GI Flashcards
features of appendicitis
vomiting anorexia fever constipation diarrhoea
DDx for appendicitis
renal stone testicular / ovarian torsion ectopic GI obstruction constipation strangulation hernia mesenteric adenitis intussusception meckel diveriticulitis
what is mesenteric adenitis
self-limitting inflammation of the mesenteric lymph nodes
RIF pain
- common DDx for appendicitis
what results would increase suspicion towards appendicitis
raised neutrophil
raised WCC
raised CRP
what should always be performed in a women with abdo pain
pregnancy test
define diverticulitis
inflammation of the diverticular
define diverticulosis
presence of diverticula in the GI tract
define diverticular disease
symptomatic diverticula
what is the main stay of conservative Mx in diverticular disease
analgesia
abx
adequate hydration
complications of diverticular disease
perforation bleeding abscess fistula strictures
how do you determine betwen inguinal and femoral hernias
inguinal - more medial + superior to pubic tubercle
femoral - inferior + lateral
most common type of hernia
inguinal (80%)
direct (20%)
how to determine the difference between indirect and direct hernia - in relation to the inferior epigastric vessels
indirect - laternal to the inferior epigastric vessels
direct - medial to the inferior epigastri cvessels
which hernia is high risk of strangulation
femoral
obstructed inguinal hernia
implies that the contents of the GI tract cannot pass
how do inferior hernias occur
- testes descend from the posterior abdominal wall into the scrotum following the processus vaginalis
–> passing through the inguinal ring into the scrotum
RF for developing inguinal hernia
chronic cough obese prematurity male heavy lifting
what are haemorrhoids?
vascular rich connective tissue cushions within the anal canal
internal - proximal to dentate line
external - distal to the dentate line
Mx for haemorrhoids
increase dietary fibre
band ligation
bloody supply to foregut / mid / hide
fore - celiac artery (up to 1/2 duodenum)
mid - superior mesenteric artery
hide - inferior mesenteric artery
metabolic electrolyte balance of acute mesenteric ischaemia
other bloods
metabolic acidosis
lactate
raised WCC
gold standard for mesentaric ischaemia
angiography
indications for splenectomy
- spontanous rupture / EBV
- trauma
- hyperspenism (hereditary sphereocytosis)
- malignancy
what do howell jolly bodies signify?
occur where there is no spleen or a non-functing spleen = asplenia
they are RBC with the nuclear remanent
most common pathogen of meningitis in asplenia
meningingitis pneumonia
long term Mx following splenectomy
- life long prophylatic abx (pen V)
2. pneumonccal vaccine
Acute pancreatis causes
gallstones alcohol trauma steroids mumps autoimmune scorp HYPER - lipidaemia / calcium / PTH ERCP drugs (azathopurine, tetracycline, mesalaine )
acute / chronic complications of acute pan
acute:
- ARDS
- shock
- DIC
- sepsis
Chronic:
- chronic panc
- pancreatic pseudocyst (fibrosis/gransulation tissue)
- pancreatic necrosis
acute panc Mx
use glasgow-imrie criteria
- determines severity of pancreatitis (48hrs after hosp admission)
- NG tube - helps prevent bacterial translocation from the gut (prevents panc necrosis)
- fluid managament
- abx therapy
- if due to gallstones –> cholecystectomy
acute panc Ix
serum lipase
- more sensitive + specific than amylase
serum amylase do not correlate with disease severity
how to detemine between small / large bowel obstruction
normal (3/6/9 rule)
small bowel
- valvulae conniventes (width of the bowel)
- central in the abdomen
- diameter is around 2.5cm
- greater than 3cm
- adhesions, from previous surgery (75%)
large bowel
- haustra (arrow head)
Most common:
- colorectal carcinoma
- diverticular strictures
causes of bowel obstruction
adhesions hernias strictures tumour diverticultis
common origin tumours going to the liver
GI tract
breast
lung
Mx for bowel obstruction
bowel rest
‘drip + suck’
- NG - give the bowel a rest from secreting gastric contents
what does TNF-a inhibitors do?
antibody directed against tumour-necrosis factor - important in establishing inflammation + granuloma formation
site of porta-systemic anatosomes
superior rectal vein shunts - haemorrhoids
paraumbilical vein shunts - caput madusae
