation (contamination)

Surgical site infection

Pelvic abscess

114
Q

What is the most common type of colon cancer?

A

Adenocarcinoma

115
Q

What mutations predispose patients to colon cancer?

A

APC

HNPCC

116
Q

What are the risk factors for colon cancer?

A

Increasing age

FH

IBD

Low fibre diet

117
Q

What are the presenting signs of colon cancer?

A

Change in bowel habit

Rectal bleeding

Weight loss

Abdo pain

118
Q

How do right sided colon cancers present?

A

Abdo pain

Occult bleeding/anaemia

Mass in RIF

Present late

119
Q

How do left sided colon cancers present?

A

Rectal bleed

Change in bowel habit

Tenesmus

Mass in LIF

120
Q

What are the main differentials to consider with rectal bleeding and change in bowel habits?

A

IBD (onset 20-40 years old)

Haemorrhoids

121
Q

What test is used to detect blood in the faeces?

A

Faecal Immunochemistry Test (FIT TEST)

122
Q

When is the tumour marker CEA used for colorectal cancer?

A

Monitor disease progression (poor diagnostic usage)

123
Q

What is the gold standard for diagnosis of colorectal cancer?

A

Colonoscopy with biopsy

124
Q

What staging is used for colon cancer?

A

Dukes staging

125
Q

What are the surgical options for colon cancer depending on location?

A

Right Hemicolectomy

Left Hemicolectomy

Sigmoidcolectomy

Anterior resection

Abdominal perineal resection

126
Q

When is an anterior resection used?

A

High rectal tumours > 5cm from anus, leaving sphincter intact

127
Q

When is an abdominal perineal resection used?

A

Low rectal tumour (excision of the distal colon, rectum and anal sphincters) resulting in permanent colostomy

128
Q

When is Hartmann’s procedure used?

A

Emergency bowel surgery e.g. obstruction or perforation

129
Q

What is involved in a Hartmann’s procedure?

A

Complete resection of recto-sigmoid colon

Forming an end colostomy

130
Q

What disease course does Crohn’s take?

A

Relapsing, remitting

131
Q

Where does Crohn’s disease commonly affect?

A

Distal ileum

132
Q

What are the features of the inflammation in Crohn’s?

A

Transmural inflammation (affecting all layers)

Cobblestone appearance

Causes fissures

Skip lesions

Non-caseating granulomatous inflammation

133
Q

Where is the site of inflammation in UC?

A

Mucosa only (in large bowel)

134
Q

What are some risk factors for Crohn’s?

A

FH

Smoking

135
Q

What are the presenting features of Crohn’s?

A

Episodic abdo pain

Bloody chronic diarrhoea

Malaise

Oral ulcers

Peri-anal disease (skin tags, abscesses)

136
Q

What are the extra-intestinal features of Crohn’s?

A

Arthritis of large joints

Erythema nodosum

Pyoderma gangrenosum (ulcers on the shins)

Anterior uveitis

Renal stones

137
Q

What investigations are there for Crohn’s?

A

Routine bloods for anaemia

Abdo xray for toxic megacolon

Faecal calprotectin (sensitivity for IBD)

138
Q

What is the gold standard investigation for Crohn’s?

A

Colonoscopy with biopsy

139
Q

How is Crohn’s managed?

A

Fluids, nutritional support, prophylactic heparin

Inducing remission - corticosteroid therapy & immunosuppressive agents (mesalazine/azathioprine)

Maintaining remission - azathioprine

(Biologics have been used in acute flare ups e.g. infliximab)

140
Q

What are some complications of Crohn’s disease?

A

Fistula

Stricture

141
Q

Where are diverticulum (outpouching) usually found?

A

Sigmoid colon

142
Q

What is diverticulosis, diverticulitis and diverticular disease and Diverticular bleed?

A

Diverticulosis = Presence of diverticula

Diverticulitis = inflammation of diverticula

Diverticular disease = symptoms of diverticula

Diverticular bleed = diverticulum erodes into a vessel

143
Q

What are the risk factors for diverticulum?

A

Age

Low dietary fibre intake

Obesity

Smoking

Family history

144
Q

How does Diverticular disease present?

A

Intermittent low abdo pain

Altered bowel habit

Flatulence

NO SYSTEMIC SYMPTOMS

145
Q

How does acute diverticulitis present?

A

Acute abdo pain

Normally pain in LIF

Decreased appetite

Pyrexia

146
Q

What are the differentials for lower abdo pain and bowel symptoms?

A

IBD

Bowel cancer

Mesenteric ischaemia

Gynaecological causes

147
Q

What investigations can be done for those with symptoms of diverticular disease?

A

Routine blood tests

FBC

CRP

U&Es

Faecal calprotectin?

G&S

148
Q

What can be used to image diverticulitis?

A

CT abdo-pelvis

149
Q

What is the imaging for uncomplicated diverticular disease?

A

Flexible sigmoidoscopy

150
Q

How is diverticular disease managed?

A

Analgesia

Encourage oral fluid intake

151
Q

How is acute diverticulitis managed?

A

ABx

Fluids

Analgesia

152
Q

What is the surgical management of Diverticular disease?

A

In perforation with faecal peritonitis / overwhelming sepsis

HARTMANN’S PROCEDURE (sigmoid colectomy and formation of end colostomy)

Anastomosis with reversal of colostomy may be available at a later date

153
Q

What are some complications of diverticular disease?

A

Stricture

Fistula (colovesical: UTIs, colovaginal)

154
Q

What is pseudo-obstruction?

A

Dilatation of the colon due to an adynamic bowel (absence of mechanical dysfunction)

155
Q

What are the associated risks of pseudo-obstruction?

A

Toxic megacolon

Bowel ischaemia

Perforation

156
Q

What things can cause pseudo-obstruction?

A

Hypercalcaemia, hypothyroidism

Opiods, CCB

Recent surgery

MS

157
Q

What are the features of pseudo obstruction?

A

Abdo pain

Abdo distension

Constipation

Vomiting = late feature

158
Q

What are the differentials for bowel obstruction?

A

Pseudo-obstruction

Paralytic ileus

Toxic megacolon

159
Q

What blood tests should be used for pseudo-obstruction?

A

U&Es

Ca2+

Mg2+

TFTs

160
Q

How should patients with pseudo-obstruction be managed?

A

Nil-by mouth

Started on IV fluids

NG tube (for vomiting)

161
Q

How is the inflammation in UC?

A

Diffuse continual mucosal inflammation from rectum

Crypt abscesses

Smoking is protective

Non granulomatous

Thumbprinting

162
Q

How does UC present?

A

Bloody diarrhoea

Mucus discharge

Increased frequency

163
Q

What are the extra intestinal signs of UC?

A

Arthritis

Erythema nodosum

Uveitis

Primary sclerosing cholangitis

164
Q

What are the investigations for UC?

A

Routine bloods: FBC, U&Es, CRP, LFTs and clotting

Faecal calprotectin

165
Q

How is an acute attack of UC treated?

A

Corticosteroid therapy

Prophylactic heparin

Corticosteroid therapy / immune supppressive agents (azathioprine)

166
Q

What can be used for maintaining remission in UC?

A

Mesalazine or Sulfasalazine

167
Q

What are the life threatening complications of UC?

A

Toxic megacolon

Bowel perforation

168
Q

What is a volvulus?

A

Twisting of loop of intestine around its mesentery

169
Q

Where do most volvuli occur?

A

Sigmoid colon (due to its long mesentery)

170
Q

What are the risk factors for volvulus?

A

Increasing age

Resident in nursing home

Chronic constipation

171
Q

What are the features of volvulus?

A

Colicky pain

Abdo distension

Absolute constipation

172
Q

What are the differentials for bowel obstruction?

A

Pseudo obstruction

Severe constipation

Sigmoid diverticular disease

173
Q

What should be checked in volvulus?

A

Bloods (incl. electrolytes, Ca2+, TFT for pseudo-obstruction)

174
Q

How is UC diagnosed?

A

Colonscopy with biopsy

Abdo X-ray for toxic megacolon

175
Q

What does a sigmoid volvulus show on XR?

A

Coffee-bean sign

176
Q

How is a sigmoid volvulus treated?

A

Sigmoidoscope decompression

177
Q

What are the indications for surgery (Hartmann’s) in UC?

A

Colonic ischaemia

Repeated failed decompressions

Necrotic bowel

178
Q

What are the immediate complications from sigmoid volvulus?

A

Bowel ischaemia

Perforation

179
Q

What are the risk factors for anal cancer?

A

HPV infection (16&18)

HIV

Increasing age

Immunosuppression

180
Q

What are the main symptoms of anal cancer?

A

Rectal pain

Rectal bleeding

Anal discharge

181
Q

Where does lymph drain from below the dentate lines?

A

Superficial inguinal nodes

182
Q

Where does lymph drain from above dentate lines?

A

Para-aortic

183
Q

What are the differentials for anal cancer?

A

Haemorrhoids

Anal fissures

Fistula in ano

Anal warts

184
Q

What are the initial investigations for anal cancer?

A

Proctoscopy

185
Q

What is the surgery for anal cancer?

A

Abdominoperineal resection ​

186
Q

What is an anal fissure?

A

Tear in the mucosal lining of the anal canal (Acute < 6 weeks)

187
Q

What are the risk factors for anal fissures?

A

Constipation

Dehydration

IBD

Chronic diarrhoea

188
Q

How do anal fissures present?

A

Intense pain post defecation

Bleeding

Itching

189
Q

Where do most anal fissures present?

A

Posterior midline

190
Q

How can anal fissures be managed?

A

Increasing fibre and fluid intake

Stool softening laxatives

Topical anaesthetics such as lidocaine

Hot baths (healing process)

191
Q

What is an anorectal abscess?

A

Collection of pus in the anal region

192
Q

What are some common organisms in anorectal abscesses?

A

E. Coli

Enterococcus spp.

193
Q

What are the features of anorectal abscesses?

A

Pain in perianal region, exacerbated when sitting down

Localised swelling

Itching

Discharge

194
Q

What is the management for anorectal abscesses?

A

Abx

Analgesia

Incision and drainage

195
Q

What are haemorrhoids?

A

Abnormal swellings of anal vascular cushions

196
Q

What are the risk factors for haemorrhoids?

A

Excessive straining (constipation)

Increasing age

Raised intra abdo pressure (pregnancy, chronic cough, ascites)

197
Q

How do haemorrhoids present?

A

Painless bright red bleeding after defecation

Priritus (mucus discharge)

Anal lump

198
Q

What are some differentials to consider for rectal bleeding?

A

Malignancy

IBD

Diverticular disease

199
Q

How are haemorrhoids diagnosed?

A

Proctoscopy

200
Q

How are haemhorroids managed?

A

Increase daily fibre / fluid intake

Laxatives

Rubber band ligation (only above dentate line)

201
Q

What are some complications of haemhorroids?

A

Thrombosis

Ulceration

Gangrene

202
Q

What are some risk factors for a perianal fistula?

A

Perianal abscess

Crohn’s / UC

Previous radiation to anal canal

203
Q

What are some risk factors for rectal prolapse?

A

Increasing age

Female gender

Multiple deliveries

204
Q

How do rectal prolapses present?

A

Rectal mucus discharge

Faecal incontinence

Per rectum bleeding

Visible ulceration

Prolapse visible on asking patient to strain

205
Q

What is the management of rectal prolapse?

A

Increase dietary fibre and fluid intake

Definitive surgical repair

206
Q

What lines should incisions follow?

A

Langer’s lines for wound strength and minimal scarring

207
Q

Where is a midline incision?

A

Anywhere from xiphoid process to pubic symphysis

208
Q

What incision is used to gain access to the gallbladder along the costal margin

A

Kocher incision

209
Q

Why does bowel obstruction require fluid resuscitation?

A

Due to secretion of large volumes of electrolyte-fluid into the bowel after increased peristalsis (3rd spacing)

210
Q

What commonly causes small bowel obstruction?

A

Adhesions and herniae

211
Q

What commonly causes large bowel obstruction?

A

Malignancy, diverticular disease and volvulus

212
Q

What are the clinical features of bowel obstruction?

A

Pain

Vomiting

Abdo distension

Absolute constipation

Tinkling bowel sounds

213
Q

What are the lab tests for bowel obstruction?

A

RBC, CRP, U&Es, LFTs, G&S

Venous blood gas (for high lactate - evidence of ischaemia)

214
Q

What is the imaging of choice in bowel obstruction?

A

CT scan with IV contrast

215
Q

Why is CT better than XR for bowel obstruction?

A

Differentiate between mechanical and pseudo-obstruction

Can find the site and cause of obstruction

May show mets

216
Q

How do small bowel and large bowel obstruction appear on XR?

A

Small = dilated bowel, central location, lines crossing the bowel

Large = dilated, peripheral location, haustra lines visible

217
Q

What is the conservative management of bowel obstruction?

A

Drip and suck =

Start IV fluid and NG tube to decompress the bowel

Urinary catheter and fluid balance

Analgesia

218
Q

What are the complications of bowel obstruction?

A

Bowel ischaemia

Bowel perforation

Dehydration and renal impairment

219
Q

What is dysphagia?

A

Difficulty in swallowing

220
Q

What are some causes of dysphagia?

A

Oesophageal malignancy

Oesophageal strictures

Pharyngeal pouch

Achalasia

Post stroke

Spasm

221
Q

What are the investigations for dysphagia?

A

Endoscopy + biopsy

FBC, LFTs

Manometry

222
Q

What are the 2 common causes of GI perforation?

A

Peptic ulcer

Sigmoid diverticulum

223
Q

What are the differentials for acute abdominal pain?

A

Acute pancreatitis

MI

Ovarian torsion

Ruptured aneurysm

GI perforation

224
Q

What are the investigations for an acute abdomen?

A

Routine blood tests

G&S

WCC

CRP

225
Q

Name 3 causes for acute mesenteric ischaemia?

A

Atherosclerosis

Embolus from AF

Hypovolaemic shock

226
Q

How does acute mesenteric ischaemia present?

A

Abdo pain out of proportion to clinical findings

Nausea

Vomiting

227
Q

What is the definitive diagnosis of acute mesenteric ischaemia informed by?

A

CT scan with IV contrast

228
Q

What is the initial management of acute mesenteric ischaemia?

A

Urgent resuscitation

Catheter

Fluid balance chart

Broad-spectrum Abx for risk of perforation

229
Q

What is the definitive management of acute mesenteric ischaemia?

A

Excision of necrotic bowel

Revascularisation

230
Q

What are the main risks form mesenteric ischaemia?

A

Bowel necrosis and perforation

Mortality

231
Q

What is the imaging for gastro perforation?

A

eCXR to show air (70% sensitive)
Gold standard = CT

232
Q

What is the management of GI perforation?

A

Broad spectrum Abx
IV fluid support
Nasogastric tube

233
Q

What can cause haematemesis?

A
  • Oesophageal varices (urgent OGD)
  • Gastric ulceration (lesser curve of stomach)
  • Mallory-Weiss tear
  • Oesophagitis (bisphosphonates)
234
Q

What are the investigations for haematemesis?

A

FBC
U&Es
LFTs (liver cause?)
Clotting
VBG
G&S
Erect chest x ray (pneumoperitoneum)

235
Q

What scoring system can be used to risk stratify pts with upper GI bleed?

A

Glasgow-Blatchford Bleeding Score

236
Q

What is the management of patients with an upper GI bleed?

A

A-E assessment
Insert 2 large bore IV cannulas
Fluid resuscitation
Crossmatch blood

237
Q

How is a peptic ulcer bleed managed?

A

Inject adrenaline
Cauterise bleed
High dose PPI

238
Q

How should oesophageal varies be managed?

A

Endoscopic banding
Terlipressin (reduce splanchnic blood flow)

239
Q

What can cause melena?

A

Peptic ulcer disease

  • *Variceal bleeds**
  • *Upper GI malignancy**
240
Q

What artery is eroded in peptic ulcer disease?

A

Gastroduodenal

241
Q

What are the investigations for melena?

A
  • Routine bloods
  • FBC
  • U&Es
  • LFTs (liver problems )
  • Clotting
  • Raised urea is indicative of an upper GI bleed (digested Hb)
  • ABG
  • OGD
242
Q

What causes fresh rectal bleeding?

A
  • Diverticular disease
  • Ischaemic colitis
  • Haemorrhoids
  • Malignancy
  • Angiodysplasia
  • Crohns
  • UC
243
Q

What are the investigations for a GI bleed?

A

FBC
U&Es
LFT
Clotting
G&S
Stool culture (for infective cause)

244
Q

How are patients with a lower GI bleed managed if they are stable/unstable?

A
  • *Unstable** = Urgent CT angiogram (source of bleeding)
  • *Stable** = flexible sigmoidoscopy
245
Q

How are unstable rectal bleeds managed?

A
  • Fluid resuscitation
  • Hb < 70 transfusion of packed RBCs
  • Anti-coag stopped
246
Q

What can cause an acute abdomen?

A
  • Ruptured AAA
  • Ruptured ectopic
  • Bleeding gastric ulcer
  • Trauma
  • Peritonitis
247
Q

How do patients with generalised peritonitis present?

A

Completely still (not to move abdomen)
Tachycardia
Involuntary guarding
Reduced / absent bowel sounds (paralytic ileus)

248
Q

What can cause RUQ pain?

A

Cholecystitis
Pyelonephritis
Ureteric colic
Hepatits
Pneumonia

249
Q

What can cause LUQ pain?

A

Pyelonephritis
Gastric ulcer
Ureteric colic
Pneumonia

250
Q

What can cause RLQ pain?

A

Appendicitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynae

251
Q

What can cause LLQ pain?

A

Diverticulitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynae
Testicular torsion

252
Q

What are the investigations in acute abdomen?

A

Urine dipstick (infection)
Pregnancy test
ABG (for sepsis)
FBC, U&Es, LFTs, CRP, amylase
Serium calcium (pancreatitis)
G&S
Blood cultures
ECG (for MI)
Ultrasound KUB for renal pathology, biliary tree for gallstones
eCXR (bowel perforation)

253
Q

What is the general management of the acute abdomen?

A
  • IV access
  • NBM
  • Analgesia
  • VTE prophylaxis
  • Urine dip
  • Bloods
254
Q

What is the small bowel usual diameter upper limit?

Large bowel?

Caecum?

A

3cm

6cm

9cm

255
Q

What is the “Top and Tail” investigation for GI malignancy?

A

OGD and Colonoscopy

256
Q

What is a covering loop ileostemy

A

A temporary ileostomy created to protect a distal anastomosis

257
Q

When is ultrasound better than CT for imaging the abdo?

A

Ovarian cysts

Cholecystitis

258
Q

What stimulates contraction of the gallbladder?

A

CCK from the duodenum

259
Q

What term describes the process of making an incision into the abdomen to explore as an open procedure the contents of the abdomen?

A

Laparotomy

260
Q

What might a surgeon use a Rutherford Morrison incision for?

A

Renal transplant

261
Q

what factors normally prevent reflux?

A
262
Q

what are the investigations for a suspected upper GI malignancy?

A

OGD

CT chest abdo pelvis and PET- CT for mets

Endoscopic ultrasound to measure penetration into oesophageal wall

263
Q

What is the main complication follow oesophageal carcinoma treatment?

A

anastomotic leak, pneumonia, death

264
Q

what is the removal of the oesophagus called?

A

Oesophagectomy - removes tumour, top of stomach and surrounding lymph nodes, stomach is then made into a tube to replace the oesophagus (Ivor-Lewis procedure does this by laparotomy)

265
Q

when can a patient eat after oesophagectomy?

A

2 weeks

266
Q

What is the consequence of poorly controlled post op pain?

A

slower recovery

reluctance to mobilise

Inadequate ventilation and subsequent atelectasis

267
Q

What is atelectasis?

A

Partial collapse of the small airways due to impairment of surfactant production causing hypoxaemia, pulmonary infections

Diagnosed CLINICALLY

268
Q

What is the treatment for atelectasis?

A

Deep breathing exercises and chest physio, adequate pain control

269
Q

On what cells do PPIs work?

A

Gastric parietal cells

270
Q

what causes EPIGASTRIC PAIN?

A
271
Q

what causes EPIGASTRIC PAIN?

A

peptic ulcer disease

Cholecystitis

Pancreatitis

Myocardial Infarction

272
Q

How to interpret LFTs ?

A

is ALT raised more than 10 times? (Hepatocyte injury)

Is ALP raised more than 3 times? (Cholestasis indicator)

Is GGT raised? (Biliary obstruction / alcohol)

Isolated raised ALP (non-hepatobiliary = bony mets, vit D deficiency, fracture)

Isolated raised bilirubin? (Pre hepatic cause e.g. gilberts, haemolysis)

Ratio between AST/ALT (AST> then alcoholic/cirrhosis or if ALT>AST then chronic liver disease)

273
Q

What can cause acute hepatocellular injury?

A

Poisoning (paracetamol)

Infection (hep A/B)

Liver ischaemia

274
Q

What is a Whipple’s procedure?

A

Removal of head of pancreas, start of duodenum, gallbladder

Tail of pancreas and hepatic duct are then attached to the jejunum

275
Q

What is courvisiers law?

A

Pesence of jaundice and enlarged gallbladder = pancreatic cancer

Treatment = radical resection

Surgery - DONE (9 decks)

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