General Surgery (Lower GI) Flashcards
Describe the pathophysiology of Appendicitis
Usually caused by luminal obstruction
secondary to
- faecoliths
- lymphoid hyperplasia
- impacted stool
- tumour
What are Faecoliths?
Faecal Debris and Calcium Salts

Give three risk factors of Appendicitis
Family History
Ethnicity (Caucasians)
Environmental (Seasonal - Summer)
Give 4 clinical features of Appendicitis
- Pain
- initial dull periumbilical, then later sharp in RIF
- Vomiting
- Nausea
- Anorexia
umbilicus to ASIS
What is McBurney’s Point?
- 2/3 from Umbilicus to ASIS
- Focus of peritoneal pain in late appendicitis

State features OE of a patient with Appendicitis
- Tachycardic
- Tachypnoeic
- Pyrexial
- Rebound tenderness and percussion pain over McBurneys point
- potential signs of guarding
State two exams which would be positive in an Appendicitis patient
Psoas Sign - RIF pain with right hip extension (retrocoecal appendix irritates psoas muscle)
Rovsing’s Sign - RIF pain when LIF is palpated
DDx for Appendicitis
- Ectopic Pregnancy
- Ovarian Cyst
- Rupture Ureteric Stones
- Diverticulitis
- IBS
- PID
- UTI
- Testicular torsion
- Epididymo-orchitis
*
what investigations are done in ?appendicitis?
- urinalysis
- pregnancy test
- routine bloods
- USS
- CT
How would you manage an Appendicitis patient?
Laproscopic Appendicectomy
appendix sent to histopathology to look for malignancy
inspect rest of abdomen during laparoscopic procedure
Describe the complications of Appendicitis. How could we reduce the risk?
Perforation - if left untreated
Surgical Site infection
Appendiceal Mass - omentum and small bowel adhere to appendix
Pelvic Abscess - abx and abscess draining
antibiotics
Describe the pathophsyiology of Colorectal Cancer
- Occurs via progression
- Normal Mucosa to Colonic Adenoma (Polyps)
- Colonic Adenoma to Invasive Adenocarcinoma

Describe the two genetic mutations associated with Colorectal Cancer
APC (Adenomatous Polyposis Coli) - Normally a tumour supressor gene, associated with FAP HNPCC - DNA mismatch repair gene, associated with Lynch Syndrome
Give four risk factors for Colorectal Cancer
Age
IBD
Family History
Low Fibre Diet
Describe 3 presentations of Right Sided Colorectal Cancer
Late Presentation
Abdo Pain
Occult Bleeding/anaemia
Mass in RIF
Describe 4 presentations of Left Sided Colorectal Cancer
Rectal Bleeding
Tenesmus
Change in bowel habit
Mass in LIF or on PR
What is the marker of Colorectal Cancer?
CEA
Not used in diagnosis but used to monitor progression
what presentations do NICE recommend get referred for urgent investigation?
- >40 eith unexplained weight loss
- >50 with unexplaied rectal bleeding
- >60 iron deficiency aneamia or change in bowel habit
- positive occult blood screening test
Give three possible imaging techniques for Colorectal Cancer
Colonoscopy CT Scan MRI Rectum
Describe Duke’s Staging of Colorectal Cancer
A - Confined to muscularis mucosa B - Trough muscularis mucosa C - Regional Lymph Nodes D - Distant Metastases
Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a RIGHT Hemicolectomy?
- Ileocolic
- Right Colic
- Right Middle Colic
Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a LEFT Hemicolectomy?
- IMV
- Left Colic
- Left branch of middle colic
Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a Sigmoidectomy?
Inferior Mesenteric Artery
Give an example of when an Anterior Resection is used
High rectal tumours

