General Surgery - Upper GI Flashcards
Causes of ACUTE upper GI bleeding?
- Peptic ulcer (duodenal and gastric).
- Mallory Weiss tear.
- Chronic liver disease (oesophageal varices).
- Gastric carcinoma.
- Following PCI (anti-thrombotics e.g.heparin, fondaparinux) in those who are also on anti-platelets (e.g. clopidogrel, ticagrelor).
Signs of acute upper GI bleeding?
- Haematemesis.
- Malaena.
- Shock (tachycardia, pallor, cold peripheries, low BP).
Causes of vomiting?
- Any GI disease.
- Infection (flu, norovirus, pertussis, UTI).
- CNS disease (raised ICP, vestibular disturbance e.g. motion sickness, migraine).
- Metabolic (uraemia, hypercalcaemia).
Conditions associated with early morning nausea and vomiting?
- Pregnancy.
- Alcohol dependence.
- Metabolic disorders e.g. uraemia.
Vomiting is regulated by?
- Central neural control centres located in the lateral reticular formation of the medulla.
Central neural control centres which regulate vomiting are stimulated by?
- Chemoreceptor trigger zones in the floor of the fourth ventricle.
- Vagal afferents from gut.
What can directly stimulate central trigger zones responsible for stimulating the central neural control centres which regulate vomiting?
- Luminal toxins.
- Inflammation.
- Mechanical obstruction.
Proctalgia fugax is?
Severe, deep rectal pain of sudden onset but short duration.
Causes of mouth ulcers?
- Idiopathic aphthous ulceration (most common),
- GI disease (e.g. IBD, coeliac).
Infection (e.g. HSV, HIV, Coxsackie, candidiasis, syphilis, TB). - Systemic disease (e.g. reactive arthritis, Behcet syndrome, SLE).
- Trauma (e.g. dentures).
- Neoplasia (e.g. SCC).
- Drugs (e.g. erythema multiforme major, toxic epidermal necrolysis, chemotherapy, antimalarials).
- Skin disease (e.g. pemphigoid, pemphigus, lichen planus).
Causes of dry mouth?
- Sjogren’s.
- Drugs (e.g. anti-muscarinics, anti-parkinsonian, lithium, tricyclics, MAOIs).
- Radiotherapy.
- Psychogenic.
- Dehydration.
Causes of sialadenitis (salivary gland infection)?
- Viral e.g. mumps.
- Bacterial e.g. staphylococcus, streptococcus.
What kind of neoplasms affect the salivary glands?
- Pleomorphic adenoma.
(15% become malignant and can cause CN VII lower motor neurone signs).
HIV is associated with oral manifestations of which diseases?
- Candidiasis (with erythema &/or white exudates).
- Oral hairy leucoplakia.
- Kaposi’s sarcoma.
- Non-Hodgkin’s lymphoma.
- Necrotising ulcerative gingivitis.
- Necrotising ulcerative periodontitis.
With regards to oesophageal mucosal defence mechanisms, the mucus and unstirred water layer trap what & why?
- Bicarbonate.
- Weak buffering mechanism.
What is the role of epithelium in oesophageal mucosal defence?
- Limit diffusion of H+ into cells.
(Apical cell membranes and junctional complexes between cells limit H+ diffusion into cells). In oesophagitis, junctional complexes are damaged > increased H+ diffusion > cellular damage).
When will stitches normally be removed following a laparoscopic cholecystectomy and by whom?
If required, 5-7 days post op by patient’s practice nurse.
When can a patient return to work following a laparoscopic cholecystectomy?
Some time off is required - 2 weeks sick note will be provided upon discharge. Further time off can be requested from GP.
When can a patient drive following a laparoscopic cholecystectomy?
Not until after at least 24 hours and must be able to safely perform an emergency stop.
When should a patient seek medical attention following discharge after a laparoscopic cholecystectomy?
- Severe pain uncontrolled by medication.
- Pain complicated by symptoms such as vomiting.
- Pain from a site other than operation sites, ribs or shoulders.
- Large amounts of blood stained fluid discharge from wounds.
- Fever or chills.
Gastric acid is stimulated by?
- Acetylcholine.
- Gastrin.
- Histamine.
Gastric acid is inhibited by?
- Somatostatin.
- Secretin.
- Cholecystokinin.
Gastric acid is composed of?
- Hydrochloric acid.
- Potassium chloride.
- Sodium chloride.
Describe the cephalic phase of gastric acid secretion.
Gastric acid produced before food enters the stomach - triggered by sight, smell, thought, tasted of food acting via vagus nerve.
Describe the gastric phase of gastric acid secretion.
Initiated by food in stomach (particularly protein-rich food). Due to G cell stimulation > gastrin release.
Describe the intestinal phase of gastric acid secretion.
Luminal distension + presence of amino acids + food in duodenum > stimulates acid production.
Describe Zollinger-Ellison syndrome.
Gastrinoma(s) form in pancreas or dudodenum. These are neuroendocrine tumours which secrete gastrin.
Signs of Zollinger-Ellison syndrome.
- Excess gastrin production can lead to increased gastric acid production.
- Multiple, severe gastric ulcers.
Very elevated ALP in the presence of jaundice indicates?
Extrahepatic obstruction - typically due to common bile duct stone or carcinoma of the head of the pancreas.
High levels of AST suggest?
Intra-hepatic disease.
- AST is a marker of liver cell damage.
Common causes of intra-hepatic cholestasis?
Drugs, alcohol, infective hepatitis, liver lesions.
High AST + jaundice indicates?
Intrahepatic cholestasis.
