Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

brs2 > general surgery in gi tract > Flashcards

general surgery in gi tract Flashcards

1
Q

what is the general approach to a presenting complaint

acute abdomen

A 
pain assessment - SOCRATES
associated symptoms
pmhx
dhx
shx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the general investigations for acute abdomen

A 
bloods: vbg,fbc,crp,u&e,lfts and amylase
urinalysis
imaging - erect and urine mc&s
cxr,axr,ctap,ct,angiogram,uss
endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how to manage acute abdomen

A

ABCDE approach
conservative management?
surgical management?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the general presentation for bowel ischaemia

A

sudden onset crampy abdo pain
severity of pain depends on length and thickness of colon affected
blood,loose stools
fever,signs of septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the risk factors for bowel ischaemia

A 
age >65yr
cardiac arythmias, atherosclerosis
hypercoagulation, thrombophilia
vasculitis
scd
profound shock causing hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how is acute mesenteric ischaemia different to ischaemic colitis

A

occurs in small bowel
usually occlusive due to thromboemboli
sudden onset - presentation and severity varies
abdo pain out of proportion of clinical signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is ischaemic colitis different to acute mesenteric ischaemia

A

occurs in large bowel
usually due to non occlusive low flow states/atherosclerosis
more mild and gradual
moderate pain and tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what would you expect to see in the fbc of bowel ischaemia

A

neutrophilic leukocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what would you expect to see in the vbg of bowel ischaemia

A

lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what might you see in a ctpap or ct angiogram of someone with bowel ischaemia

A

disrupted flow
vascular stenosis
‘pneumatosis intestinalis’ - transmural ischaemia/infarction
ischaemic colitis - thumbprint sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when might you use endoscopy in someone with bowel ischaemia

A

for mild/moderate causes of ischaemic colitis

oedema, cyanosis, ulceration of mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the conservative management for bowel ischaemia

A 
iv fluid resusitation
bowel rest
broad spectrum antibiotics( colonic ischaemia can result in bowel translocation + sepsis)
ng tube for decompression
treat/manage underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the indications for surgical management of bowel ischaemia

A 
small bowel ischaemia
signs of peritonitis/sepsis
haemodynamic instability
massive bleeding
fulminant colitis with toxic megacolon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the surgical management of bowel ischaemia

A

exploratory laparotomy - resection of necrotic bowel +- open surgical embolectomy or mesenteric arterial bypass
endovascular revascularisation - balloon angioplasty/thrombectomy
in patients without signs of ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

typical presentation of appendicitis

A

initially periumbilical pain that migrates to RLQ (within 24hrs)
anorexia, nausea +- vomiting, low grade fever, change in bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the important signs of appenditicitis

A

mcburneys point - tenderness in rlq
blumbeg sign - tenderness expecially in rif
rovsing sign - rlq pain elicited on deep palpation of llq
psoas sign - rlq pain elicited on flexion of right hip against resistance
obturator sign - rlq pain on passive internal rotation of hip with hip and knee rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what would you expect to see on blood of one with appendicitis

A

fcb - neutrophilic leukocytosis
elevated crp
urinalysis - possible mild pyuria/haematuria
electrolyte imbalances in profound vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what imaging techniques would be used for appendicitis

A

ct - gold standard in adults esp if age >50
uss - for children/pregnancy,breastfeeding
mri - in pregnancy if uss inconclusive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when might you use a diagnostic laparoscopy in appendicitis

A

if in persistent pain and inconclusive imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what scale is used for severity of appendicitis

A 
alvarado score:
rlq tenderness
fever
rebound tenderness
pain migration
anorexia
nausea and vomiting
wcc
neutrophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the conservative management for acute appendicitis

A

iv fluids
analgesia
iv/po antibiotics
in abscess,phlegmon or sealed perforation - resuscitation and iv antibiotics +- percutaneous drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the indications for conservative management of acute appendicitis

A

after negative imaging in selected patients with clinically umcomplicated appendicitis
in delayed presentation with abscess/phlegmon formation - ct guided drainage
*consider interval appendicetomy - rate of recurrence after conservative management of abscess/perforation is 12-24%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why is laparoscopic preferred over open appendicetomy

A 
less pain
lower incidence of surgical site infection
decreased length of hospital stay
earlier return to work
overall costs
better quality of life scores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the steps in laparoscopic appendicetomy

A
  1. trocar placement - usually 3
  2. exploration of rif and identification of appendix
  3. elevation of appendix and division of mesoappendix(containing artery)
  4. base secured with endoloops and appendix is divided
  5. retrieval of appendix with plastic retrieval bag
  6. careful inspection of rest of pelvic organs/intestines
  7. pelvic irrigation and haemostasis
  8. removal of trocars and wound closure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is intestinal obstruction

A

restriction of normal passage of intestinal contents
2 main groups:
paralytic(adynamic) ileus
mechanical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how is mechanical obstruction classified

A

speed of onset: acute,chronic, acute on chronic
site; high/low
nature: simple/stangulating
aetiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the different causes of bowel obstruction in lumen

A

faecal impaction

gallstone ‘ileus’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the causes in wall in bowel obstruction

A

chrons disease, tumours, diverticulitis of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the causes of bowel obstruction outside the wall

A 
strangulated hernia (external/internal)
volvulus
obstruction due to adhesions/ bands
30
Q

what is meant by simple bowel obstruction

A

bowel is occluded without damage to blood supply

31
Q

what is meant by strangulating bowel obstruction

A

blood supply of involved segment of intestine is cut off

e.g strangulated hernia, volvulus, intussusception

32
Q

what are some causes of small bowel obstruction

A

adhesions (60%) - hx of previous abdominal surgery
neoplasia(20%) - primary,metastatic, extraintestinal
incarcerated hernia
chrons disease
other e.g intussesception, foreign body,bezoar

33
Q

what are some causes of large bowel obstruction

A

colorectal carcinoma
volvulus - sigmoid, caecal
diverticulitis - inflammation, strictures
faecal impaction
hirschsprung disease - commonly found in infants

34
Q

what is the presentation of small bowel obstruction

A

colicky and central abdominal pain
early onset of vomiting, large amounts and bilious
constipation is a late sign
less significant abdominal distention
other signs: dehyration, increased high pitched tinkling bowel sounds, absent bowel sounds(late)
diffuse abdominal tenderness

35
Q

what is the presentation of large bowel obstruction

A

colicky or constant abdo pain
late onset vomiting, initially bilious and progresses to faecal vomiting
constipation is early sign
abdominal distention is an early sign and significant
other signs: dehyrdration, increased high pitched tinkling bowel sounds / absent bowel sounds(late)
diffuse abdominal tenderness

36
Q

how to diagnose bowel obstruction

A
  • diagnosed by presnece of symptoms
    examinatio should always include search for hernias and abdo scars, incl laparoscopic portholes
    is it simple/strangulating
37
Q

what are some features suggesting strangulation

A 
change in character of pain from colicky to continuous
tachycardia
pyrexia
peritonism
bowel sounds absent/reduced
leucocytosis
elevated crp
38
Q

where are common hernial sites

A 
epigatric
umbilical
incisional
inguinal
femoral
39
Q

bloods for bowel obstruction

A

wcc/crp usually normal
u&e - electrolyte imbalance
vbg - if vomiting hypocl-/k+ , metabolic alkalosis
vbg if strangulation

40
Q

imaging for bowel obstruction

A

erect cxr/axr
sbo - dilated small bowel loops >3cm proximal to obstruction
lbo - dilated large bowel >6cm
ct abdo/pelvis

41
Q

what would you see in an abdo x ray in small bowel obstruction

A

ladder pattern of dilated loops and their central position

striations that pass completely across width of distended loop produced by circular mucosal folds

42
Q

what would you see in abdo xray in large bowel obstruction

A

distended large bowel tends to lie peripherally

show haustrations of taenia coli - do not extend across whole width of bowel

43
Q

why is a ct scan useful in bowel obstruction

A

Can localize site of obstruction
Detect obstructing lesions & colonic tumours
May diagnose unusual hernias (e.g. obturator hernias).

44
Q

supportive management in bowel obstruction

A

In patients with no signs of ischaemia/no signs of clinical deterioration
Supportive management
NBM, IV peripheral access with large bore cannula -IV Fluid resuscitation
IV analgesia, IV antiemetics, correction of electrolyte imbalances
NG tube for decompression, urinary catheter for monitoring output
Introduce gradual food intake if abdominal pain and distention improve

45
Q

conservative treatment of bowel obstruction

A

Faecal impaction: stool evacuation (manual, enemas, endoscopic)
Sigmoid volvulus: rigid sigmoidoscopic decompression
SBO: oral gastrograffin (highly osmolar iodinated contrast agent)can be used to resolve adhesionalsmall bowel obstruction

46
Q

indications for surgical management of bowel ostruction

A

Haemodynamic instability or signs of sepsis
Complete bowel obstruction with signs of ischaemia
Closed loop obstruction
Persistent bowel obstruction >2 days despite conservative management

47
Q

what are the operations for bowel obstruction

A

Exploratory laparotomy/Laparoscopy
Restoration of intestinal transit (depending on intra-operational findings)
Bowel resection with primary anastomosis or temporary/permanent stoma formation
or endoscopic stenting if obstruction is distal

48
Q

how do gi perforations present

A

sudden onset severe abdominal pain associated with distention
diffuse abdominal guarding, rigidity and rebound tenderness
pain aggravated by movement
nausea, vomiting, absolute constipation
fever, tachycardia, tachypnoea, hypotension
decreased or absent bowel sounds

49
Q

what is the presentation of perforated peptic ulcer

A

sudden epigastric/diffuse pain
referred shoulder pain
- history of NSAIDs,steroids, recurrent epigastric pain

50
Q

what is the presentation of perforated diverticulum

A

llq pain

constipation

51
Q

what is the presentation of perforated appendix

A

migratory pain
anorexia
gradual worsening rlq pain

52
Q

what is the presentation of perforated malignancy

A

change in bowel habit
weight loss
anorexia
pr bleeding

53
Q

blood investigations for gi perforation

A

fbc: neutrophilic leukocytosis
possible elevation of urea and creatine
vbg - lactic acidosis

54
Q

what imaging is used to investigate gi perforations

A

erect cxr - check for subdiaphragmatic free air (pneumoperitoneum)
ct abdo/pelvis - pneumoperitoneum, free gi content, localised mesenteric fat stranding
- can exclude common differential diagnoses e.g pancreatitis

55
Q

what are some differential diagnosis for gi perforation

A

acute cholecystitis
appendicitis
mi
acute pancreatitis

56
Q

what is the supportive management for gi perforations on presentation

A 
nbm and ng tube
iv peripheral access with large bore canuula - iv fluid resuscitation
broad spectrum antibiotics
iv ppi
paraenteral analgesia and amt emetics
urinary catheter
57
Q

what is the conservative management in localised peritonitis without signs of sepsis
* very rare

A

ir - guided drainage of intraabdominal collection

serial abdominal examination and abdominal imaging for assessment

58
Q

surgical management in generalised peritonitis +- signs of sepsis

A

exploratory laparotomy/ laparoscopy
primary closure of perforation with/without omental patch
resection of perforated segment of bowel with primary anastmosis/temporary stoma
obtain intra abdominal fluid for mc and s, peritoneal lavage

59
Q

what is the surgery for perforated appendix

A

laparoscopy or open appendicectomy

60
Q

what is the surgical management for malignancy in gi perforation

A

intraoperative biopsies if possible

61
Q

symptoms of biliary colic

A

postprandial ruq pain with radiation to shoulder

nausea

62
Q

expect to see in investigations of biliary colic

A

normal blood results

uss: cholelithiasis

63
Q

symptoms of acute cholecystitis

A

acute, severe ruq pain
fever
murphys sign

64
Q

what would you expect to see in investigations of acute cholecystitis

A

elevated wcc/crp

uss - thickened gallbladder wall

65
Q

how to manage acute cholecystitis

A 
fluids
antibiotics
analgesia
blood cultures
early or elective cholecystectomy (4-6wks)
66
Q

symptoms of acute cholangitis

A

charcots triad: jaundice, ruq pain and fever

67
Q

what would you expect to see in investigations of acute cholangitis

A

elevated lfts,wcc,crp, blood mcs (positive)

uss: biliary dilation

68
Q

management of acute cholangitis

A

fluids
iv antibiotics
analgesia
ercp within 72hrs for clearance of bileduct/stenting

69
Q

what are the symptoms of acute pancreatitis

A

severe epigastric pain radiating to back
nausea +- vomiting
history of gallstones and ethanol use

70
Q

what do you expect to find in investigations for acute pancreatitis

A

raised amylase/lipase
high wcc/ low calcium
ct and us to assess for complications/cause

71
Q

what is the management for acute pancreatitis

A

admission score - glasglow imrie
aggressive fluid resusitation,o2
analgesia and antiemetics
itu/hdu involvement

brs2 (65 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions