GI Flashcards

1
Q

What are haemorrhoids?

A

Enlarged symptomatic anal vascular cushions (not just dilated veins)

-Anal vascular cushions –> part normal anatomy, containing AV channels that connect superior rectal artery and vein, usually positioned 3, 7, 11 oclock. Can be smaller additional ones in haemorrhoids.

RF –> middle age, constipation w prolonged straining, pregnancy

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2
Q

What is the typical presentation of haemorrhoids?

What is the grading of haemorrhoids?

A

Bright red rectal bleeding –> on toilet paper and often coating stools, or dripping into toilet.

  • There may be mucous discharge and pruritus ani.
  • Usually painless, thrombosed external haemorrhoids can be painful and present acutely.
  • Severe anaemia may occur.
  • Symptoms such as weight loss, tenesmus, and change in bowel habit should prompt thoughts of other pathology.
Grading 
1 Never prolapse 
2 Prolapse and reduce spontaneously
3 Prolapse and require manual reduction 
4 Irreducible
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3
Q

What are the investigations for haemorrhoids?

A
  • DRE –> internal haemorrhoids can be hard to palpate
  • Proctoscope for examining haemorrhoids –> examine colour and pain. Internal ask to strain and appear blue. Thrombosed painful and purple.
  • In all rectal bleeding do –> An abdominal examination to rule out other diseases, PR exam: prolapsing piles are obvious. Internal haemorrhoids are not palpable. Colonoscopy/flexible sigmoidoscopy to exclude proximal pathology if >50 years old.
  • FBC –> Check anaemia
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4
Q

How should haemorrhoids be managed?

What are the options?

A

1 –> 1st degree –> Medical –> -Reassure, avoid straining, soften stools (fibre and fluids, bulk). Topical local anaesthetic cream (short term)

2 –> Non operative –> 2 and 3 degree or 1st and medical not working –> Rubber band litigation (IMPORTANT) (not for external as normal sensory supply). Sclerosants (phenol oil). Infrared coag, coags vessels less painful. Bipolar diathermy and direct current electrotherapy causes coag and fibrosis.

3 –> Surgery –> Excisional haemorrhoidectomy is the most effective treatment (excision of piles ± ligation of vascular pedicles, as day-case surgery, needing ~2wks off work). Stapled haemorrhoidopexy (procedure for prolapsing haemorrhoids) may result in less pain, a shorter hospital stay, and quicker return to normal activity than conventional surgery.

-Prolapsed, thrombosed piles –> Analgesia, ice packs, and stool softeners. Pain usually resolves in 2–3wks. Some advocate early surgery.

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5
Q

What is appendicitis?

A
  • Inflammation of the vermiform (worm shaped tube extending from caecum) appendix.
  • Most commonly results from obstruction of appendiceal lumen –> usually secondary to a faecolith (hardened mass of faeces) obstruction w subsequent bacterial overgrowth leading to infection and pus formation(b frigilis, e.coli)
  • Obstruction –> increase pressure of appendix –> compromise blood supply –> ischaemia, perforation, gangrene
  • Lifetime risk 1 in 15
  • RF –> constipation, younger age common in early teens
  • Uncomplicated, non perforated. Complicated perforated.
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6
Q

What is the typical presentation of appendicitis?

A
  • Anorexia commonly 1st sign, followed by abdo pain and vomiting.
  • Abdo pain initially visceral colicky pain in umbilical region, then moves to RIF over 24-48 hours and becomes consistent.
  • RIF pain –> inflammation affecting the tissue and peritoneum surrounding appendix.
  • RIF peritonism –> pain on moving or coughing, guarding, rebound tenderness.
  • Fever tends to be mild.
  • Tenderness can be localised to mcburnies point
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7
Q

What are three potential signs in appendicitiis?

A
  • Rovsings –> press in LIF and get RIF pain
  • Psoas sign –> pain on extending hip (when retrocaecal appendix)
  • Cope (obturator) sign –> pain on flexion and internal rotation of right hip
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8
Q

What are the differential diagnosis in appendicitis?

A

Meckels diverticulitis, , gastroenteritis, intussusception, crohns,
PID, ovarian cyst, ectopic pregnancy
UTI, renal colic

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9
Q

What are the investigations for appendicitis?

A
  • Diagnosis –> most cases clinical.
  • Bloods –> increased CRP and WBC.
  • Diagnosis not sure or in older may have imaging
  • Abdo pelvis CT –> best imaging often not required. US less sensitive but acceptable in pregnancy and children.
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10
Q

What is the management for appendicitis?

A
  • Surgery –> appendectomy definitive. Laparoscopic fewer complications e.g abscess formation. In pregnancy open is safer.
  • Ab before surgery and 24 hours after, urgently when perforated. Ab –> cover g+ve and –ve e.g coamoxiclav.

-Most cases of uncomplicated appendicitis resolve in 10 days w Ab alone but surgery performed as high risk recurrence w/o surgery, 25% within 1 year and 40% within 5 years.

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11
Q

What are the complications of appendicitis?

A
  • Untreated can lead to perforation, generalised peritonitis and abscess formation
  • Appendix mass, omentum and small bowel may adhere to inflamed appendix.
  • Abscess can be treated w IV Ab and CT drainage. Abscess –> internal appendicectomy –> few weeks are intiial presentation following course Ab.
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