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Y2 Gastroenterology > General surgery in the GI tract > Flashcards

General surgery in the GI tract Flashcards

1
Q

What are the presentations for bowel ischaemia?

How does this differ between the SB and LB?

A

Current jelly stool on PR
Fever
Septic shock
Crampy pain

SB - sudden onset, LB - milder & more gradual pain

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2
Q

What are the risk factors for bowel ischaemia? (5)

A

Age >65
Cardiac arrhythmias (esp AF), atherosclerosis
Hypercoagulation/thrombophilia
Vasculitis
Sickle cell disease

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3
Q

What investigations would you do for bowel ischaemia?

A

Bloods: FBC (neutrophilic leukocytosis), VBG (lactic acidosis) - both are late signs

CT: disrupted flow, vascular stenosis, thumbprint sign for ischaemic colitis

Late sign: Pneumatosis intestinalis - air inside bowel wall

Endoscopy

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4
Q

What are the conservative management options for bowel ischaemia?

What type of bowel ischaemia is this applicable to?

A

IV fluid resuscitation
Antibiotics
Anticoagulation
NG tube for decompression
Bowel rest
Continuous monitoring

Mild-moderate ischaemic colitis, not SB

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5
Q

What surgical management options are there for bowel ischaemia?

A

Exploratory laparotomy
Endovascular revascularisation

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6
Q

What is the typical presentation for acute appendicitis? (5)

A

Initial periumbilical pain, migrates to RLQ within 24 hours
Anorexia
Nausea & vomiting
Fever
Changes in bowel habit

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7
Q

Where is McBurney’s point?

A

1/3 along the way from R ASIS to umbilicus

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8
Q

What is Blumberg’s sign? What does it show?

A

Rebound tenderness
Perotonitis

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9
Q

What is Rovsing’s sign?

A

RLQ pain during deep palpation of LLQ

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10
Q

What is the psoas sign?

A

RLQ pain when flexing right hip against resistance

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11
Q

What is the obturator sign?

A

RLQ on passive internal rotation of hip while hip & knee are flexed

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12
Q

What would bloods show in acute appendicitis?

A

FBC: neutrophilic leukocytosis
CRP: raised
Electrolyte imbalances if vomiting

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13
Q

What imaging should be done in acute appendicitis?

What investigation should be done if all imaging is inconclusive?

A

CT - gold standard if under 50
Ultrasound - children, breastfeeding, pregnancy
MRI - pregnancy if US inconclusive

Diagnostic laparoscopy

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14
Q

What is included in the Alvarado score for acute appendicitis? (MANTRELS)

What are the scoring criteria?

A
  1. Migration of pain to RLQ (1)
  2. Anorexia (1)
  3. Nausea & vomiting (1)
  4. Tenderness in RLQ (2)
  5. Rebound tenderness (1)
  6. Elevated temperature >37.3C (1)
  7. Leukocytosis >10 (2)
  8. Shifted neutrophils to left 75% (1)

<4 unlikely, 5-6 possible, >7 likely (out of 10)

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15
Q

What conservative management options are there for acute appendicitis?

A

IV fluids
Analgesia
Antibiotics
Percutaneous drainage if abscess seen

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16
Q

What are the surgical management options for acute appendicitis?

A

Laparoscopic appendectomy
Open appendectomy

Interval appendectomy - delayed removal of appendix after initial presentation to reduce rate of recurrence

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17
Q

What are the two main groups of bowel obstruction?

A
  1. functional - paralytic ileus (lack of muscle contraction)
  2. mechanical
18
Q

How is mechanical bowel obstruction classified? (4)

A
  1. Speed of onset - acute vs chronic, acute-on-chronic
  2. Site - high or low
  3. Nature (blood supply) - simple vs strangulated
  4. Aetiology - lumen, wall, outside bowel
19
Q

What are some common causes of small bowel obstruction? (4)

A

Adhesions
Neoplasia
Incarcerated hernia
Crohn’s

20
Q

What are some common causes of large bowel obstruction? (5)

A

Colorectal carcinoma
Volvulus
Diverticulitis
Faecal impaction
Hirschspring disease - lack of peristalsis in a section of the colon

21
Q

Describe vomiting symptoms in SB and LB obstruction?

A

SB - early onset, bilious
LB - late onset, can progress to faecal vomiting

22
Q

Describe absolute constipation and abdominal distension in SB and LB obstruction?

A

SB - late sign, less significant
LB - early sign, significant

23
Q

What are some signs of bowel obstruction? (6)

A

Abdominal pain
Vomiting
Constipation
Abdominal distention
Dehydration
Tinkling bowel signs (early), absent bowel sounds (late)

24
Q

What signs are seen in strangulated obstructions?

A

Pain changes from colicky to continuous
Tachycardia
Fever
Peritonism
Absent bowel sounds
Leucocytosis
Raised CRP

25
Q

What are some common sites of hernias? (6)

A

Epigastric
Umbilical
Periumbilical
Incisional
Inguinal
Femoral

26
Q

What is a Richter’s hernia?

A

Strangulated but no obstruction

27
Q

What bloods can be done to investigate bowel obstruction?

A

U&E - electrolyte imbalances
WCC/CRP - raised in strangulations/perforations
VBG - if vomiting low K+ and Cl-, metabolic alkalosis
VBG - if strangulated, metabolic acidosis

28
Q

What are the normal widths of the bowel on an X-ray?

A

SB - 3cm
LB - 6cm
Caecum - 9cm

29
Q

What conservative management is used to treat sigmoid volvulus?

A

Sigmoidoscopy
Pass soft rubber tube along (flatus tube)
Usually untwists and releases contents

30
Q

What are the conservative management options for bowel obstruction?

A

IV fluids, NBM
IV analgesia, antiemetics, electrolyte correction
NG decompression
Stool evacuation

31
Q

What contrast agent can be used to visualise small bowel obstructions?

A

Gastrografin on CT scans

32
Q

What are the indications for surgical management of bowel obstructions?

A

Haemodynamically unstable
Complete bowel obs with ischaemia
Closed loop obstruction
Persistent obs after 2 days of conservative management

33
Q

What surgical management options are there for bowel obs?

A

Exploratory laparotomy/laparoscopy
Bowel resection with primary anastomosis
Stoma

34
Q

What are the presentations for GI perforation?

A

Sudden onset severe abdo pain
Distention
Diffuse guarding, rigidity, rebound tenderness
Pain worse on movement
Nausea & vomiting
Constipation
Fever, tachycardia, hypotension, tachypneoa
Decreased bowel sounds

35
Q

What investigations can be done for GI perforation?

A

Bloods - FBC, U&E, VBG
X-ray & CT - air under diaphragm

36
Q

What are the conservative management options for GI perforation? (6)

A

NBM & NG tube
IV fluids
Antibiotics
IV proton pump inhibitors
Analgesia & antiemetics
Urinary catheter

37
Q

What are the symptoms of biliary colic (gallstones)?

A

Postprandial RUQ pain
Radiation to back and right shoulder
Nausea

38
Q

What symptoms are seen in acute cholecystitis?

A

Murphy’s sign
Acute, severe RUQ pain
Fever

39
Q

Symptoms in acute cholangitis

A

Jaundice
RUQ pain
Fever

(Charcot’s triad)

40
Q

What is a coffee bean sign on an X-ray indicative of?

A

Sigmoid volvulus

41
Q

What is portal pyaemia?

What is the most common aetiology?

A

Infection and thrombosis in portal vein

Intra-abdominal infection

Y2 Gastroenterology (1 decks)

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