General Surgery in the GI tract Flashcards
How do we assess abdominal pain?
SOCRATES
site, onset, character, radiation, association, time course, exacerbating and relieving factors, severity
How do we manage any emergency?
ABCDE
airways, breathing, circulation, disability, exposure
What are some differential diagnosis associated with right upper quadrant pain?
biliary colic
cholecystitis
acute hepatitis
What are some differential diagnosis associated with epigastrium pain?
acute gastritis
acute pancreatitis
peptic ulcer
What are some differential diagnosis associated with left upper quadrant pain?
peptic ulcer
acute pancreatitis
splenic infarction
What are some differential diagnosis associated with right lower quadrant pain?
acute appendicitis
colitis
inflammatory bowel disease
What are some differential diagnoses for suprapubic pain?
bowel obstruction
bowel perforation
constipation
What are some differential diagnoses associated with left lower quadrant pain?
diverticulitis
colitis
ureteric stone
ectopic pregnancy
How does bowel ischaemia present?
- sudden onset crampy abdominal pain
- pain
- bloody loose stool
- fever and signs of septic shock
What are risk factors for bowel ischaemia?
- over 65
- cardiac arrythmia
- sickle cell disease
- vasculitis
- thromophilia
What is ischaemic colitis?
large bowel ischaemia - usually due to atherosclerosis
What is acute mesenteric ischaemia?
ischaemia affecting the small bowel, usually due to occlusive thromboemboli
How does ischaemic colitis present differently to acute mesenteric ischaemia?
IC usually present gradually with moderate pain and tenderness, whereas AMI presents suddenly with a lot of pain
What investigations must be done for bowel ischaemia?
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
What is pneumatosis intestinalis?
sign of transmural ischaemia/ infarction - presence of gas bubbles in the bowel wall