GI

Question 1

What is the most common site for a volvulus

Answer 1

Sigmoid colon

Question 2

What is the classic sign of a volvulus on x rat

Answer 2

Coffee bean sign

Question 3

What are risk factors for a volvulus

Answer 3

• adhesions eg from abdo surgery
• chronic constipation
• neuromuscular disorders eg Parkinson’s
• excessive laxative use

Question 4

What are the symptoms of a volvulus

Answer 4

Presents with a bowel obstruction.

• bilious vomiting
• absolute constipation
• no flatulence
• abdo pain
• abdo distension

Question 5

Complications of a volvulus

Answer 5

Bowel ischaemia

Question 6

Definitive Management of a volvulus

Answer 6

Sigmoid: flexible sigmoidoscopy to un twist the bowel via endoscopic decompression

Or hartmanns procedure which involves resection of the sigmoid colon and forming a colostomy

Caecal: right hemicolectomy

Question 7

Initial management of volvulus (bowel obstruction)

Answer 7

1. Nil by mouth
2. NG tube to release air
3. IV fluids to rehydrate bc fluid gets pulled into bowel wall

Question 8

Investigations for suspected volvulus

Answer 8

1 abdo x ray

2. Contrast CT to confirm

Question 9

presentation of acute pancreatitis

Answer 9

non specific eg
epigastric pain radiates to back
, nausea and vomiting,

Question 10

investigations in acute pancreatitis

Answer 10

1. serum amylase
2. serum lipase
3. uss pancreas
4. WCC will be raised
5. LFTs may be abnormal usually cholestatic if gallstones is the cause

Question 11

signs found on examination in acute pancreatitis

Answer 11

cullens sign (peri umbilical bruising)

grey turners sign - bruising in the flank due to peritoneal haemorrhage

Question 12

causes of acute pancreatitis

Answer 12

gallstones
alcohol 
scorpion poisoning 
autoimmune
metabolic - hypercalcaemia, hypertriglycerideaemia
ERCP
abdo trauma
malignancy - pancreatic, lymphoma
infection - viral mumps, HIV, coxsackie, hepatitis
drugs - tetracyclines, azathioprine, furosemide
haemolytic uraemic syndrome
SLE
cystic fibrosis

Question 13

what is required for the diagnosis of acute pancreatitis (criteria)

Answer 13

2 out of 3 of:

1. epigastric pain
2. elevated amylase/lipase 3x normal limit
3. abnormal pancreatic imaging

Question 14

what scoring systems can be used to assess severity of severe pancreatitis and what factors do they include

Answer 14

APACHE 2
Ranson

involves:
hypocalcaemia
hypoxia
hyperglycaemia
raised lactate
raised AST / LDH
age over 5

Question 15

mneumonic for acute pancreatitis causes

Answer 15

I GET Smashes
idiopathic
Gallstone
Ethanol
Scorpion 
Mumps / malignancy
Autoimmune
Steroids
Hypercalcademia/ high triglycerides
ERCP
Drugs - azathioprine, tetracyclines, steroids

Question 16

findings on USS acute pancreatitis

Answer 16

may see a necrotic, oedematous pancreas
peritoneal haemorrhage
may see gallstones/ dilated bile ducts

Question 17

mneumonic for acute pancreatitis causes

Answer 17

I GET Smashed
idiopathic
Gallstone
Ethanol
Scorpion 
Mumps / malignancy
Autoimmune
Steroids
Hypercalcaemia/ high triglycerides
ERCP
Drugs - azathioprine, tetracyclines, steroids, GLP-1 agonists eg exenatide