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GI 3 Flashcards

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1
Q

What is ascites?

A

accumulation of free fluid within the peritonieal cavity

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2
Q

What are causes of ascites?

A

local inflammation - peritonitis/intra-abdominal surgery, abdo cancers

low protein - hypoalbuminaemia, nephrotic syndrome, malnutrition

low flow - fluid cannot move forwards - cirrhosis, budd-chiari syndrome, cardiac failure

*high sodium diet, HCC, splanchnic vein thrombosis

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3
Q

How would ascites present?

A

abdominal swelling - over days or weeks

distended abdomen

fullness in the flanks and shifting fullness

mild abdo pain and discomfort

  • if severe pain, investigate bacterial peritonitis
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4
Q

How would you investigate and manage ascites?

A
  • shifting dullness

- diagnostic aspiration using ascitic tap - raised WCC, gram stain and culture, cytology

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5
Q

What can you suggest from protein measurement of the ascitic fluid from ascitic tap?

A

Transudate (low protein) - portal hypertension, contrictive pericarditis, cardiac failure, budd-chiari syndrome

exudate (high protein) - malignancy, peritonitis, pancreatitis, peritoneal tuberculosis, nephrotic syndrome

reduce sodium

Diuretic - aldosterone antagonist (K+ sparing)

drain fluid - 5 litres at a time

TIPS

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6
Q

What is the anatomical limits of the foregut? Where would the site of autonomic pain be?

A

Lower oesophagus to D2 (liver, spleen & gallbladder)

pain = epigastric

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7
Q

What is the anatomical limits of the midgut? Where would the site of autonomic pain be?

A

D2 to 2/3 across transverse colon (majority of abdomen)

pain = periumbilical

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8
Q

What is the anatomical limits of the hindgut? Where would the site of autonomic pain be?

A

transverse colon to upper rectum

pain = hypogastric

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9
Q

What are the main causes of peritonitis?

A

bacterial - gram-negative - E.coli and Klebsiella

gram-positive - staphylococcus aureus

chemical - bile, old clotted blood, (leakage of intestinal contents, ruptured ectopic)

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10
Q

How would peritonitis present?

A

perforation = sudden onset - acute severe abdo pain –> general collapse and shock

will want to stay still

rigid abdomen

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11
Q

How would you investigate peritonitis?

A

FBC -leucocytosis , anaemia (bleed)

Ascitic fluid - if ‘hazy, cloudy, bloody’, ascitic fluid absolute neutrophil count, fluid gram stain, fluid culture

Periscreen

standard urine leukocyte reagent strip test of ascitic fluid

blood culture

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12
Q

How would you manage peritonitis?

A

Cefotaxime + Vancomycin

Meropenem

albumin if there’s renal dysfunction

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13
Q

What is a volvulus? Where can it occur?

A

complete twisting of a loop of intestine around its mesenteric attachment

can occur at stomach, small intestine, caecum, transverse colon and sigmoid colon

sigmoid volvulus - commonest form

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14
Q

How would a volvulus present?

A

bilious vomiting

failure thrive

anorexia

constipation

bloody stools

abdo pain

malnutrition

immunodeficiency

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15
Q

What is the classical triad of GI obstruction?

A

Vomiting

Pain

Failed attempts to pass a NG tube

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16
Q

How would you investigate a volvulus?

A

X-ray - coffee bean sign (big fuck off coffee bean). Friman/Dahl sign
CT abdomen - whirl sign, bird beak sign
FBC

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17
Q

How would you manage a volvulus?

A

open laparotomy and Ladd procedure

cefoxitin

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18
Q

What are the different kinds of oesophageal tumours?

A

Squamous cell carcinoma - middle third (40%) and upper third (15%)

Adenocarcinoma - lower third and at the cardia (45%)

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19
Q

What are some risk factors for oesophageal squamous cell carcinoma?

A

alcohol

achalasia

tobacco

obesity

smoking

low fruit and veg

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20
Q

What are some risk factors for adenocarcinoma of the oesophagus?

A

Barrett’s oesophagus (reflux)

smoking
tobacco
GORD
obesity
diet low in Vit A & C
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21
Q

How would a oesophageal tumour present?

A

no physical signs until extremely advanced

if dysphagia to solids and liquids from the start this indicates BENIGN DISEASE

weight loss

lymphadenopathy

anorexia

pain due to impaction of food

signs from upper 1/3 of oesophagus

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22
Q

How would you investigate oesophageal cancer?

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A

OGD with biopsy

metabolic profile - hypokalaemia, elevated creatinine and serum urea/nitrogen

23
Q

How would you manage oesophageal cancer?

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A

endoscopic resection with or without ablation

oesophagectomy

preoperative chemo and postop chemo

24
Q

What types of gastric tumours are there?

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A

adenocarcinoma

25
What are causes/risk factors of gastric tumours?
smoking h.pylori dietary factors - high salt and nitrates increase risk non-starchy vegetables, fruit, garlic and low salt decrease risk loss of p53 CDH1 gene pernicious anaemia
26
How would carcinoma of the stomach present?
epigastric pain (indistinguishable from peptic ulcer disease) nausea, anorexia weight loss vomiting frequent dysphagia anaemia from occult clood loss liver, bone , brain and lung mets palpable Virchow's node
27
How would you investigate stomach carcinoma?
upper gastrointestinal endoscopy with biopsy CT/MRI
28
How would you treat stomach cancer?
surgery perioperative and postoperative chemoradiation
29
What is a colonic polyp? What sort of cell are they?
Abnormal growth of tissue projecting from the colonic mucosa Adenomas
30
What are some forms of inherited colonic polyp?
Familial adenomatous polyposis (FAP) - AD mutation in the APC gene Lynch syndrome - hereditary non-polyposis colon cancer (HNPCC) -AD mutation rapidly progress to colon cancer
31
What type of cancers are normally colorectal, where do they normally occur?
Usually adenocarcinoma Occur in the distal colon
32
What are risk factors for colorectal carcinoma?
Increasing age low fibre diet saturated animal fat and red meat consumption colorectal polyps alcohol smoking obesity UC fam Hx
33
How would a colorectal carcinoma present?
Right-sided - usually asymp. - mass, weight loss, low haemoglobin, abdo pain Left-sided and sigmoid carcinoma - change in bowel habit with blood and mucus in stools, diarrhoea, constipation, thin/altered stools Rectal carcinoma - rectal bleeding and mucus, thinner stools and tenesmus
34
What is an emergency presentation of colorectal carcinoma?
Obstruction I) absolute constipation ii) colicky abdo pain iii) abdo distension iv) vomiting (faeculent)
35
How would you investigate colorectal carcinoma?
FBC Colonoscopy Double- contrast barium enema
36
How would you treat a colorectal carcinoma?
local excision or radical excision preoperative radiotherapy and chemotherapy if surgery not suitable - cetuximab
37
What is the duke staging classification of colorectal cancer?
A - confined to the mucosa B1 - tumor growth into the muscularis propria B2 - tumour growth through muscularis propria and serosa C1 - tumour spread to 1-4 regional lymph nodes C2 tumour spread to more than 4 regional lymph nodes D - distant metastases (liver, lung, bones)
38
How would you classify hernia?
Reducible - can be pushed back Irreducible - cannot be pushed back (obstructed, incarcerated, strangulated)
39
What is the contents of the spermatic cord?
3 arteries - testicular, cremasteric and artery of Vas 3 veins - pampiniform plexus of testicular veins, cremasteric vein and vein of the Vas 3 nerves - ilioinguinal nerve, genitofemoral nerve, sympathetic nerve 3 others - vas deferens, lymph vessels, tunica vaginalis
40
What are risk factors for inguinal hernia?
``` Male Chronic Cough Constipation Urinary obstruction Heavy lifting Ascites Past abdo surgery ```
41
Whats the difference between a direct inguinal hernia and an indirect inguinal hernia?
Direct - less common, peritoneal sac through posterior wall, rarely strangulate, reduces easily Indirect - more common, peritoneal sac enters inguinal canal through deep inguinal ring, can strangulate
42
How would you manage an inguinal hernia?
strangulated - surgical repair open mesh or laparoscopic repair
43
What is a femoral hernia?
bowel comes through femoral canal below the inguinal ligament likely to be irreducible and to strangulate due to the rigidity of the canals borders
44
What is a hiatus hernia? What are the different types?
Sliding hiatus hernia - where the gastro-oesophageal junction and part of the stomach slides up into the chest via the hiatus so that it lies above the diaphragm rolling or para-oesophageal hiatus - gastro-oesophageal junction remains in the abdomen but part of the fundus of the stomach prolapses throught the hiatus
45
How would you treat a hiatus hernia?
IF hemmorhage and/or obstruction/volvulus - resus and urgent surgical repair PPI and lifestyle changes
46
When would diarrhoea be considered chronic?
more than 2 weeks
47
What are the different mechanisms of diarrhoea? What are some causes for each?
Infective Inflammatory Osmotic - laxatives, generalised malabsorption Secretory - enterotoxins, bile salts following ileal disease, resection or idiopathic bile acid malabsorption Functional - IBS
48
What are the causes of infective diarrhoea ?
Children - rotavirus, E.coli, salmonella, shigella Adults - norovirus, campylobacter jejuni (most common cause of bacteria diarrhoea)
49
What antibiotics can give rise to abx induced Clostridium Difficile?
In general, ones that start with C Clindamycin Ciprofloxacin Co-amoxiclav Cephalosporins
50
What are risk factors for C.diff diarrhoea?
elderly abx long hospital stay immunocompromised acid suppression (PPI or H2 receptor antagonist)
51
How would you investigate a possible C.Diff infection?
FBC - WBC increased Stool guaiac - test for blood Stool PCR - positive Stool immunoassay for glutamate dehydrogenase - detects C.diff in bowel
52
How would you manage a C.diff infection?
Vancomycin Isolate and barrier nurse check for causative agent
53
Presentation of C. Diff? Complications?
3-9 days post antibiotics High amount of green, foul smelling stool with crampy abdo pain Complications – toxic megacolon, perforation, spread of infection

Gastro (4 decks)

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