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Gatsro 2 > General Surgery In the GI Tract > Flashcards

General Surgery In the GI Tract Flashcards

1
Q

What range of investigations are there in a general abdominal assessment?

A

-Bloods
-Urinalysis
-Imaging
-Endoscopy

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2
Q

Give 5 diseases associated with the RUQ (right upper quadrant).

A
  • Biliary Colic
  • Duodenal Ulcer
  • Liver abscess
  • Portal vein thrombosis
  • Acute hepatitis
  • Nephrolithiasis
  • RLL pneumonia
  • Cholecystitis/Cholangitis
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3
Q

Give 5 diseases associated with the epigastrium.

A
  • Acute gastritis/GORD
  • Gastroparesis
  • Peptic ulcer disease/perforation
  • Acute pancreatitis
  • Mesenteric ischaemia
  • AAA (Abdominal Aortic Aneurysm) Aortic dissection
  • Myocardial infarction
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4
Q

Give 5 diseases associated with the LUQ.

A
  • Peptic ulcer
  • Acute pancreatitis
  • Splenic abscess
  • Splenic infarction
  • Nephrolithiasis
  • LLL Pneumonia
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5
Q

Give 5 diseases associated with the right lumbar region.

A
  • Acute Appendicitis
  • IBD
  • Colitis
  • Infectious colitis
  • Ureteric stone/Pyelonephritis
  • PID/Ovarian torsion
  • Ectopic pregnancy
  • Malignancy
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6
Q

Give 5 diseases associated with the suprapubic/central region.

A
  • Early appendicitis
  • Mesenteric ischaemia
  • Bowel obstruction
  • Bowel perforation
  • Constipation
  • Gastroenteritis
  • UTI/Urinary retention
  • PID
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7
Q

Give 5 diseases associated with the Lower left quadrant.

A
  • Diverticulitis
  • IBD (Inflammatory Bowel Disease)
  • Colitis
  • Infectious colitis
  • Ureteric stone/Pyelonephritis
  • PID/Ovarian torsion
  • Ectopic pregnancy
  • Malignancy
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8
Q

What are the 2 main groups of intestinal obstruction?

A
  • Paralytic (adynamic) ileus e.g. someone with abdomen full of pus, this irritates bowel and bowel stops peristalsis (this is an ileus) and doesn’t stop til irritation gone
  • Mechanical e.g. mechanically a bit of the bowel closes off
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9
Q

What are the 4 different ways to classify a mechanical intestinal obstruction?

A

-Speed
-Site
-Nature
-Aetiology

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10
Q

What is meant by nature in the classification of mechanical intestinal obstructions.

A

Simple vs strangulating

  • Simple- bowel is occluded without damage to blood supply
  • Strangulating- blood supply of involved segment of intestine is cut off
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11
Q

What are the majority of small bowel obstructions caused by?

A

-Adhesions (from previous surgery)
-Neoplasia
(15% from hernias and Crohn’s disease)

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12
Q

What is volvulus?

A

Imagine a party balloon being twisted and giving a closed loop.

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13
Q

What are the commonest causes of large bowel obstruction

A
  • Colorectal cancer- commonest cause- usually obstructs on left hand side because on right the bowel can expand and compensate
  • Volvulus- sigmoid, caecal
  • Diverticulitis- inflammation, strictures
  • Faecal impaction
  • Hirschsprung disease
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14
Q

What are the differences in the way abdominal pain presents in small and large bowel obstructions.

A
  • Small bowel obstruction- colicky, central
  • Large bowel obstruction- colicky or constant
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15
Q

What are the differences in the way vomiting presents in small and large bowel obstructions.

A
  • Small bowel obstruction- early onset, large amount, bilious (with bile)
  • Large bowel obstruction- late onset, initially bilious, progresses to faecal vomiting (vomit looks like faeces)
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16
Q

Whats the difference in the way absolute constipation presents in Small/Large bowel obstructions

A
  • Small bowel obstruction- late sign
  • Large bowel obstruction- early sign
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17
Q

What is the difference in the way absolute abdominal distention presents in Small/Large bowel obstructions

A
  • Small bowel obstruction- less significant
  • Large bowel obstruction- early sign and significant
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18
Q

What are features suggesting strangulation? (7)

A
  • Change in character of pain from colicky to continuous
  • Peritonism (symptom complex of vomiting, pain/abdo tenderness and shock)
  • Tachycardia
  • Pyrexia
  • Leukocytosis
  • Increased CRP
  • Bowel sounds absent or reduced
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19
Q

What is a Richter’s hernia?

A

Hernia in the bowel not associated with obstruction.

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20
Q

What is CRP?

A

C reactive protein, marker for inflammation

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21
Q

What does VBG stand for

A

Venous blood gas. Tests for levels of oxygen and carbon dioxide in the blood.

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22
Q

What blood tests will you usually do with bowel obstruction?

A
  • WCC/CRP usually normal (if raised then suspicion of strangulation/perforation)
  • U&E: electrolyte imbalance e.g. if vomiting
  • VBG if vomiting: HypoCl-, HypoK+ metabolic alkalosis
  • VBG if strangulation: metabolic acidosis (lactate)
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23
Q

What supportive management is there for bowel obstruction

A

IV analgesia etc

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24
Q

What are the 2 types of ischaemic bowel?

A

-Acute mesenteric ischaemia (affects small bowel)
-Ischaemic colitis (affects large bowel)

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25
Q

What are the causes for acute mesenteric ischaemia and ischaemic colitis?

A

-Acute mesenteric ischaemia → usually occlusive and secondary to thromboembolus, if someone has AF, a small clot can come and get blocked in SMA- superior mesenteric artery

-Ischaemic colitis → usually due to non-occlusive low flow states, or atherosclerosis

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26
Q

What is an exploratory laparotomy?

A

Opening abdomen up for exploration

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27
Q

How does acute appendicitis present?

A
  • Initially periumbilical pain that migrates to
    RLQ (within 24 hours)
  • nausea +/- vomiting
  • low grade fever
28
Q

What are important clinical signs to look out for? (Signs & points)
Hint: acronym PROBM

A

-Psoas sign
-Rovsing sign
-Obturator sign
-Blumberg sign
-McBurney’s point

29
Q

RLQ pain elicited on flexion of right hip against resistance is what?

A

Psoas sign

30
Q

RLQ pain elicited on deep palpation of the LLQ is what?

A

Rovsing sign.

31
Q

RLQ pain on passive internal rotation of the hip with hip and knee flexion is what?

A

Obturator sign

32
Q

Rebound tenderness (press down then release) especially in RIF, is what?

A

Blumberg sign (Blumberg-> bouncy->rebound tender)

33
Q

Tenderness in RLQ (lateral 1/3 of a hypothetical line drawn from the right ASIS to the umbilicus) is what?

A

McBurney’s point

34
Q

What is the clinical scoring system for appendicitis?

A

The Alvarado score

35
Q

After conservative management of acute appendicitis, what do we consider?

A

Interval Appendicectomy

36
Q

What is better laparoscopic or open appendicectomy?

A

Laparoscopic surgery (less invasive better patient QOL)

37
Q

How do GI perforations present? (6)

A
  • Sudden onset severe abdominal pain associated with distention
  • Pain aggravated by movement
  • Diffuse abdominal guarding, rigidity, rebound tenderness
  • Nausea, vomiting, absolute constipation (due to ileus of chemical irritation rather than mechanical obstruction)
  • Decreased or absent bowel sounds (because of ileus)
  • Fever, tachycardia, tachypnoea, hypotension
38
Q

What is the most common cause of GI perforations?

A

Perforated peptic ulcer

39
Q

Where can you also get pain with a perforated peptic ulcer and why?

A

Referred shoulder pain- due to irritation of diaphragm (innervated by phrenic nerve which also innervated right shoulder)

40
Q

What are the 4 causes of GI perforation (The 4 main examples)

A

-Perforated peptic ulcer
-Perforated diverticulum
-Perforated appendix
-Perforated malignancy

41
Q

How does a perforated diverticulum present?

A
  • LLQ pain- insidious onset
  • Constipation
42
Q

How does a perforated appendix present?

A
  • Change in bowel habit
  • PR bleeding
  • Weight loss
  • Anorexia
43
Q

What are the 2 types of investigations we do for gastric perforations?

A
  • FBC- neutrophilic leukocytosis
  • VBG- lactic acidosis
  • Possible elevation of urea, creatinine
44
Q

What imaging can we do to help us localize the perforation?

A

-Erect chest x-ray
-CT abdo/pelvis

45
Q

What would an erect chest x-ray help us detect?

A

subdiaphragmatic free air.

46
Q

What surgical management options are there for patients with generalized pancreatitis +/- signs of sepsis?

A

Exploratory laparotomy

47
Q

What Biliary colic symptoms (Gallbladder/gallstones)

A

Sudden, intense pain in the right upper Quad that may radiate up to the shoulder seen typically after eating a large, fatty meal.

48
Q

What investigations would you do for biliary colic symptoms?

A

Ultrasound to find gallstones.

49
Q

How do you manage biliary colic/ gallstones

A
  • Conservative- analgesia, antiemetics, spasmolytics
  • Follow up for elective cholecystectomy
50
Q

What is cholecystitis?

A

Infection of the gallbladder.

51
Q

Symptoms of cholecystitis?

A
  • Acute, severe RUQ pain
  • Fever
    -MURPHY’S SIGN
52
Q

What is pleuritic chest pain?

A

Chest pain when you take deep breath in and you feel sharp pain in chest wall, not abdomen

53
Q

What is this:
Placing hand in RUQ, it may feel non tender, then ask patient to take deep breath in and liver pushes gallbladder down which touches hand and patient yelps

A

Murphy’s sign

54
Q

What Investigations would you do to diagnose Acute cholecystitis and what would you find?

A

Blood tests: Elevated WCC/CRP
Ultra sound scan: thickened gallbladder wall

55
Q

What is acute cholangitis?

A

Acute cholangitis is a medical condition characterized by inflammation of the bile ducts within the liver.

56
Q

What usually causes acute cholangitis?

A

Blockage of billiary tree, usually due to gallstones.

57
Q

What are the symptoms of acute cholangitis?

A

Charcot’s triad- jaundice, RUQ pain, fever

58
Q

What would you see on an ultrasound of someone with acute cholangitis?

A

Biliary tree dilation

59
Q

What investigations would you do for acute cholangitis and what would you find?

A

LFT (liver function test)- Elevated
WCC- Elevated
CRP-Elevated
Blood cultures (+ve)

60
Q

What should you do within 72 hours for clearance of the bile duct?

A

ERCP

61
Q

Acute pancreatitis symptoms

A
  • Severe epigastric pain radiating to back
  • Nausea +/- vomiting
62
Q

What is the most common cause of acute pancreatitis?

A

Gallstones

63
Q

What would you find in investigations for acute pancreatitis?

A
  • Raised amylase/lipase
  • High WCC/low Ca2+
64
Q

What is used to predict the severity and likelihood of mortality in individuals with acute pancreatitis.

A

Glasgow-imrie admission score

65
Q

What are antiemetics?

A

Drugs used to treat nausea and vomiting.

Gatsro 2 (8 decks)

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