General Surgery In The GI Tract Flashcards
What are the two types of bowel ischaemia & how does it generally present?
How do they each differ
What are their risk factors?
AMI and IC: Abdo pain, bloody loose stool, fever
Acute mesenteric ishchaemia- sudden onset and abdominal pain out of proportion
Ishcaemic colitis-more mild and gradual onset and mild abdominal pain
RF: age > 65, AF, vasculitis, SCD
What investigations are carried out for bowel ischaemia?
FBC for neutrophils leukocytosis HIGH crp, wbc
Angiogram
Endoscopy
How is bowel ischaemia managed?
When is surgery the management chosen?
IV fluid
Bowel rest
Antibiotics broad spectrum
Treat underlying cause
Surgery is chosen if its the SB, patient is septic or toxic megacolon
Resection of necrotic bowel
Thrombectomy
How does appendicitis present?
Periumbilical pain that radiates to RLQ
Anorexia
Nausea
Vomiting
What are the investigations for appendicitis?
What is the gold standard for adults/pregnant women and children?
FBC: CRP, WBC
Urinalysis
CT gold standard for adults
USS for children/pregnant women
How is appendicitis managed?
IV fluids
Analgesia
AB
Drainage of abscess
Laparascopic appendectomy
Open appendectomy
What are the different types of bowel obstruction?
How is the second one classified?
Paralytic- no physical obstruction
Mechanical- speed of onset,
Site (high or low),
Simple vs strangulating: simple: bowel is occluded without damaging Blood supply whereas strangulating involves blood supply
Aetiology (gall stones, chrons disease, tumour, hernia)
What are the cardinal symptoms of bowel obstruction?
How do these differ between small bowel and large bowel?
Cardinal: Abdo pain, vomiting, constipation, abdo distension
SB: colicky central, early onset vomiting, late constipation, not much distension
LB: colicky constant, late onset vomiting, early constipation, significant distension
How do you diagnose bowel obstruction?
What should you always check for?
Always search for hernias and abdo scars
Find out if it’s simple or strangulated
FBC: increases CRP and WBC
Pyrexia
Tachycardia
AXR
CT
VBG
How is bowel obstruction managed?
NBM
IV fluids
NG tube
Bowel resection and anastamosis
Laparoscopy
How does a GI perforation present?
Sudden severe onset of abdominal pain
Rebound and distension of abdomen
Nausea vomiting constipation
Pain worse on movement
Fever
Tachycardia
How do we investigate for GI perforation?
FBC
VBG
CXR
CT abdo
How are GI perforations managed?
NBM
NG tube
Broad spectrum AB
Urinary catheter
Laparoscopy
Résection with anastamosis
Closure of perforation
What is the difference between Biliary colic, Acute cholecystitis, acute cholangitis, and acute pancreatitis?
Biliary colic- stone caught in cystic duct or common bile duct
Acute cholecystitis- inflammation of the gall bladder
Acute cholangitis- bacterial infection of biliary tree JAUNDICE
Acute pancreatitis- inflammation of pancreas
