General Surgery, GI and HPB Flashcards
Gastro-Oesophageal Reflux Disease
1) Clinical diagnosis - resolution of symptoms after trial of PPI
2) If red flags/resistant GORD - Urgent OGD
3) If medical treatment fails, and surgery is being considered - 24hr pH monitoring + Oesophageal manometry
Barrett’s Oesophagus
1) Histological diagnosis - OGD
Oesophageal Cancer
1) OGD to be performed within 2 weeks - Biopsy and sent for histology
2) CT CAP/PET-CT - for distant met
Oesophageal Perforation
1) Initial - CXR
2) Gold Standard = CT CAP with IV and Oral contrast
Achalasia
1) Gold Standard = Oesophageal manometry
2) Urgent OGD - to exclude cancer
Hiatus Hernia
1) Gold Standard = OGD
Peptic Ulcer Disease
1) OGD
2) Non-invasive H.pylori testing
- Urea breath test
- Stool antigen test
Gastric Cancer
1) Urgent OGD
2) Staging and planning treatment - CT CAP + Staging laparoscopy
Angiodysplasia
1) Exclude malignancy - OGD/Colonoscopy depending on site of bleed
2) Small bowel bleeds - Wireless capsule endoscopy
3)
Acute Appendicitis
1) First line - Ultrasound
2) CT - Good sensitivity and specificity
Colorectal Cancer
1) Gold Standard = Colonoscopy with biopsy
2) CT - to look for distant mets
3) MRI - to assess depth of invasion
Diverticulosis
1) Found incidentally during routine colonoscopy or CT
Diverticulitis
1) Investigation of choice - CT Abdo-Pelvis
* Colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation
Uncomplicated diverticular disease
1) Flexible sigmoidoscopy (dont do in diverticulitis) - to identify any rectosigmoid lesion
2) If not suitable - CT colonography alternative
Crohn’s Disease
1) Acutely - Abdo XR
2) Gold standard = Colonoscopy with biopsy
3) CT Abdo-Pelvis - Severe crohn’s (can demonstrate bowel obstruction, perforation, fistulae)
4) MRI scan – particularly useful for looking for enteric fistulae
Ulcerative Colitis
1) Acutely - Abdo XR/CT
2) Gold standard = Colonoscopy with biopsy
3) A flexible sigmoidoscopy may be sufficient
*colonoscopy should be avoided in acute severe exacerbations
Volvulus
1) Initial - CT Abdo-Pelvis with contrast
2) Some centres - AXR (Coffee bean sign)
Haemorrhoids
1) Proctoscopy - to confirm diagnosis
2) Exclude malignancy - Flexible Sigmoidoscopy/Colonoscopy
Perianal Fistula
1) Proctoscopy - visualise the opening of the tract
2) Complex Fistula - MRI (visualise anatomy of tract)
Anal Cancer
1) Proctoscopy - take a biopsy too
2) USS-guided Fine Needle Aspiration - Inguinal lymph nodes
3) CT CAP - distant mets
4) MRI - to assess local invasion
Biliary Colic and Cholecystitis
1) Trans-abdominal ultrasound - sensitive for visualising gallstone disease
2) Gold standard* = MRCP
*Any patient with symptoms suggestive of gallstones with inconclusive US (or CT scans) should undergo a MRCP
Ascending Cholangitis
1) USS of biliary tract - bile duct dilation
2) Gold Standard = ERCP
(some donnies will also do MRCP, but ERCP here is both diagnostic and therapeutic)
Cholangiocarcinoma
1) Initially - USS to confirm obstructive cause
2) Optimal imaging for diagnosis - MRCP
3) ERCP - may demonstrate site of obstruction and can be used for biopsy
4) Staging - CT (CT>MRI for locating distant mets)
Hepatocellular Carcinoma
1) Gold standard = USS
2) For further evaluation - Staging CT
3) MRI - if suggestive US nodules and rising AFP
3) In still doubtful - biopsy or percutaneous fine-needle aspiration
