General Surgery in the GI tract

Question 1

How do we assess abdominal pain?

Answer 1

SOCRATES

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

Question 2

How do we manage any emergency?

Answer 2

ABCDE

airways, breathing, circulation, disability, exposure

Question 3

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

Answer 3

biliary colic
cholecystitis
acute hepatitis

Question 4

What are some differential diagnosis associated with epigastrium pain?

Answer 4

acute gastritis
acute pancreatitis
peptic ulcer

Question 5

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

Answer 5

peptic ulcer
acute pancreatitis
splenic infarction

Question 6

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

Answer 6

acute appendicitis
colitis
inflammatory bowel disease

Question 7

What are some differential diagnoses for suprapubic pain?

Answer 7

bowel obstruction
bowel perforation
constipation

Question 8

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

Answer 8

diverticulitis
colitis
ureteric stone
ectopic pregnancy

Question 9

How does bowel ischaemia present?

Answer 9

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

Question 10

What are risk factors for bowel ischaemia?

Answer 10

• over 65
• cardiac arrythmia
• sickle cell disease
• vasculitis
• thromophilia

Question 11

What is ischaemic colitis?

Answer 11

large bowel ischaemia - usually due to atherosclerosis

Question 12

What is acute mesenteric ischaemia?

Answer 12

ischaemia affecting the small bowel, usually due to occlusive thromboemboli

Question 13

How does ischaemic colitis present differently to acute mesenteric ischaemia?

Answer 13

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

Question 14

What investigations must be done for bowel ischaemia?

Answer 14

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

Question 15

What is pneumatosis intestinalis?

Answer 15

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

Question 16

How is bowel ischaemia managed on bedside?

Answer 16

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

Question 17

How do we manage bowel ischaemia surgically?

Answer 17

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

endovascular revascularisation - balloon angioplasty, thrombectomy

Question 18

How does acute appendicitis present?

Answer 18

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

Question 19

What are important clinical signs of appendicitis?

Answer 19

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

Question 20

What is mcburney’s point?

Answer 20

tenderness in RLQ

Question 21

What is the blumberg sign in appendicitis?

Answer 21

rebound tenderness especially in the right iliac fossa

Question 22

What is rosvings sign?

Answer 22

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

Question 23

What is psoas sign?

Answer 23

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

Question 24

What is obturator sign?

Answer 24

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