General Surgery in the GI tract Flashcards

1
Q

How do we assess abdominal pain?

A

SOCRATES

site, onset, character, radiation, association, time course, exacerbating and relieving factors, severity

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2
Q

How do we manage any emergency?

A

ABCDE

airways, breathing, circulation, disability, exposure

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3
Q

What are some differential diagnosis associated with right upper quadrant pain?

A

biliary colic
cholecystitis
acute hepatitis

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4
Q

What are some differential diagnosis associated with epigastrium pain?

A

acute gastritis
acute pancreatitis
peptic ulcer

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5
Q

What are some differential diagnosis associated with left upper quadrant pain?

A

peptic ulcer
acute pancreatitis
splenic infarction

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6
Q

What are some differential diagnosis associated with right lower quadrant pain?

A

acute appendicitis
colitis
inflammatory bowel disease

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7
Q

What are some differential diagnoses for suprapubic pain?

A

bowel obstruction
bowel perforation
constipation

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8
Q

What are some differential diagnoses associated with left lower quadrant pain?

A

diverticulitis
colitis
ureteric stone
ectopic pregnancy

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9
Q

How does bowel ischaemia present?

A
  • sudden onset crampy abdominal pain
  • pain
  • bloody loose stool
  • fever and signs of septic shock
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10
Q

What are risk factors for bowel ischaemia?

A
  • over 65
  • cardiac arrythmia
  • sickle cell disease
  • vasculitis
  • thromophilia
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11
Q

What is ischaemic colitis?

A

large bowel ischaemia - usually due to atherosclerosis

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12
Q

What is acute mesenteric ischaemia?

A

ischaemia affecting the small bowel, usually due to occlusive thromboemboli

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13
Q

How does ischaemic colitis present differently to acute mesenteric ischaemia?

A

IC usually present gradually with moderate pain and tenderness, whereas AMI presents suddenly with a lot of pain

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14
Q

What investigations must be done for bowel ischaemia?

A

FBC - neutrophilic leukocytosis
VBG - lactic acidosis

imaging - CT angiogram - shows disrupted flow and vascular stenosis and pneumatosis intestinalis

endoscopy - for cases of ischaemic colitis, seeing oedema, ulceration and cyanosis

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15
Q

What is pneumatosis intestinalis?

A

sign of transmural ischaemia/ infarction - presence of gas bubbles in the bowel wall

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16
Q

How is bowel ischaemia managed on bedside?

A
IV fluid resuscitation 
bowel rest
broad spectrum antibiotics
NG tube for decompression 
anticoagulation 
serial abdominal examination
17
Q

How do we manage bowel ischaemia surgically?

A

exploratory laparotomy - resection of necrotic bowel, surgical embolectomy or mesenteric arterial bypass

endovascular revascularisation - balloon angioplasty, thrombectomy

18
Q

How does acute appendicitis present?

A

periumbilical pain - anorexia, nausea, vomiting, low grade fever and change in bowel habit

19
Q

What are important clinical signs of appendicitis?

A

mcburney’s point - tenderness in RLQ

blumberg sign - rebound tenderness especially in the right iliac fossa

rosving sign - right lower quadrant pain elicited on the deep palpation of the left lower quadrant

psoas sign - right lower quadrant pain elicited on flexion of right hip against resistance

obturator sign - pain on passive internal rotation on the hip with hip and knee flexion

20
Q

What is mcburney’s point?

A

tenderness in RLQ

21
Q

What is the blumberg sign in appendicitis?

A

rebound tenderness especially in the right iliac fossa

22
Q

What is rosvings sign?

A

right lower quadrant pain elicited on the deep palpation of the left lower quadrant

23
Q

What is psoas sign?

A

right lower quadrant pain elicited on flexion of right hip against resistance

24
Q

What is obturator sign?

A

pain on passive internal rotation on the hip with hip and knee flexion