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Phase 2a Concise > GI > Flashcards

GI Flashcards

1
Q

Appendicitis

A

Inflammation of appendix

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2
Q

Appendicitis patho

A

Gut orgs invade appendix wall after lumen obstruction from:

  • lymphoid hyperplasia
  • faecolith
  • filarial worms
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3
Q

Appendicitis Px

A
  • Pain (umbilical -> RIF, McBurney’s point)
  • Oedema
  • Fever
  • Tachycardia
  • Anorexia
  • N+V
  • Constipation, maybe diarrhoea
  • RIF tenderness, guarding
  • Rovsing’s sign - pain greater in RIF than LIF when LIF pressed
  • Psoas sign - pain on extending hip if retrocaecal appendix
  • Cope sign - pain on flexion and internal rotation of hip (if appendix close to obturator internus)
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4
Q

Appendicitis DDx

A

Other causes of abdo pain - think systems (GI, urological, gynaecological…)

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5
Q

Appendicitis Ix

A

Bloods - raised WCC, CRP, ESR

USS

CT

Pregnancy test

Urinalysis (exclude UTI)

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6
Q

Appendicitis Mx

A

Laparoscopic appendectomy

IV ABs (metronidazole, cefuroxime)

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7
Q

Appendicitis Cx

A

Rupture -> peritonitis

Forms a mass

Abscess - after failure to resolve

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8
Q

Acute mesenteric ischaemia

A

Impaired blood flow gut (almost always SI)

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9
Q

AMI Causes

A

SMA thrombosis (commonest)

SMA embolism (eg AF)

Mesenteric vein thrombosis (hypercoagulable state)

Non-occlusive disease (low flow states, eg low CO)

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10
Q

AMI Px

A
  • acute severe abdo pain
  • no abdo signs
  • rapid hypovolaemia (shock - pale skin, weak rapid pulse, reduced urine output, confusion)
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11
Q

AMI Ix

A

CT angiography - shows vessel blockage

Bloods (lactate), AXR

Laparotomy (cut into abdo wall)

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12
Q

AMI Mx

A

Resus - fluids, O2

ABs - IV gentamicin, metronidazole

IV heparin

Surgery to remove dead bowel

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13
Q

AMI Cx

A

Bacterial translocation across dying gut wall - septic peritonitis, SIRS

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14
Q

Chronic mesenteric ischaemia

A

chronic atherosclerotic disease of vessels supplying intestine

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15
Q

CMI cause

A

atherosclerosis - low flow of blood

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16
Q

CMI Px

A
  • severe colicky post-prandial abdo pain (gut claudication)
  • decreased wt
  • upper abdo bruit (sounds), maybe PR (per rectum) bleeding

malabsorption, N+V, fear of eating, usually history of CVD

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17
Q

CMI Ix

A

CT angiography

CXR/AXR to exclude other stuff

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18
Q

CMI Mx

A

Stop smoking

Antiplatelet therapy

Surgery - angioplasty, stent

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19
Q

CMI Cx

A

malnutrition, reduced QoL from fear of eating

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20
Q

Ischaemic colitis

A

compromise of blood circulation supplying colon

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21
Q

IC patho

A

Causes - thrombosis, emboli, decreased CO, drugs (OCP), surgery, coagulation disorders

splenic flexure at risk - watershed between middle colic (SMA) and left colic (IMA)

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22
Q

IC Px

A

signs
shock
signs of CVD

symptoms
abdo pain, sudden onset, lower left side
bright red blood +/- diarrhoea

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23
Q

IC DDx

A

other causes of acute colitis, eg IBD

dysentry, diverticulitis

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24
Q

IC Ix

A

CT

Colonoscopy and biopsy

Barium enema maybe

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25
Q

IC Mx

A

Fluids

ABs

Surgical resection of bowel (could be gangrenous bowel)

mitigate risk factors - smoking, antiplatelet therapy etc

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26
Q

Diverticulitis

A

Inflammation of diverticulum (outpouching of gut wall)

diverticular disease - symptoms without inflammation

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27
Q

Diverticular disease patho

A

High intraluminal pressures (maybe lack of fibre), force mucosa to herniate through muscle layers of gut, usually near vessel entry sites

Causes - lack of fibre, obesity, smoking, NSAIDs

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28
Q

Diverticulitis patho

A

faeces obstructs neck of diverticulum, bacteria multiply, inflammation

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29
Q

Diverticular disease Px

A 
altered bowel habit
left sided colic, relieved by defecation
nausea
flatulence
pain/constipation (severe)
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30
Q

Diverticulitis Px

A

As diverticular disease

pyrexia
tachycardic
tenderness, guarding
severe pain
symptoms of peritonitis

similar to appendicitis, but on left side

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31
Q

Diverticulitis Ix

A

CT colonography

Bloods - increased WCC, ESR, CRP

AXR, barium enema

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32
Q

Diverticular disease Mx

A

High fibre diet

antispasmodic - mebeverine

maybe surgical resection

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33
Q

Diverticulitis Mx

A

Fluids, ABs (ciprofloxacin, metronidazole)

Surgical resection

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34
Q

Diverticulitis Cx

A

perforation, fistula formation, intestinal obstruction, bleeding, mucosal inflammation, abscesses

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35
Q

Meckel’s diverticulum

A

outpouching of distal ileum

surgical removal

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36
Q

Oesophageal cancer

A

carcinoma of oesophagus

squamous cell carcinoma (SCC) or adenocarcinoma (AC)

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37
Q

Oesophageal cancer patho

A

SSC in upper 2/3, AC lower 1/3

Barrett’s: acid, stratified squamous epithelium -> simple columnar mucosa

often presents late in disease

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38
Q

oesophageal cancer causes

A 
alcohol
achalasia (reduced peristalsis)
smoking
obesity
GORD
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39
Q

oesophageal cancer Px

A

signs

  • lymphadenopathy
  • hoarseness, cough

symptoms

  • dysphagia, progressive (solids, then liquids)
  • weight loss
  • anorexia
  • vomiting
  • pain
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40
Q

oesophageal cancer Ix

A

endoscopy

barium swallow

CT/MRI/PET - stage tumour

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41
Q

oesophageal cancer Mx

A

chemo

resection

palliative

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42
Q

Benign oesophageal tumour

A

1% oesophageal tumours, slow growing

asymptomatic, dysphagia, pain, regurgitation

endoscopy

surgical removal

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43
Q

Gastric cancer

A

adenocarcinoma (epithelial tissue) of stomach

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44
Q

gastric cancer patho

A

Intestinal cancer - well formed, differentiated glandular structures

Diffuse - infiltrative, undifferentiated, worse prognosis

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45
Q

gastric cancer causes

A 
smoking
H.pylori
dietary factors
genetics
pernicious anaemia - atrophic gastritis
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46
Q

gastric cancer Px

A

advanced, metastases (bone, brain, lung)

signs

  • anaemia from blood loss
  • jaundice (liver metastases)
  • palpable shoulder lymph node

symptoms

  • epigastric pain, dyspepsia (indigestion)
  • N+V
  • anorexia
  • weight loss
  • dysphagia if tumour in fundus
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47
Q

gastric cancer Ix

A

gastroscopy and biopsy

USS, CT, MRI, PET

FBC, LFT

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48
Q

gastric cancer Mx

A

surgical resection

chemo/radio

treat symptoms

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49
Q

SI tumours

A

rare, AC most common, maybe lymphomas

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50
Q

SI tumours Px

A

signs

  • anaemia
  • palpable mass

symptoms

  • pain
  • diarrhoea
  • anorexia
  • wt loss
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51
Q

SI tumours Ix

A

USS

endoscopic biopsy

CT

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52
Q

SI tumours Mx

A

radiotherapy

surgical resection

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53
Q

Colonic polyps

A

abnormal growth of tissue from colonic mucosa

adenoma/inherited

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54
Q

Colonic polyps Px

A

mostly asymptomatic

signs
- rectal polyps/masses

symptoms

  • bleeding
  • diarrhoea, abdo pain, mucous discharge
  • obstruction - constipation, vomiting, peritonitis
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55
Q

colonic polyps Ix

A

colonoscopy with biopsy

CT/MRI

Genetic testing

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56
Q

Colonic polyps Mx

A

surgical removal

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57
Q

colorectal cancer

A

carcinoma of LI, usually AC

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58
Q

colorectal cancer patho

A

majority in distal colon

normal epithelium -> adenoma -> colorectal adenocarcinoma -> metastatic (to liver, lung, brain)

Genetics - familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer

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59
Q

colorectal cancer RFs

A

increasing age, low fibre, sat fats, red meat, sugar, polyps, alcohol, smoking, obesity, UC, FHx, genetics

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60
Q

colorectal cancer Px

A

depends on location

signs
- anaemia (bleeding)

symptoms

  • blood and mucus
  • change in bowel habit
  • diarrhoea/constipation
  • wt loss
  • abdo pain (right sided)
  • thin altered stools
  • tenesmus (feeling of incomplete defecation)

may present as emergency - obstruction

jaundice/hepatomegaly - liver metastases

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61
Q

colorectal cancer DDx

A

haemorrhoids, anal fissure, prolapse, diverticular disease, IBD, GI bleed

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62
Q

colorectal cancer Ix

A

CT colonoscopy and biopsy

FBC - anaemia

barium enema

MRI to determine spread

classify - Dukes, TNM

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63
Q

colorectal cancer Mx

A

radio/chemo

surgery - resection, stenting

64
Q

GORD

A

reflux of stomach acid/bile

65
Q

GORD causes

A
  • LOS hypotension
  • hiatus hernia (rolling/sliding)
  • obesity
  • overeating
  • smoking
  • alcohol
  • pregnancy
  • drugs
66
Q

GORD Px

A

signs

  • chronic cough (aspiration of stomach contents)
  • sinusitis
  • weight loss
  • haematemesis
  • anaemia

symptoms

  • heartburn
  • belching
  • food/acid brash
  • water brash
  • odynophagia (painful swallowing)

alarm bell signs
wt loss, haematemesis, dysphagia

67
Q

Dyspepsia ALARMS symptoms

A 
Anaemia
Loss of weight
Anorexia
Recent onset / progressive of symptoms
Melaena / haematemesis
Swallowing difficulty
68
Q

GORD DDx

A 
peptic ulcer disease
malignancy
NSAIDs
infection
cardiac disease
oesophageal spasm
69
Q

GORD Ix

A

clinical dx

endoscopy if alarm bell signs, >55yo, tx not working, palpable mass

barium swallow - hiatus hernia

70
Q

GORD Mx

A

lose weight, stop smoking, small meals, avoid hot drinks, spicy food, raise bed head

antacids - magnesium trisillicate mixture, gaviscon

PPI - lansoprazole

H2 receptor antagonist - cimetidine, ranitidine

Nissen fundoplication - surgically increase resting LOS pressure (only in severe GORD)

71
Q

GORD Cx

A

Barrett’s oesophagus - metaplasia from stratified squamous to columnar

Peptic stricture - inflammation

Mallory-Weiss tear, iron deficiency, ulcers

72
Q

Ulcerative Colitis

A

chronic inflammatory disorder of colonic mucosa (an IBD)

73
Q

UC patho

A

Inappropriate immune response to colonic flora in genetically susceptible individuals

Only involves mucosal layer

Starts in rectum, extends proximally (stops at SI)

Smoking is protective

74
Q

UC Px

A

signs

  • during attack - fever, tachycardia, tender distended abdo, anorexia, malaise, wt loss
  • extraintestinal signs - clubbing, oral ulcer, erythema nodosum, inflammatory pustule, conjunctivitis, episcleritis, iritis, large joint arthritis, ankylosing spondylitis, primary sclerosing cholangitis

symptoms

  • episodic/chronic diarrhoea +/- blood, mucus
  • bowel urgency
  • tenesmus
  • crampy abdo discomfort
75
Q

UC Ix

A

Bloods - FBC, ESR, CRP, U+E, LFT, culture

Stool MC&S

Faecal calprotectin - test for GI inflammation

AXR - no faecal shadows, mucosal thickening, colonic dilatation

Lead-pipe colon on barium X ray

Lower GI endoscopy

76
Q

UC Mx

A

Avoid foods that cause flare ups

mild
5-ASA - mesalazine/mesalamine
topical steroid - hydrocortisone/prednisolone

moderate
oral prednisolone
5-ASA

severe
IV fluids
IV steroids

Azathioprine, ciclosporin (DMARD), infliximab

Surgery - colectomy

77
Q

UC Cx

A

Colonic cancer, venous thromboembolism, toxic dilatation of colon

78
Q

Crohn’s

A

chronic inflammatory disease of GI tract characterised by transmural granulomatous inflammation

79
Q

Crohn’s patho

A

Can affect any part of gut

Skip lesions

Inappropriate immune response to gut flora in genetically susceptible individuals

Most commonly affects terminal ileum (bile salts and B12 absorbed here)

80
Q

Crohn’s Px

A

signs

  • bowel ulceration
  • abdo tenderness
  • perianal abscess/fistulae
  • mouth ulcers
  • finger clubbing
  • conjunctivitis, episcleritis, iritis
  • associated with spondyloarthropathies

symptoms

  • diarrhoea
  • abdo pain
  • wt loss
  • fatigue, fever, malaise, anorexia
81
Q

Crohn’s Ix

A 
Bloods
MC&S
Faecal calprotectin
Colonoscopy, bowel biopsy
Capsule endoscopy - swallow small camera
MRI to assess Cx
String sign on barium x ray
82
Q

Crohn’s Mx

A

Stop smoking, optimise nutrition

Oral prednisolone

Severe - IV fluids, IV steroids

Azathioprine (immunosuppressant)

Infliximab

Surgery - not curative

83
Q

Crohn’s Cx

A

SI obstruction, toxic dilatation, abscess formation, fistulae, cancer, malnutrition

84
Q

Intestinal obstruction

A

arrest/blockage of onward propulsion of intestinal contents

85
Q

paralytic ileus

A

loss of peristalsis, caused by abdo surgery commonly, absent bowel sounds, less pain

86
Q

intestinal obstruction patho

A

Intraluminal - tumour, fibrous diaphragm formation, meconium ileus (sticky bowel contents), gallstone

Intramural - inflammatory (Crohn’s, diverticulitis), tumours, neural (Hirschprung’s)

Extraluminal - adhesions, volvulus, tumour

87
Q

Intestinal obstruction DDx

A

SBO / LBO
SBO - vomiting earlier, less distension, pain higher in abdo
LBO - pain more constant

ileus / mechanical obstruction
ileus - bowel sounds absent, pain tends to be less

simple / closed loop / strangulated
simple - one obstruction point, no vascular compromise
closed loop - obstruction at two points, eg sigmoid volvulus - perforation risk
strangulated - blood supply compromised, more pain, fever, peritonism

88
Q

SBO

A

mechanical most common

distension above blockage

obstruction -> ischaemia, necrosis, perforation

Causes - adhesions, hernia, malignancy, Crohn’s

89
Q

SBO Px

A

signs

  • distension (more distal, more distension)
  • tenderness -> ?strangulation
  • increased bowel sounds

symptoms

  • pain, initially colicky, then diffuse
  • vomiting
  • nausea, anorexia
  • constipation, no wind
90
Q

SBO Ix

A

AXR, CT

91
Q

SBO Mx

A

Drip and suck - NGT to suck out bowel contents, IV fluids

Analgesia, antiemetic, ABs

Surgery

92
Q

SBO Cx

A

Ischaemia, perforation, necrosis

93
Q

LBO

A

25% of all intestinal obstruction

Proximal dilatation

Bacterial translocation -> sepsis

Colonic volvulus -> sigmoid

Cancer most common cause

94
Q

LBO Px

A

signs

  • abdo distension
  • bowel sounds normal, then increased, then quiet
  • palpable mass

symptoms

  • abdo pain
  • late vomiting (faecal)
  • constipation
  • fullness/bloating/nausea
95
Q

LBO Ix

A

DRE - empty rectum, hard stools, blood

AXR, CT

96
Q

LBO Mx

A

much same as SBO

Surgery

97
Q

Pseudo-obstruction

A

clinical picture mimics obstruction, but no mechanical cause

likely a Cx of other things: trauma, fractures, post-operation, drugs

Px - abdo distension, worsening pain

Ix - x-ray - large gas-filled bowel

Mx - tx underlying condition, correct fluids/electrolytes, IV neostigmine promotes colonic motility

98
Q

IBS

A

mixed group of abdo symptoms, no organic cause

constipation, diarrhoea, both

99
Q

IBS patho

A

dysfunction in brain-gut axis, abnormal smooth muscle activity

100
Q

IBS RFs

A

stress, menstruation, depression/anxiety, GI infection, abuse, eating disorders

101
Q

IBS Px

A

signs

  • urinary freq, urgency, nocturia, incomplete bladder emptying
  • joint hypermobility

symptoms

  • abdo pain/discomfort, relieved by defecation
  • bloating
  • change in bowel habit
  • painful period
  • back pain
  • fatigue, nausea
  • symptoms worsen after food
102
Q

IBS DDx with IBD

A

IBS:

normal Ix results
fever not likely
no extraintestinal symptoms
no blood in stool
no melaena
no wt loss
no mouth ulcers
constipation more common
bloating more common
103
Q

IBS Ix

A

Rule out differentials

Bloods
Faecal calprotectin (raised in IBD)
Colonoscopy (rule out colorectal cancer)

104
Q

IBS Mx

A

Regular/small meals, fluids, reduce caffeine, alcohol

IBS-D and bloating - reduce insoluble fibre
Wind/bloating - increase soluble fibre
Low FODMAP diet

Pain/bloating - antispasmodic (mebeverine/buscopan)

Constipation - laxative (eg mavicol)

Diarrhoea - loperamide

TCA (amitriptyline), SSRI

CBT

105
Q

IBS - cancer red flags

A 
wt loss unexplained
PR bleed
FHx
change in bowel habit and +50yo
nocturnal symptoms
mass
anaemia
raised inflammatory markers
106
Q

Mallory-Weiss tear

A

Linear mucosal tear at oesophageal gastric junction - upper GI bleed

107
Q

MW tear causes

A

forceful vomiting, retching, coughing, straining
NSAID abuse
peptic ulcers - majority

RFs - alcohol, conditions predisposing to vomiting, chronic cough, hiatus hernia, trauma

108
Q

MW tear Px

A

signs
postural hypotension

symptoms
vomiting
haematemesis
retching
dizziness / syncope
109
Q

MW tear DDx

A

gastroenteritis, peptic ulcer, cancer, varices

110
Q

MW tear Ix

A

endoscopy

FBC, coagulation studies, renal function…

111
Q

MW tear Mx

A

ABCDE, O2, fluids

Endoscopy - banding/clipping

112
Q

MW tear Cx

A

vomiting - hypokalaemia, metabolic distubances

bleed - hypovolaemic shock

113
Q

Achalasia

A

oesophageal aperistalsis, impaired relaxation of LOS

114
Q

Achalasia cause

A

unknown, though to be abnormal psym innervation

115
Q

Achalasia Px

A
  • dysphagia
  • food regurgitation, esp at night
  • substernal cramps
  • wt loss
  • spontaneous chest pain
116
Q

Achalasia DDx

A

other causes of dysphagia - cancer, stricture, GORD

117
Q

Achalasia Ix

A

CXR - dilated oesophagus

Barium swallow - lack of peristalsis

Manometry - shows aperistalsis

CT, oesophagoscopy - rule out carcinoma

118
Q

Achalasia Mx

A

Relieve symptoms

Tx to relax LOS - nifedipine, nitrates, sildenafil

Surgical - balloon dilation to open LOS, division of LOS, botox injection to relax it

119
Q

Achalasia Cx

A

aspiration pneumonia

120
Q

Gastritis

A

inflammation of stomach mucosa

121
Q

Gastritis causes

A 
H.pylori
Autoimmune gastritis
Aspirin, NSAIDs
Viruses
Duodenogastric reflux
Ischaemia
Increased acid - eg stress
Alcohol
122
Q

Gastritis Px

A

signs
- abdo bloating

symptoms

  • N+V
  • recurrent upset stomach
  • epigastric pain
  • indigestion
  • haematemesis
123
Q

Gastritis DDx

A

peptic ulcers, GORD, dyspepsia, carcinoma

124
Q

Gastritis Ix

A

Endoscopy
Biopsy
H.pylori urea breath test, stool antigen test

125
Q

Gastritis Mx

A 
Remove cause - eg stress, alcohol
H.pylori - PPI + 2 ABs
H2 antagonist - ranitidine, cimetidine
PPI - lansoprazole/omeprazole
Antacid
126
Q

Peptic ulcer disease (PUD)

A

break in superficial epithelial cells down to muscularis mucosa

in stomach/duodenum

127
Q

PUD Patho

A

ulcers -> gastritis

NSAIDs
inhibit COX1, prostaglandin synthesis, mucous secretion

H.pylori
urease - urea -> CO2 + ammonia
ammonium toxic to mucosa - less mucous produced
inflammation

ischaemia of gastric cells
produce less mucin

overproduction of acid
overwhelms mucin

128
Q

PUD causes

A 
H.pylori
NSAIDs
smoking
alcohol
bile salts
steroids
stress
129
Q

PUD Px

A 
burning epigastric pain
nausea
oral flatulence
epigastric tenderness
duodenal ulcer - worse several hours after eating, relieved by eating
ALARMS
anaemia
loss of weight
anorexia
recent onset / progressive sym
melaena / haematemesis
swallowing difficulty
130
Q

PUD DDx

A

cancer, gastric outlet obstruction, non-ulcer dyspepsia, duodenal Crohn’s, GORD

131
Q

PUD Ix

A

FBC - iron-deficiency anaemia

H.pylori tests
C-urea breath test - measure CO2 in breath after ingesting C-urea
IgG serology detection
Stool antigen test

Endoscopy

132
Q

PUD Mx

A

Reduce stress, irritating foods, smoking, alcohol

Stop NSAIDs

PPI - lansoprazole
H2 antagonist - ranitidine/cimetidine
Surgery - for Cx, eg bleed
endoscopic intervention for bleeding ulcers

133
Q

H.pylori Mx

A

PPI

2 ABs - metronidazole, clarithromycin (high resistance), amoxicillin (low res), tetracycline (low), bismuth

Quinolone, eg ciprofloxacin, where normal tx fails

134
Q

PUD Cx

A

Cancer, haemorrhage (duodenal ulcer erodes to gastroduodenal artery), peritonitis, acute pancreatitis

135
Q

Haemorrhoids

A

dilated anal cushions due to swollen veins

internal/external

internal categorised by degree it prolapses

136
Q

haemorrhoids causes

A

constipation, prolonged straining
diarrhoea
congestion from pelvic tumour, pregnancy, portal HTN
anal intercourse

137
Q

haemorrhoids Px

A

signs
- severe anaemia

symptoms

  • bright red rectal bleeding
  • mucus discharge, pruritus ani (itchy bottom)
  • wt loss, changes in bowel habit
  • pain (external)
138
Q

haemorrhoids Ix

A

abdo exam - rule out other disease

PR exam

proctoscopy (rectal scope)

sigmoidoscopy

139
Q

haemorrhoids Mx

A

1st degree - increase fluid, fibre, topical analgesic, stool softeners

2/3 - rubber band ligation, infrared coagulation

4 - surgery to remove

140
Q

Anal fistula

A

track communicates between skin and anal canal

141
Q

anal fistula causes

A 
perianal sepsis
abscesses
Crohn's
TB
diverticular disease
rectal carcinoma
142
Q

anal fistula Px

A

pain
discharge (bloody/mucus)
pruritus ani
systemic abscess if infected

143
Q

anal fistula Ix

A

MRI

endoanal USS

144
Q

anal fistula Mx

A

surgical - fistulotomy, excision

drain abscess, ABs if infected

145
Q

anal fissure

A

tear in squamous skin-lined lower anal canal

146
Q

anal fissure causes

A

hard faeces

STI, trauma, Crohn’s, cancer

90% posterior, anterior follows childbirth

147
Q

anal fissure Px

A

extreme pain, esp on defecation

bleeding

148
Q

anal fissure Ix

A

Dx often on history
perianal inspection
PR exam often not possible due to pain

149
Q

anal fissure Mx

A

increase fluids, fibre - make stools soft

Lidocaine ointment, GTN ointment, topical diltiazem (promotes healing)

Botox injection

Surgery - sphincterotomy

150
Q

anorectal abscess

A

collection of pus in anal/rectal region

RFs - DM, immunocompromised, anal sex

151
Q

anorectal abscess Px

A

painful swellings
tender
pus discharge

152
Q

anorectal abscess Ix

A

DRE
MRI
endoanal USS

153
Q

anorectal abscess Mx

A

surgical excision

drainage with ABs

154
Q

Pilonidal sinus

A

hair follicles get stuck under skin in butt crack, irritation/inflammation, leads to small tracts that can become infected (abscesses)

155
Q

pilonidal sinus Px

A

asymptomatic

painful swelling, tender
pus, foul smell from abscess
systemic signs of infection

chronic - 4/10 recurrent

156
Q

pilonidal sinus Ix

A

clinical examination

157
Q

pilonidal sinus Mx

A

surgery - excise sinus tract, drain pus
ABs pre-op

painkillers

hygiene and hair removal advice

Phase 2a Concise (9 decks)

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