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F year medicine facts > Gi > Flashcards

Gi Flashcards

1
Q

ph findings in mesenteric ishaemia

A
  • metabolic acidosis
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2
Q

when does mesenteric adenitis typically happen

A
  • after URTI
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3
Q

3 types of mechanical intestinal obstruction

A
  • luminal; gallstones, faeces, foreign body, meconium
  • intra mural; strictures, intussusception
  • extraluminal; hernia, adhesions, volvulus
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4
Q

different symptoms depending on small vs large bowel obstruction

A 
Small; 
pain = high frequency colic, central
vomit = early
distention = late
constipated = late

large bowel

  • pain = low frequency colic, lower abdo
  • vomit = late
  • distention = early
  • constipated = early
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5
Q

causes of paralytic intestinal obstruction

A
  • sympathetic activity; reflex post op, rtroperitoneal bleed, malignancy
  • bacteria
  • biochem = k, urea, ca
  • opiates, anticholinergics
  • inflammation
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6
Q

what is considered dialtation in the small bowel

A
  • > 3cm.

- valvulae coneventei all the way round

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7
Q

what is considered dilatation in large bowel

A
  • 6cm +

- haustra not all the wat

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8
Q

what condition do you get the late sign of hiccups

A
  • Peptic ulcer perforation
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9
Q

what glasgow blatchford score do you need to have a high chance of needing an intervention for UGI bleed

A
  • 6+
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10
Q

what score predicts a high risk of death from UGI bleed in the rockall system

A
  • > 8
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11
Q

if a patient has haematemesis due to UGI bleed, where most likely is the problem

A
  • proximal to the duodenal jejunal flexure
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12
Q

what one Warfarin reversal agent do you not give in UGI bleed

A
  • PCC, give FFP and plt instead if needed
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13
Q

what are the ALARMS symptoms

A
  • anaemia
  • loss of weight
  • anorexia
  • recent onset of progressive symptoms
  • Malaena/ haematemesis
  • Swallowing issues
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14
Q

how long before OGD must a patient nto eat

A
  • 6hrs
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15
Q

what kind of cancer does barrets usually become-

A

invasive adenocarcinoma

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16
Q

define short vs logn barretts

A
  • <3cm

- >3cm

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17
Q

surveillance guidance for baretts

A

no dysplasia - 2-5yrs

low grade; 6/12; biopsy every 1cm. radiofrequency ablation

high grade - 3/12. if visible lesion = endoscopic ablation with mucosal resection or radiofrequency ablation / oesophagectomy

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18
Q

typical sx Oesophageal ca

A
  • dysphagia progress from solids to liquids
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19
Q

symptoms of diffuse oesophageal spasm

A
  • intermittent dysphagia +/- chest pain
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20
Q

what is the mechanism behindd achalasia

A
  • degeneration of myenteric plexus stopping the LES from relaxing
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21
Q

sx achalasia

A
  • dysphagia
  • regurg
  • weight loss
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22
Q

rx achalasia

A
  • endoscopic baloon dilatation
  • hellers cardiomyotomy

then PPI
0r

Botox if no surgery

CCB and nitrates also relax sphincter

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23
Q

plummer vinson sydrome triad

A
  • oesephageal webs
  • IDA
  • post cricoid dysphagia
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24
Q

which type of oesophageal ca is HPV a RF for

A
  • squamous
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25
Q

what are you doing in a iv lewis oesophagectomy

A
  • right sided thoractomy
  • stomach into chest and oesophagus division mobilised
  • anastamosis = intrathoracic oesophagogastric
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26
Q

what is zollinger ellison syndrome

A
  • pancreatic or gastric gastrin secreting tumour
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27
Q

zollinger ellison syndrom sx

A
  • abdo pain, dyspepsia, chornic diarrhoea and steatoorhea due to inactivation of pancreatic enzymes and damaged intestinal mucosa
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28
Q

zollinger ellison syndrom ix

A
  • fastign gastrin level in serum . 3 x 3 days

- hypochlorhydria = reduced acid production will also cause increased gastrin production - ph will be <2

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29
Q

zollinger ellison syndrome rx

A
  • high dose PPI

- surgery unless MEN1 = multiple adn mets #- somatosatin analogue and chemo

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30
Q

what type of ab is produced in h pylori

A

igg

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31
Q

screening test for h pylori and instructions

A
  • urea breath test; stop abx 4 weeks before and PPis 2 weeks before
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32
Q

what does NICE recommend for gastric ulcers

A

all to biopsy as high malignant potential

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33
Q

rf gastric ca

A
  • h pylori
  • smoking
  • alcholo
  • diet high in nitrates
  • EBV; diffuse type
  • autoimmune gastritis
  • e cadherin mutation = diffuse type. fhx
  • FAP - intestinal type
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34
Q

two types of gastric adenoca

A
  • diffuse = worse prognosis, young people. signet cells

- intestinal - old - better prognosis

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35
Q

where does gastric ca spread to

A
  • Lymph

- lungs, liver, brain, ovaries via transcoelemic

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36
Q

rx gastric ca

A
  • <5cm to OG jnct - total gastrectomy
  • 5-10cm from jnct = sub total gastrctomy

+/- ESSMR
+ d2 NODAL RESECTION + chemo

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37
Q

name the 3 types of surgery that can be done for gastric ca

A
  • bilroth 1
  • bilroth 2
  • roux en y
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38
Q

what is bilroth one surgery

A
  • partial gastrectomy with simple anastamosis
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39
Q

what is bilroth 2 surgery

A
  • partial gastrectomy wtih duodenal stump oversewn and anastamosis in jejunum
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40
Q

roux en y

A
  • total or partial
  • proximal duodenum oversewn
  • proximal jejunum divided from distal
  • proximal jejunum connects to oesophagus
    • distal duodenum connects to jejunum
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41
Q

what is mirizzi syndrome

A
  • compression of common bile duct by stone impacted in cystic duct
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42
Q

what can present similarly to jaundice

A
  • hypercarotenaemial after prolonged and excess consumption of foods containing carotene
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43
Q

how to treat ascending cholangitis

A

ERCP

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44
Q

which anaesthetic can cause jaundice

A
  • halothane
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45
Q

what liver problem is xanthelesmata a indication of

A
  • primary biliary cirrhosis
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46
Q

what happens to colour of urine in hepatic jaundice

A
  • darker as conjugated bilirubin is excreted by the kidney
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47
Q

what happens t o colour of urine and stools in post hepatic jaundice

A
  • dark urine

- pale stool

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48
Q

common drugst that cause cholestatic jaundice

A
  • fluclox
  • steroids; cocp, anabolic
  • sulfonylureas
  • prochloperazin r
  • chlorpromazine
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49
Q

where is hep a an endemic

A
  • south america and africa
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50
Q

incubation period of hep a

A

2-6 weeks

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51
Q

what type of vaccine is available for hep a and who gets it

A
  • inactivated = havrix monodose
  • at risk; travellers tp endemic areas, close contacts, chronic liver disease, blood clotting disorders, MSM, IVDU, Occupational, HIV
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52
Q

hep b incubation period

A
  • 1-6 months
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53
Q

what bone issue do patients with hep a and b get

A
  • arthralgia
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54
Q

what does antihbs indicate

A
  • previous immunisation or exposure
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55
Q

what does hbsag indicate

A
  • current infection
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56
Q

what does anti hbcag indicate

A
  • past infection

- sometimes current

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57
Q

what does hbeag indicate

A
  • infectivity
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58
Q

complications of hep b infection

A
  • chronic; ground glass hepatocytes on microscopy
  • HCC
  • cryoglobulinaemia
  • polyarteritis nodosa
  • glomerulonephritis
  • fulminant liver failure
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59
Q

when are kids immunised for hep b

A

2,3,4 minths

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60
Q

what do the following anti-Hbs levels mean
post immunisation

  1. > 100
  2. 10-100
  3. <10
A
  1. adequate response, no more test. booster at 5yrs
  2. suboptimal response. 1 more dose. if immunocompetent then no further tests needed
  3. non responser. test for current or past infection. give course of 3 vaccinations and testing after.
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61
Q

rx hep b

A
  • pegylated interferon 1st

- tenofovir 2nd

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62
Q

hep c incubation period

A
  • 6-9 weeks
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63
Q

can you breastfeed if you have hep b/c

A

yes

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64
Q

hep c ix

A
  • HCV RNA
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65
Q

hep c complications if chronic

A
  • arthralgia, arthritis
  • sjogrens
  • HCC, Cirrhosis
  • cryoglobulinaemia
  • porphyria cutanea tarda esp with alcohol abuse
  • membranoproliferative glomerulonephritis
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66
Q

what is porphyria cutanea tarda

A
  • blistering skin on sun exposure
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67
Q

rx hep c acute

A
  • support
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68
Q

rx hep c chronic

A
  • test viral genotype

- protease inhibitor +/- ribavarin

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69
Q

ribavarin SE

A
  • Cough, haemolytic anaemia. teratogen. cotnraception till 6 months after stopping
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70
Q

hep d ix and rx

A

= anti hdv if hbsag present

  • INF alpha
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71
Q

what should babies born from hep c/b positive mums have

A
  • full course vaccien + ig
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72
Q

2 types of autoimmune hepatitis

A
  • 1 = 80%, young and middle aged. anti - SMA +ve, 10% ANA +Ve. IgG raised
  • Type 2 - anti-LKM1 +ve . ana and asma -ve
    kids and europe
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73
Q

rx autoimmune hepatitis

A
  • prednisolone
  • azathiprime for maintenance from remission usually in 2-3 yrs
  • transplant
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74
Q

what is the classification system for encephalopathy

A
  • west haven
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75
Q

west haven classificaiton of encephalopathy grades

A
  1. sleep reversasl, lack of awareness, short attention span, impaired computations
  2. lethargy, memory impaired, personality change, asterixis
  3. somnolence, confused, disorientated. hyper-reflexia, nystagmuus, clonus, rigidity
  4. stupor/ coma
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76
Q

rx encephalopathy

A

lacutlose

rifaximin as prophylaxis

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77
Q

indicators of poor prognosis in acute liver failure that is paracetemol induced

A
  • ph 7.3 or
  • INR >6.5/ PT >100seconds
  • grade 3/4 encephalopathy
  • creat >300
  • lactate >£
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78
Q

indicators of poor prognosis in acute liver failure that is NOT paracetemol induced (also kings college criteria for transplant)

A
  • Ph <7.3 post volume resus
  • PT >100 s
or 
3 of beloow 
- PT >50 (INR >3.5)
- Bili >300
- jaundice to enceph >7/7
- age <10/ >40
- etiology; NANB (non hep a , non hep b) or drug induced
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79
Q

if acute liver failure and hepatic encephalopathy + cerebral oedema - RX

A
  • Mannitol

- hyperventilate

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80
Q

5 stages of cirrhosis

A
  1. no varices
  2. varces

decompensated

  1. bleed
  2. ascites
  3. ascites bleeding
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81
Q

what metabolic issues canc ause decompensated liver failure

A
  • hypokalaemia as causes ammonia to build up and cross BBB
  • metabolic alkalosis
  • increased protein intake = more ammonia
  • constipation - prolonged exposure of GI content
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82
Q

RF for Alcoholic liver disease

A
  • alcohol
  • hep c
  • female
  • obese
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83
Q

what happens to plt in liver disease

A
  • goes down due to splenic sequestration
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84
Q

what happens to na in liver disease

A
  • down in cirrhosis
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85
Q

what happens to ast:alt ratio in cirrhosis

A
  • > 1
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86
Q

what scoring system predicts prognosis in chronic liver disease

A
  • child pugh
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87
Q

what is the minimum score on UKELD to be added to transplant list for liver

A
  • 49
88
Q

transudate causes of ascite s= low protein

A
  • cardiac failure
  • liver failure
  • nephrotic syndrome
  • myxoedema
89
Q

exudate causes of ascites = high protein

A
  • cirrhosis
  • abdo malignancy
  • pancreatitis
  • infection/ TB/perforation
  • lymphatic obstruction
90
Q

ix for someone with ascites

A
  • FBC, = infection
  • u and e = renal failure
  • LFT
  • CLotting
  • TFT
  • hepatitis screen
  • amylase
  • USS/CT
  • Ascitic tap + mc&s, cytology and biochem
91
Q

rx ascitic liver disease-

A

salt restrict

  • spironolactone 1st line
  • furosemide 2nd
  • paracentesis + fluid replace
  • TIPS
92
Q

what does alt>ast indicate in terms of NASH/NAFLD

A

-NASH

93
Q

what does steatosis mean

A
  • fat in the liver
94
Q

what does steatohepatitis mean

A
  • fat with inflammation –> NASH
95
Q

ix for NAFLD

A
  • If incidental found on liver uss –> enhanced liver fibrosis blood test. if unavailable fib4 score and fibroscan
  • liver biopsy for staging
96
Q

most common type of pancreatic cancer

A
  • adenocarcinoma
97
Q

rf pancreatic cancer

A

= smoking

98
Q

what is the only curative surgery in pancreatic ca

A
  • whipples procedure

- remove distal stomach, gallbladder, common bile duct, head of pancreas,e duodenum, proximal jejunum and regional LN

99
Q

rare features of pancreatic ca

A
  • thrombophlebitis migricans = arm vein swells thena leg one
  • high ca
  • endocarditis
  • portal HTN = splenic vein thrombosis
  • nephrosis. renal vein mets
100
Q

sx of body of pancreas ca

A
  • back pain
  • steatorrhoea
  • weight loss
  • anorexia
  • abdo pain relieved by sitting forward
101
Q

sx of tail of the pancrease ca

A
  • late presentation with mets, malignant ascites or unexplained anaemia
102
Q

define acute diarrhoea

A
  • <14 days
103
Q

define chronic diarrhoea

A
  • > 30 days
104
Q

4 types of diarrhoea

A
  • osmotic
  • secretory
  • infectious.infla
  • deranged motility
105
Q

What happens in osmotic diarrhoea

A
  • food is staying in intestine so drawing more water in
106
Q

what causes secretoroy diarrhoea

A
  • cholera
  • laxatives
  • hormones from tumours
107
Q

extra intestinal manifestations of UC

A
  • Ank spond
  • osteoporosis
  • osteopenia
  • uveitis
  • episcleritis
  • conjunctivitis
  • erythema nodosum
  • pyoderma gangrenosum
108
Q

crypt abscesses are a typical feature of which type of IBD

A
  • UC
109
Q

classify severity of UC

A
  • Mild = <4 stools passed, only little blood
  • moderate 4-6 stools, moderate varied amount of blood, no systemic upset
  • severe - >6 bloody stools pr day + systemic upset
110
Q

UC treatment

A

induce remission;

mild/moderate - topical salicylate

  • no improvement in 4/52 –> oral ASA, then if doesnt work then oral steroids

severe –> IV steroids/ ciclosporin if steroid CI

maintain

  • mild/mod and proctitis = topical asa or topical and oral asa
  • mild/mode and left sided or extensive = oral ASA

severe or more than 2+ relapses in a year = azathioprine

111
Q

rx crohns disease

A

induce; steroids or budesonide if CI

+/- enteral feed

5-ASA 2nd line

maintain 
- stop smoking
azathiprine/ mercapto
- 2nd = methotrexate
- 3rd - ASA

surgery;
ileocaecal resection

right hemicolectomy

hartmanns

I and D with seton

112
Q

UC surgery options

A
  • total coelectomy with
  • ileo anal anastamosis
  • ileall pouch
  • end ileostomy
  • sub total colectomy
113
Q

what nutritional deficiency do patients with crohsn often have

A
  • b12 and folate
114
Q

p ANCA is more often found in which type of IBD

A
  • UC
115
Q

determining severeity of UC is classified by which system

A
  • true love and whitts criteria
116
Q

thumb printing, lead pipe and toxic megacolon are common in which type of IBD

A
  • UC
117
Q

apple core strictures are seen in which type of IBD

A
  • Crohns
118
Q

contraindications to liver biopsy patients

A
  • uncooperative patient
  • bacterial cholangitis
  • coagulopathy
119
Q

what size liver HCC can be resected

A
  • <5cm

- or up to 3 lesions <3cm

120
Q

what cells are affected in carcinoid syndrome

A
  • enterochromaffin
121
Q

what are cardiac complications of carcinoid syndrome

A
  • pulmonary stenosis

- tricuspid incompetence

122
Q

ix and rx carcinoid syndrome

A
  • High 5-IHIAA in urine

rx
- somatostatin analogue

123
Q

cholangiocarcinoma causes

A
  • flukes

- primary sclerosing cholangitis, hep

124
Q

cholangiocarcinoma rx

A
  • major hepatectomy + extrahepatic bile duct excision + caudate lobe resection.
  • post op comp = bile leak, liver failure and obstructed extrahepatic biliary tree - fix with ERCP
125
Q

liver adenomas are associated with what rf

A
  • cocp

- anabolic steroids

126
Q

when to treat liver adenoma and how

A
  • if sympto or >5cm
  • stop cocp
  • resect
127
Q

abx for amoebic liver abscess

A
  • metronidazole
128
Q

what liver issue can cause a pleural effusion in the right lower zone

A
  • liver abscess
129
Q

what bone issue does hereditary haemochromatosis cause

A
  • chondrocalcinosis
130
Q

incubation period noro

A
  • 24-48hrs
131
Q

incubation period of staph and abcillus

A
  • 1-6hrs
132
Q

incubation period of salmonella and ecoli

A

12-48hrs

133
Q

incubation period shigella and campylobacter

A
  • 48-72hrs
134
Q

incubation period giardiasis and amoeibasis

A
  • > 7/7
135
Q

ix gastroperesis

A
  • scintigraphy - >10% retention after 4hrs of meal
136
Q

rx gastroperesis

A
  • prokinetic e.g. metoclopramide

- antidepressant

137
Q

IBS diagnostic criteria`

A
  • recurrent abdo pain at least 3 days/month for 3months with 2 or more of the following
  • relief on defecation
  • onset assocaited with change in frequency of stool
  • onset associated with change in form/áppearance of stool
138
Q

which types of polyps are higher risk of colon cancer

A

= villous

139
Q

what is the mechanism of cancer in FAP-

A
  • germline mutation in APC gene - chromosome instability pathway.
140
Q

inheritance pattern of FAP

A
  • AD
141
Q

Why do we do prophylactic panproctocolectomy in FAP patients

A
  • 100% get colon adenocarcinoma by 40. have many polyps and every single cell in body already has mutation so only needs one more hit for cancer.
142
Q

cancers more common in FAP-

A
  • Colorectal; small intestine
  • gastric cancer
  • desmoid tumours
  • thyroid cancers
  • osteomas
  • RPE congenital hyeprtrophy
143
Q

lynch syndrome MOA and inheritance pattern

A
  • microsatellite instability pathway; mismatch repair genes mutations - one allele of MSH6, MSH2, MLH1, PMS2
144
Q

cancers more common in lynch syndrome

A

colorectal

  • endometrial
  • stomach
  • pancreas
  • small bowel
  • ureter
  • renal pelvis
  • ovarian cancer
145
Q

what side of colon to lynch syndrome cancers appear

A
  • right side
146
Q

what is constipation defined as

A
  • <2 motion/week
  • less than normal
  • difficult/ incomplete evacuation
147
Q

what metabolic abnormalities can cause constipation

A
  • hyperca
  • hypothyroid
  • hypok
  • porphyria
  • lead poisoning
  • T2DM
148
Q

what common drugs given in HTN cause constipation-

A

CCB

Diuretics

149
Q

other name for lynch syndrome

A
  • HNPCC
150
Q

dukes criteria staging

A

A = mucosa, submucosa +/- muscularis propria

B = subserosa and beyond

C = Any with LN involved

D = distant mets

151
Q

what surgery do you do for rectal tumours

A
  • anterior resection
    = remove all rectum with primary anastamosis
  • abdomino perineal resection = if tumour low in rectum <8cm from anus = remove rectum and anus and permanent colostomy
  • total mesorectal excision
152
Q

all surgical resections of colon require hwo many cm clearance

A

5cm

153
Q

which side of colon are hyperplastic polyps usually seen?

what about sessile?

A

left

right

154
Q

what do alpha cells in pancreas make

A
  • glucagon
155
Q

what do delta cells in the pancreas make

A
  • somatostatin - supresses release of gastric hormones so decreased rate of gastric emptying
156
Q

why does calcium rise cause pancreatitis

A
  • activates conversion of trypsinogen to trypsin –> autodigestion
157
Q

complications of acute pancreatitis

A
  • shock
  • aki
  • ards
  • DIC
  • Sepsis
158
Q

modified glasgow criteria for pancreatitis

A 
Pao2 <8
Age >55
N = WCC>15
C = calcium <2
Renal= urea >16
Enzymes = LDH >600/ AST>200
A = albumin <32
S= sugar >10

1 point if any criteria in first 48h. 3+ = ITU

159
Q

rx acute pancreatitis

A
  • fluid resus
  • ng tube to decompress
  • analgesia - not morphine if possible
  • antiemetic
  • sort glucose
  • vitals
  • ERCP if gallstones
160
Q

what skin issue can you get in chronic pancreatitis

A
  • erythem ab igne
161
Q

what type of DM does chronic pacnratitis cause

A
  • type 3c; disease of exocrine pancreas
162
Q

cause of acute mesenteric ischaemia

A
  • embolus, thrombus, non occlusive ischaemia
163
Q

cause of chronic mesenteric ischaemia

A
  • atherosclerosis of all 3 vessels supplying the gut
164
Q

sx acute mesenteric ischeamie

A
  • abdo pain
  • no abdo sign
  • shock
165
Q

sx chronic mesenteric ischaemia

A
  • severe colicky post prandial pain = gut claudication
  • pr bleed
  • weight loss
  • feaer of food
  • malabsoprtion
  • fatigue
  • abdo bruits
  • abdo tender
166
Q

sx chronic large bowel ischaemia

A
  • bloody diarrhoea
  • left sided abdo pain
  • fever
  • tachy
  • PR blood
167
Q

what is the colalteral blood supply to the colon

A
  • marginal artery of drummond
168
Q

watershed zones in the colon vulnerable to mesenteric ischaemia

A
  • right colon as artery of drummon not well developed here.
  • splenic flexure as tenuous or missing artery of drummond
  • rectosigmoid junction as distal to last collateral of proximal arteries that supply colon
169
Q

most common organ involved in stabbings

A
  • liver
170
Q

organ most commonly involved in gunshot wounds

A

small bowel

171
Q

indications for resus laparotomy in abdo trauma

A
  • life threatening blunt trauma

- unresponsive hypotension despite resus with no other cause of bleeding found

172
Q

indications for urgent laparotomy in abdo trauma

A
  • blunt trauma with positive lavage or free blood on USS with unstable circulation
  • peritonitic
  • kinfe injury associated with visible viscera, peritonitis, haemodynamic instability or sepsis
  • gunshot wound
173
Q

what is choledocholithasis

A
  • gallstone obstruct common bile duct
174
Q

what is gallstone ileus

A
  • obstruction of small bowel by gall stone via fistula. the obstruction causes vigorous peristalsis = gallstone ileus (different to what ileus normally means)
175
Q

in which gallstone related disease would you do a U and E and G and s as well as clotting and ABG

A
  • ascending cholangitis
176
Q

who are spigelian hernias most commonly seen in, and what are they called

A
  • older pts
  • lateral ventral; hernia through spigelian fascia (the aponeurosis between the rectus abdominas medially annd the semilunar line laterally
177
Q

what is a richters hernia

A
  • only antimesenteric border of the bowel herniates through the fascial defect
178
Q

congenital inguinal hernias are more common on which side

A
  • right
179
Q

where are inguinal hernias in relation to the pubic tubercle

A
  • medial and above
180
Q

direct vs indirect hernia relationship to inferior epigastric artery

A
  • medial = direct

- lateral = indirect

181
Q

direct hernia rx

A
  • open mesh/ lap

- wait and watch

182
Q

indirect hernia rx

A
  • kids = herniotomy, adults = open mesh/lap

- wait and warch

183
Q

inarcerated femoral hernia operation

A

= iguinal approach

if not incarcerated and not small bowel involved can do infrainguinal

184
Q

where do femoral hernias lie in relation to femoral vein

A
  • medial
185
Q

how to treat incisional hernias

A
  • <4cm = simple sutures
  • > 4cm = place mesh between posterior rectus sheath and rectus abdominis
  • lap approach
186
Q

what is zenkers divcerticulum

A
  • pharyngoesophageal false diverticulum. oesophageal dysmotility = herniation of mucosa at killians triangle b/ween thyro and cricopharyngeal constrictor
187
Q

sx of zenkers diverticulum

A
  • dysphagia
  • obstruction
  • gargling
  • halitosis
  • neck mass
  • aspiration
188
Q

zenkers diverticulum mnemonic

A
  • elder mike has bad breath
  • elderly people
  • killian triangle
  • halitosis
  • oesophageal dymsotility
189
Q

what are the rule of 2s for meckels diverticulum

A
  • 2 times more common in men
  • 2 inches long
  • 2ft from IC valve
  • 2% population
  • common presents in first 2yrs of life
  • 2 types of epithelia; gastric/pancratic
190
Q

staging for surgery or not in diverticular disease (hinchey classification)

A

stage 0 = no abscess

stage 1; pericolic or mesenteric abscess
= no surgery - radiological drain

2 = walled off or pevic abscess = sometimes surgery - lap washout/radio drain

3= generalised purulent peritonitis = surgery - wash out/ hartmanns

4= generalised faecal peritonitis = surgery - hartmanns

191
Q

pus somewhere pus nowhere in context of asbcess means…

A
  • pus under diaphragm
192
Q

what abx do we most commonly give in acute diverticulitis

A
  • cipro

- metro

193
Q

where do far eastern people get diverticulitis

A
  • right side
194
Q

appendicitis GS dx

A
  • CT
195
Q

what is the scoring system used in appendicitis

A
  • alvadaro score >7 = appendicitis
  • <5 - unlikely
  • RIF tenderness 2
  • rebound tenderness 1
  • rif migratory pain 1
  • anorexia 1
  • n and v 1
  • fevver 1
  • leukocytosis 2
  • left shift neutrophils 1
196
Q

what incision is used in open appindectomy

A
  • grid iron
197
Q

why do you never make a lateral incision at mcburneys point in appindectomy

A
  • can cut ileohypogastric nerve
198
Q

main RF for cholangiocarcinoma

A
  • Primary sclerosing cholangitis
  • liver flukes
  • typhoid
199
Q

anal cushion positions

A
  • 3,7, 11 oclock
200
Q

where does lymph drainage above the pectinate line occur

- below?

A
  • pelvic

- inguinal

201
Q

classification of haemorrhoids

A
  1. remains in rectum
  2. prolapses through anus on defecation but reduces spontaneously
  3. protrudes throught anus but needs digital reduction
  4. remain persistently prolapsed

OR INTERNAL VS external - pectinate line seperates

202
Q

surgical rx for haemorrhoids and there associated side effects

A
  • band ligation - banding = ulcer tethering mucosa. SE = Bleed, pain, infection
  • sclerotherapy; SE = Impotence, prostatitis
  • infra red photocoag
  • surgical removal in grade 4 and where other options failed. SE - Haemorrhage and stenosis. 2 weeks off work needed.
203
Q

anal fissure rx

A
  • conservative
  • lidocaine for topical pain relief
  • GTN ointment
  • diltiazem
  • botox
  • lateral sphincterotomy
204
Q

what is goodsalls law for fistula in ano

A
  • anterior fistula = vertical drain

- posterior drain at 6o clock

205
Q

anal abscess classification

A
  • intersphincteric = in between internal and externals phoncter
  • perirectal = ischiorectal psace
  • supralevator = above anorectal ring
206
Q

parks classification of anal fistulas

A
  • intersphincteric
  • transphincteric ; through external sphincter
  • suprasphoncter - ascends from intersphinceteric space to puborectalis then levator ani
  • extrasphinceric - outside external sphinc
207
Q

fistula rx

A
  • fistulotomy and excise

- seton suture esp if high fistula where excising = incontinence

208
Q

what kind of cancer is anal ca most commonly

A
  • SCC
209
Q

what type of anal cancer has worse prognosis

A
  • above pectinate line is worse
210
Q

rx anal ca

A
  • chemo and radio = preferred

- AP resection if failed after 6 weeks of CHRT

211
Q

rx rectal prolapse

A
  • manual reduction
    or if persists
  • abdo approach = rectopexy +/- mesh +/- rectosigmoidoscopy
  • perineal approach - delornes procedure = resect close to dentate and sutture muscosal boundries
212
Q

causes of b1 defi and sx

A
  • alcoholics or white rice diet

- polyneuropathy, HF, Wernickes

213
Q

causes of B2 def

A
  • decreased milk or chronic malabsoprtion
214
Q

B3 deficiency causes

A
  • Dermatitis
  • diarrhoea
  • dementia
  • -> v photosensitive
215
Q

sx vit c deficiency

A
  • gingivitis, petechiae, rash, internal bleeds, impaired wound healing
  • need for bone and bvs
216
Q

rx for morbid obesity

A

conservative
medical ; orlistat if BMI >30 or >28 + RF. Max 1 yr use

surgical if BMI >40 OR 35+ with comorbidities and failure of diet measures

  • gastric banding
  • bypass
  • sleeve gastrectomy; remove part of stomach
  • intra gastric ballooon – filled with air or salt water then passed downt throat
  • biliopancratic diversion

F year medicine facts (19 decks)

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