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Gastro > GI 3 > Flashcards

GI 3 Flashcards

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?

A

OGD with biopsy

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

23
Q

How would you manage oesophageal cancer?

A

endoscopic resection with or without ablation

oesophagectomy

preoperative chemo and postop chemo

24
Q

What types of gastric tumours are there?

A

adenocarcinoma

25
Q

What are causes/risk factors of gastric tumours?

A

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
Q

How would carcinoma of the stomach present?

A

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
Q

How would you investigate stomach carcinoma?

A

upper gastrointestinal endoscopy with biopsy

CT/MRI

28
Q

How would you treat stomach cancer?

A

surgery

perioperative and postoperative chemoradiation

29
Q

What is a colonic polyp? What sort of cell are they?

A

Abnormal growth of tissue projecting from the colonic mucosa

Adenomas

30
Q

What are some forms of inherited colonic polyp?

A

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
Q

What type of cancers are normally colorectal, where do they normally occur?

A

Usually adenocarcinoma

Occur in the distal colon

32
Q

What are risk factors for colorectal carcinoma?

A

Increasing age

low fibre diet

saturated animal fat and red meat consumption

colorectal polyps

alcohol smoking

obesity

UC

fam Hx

33
Q

How would a colorectal carcinoma present?

A

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
Q

What is an emergency presentation of colorectal carcinoma?

A

Obstruction

I) absolute constipation

ii) colicky abdo pain
iii) abdo distension
iv) vomiting (faeculent)

35
Q

How would you investigate colorectal carcinoma?

A

FBC
Colonoscopy
Double- contrast barium enema

36
Q

How would you treat a colorectal carcinoma?

A

local excision or radical excision

preoperative radiotherapy and chemotherapy

if surgery not suitable - cetuximab

37
Q

What is the duke staging classification of colorectal cancer?

A

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
Q

How would you classify hernia?

A

Reducible - can be pushed back

Irreducible - cannot be pushed back (obstructed, incarcerated, strangulated)

39
Q

What is the contents of the spermatic cord?

A

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
Q

What are risk factors for inguinal hernia?

A 
Male
Chronic Cough
Constipation
Urinary obstruction
Heavy lifting
Ascites
Past abdo surgery
41
Q

Whats the difference between a direct inguinal hernia and an indirect inguinal hernia?

A

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
Q

How would you manage an inguinal hernia?

A

strangulated - surgical repair

open mesh or laparoscopic repair

43
Q

What is a femoral hernia?

A

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
Q

What is a hiatus hernia? What are the different types?

A

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
Q

How would you treat a hiatus hernia?

A

IF hemmorhage and/or obstruction/volvulus - resus and urgent surgical repair

PPI and lifestyle changes

46
Q

When would diarrhoea be considered chronic?

A

more than 2 weeks

47
Q

What are the different mechanisms of diarrhoea? What are some causes for each?

A

Infective

Inflammatory

Osmotic - laxatives, generalised malabsorption

Secretory - enterotoxins, bile salts following ileal disease, resection or idiopathic bile acid malabsorption

Functional - IBS

48
Q

What are the causes of infective diarrhoea ?

A

Children - rotavirus, E.coli, salmonella, shigella

Adults - norovirus, campylobacter jejuni (most common cause of bacteria diarrhoea)

49
Q

What antibiotics can give rise to abx induced Clostridium Difficile?

A

In general, ones that start with C

Clindamycin
Ciprofloxacin
Co-amoxiclav
Cephalosporins

50
Q

What are risk factors for C.diff diarrhoea?

A

elderly

abx

long hospital stay

immunocompromised

acid suppression (PPI or H2 receptor antagonist)

51
Q

How would you investigate a possible C.Diff infection?

A

FBC - WBC increased

Stool guaiac - test for blood

Stool PCR - positive

Stool immunoassay for glutamate dehydrogenase - detects C.diff in bowel

52
Q

How would you manage a C.diff infection?

A

Vancomycin

Isolate and barrier nurse

check for causative agent

53
Q

Presentation of C. Diff? Complications?

A

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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