GI Flashcards

1
Q

if active UGI bleed how many units should you Xmatch?

A

6

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2
Q

what are transfusion criteria following UGI bleed?

A

Hb <70
platelets <50 and active bleeding
PTT>1.5 transfuse FFP

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3
Q

which score can be done pre-endoscopy to calculate the risk of a re-bleed?

A

Blatchford score

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4
Q

Which score can be done post endoscopy to predict mortality?

A

Rockall

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5
Q

What is the management for a non-variceal bleed?

A

endoscopy:
either heat treatment of dual therapy (adrenaline + other)
PPI if stigmata of bleed on endoscopy
test H pylori

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6
Q

What is the management of a variceal bleed

A

terlepressin and broad spectrum Abx on presentation

band ligation/ glueing in endoscopy

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7
Q

If unable to contro variceal UGI bleed what tube can be used?

A

Sengstaken-Blakemore tube

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8
Q

define chronic constipation

A

stools <3/52
more than 6 months
symptoms- straining/ pain on defecation

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9
Q

what investigations would you send a stool sample for in acute diarrhoea?

A

MC+S
ova and parasites
cysts
c diff toxin

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10
Q

Using a surgical seive list causes of chronic constipation

A
(Vascular)
Inflammatory/ infective- IBS/ diverticular disease
Trauma- obstruction
(AI)
Metabolic- pregnancy, hypercalcaemia
Idiopathic/ iatrogenic- lack of fibre/ activity, opiates
neoplastic- colon cancer
Congenital- hirschprung
degenerative- MS, Parkinsons
endocrine- hypothyroid
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11
Q

Using a surgical sieve list causes of diarrhoea

A

(Vascular)
Inflammatory/ infective- IBS/ diverticular disease/ infection e.g. C diff- viral, bacterial or parasitic, appendicitis
Trauma- short bowel syndrome
AI- crohns
Metabolic- anxiety, pancreatic insufficiency
Idiopathic/ iatrogenic- antibiotic colitis/ laxatives, constipation with overflow
neoplastic- colon cancer
Congenital-
degenerative-
endocrine- hyperthyroid

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12
Q

what food item might you advise patients to avoid during acute diarrhoea?

A

dairy- risk of future intolerance

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13
Q

when are anti-motility drugs contraindicated in acute diarrhoea?

A

blood in stool

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14
Q

which pathogens causing acute diarrhoea are more likely to cause reactive complications?

A

shigella
campylobacter
salmonella

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15
Q

which drug is used to treat C diff

A

metronidazole

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16
Q

which pathogens cause non-bloody diarrhoea with mid-abdominal pain?

A

giardia lamblia- explosive, flatulance, dirty water

noravirus/ rotavirus

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17
Q

which pathogens are more likely to cause lower abdo pain/ tenesmus/ bloody diarrhoea?

A

Campylobacter- petting zoo
shigella
salmonella- can cause TMC
E coli 0157- can cause HUS

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18
Q

What should be avoided in E coli 0157?

A

antibiotics increase risk of HUS

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19
Q

what is HUS?

A

haemolytic uraemic sundrome- AKI + haemolytic anaemia

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20
Q

which blood test can be used to test for coelic’s?

A

anti a-gliadin, total immunoglobulin A, IgA tissue transglutaminase (ttg)

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21
Q

How is hepatitis A spread?

A

faecal-oral- long incubation period so often difficult to identify cause

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22
Q

investigations for Hep A

A

IgM

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23
Q

who can get infected with hepatitis D?

A

anyone already infected with hep D, increases risk of HCC and cirrhosis

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24
Q

what is the first line treatment for chronic hep B?

A

interferon,

if not tolerated then lifelong NRTI

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25
Q

Patient with Hep B bloods as follows:
sAg +
anti HBs -
anti HBc +

A

current Hep B infection (sAg marker of current infection, anti HBc not found in vaccine)

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26
Q

Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc +

A

previous Hep B infection (anti HBs marker of current immunity, anti HBc not found in vaccine)

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27
Q

Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc -

A

previously immunised against Hep B

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28
Q

what is the prognosis for hep C infection?

A

poor- some may clear spontaneously
20 years 15% cirrhosis
up to 20% HCC

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29
Q

Pain in RUQ, worse after eating, radiates to back, reduces spontaneously

A

biliary colic

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30
Q

what is murphy’s sign?

A

2 fingers pressed on RUQ on inspiration causes pain and arrest of inspiration
not reproducable on L
sign of cholecystitis

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31
Q

RUQ and fever, murphys sign positive

A

cholecystitis

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32
Q

RUQ pain, fever and jaundice, dark stools and pale urine

A

cholangitis`- charcots triad

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33
Q

what is the difference between MRCP and ERCP?

A

MRCP diagnostic, ERCP can be used for treatment too

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34
Q

when should you perform a lap cholecystectomy?

A

if acute pancreatitis/ recurrent within a week, otherwise 6-8 weeks after symptoms stop

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35
Q

what score can be used in cirrhosis to estimate life expectency?

A

child-pugh score

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36
Q

what score can be used in decompensated cirrhosis for transplant planning?

A

MELD score

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37
Q

how often should USS be performed in cirrhosis?

A

every 6 months + AFP to screen for HCC

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38
Q

What can be used for pruritus in cirrhosis?

A

antihistamine

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39
Q

list 3 causes of portal hypertension

A

pre-hepatic: portal vein thrombosis/ extrinsic tumours
hepatic causes: cirrhosis, chronic hepatitis, schistosomiasis
post-hepatic causes: RHF, budd chiari syndrome

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40
Q

what screening should be performed in pulmonary hypertension?

A

endoscopy for varices, if none 2-3 yearly
if small yearly
if larger prophylactic BB/ banding
screen for HCC and cirrhosis

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41
Q

how much fluid in ascites can be detected by shifting dullness?

A

1.5L

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42
Q

how much fluid in ascites can be setected on USS?

A

500ml

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43
Q

Name 3 causes of ascites

A

cirrhosis
malignancy
HF

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44
Q

how soon after admission should an ascitic tap be performed?

A

within 24 hours

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45
Q

what does a low serum ascites-albumin gradient (<11g/L) indicate?

A

peritoneal cause of ascites- malignancy, TB, peritonitis

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46
Q

what does a high serum ascites-albumin gradient (>11g/L) indicate?

A

portal hypertension cause of ascites:

cirrhosis, HF, nephrotic syndrome

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47
Q

what is the best initial treatment for ascites?

A

reduced sodium diet
spironolactone
aim for 0.5-1kg wight loss/ day

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48
Q

what should be given following therapeutic paracentesis?

A

small (<5L) synthetic plasma expander

large (>5L) HAS

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49
Q

which condition is associated with crypt abscesses?

A

UC

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50
Q

Crohn’s may have what appearance?

A

cobblestone appearance

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51
Q

Where are Crohns lesions most commonly found?

A

terminal ileum

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52
Q

which form of IBD has transmural lesions?

A

Crohn’s

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53
Q

what is faecal calprotectin a marker of?

A

inflammation in colon

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54
Q

what staging system can be used for Crohn’s?

A

Crohn’s disease severity index

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55
Q

which medication should be avoided in UC?

A

loperamide, increases risk of TMC

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56
Q

treatment for mild UC?

A

5-ASA

no improvement add steroids

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57
Q

treatment for mod UC?

A

prednisolone + 5-ASA, +/- steroid enemas

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58
Q

treatment for severe UC (systemically unwell + 6+ bowel motions a day)?

A

IV + rectal steroids +5-ASA
?NBM
examine BD for TMC
if no response consider surgery/ ciclosporin or infliximab to maintain remission

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59
Q

what is used to maintain remission in UC?

A

5-ASAs (sulphasalazine)

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60
Q

which form of IBD is pANCA +ve?

A

UC

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61
Q

which form of IBD can present with a RLQ mass?

A

Crohn’s

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62
Q

list 3 extra-intestinal symptoms of IBD?

A

large joint arthritis
erythema nodosum
irisitis
pyoderma gangrenosum

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63
Q

what treatments are used in Crohn’s?

A

only to induce remission not to maintain- no 5-ASA only steroids. No response to steroids infliximab

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64
Q

surgical management for Crohn’s?

A

resection

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65
Q

Surgical treatment for UC?

A

resection + restorative protocolectomy 92 operations- 1 to create pouch out of ileus and 1 to attach to anus)

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66
Q

what is the M rule?

A

for primary biliary cirrhosis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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67
Q

LLQ pain increased on eating, decreased on OB

A

divertticular disease

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68
Q

what investigation is most useful for giving a diagnosis of diverticulosis?

A

barium enema/ flexible sigmoidoscopy- however should not be done in acute settinng as increased risk of perforation

69
Q

Name 5 general indications for admitting someone with GI problems

A
cant control pain
cant tolerate oral fluids
comorbidities/ frail
symptoms persisting after treatment
complications
70
Q

what is management for asymotomatic diverticular disease?

A

increase fibre intake, avoid NSAIDs

71
Q

what it the management for diverticulitis?

A

Broad spectrum antibiotics
pain relief (non-constipating)
fluids

72
Q

what is the long term management for symptomatic diverticular disease?

A

analgesia (non-constipating)
laxatives - non stimulant
anticholinergics if over-active sigmoid colon
surgery to resect sigmoid if severe

73
Q

what is Rosving’s sign?

A

pain on palpation of LLQ increases pain in RLQ (appendicitis)

74
Q

which score can be used for appendicitis?

A

Alvarado score:
<4 unlikely
5-6 observe
7+ operate

75
Q

what is the treatment for appendicitis?

A

appendicectomy urgently- contraindications include Crohn’s involving caecum/ very elderly

76
Q

which is more common: small or large bowel obstruction?

A

small

77
Q

Name some causes of SBO?

A

extrinsic- adhesions, strangulated hernia, volvulus
wall- IBD
luminal- gallstone ileus

78
Q

name 3 causes of large bowel obstruction

A

extrinsic- sigmoid/ caecal volvulus, gynae cancer
wall- diverticular, strictures, cancer
luminal- faecal impaction

79
Q

what would absent BS indicate?

A

peritonitis (perforation)

80
Q

which type of bowel obstruction is more likely to present acutely?

A

SBO

81
Q

What would tinkling BS indicate?

A

bowel obstruction

82
Q

5 radiological findings of SBO?

A
dilatation >3cm
central location
valvulae conniventes
air fluid levels
distally no dilation
83
Q

radiological appearance of LBO?

A

caecum >9cm/ rest >6cm
peripheral location
haustra
distally no dilation

84
Q

management of obstruction

A

“drip and suck”

IV fluids, gut rest, Ryle’s NG for intestinal decompression (if sigmoid volvulus requires decompression via flex sigmoidoscopy)

85
Q

how long after surgery can you expect an ileus to take to resolve?

A

Small bowel 24hrs

large bowel 3-5 days

86
Q

Causes of an ileus

A

Vascular- mesenteric artery ischaemia
Inflammatory/ infective- appendicitis/ diverticular disease/ sepsis/ gatroenteritis
Trauma- surgery
(AI)
Metabolic- electrolyte abnormalities (hypo K/Na)
Idiopathic/ iatrogenic- anticholinergics/ narcotics
(neoplastic)
(Congenital)
(degenerative)
(endocrine)

87
Q

what would differentiate an ileus from an obstruction on Xray?

A

ileus dilation throughout bowel

88
Q

what criteria can be used to diagnose IBS?

A

ROME II criteria

89
Q

According to the ROME II criteria, how long must symptoms be present for for a diagnosis of IBS?

A

6 months

90
Q

what cancer is CA 125 a tumour marker of?

A

ovarian

91
Q

where is colorectal cancer most commonly found?

A

1/3 rectal
1/3 L-sided colon
1/3 other

92
Q

what other cancers are patients with HNPCC at increased risk of?

A

endometrial

gastric

93
Q

what is the most common type of colorectal cancer?

A

adenocarcinoma

94
Q

which tumour marker can be used to monitor progression in colorectal cancer?

A

CEA

95
Q

What staging is used for colorectal cancer?

A
Duke's staging
A- invasion not through bowel wall
B- invasion through bowel wall
C- lymph nodes
D- distant mets
96
Q

what screening is available for colorectal cancer?

A

FOB every 2 years from 60-74

97
Q

how does an ileostomy appear?

A

R sided
spouted
green liquid

98
Q

How does a colostomy appear?

A

L sided
flush to skin
faecal content

99
Q

what surgery can be done for rectal cancer?

A

upper- anterior resection

lower- abdominal perineal resection (permanent stoma needed)

100
Q

what symptoms may suggest rectal prolapse?

A

tenesmus/ feeling of incomplete emptying
chronic constipation
slight bleed/ mucus on defecation

101
Q

what is a complication of rectal prolapse?

A

ulcers

102
Q

what may you tell a pregnant lady presenting with haemorrhoids?

A

they will resolve after delivery

103
Q

what is the dentate line and why is it important?

A

2cm above anal verge, haemorrhoids above painless (unless srtangulated) below are lined with squamous cells so will be painful and itchy

104
Q

what is a primary haemorrhoid?

A

internal- some bleed but not visible externally

105
Q

what is a second degree haemorrhoid?

A

prolapsing- bleed and may pop out but retract spontaneously

106
Q

what is a third degree haemorrhoid?

A

prolapsed- requiring manual replacement

107
Q

what management can be used for haemorrhoids?

A

non-surgical (grade 2+) sclerotherapy/ band ligation via protoscopy
surgical- haemorrhoidectomy under GA

108
Q

name a risk factor for perianal abscesses?

A

immunocompromise/ DM
MSM
IBD

109
Q

where is 12 o’clock on anal examination?

A

anterior

110
Q

which are more common primary or secondary anal fissures?

A

primary, secondary can be due to IBD

111
Q

what is the first line management for anal fissures?

A

analgesia, topical GTN ointment, stool softeners

112
Q

how do you calculate BMI?

A

Weight (kg)/ height (m)2

113
Q

when should nutritional support be offered?

A

BMI <18.5, loss of >10% body weight in <6 months, reduced absorption, eaten little for 5+ days

114
Q

what score for malnutrition should be calculated on admission

A

Malnutrition universal screening tool- should be repeated weekly

115
Q

if eaten little/ nothing for 5+ days what should be done to avoid refeeding syndrome?

A

include dietician, start at 50% daily calorie allowance and slowly build up

116
Q

what deficiency may present with night blindness and immune deficiency?

A

vitamin a

117
Q

what deficiency may present with bleeding gums and reduced wound healing?

A

vitamin C (scurvy)

118
Q

what deficiency may present with osteoporosis and bow legs?

A

vitamin D (rickets)

119
Q

what deficiency may present with anaemia and neuro symptoms?

A

B12- subacute degeneration of spinal cord

120
Q

What is GORD?

A

reflux of gastric contents causing pathological changes in oesophagus (note not just occasional feeling of heartburn)

121
Q

what happens in Barrett’s oesophagus?

A

squamous epithleium replaced by columnar, increased risk of adenocarcinoma

122
Q

what are the 2 most common type of oesophageal cancer?

A

adenocarcinoma (western countries- Barretts) and squamous cell carcinoma (developing countries- smoking and hot drinks)

123
Q

where in the oesophagus does SCC occur?

A

upper 2/3

124
Q

where in the oesophagus does adenocarcinoma occur?

A

lower 1/3

125
Q

what is the most common site of metastasis for oesophageal cancer?

A

adenocarcinoma- liver

SCC- lung, brain, bone, liver

126
Q

how would you recognise a hiatus hernia on CXR?

A

retrocardiac fluid level

127
Q

what is a complication of hiatus hernias?

A

ulcer formation-> upper GI bleed

128
Q

which type of peptic ulcer is more common?

A

duodenal> gastric

129
Q

how might a gastric ulcer typically present?

A

pain soon after food, not reduced by eating

anorexia and weight loss

130
Q

how might a duodenal ulcer typically present?

A

pain 2-3 hours after food, relieved by eating therefore often maintain or increase weight

131
Q

name 3 causes of peptic ulcers?

A

h pylori infection, NSAID use, stress

132
Q

what is the test for H pylori?

A

carbon B urea breath test

stool antigen test

133
Q

what age of patient presenting with a peptic ulcer would you do an endoscopy in?

A

> 55/ red flags (including Fe deficiency anaemia)/ epigastric mass

134
Q

what is the eradication regime for H pylori

A

PPI+ 2 Abx eg amoxicillin and clarythromycin 7 days

135
Q

If caused by NSAID use and H pylori negative what is the treatment for peptic ulcers?

A

PPI 2 months

136
Q

what is the most common type of gastric cancer?

A

adenocarcinoma

137
Q

name 3 risk factors for gastric cancer?

A

H pylori infection
high salt/ preserved food diet
FAP/ HNPCC

138
Q

what imaging would you use for gastric cancer?

A

CT and endoscopy for diagnosis

no PET for staging as does not pick up intra-peritoneal seedlings well therefore laparoscopy

139
Q

what is the most common type of pancreatic cancer?

A

ductal adenocarcinoma- may be cystic/ endocrine

140
Q

where is the most common site for pancreatic cancer?

A

head of pancreas

141
Q

which tumour marker can be used for pancreatic cancer?

A

Ca19.9- also raised in obstructive jaundice

142
Q

what imaging is used for diagnosis/ staging of pancreatic cancer?

A

USS for diagnosis- endoscopic USS allows stenting until staging
spiral contrast CT for staging

143
Q

Whast foods should coeliacs avoid?

A

wheat, rye and barley

144
Q

where should biopsies be taken for coeliac’s diagnosis?

A

4 from distal duodenum

145
Q

what does I GET SMASHED stand for?

A
Idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion stings 
hyperlipidaemia/ hypothyroidism
ERCP
drugs (azathioprine, diuretics)
146
Q

what level of amylase is significant for acute pancreatitis?

A

> 3x normal/ ?1000U/L

147
Q

which imaging should be done in acute pancreatitis?

A

AXR if ?obstruction
CXR for pleural effusion
USS if ?gallstones
contrast CT at 48hrs for necrosis (+ raised CRP)

148
Q

name 3 other causes of raised amylase

A

renal failure
ectopic
DKA
perforated duodenal ulcer

149
Q

treatment of acute pancreatitis

A
analgesia (NSAIDs good, avoid morphine)
NBM+ IVI (Hartmann's ? colloids)
NG if vomitting/ NJ
if necrosis Abx
involve ICU early, may need surgical debridement
150
Q

What is primary and secondary peritonitis?

A

primary due to SBP

secondary due to perf

151
Q

are inguinal hernias more common in men or women?

A

men

152
Q

which is more common- indirect or direct inguinal hernia?

A

indirect

153
Q

where does an indirect inguinal hernia pass?

A

through internal inguinal ring and inguinal canal

154
Q

which hernia should always be repaired?

A

femoral

155
Q

where does a femoral hernia pass?

A

femoral canal (in sheath with femoral artery and vein)

156
Q

what is an anal fistula?

A

communication between the anal canal and perianal skin, commonly caused by Crohn’s/ diverticulitis. treated surgically

157
Q

What is a perianal haematoma?

A

collection of blood under perianal skin, presents as swelling and pain. Cannot be reduced (ddx= haemorrhoids) conservative management/ surgical evacuation

158
Q

What is a risk factor for anal cancer?

A

HPV 16/18

159
Q

what is FAP?

A

familial adenomatous polyposis- many polyps, increased risk of adenomas. Autosomal dominant inheritance therefore regular colonoscopies for screening

160
Q

what is petuz- jeghers syndrome?

A

autosomal dominant disorder characterised by mucosal pigmentation of lips and gums + intestinal polyps

161
Q

what might indicate a patient is in hepatic failure?

A

coagulopathy (INR>1.5)
encephalopathy
Jaundice
ascites

162
Q

name 3 risk factors for hepatocellular carcinoma?

A

HBV/ HCV infection
alcoholism
genetic haemochromatosis

163
Q

what is the most common cause of liver abscesses in the developed world?

A

secondary to infection in abdomen- Crohns, diverticulitis, appendicitis etc

164
Q

how might a liver abscess present?

A

RUQ pain, swinging fever, night sweats, pyrexia unknown origin, jaundice

165
Q

what is a subphrenic abscess?

A

accumulation of fluid between diaphragm, liver and spleen often following surgery.

166
Q

what is the most common cause for chronic pancreatitis?

A

mostly alcohol use, can be CF or obstruction of pancreatic duct (benign/ malignant)

167
Q

what are 3 causes of gastritis?

A

excess alcohol
H Pylori
bile reflux
NSAID use

168
Q

whata is achalasia?

A

an oesophageal motility disorder, whereby the bottom of the oesophagus may not relax properly during swallowing. causes dysphagia, regurgitation and chest pain. commonly occurs spontaneously but also after surgery/ as a result of gastric carcinoma.