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BRS Y2 > General surgery in GI > Flashcards

General surgery in GI Flashcards

1
Q

Bowel ischaemia​- small vs large bowl- name of condition

A

Mesenteric ischaemia: small bowel​

Ischaemic colitis: Large bowel

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2
Q

Acute Mesenteric Ischaemia-
where
cause
onset
pain?

A

Small bowel​

Usually occlusive due to thromboemboli​

Sudden onset (but presentation and severity varies)​

Abdominal pain out of proportion of clinical signs​

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3
Q

​Ischaemic Colitis
​where
cause
onset
pain?

A

Large bowel​

Usually due to non-occlusive low flow states, or atherosclerosis​

More mild and gradual (80-85% of the cases)​

Moderate pain and tenderness​

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4
Q

Bowel ischaemia- presentation

A

Acute/chronic pain​

All over abdomen​

Rectal bleeding  colonic ischaemia

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5
Q

Bowel ischaemia​- risk factors

A

Age >65yrs, arrhythmias, atherosclerosis, hypercoagulation/thrombophilia, vasculitis, SCD, hypotension (due to shock)

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6
Q

bowel ischaemia -Investigations

A

Bloods: FBC, VBG​

Imaging (CT angiogram): detects disrupted flow​

Endoscopy: for mild or moderate cases of ischaemic colitis

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7
Q

Bowel ischaemia - conservative Management

A

For mild to moderate cases ​
-IV fluid resuscitation​
-Bowel rest​
-Broad-spectrum antibiotics​
-NG tube for decompression​
-Anticoagulation​
-Treat/manage underlying cause​
-Repeated imaging and examinations

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8
Q

Bowel ischaemia -Surgical management

A

Indications: small bowel ischaemia, signs of sepsis, instability bp, massive haemorrhage, severe colitis with toxic megacolon​

Laparotomy: resection of necrotic bowel ± open surgical embolectomy or mesenteric arterial bypass​

Endovascular revascularisaiton: balloon angioplasty/ thrombectomy; in patients without signs of ischaemia

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9
Q

Acute appendicitis​-Examination and what is McBurney’s point:

A

General inspection: pain (worsen on movement), lying still (peritonitis)​.

McBurney’s point: tenderness in the RLQ (lateral 1/3 of a hypothetical line drawn from the right ASIS to the umbilicus)

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10
Q

Appendicitis- 4 signs

A

-Rovsing’s Sign
-obturator sign
-psoas sign
-rebound tenderness

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11
Q

what is rovsing’s sign

A

Pain is greater in RIF than LIF when LIF is pressed

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12
Q

what is Obturator sign

A

Pain on passive flexion and internal rotation of the hip

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13
Q

what is psoas sign

A

Pain on extending hip (only with retrocaecal appendix)

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14
Q

what is Rebound tenderness​

A

If infection involves peritoneum

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15
Q

Appendicitis investigations

A

1st line: CT abdomen​

USS: used in children/pregnancy/breastfeeding​

Bloods: neutrophilic leukocytosis, elevated CRP​

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16
Q

appendicitis investigation- alvorado score

A

-right lower quadrant tenderness (2)
-temp 37.c + (1)
-rebound tenderness (1)
-anorexia (1)
-Nausea/vomiting (1)
-migration of pain to right lower quadrant (1)
-leukocytosis 10,000+ (2)
-left shift- (1)

1-4: Discharge ,​
5-6: Observe,​
7-10: Surgery,

17
Q

Appendicitis - Management- conservative

A

IV fluids, analgesia, IV/PO antibiotics​

recurrence after conservative management-consider interventional appendicetomy

18
Q

Appendicitis - Management- surg

A

Laparoscopic vs Open appendicectomy​

-Less pain​
-Lower incidence of surgical site infection​
-↓ed length of hospital stay​
-Earlier return to work​
​-Better quality of life scores

19
Q

Bowel obstruction​- presentation, cause- SBO vs LBO

A

SBO =central pain. abdominal distension​ less sig. early onset- vomiting
LBO=constant pain. abdominal distension​ sig. early sign=absolute constipation

dehydration/absent bowel sound (late sign)

Cause:
SBO =adhesions; neoplasia.
LBO= colorectal tumours, volvulus + diverticulitis

20
Q

Bowel obstruction -INVESTIGATION

A

AXR: Rigler’s sign, volvulus (caecal or sigmoid)​

CT abdomen​

Bloods: FBC, X-match, U&Es etc.

21
Q

Bowel obstruction- What is seen on x-ray and CT purpose

A

SBO =central loops, striations completely visible​

LBO = peripheral large bowels​

CT scans can localise site of obstruction

22
Q

Bowel obstruction - management- conservative

A

-Faecal impaction​-stool evacuation

-Sigmoid volvulus – rigid sigmoidoscope decompression

23
Q

Bowel obstruction - management- Supportive

A

Fluids​

Analgesia​

NBM​

NG tube for decompression​

Gradual food intake

24
Q

Bowel obstruction - management​ -surg

A

Laparotomy ​

Bowel resection + anastomosis

25
Q

GI perforation presentation overview

A

Sudden abdominal pain​

N&V​

Constipated​

Shock -> tachycardia, hypotension, tachypnoea

26
Q

GI perforation- 4 types of cause and presentation

A

perforated peptic ulcer
-sudden epigastric pain
-referred to shoulder
-hX of NSAIDs, steroids

perforated diverticulum
-LLQ pain
-constipation

perforated appendix
-migratory pain
-anorexia
-gradual worsening RLQ pain

perforated malignancy
-change in bowel habit
-weight loss
-anorxia
-PR bleeding

27
Q

GI perforation​- blood and imaging results

A

Bloods​
-FBC – neutrophilic luekocytosis, lactic acidosis​
-Inflammatory markers raised​

Imaging​
-Pneumperitoneum- presence of gas in abdominal cavity

28
Q

GI perforation supportive management and surg

A

Supportive management​
Fluids, analgesia, NBM​

Surgical​
-Laparotomy ​
-Resection of perforated segment + anastomosis

29
Q

Sigmoid volvulus​- sign on X-ray

A

​​X-ray – coffee bean sign

30
Q

Sigmoid volvulus- treatment

A
  1. rigid sigmoidoscope: untwists the volvulus and leads to release of lots of flatus + liquid faeces​
  2. Surgical if this doesn’t work: hartmanns procedure
31
Q

what happens if you leave sigmoid volvulus untreated

A

tissue undergoes necrosis and bowel death

32
Q

Biliary Colic​- management

A

Analgesia, Antiemetics,

Follow up for elective cholecystectomy

33
Q

Acute Cholecystitis- symptom and treatment

A

Fever​/ Murphy’s sign

Fluids, ABx, Analgesia, Blood cultures​

elective cholecystectomy

34
Q

Acute Cholangitis symptom and treatment

A

Charcot’s triad: jaundice, RUQ pain, fever

Fluids, IV Abx, Analgesia​

ERCP (Endoscopic retrograde cholangiopancreatography) (within 72hrs) for clearance of bile duct or stenting

35
Q
A

BRS Y2 (60 decks)

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