General Surgery (colorectal) Flashcards
What are the causes of pancreatitis?
Gallstones
Alcohol
Steroids
Other:
- trauma, mumps, SLE, ERCP, hypothermia, hypercalcaemia
Drugs:
- azathioprine and mesalazine, NSAIDs, diuretics, sodium valproate
Brief pathophysiology of pancreatitis
duct obstruction leads to ischaemia and acinar cell injury
- lipase released: fat necrosis with fatty acids binding calcium leading to hypocalcaemia
- islet cells damaged: hyperglycaemia
- protease and elastase released: haemorrhage
All leading to infection and inflammation
Aside from pancreatitis, when else would amylase be raised?
Ectopic pregnancy Renal failure DKA cholecystitis mesenteric ischaemia
Why is serum lipase not accurate in diagnosing pancreatitis?
It takes 8 hours after symptom onset to rise
If you were to do an AXR or CXR in pancreatitis, what might it show?
CXR: pneumoperitoneum or pleural effusion
AXR: sentinel loop sign (dilated proximal bowl)
What are the signs and symptoms of pancreatitis?
Epigastric pain radiating to the back
Guarding
Nausea and vomiting
Tetany (hypocalcaemia)
Tachycardic and hypotensive
Cullens: peri-umbilical brusing
Grey-turners: flank brusing
Left sided pleural effusion
What system would you use to calculate the severity/prognosis? What are some markers used in this score?
Glasgow scoring system
Low sats
>55
Raised neutrophils
Raised Urea
Raised LDH
Raised glucose
Hypoalbuminaemia
Hypocalcaemia
What is the management of pancreatitis?
IV Fluids
Analgesia
Antiemetics
Monitor Blood Glucose
Analgesia
What are some complications of pancreatitis?
Infective necrosis Abscess Pseudocyst Chronic pancreatitis DIC ARDS and pleural effusions
What is the difference between acute and chronic pancreatitis? Therefore, how does chronic pancreatitis present?
In chronic pancreatitis it is the secretory function of the pancreas that is damaged
Diabetes
Steatorrhea
+ pain after eating
What are the causes of chronic pancreatitis?
Alcohol
Cystic fibrosis
Duct obstruction with tumour or stones
How should you investigate chronic pancreatitis? What is seen?
CT
Shows pancreatic calcifications
How is chronic pancreatitis managed?
Fat soluble vitamins
Pancreatic enzymes
Analgesia
Where are pancreatic pseudocysts most commonly located?
Lesser sac
Gastro-epiploic foramen
How do pancreatic pseudocysts present?
Biliary or gastric outlet obstruction
When and how does post-op ileus present?
Few days post-op
!!Hypovolaemia and low electrolytes despite positive fluid balance!!
Distension
N&V
Absolute constipation
What is third spacing?
How is it managed?
obstruction = proximal bowel hugely dilates = increased peristalsis = electrolyte rich secretions move from vascular space to bowel
Fluid resus
How does bowel obstruction present?
Distension + absolute constipation + vomiting + pain + empty rectum
What measurements constitute enlarged small bowel, large bowel and caecum?
small >3cm
large >6cm
caecum >9cm
What causes large bowel obstruction?
Colorectal cancer
Diverticulitis
Volvulus
IBD
What causes small bowel obstruction?
Hernia
Adhesions
Tumours, peritoneal metastasis, lymphomas
Compare what you’d hear on auscultation of large and small bowel obstruction
Large: loud but normal pitch
Small: high pitch tinkling
Percussion of a small bowel obstruction sounds like what?
Tympanic
How is bowel obstruction managed?
Fluid resuscitation
NG tube to decompress