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General Surgery > GI > Flashcards

GI Flashcards

1
Q

Causes of constipation (electrolyte)

A

Hypercalcaemia

Hypothyroidism

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2
Q

What will happen to psoas shadow if abdomen is filled with fluid

A

Psoas shadow disappears

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3
Q

Where does flexible sigmoidoscopy go up to?

A

Up to splenic flexure

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4
Q

Where does colonoscopy go up to?

A

Terminal ileus

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5
Q

What is a hiatus hernia?

A

Protrusion of an organ from the abdominal cavity into thorax through oesophageal hiatus

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6
Q

Investigations of hiatus hernia

A

OGD gold standard

Upwards displacement of Z line

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7
Q

Indications for surgery in hiatus hernia

A

Symptomatic despite medical therapy
If increased risk of strangulation/volvulus
If nutritional failure due to GOO

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8
Q

Surgical management of hiatus hernia

A

Cruroplasty: hernia reduced back into abdomen, mesh to strengthen repair
Fundoplication: fundus wrapped around LOS and stitched into place

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9
Q

Complications of hernia surgery

A

Recurrence
Abdominal bloating
Dysphasia
Fundal necrosis if blood supply disrupted

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10
Q

Complications of hiatus hernia

A

Prone to incarceration and strangulation
Gastric volvulus
Borcharts triad: severe epigastric pain, retching without vomiting, inability to pass NG tube

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11
Q

What are haemorrhoids?

A

Distended and prolapsed anal cushions

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12
Q

Clinical features of haemorrhoids

A 
Bleeding
Prolapse 
Discharge
Pruritis
Pain sometimes
Aching/ dragging discomfort on defaecation
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13
Q

Management of haemorrhoids

A 
Reassurance
Increase fluid
High fibre diets
Avoid straining and use laxatives
Surgical intervention: block vessels, rubber band ligation, submucosa injection of sclerosant, haemorrhoidectomy
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14
Q

What is an anal fissure?

A

Lineal anal ulcer most frequently in posterior midline of anal canal
Anterior fissure seen in a Crohns and pregnancy
Skin tag sentinel pile, thickened mucosa at distal end

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15
Q

Causes of anal fissure

A

Idiopathic mostly
Hard faeces/ pregnancy
Dehydration
Crohns

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16
Q

Management of anal fissure

A 
Alleviate pain and spasm 
High fibre diet/fluids
Stool softener/ bulk laxatives
Analgesic cream and warm baths
GTN ointment, oral or topical diltiazem 
Boutilism toxin injection (reduce sphincter tone)
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17
Q

Medical management of perianal warts

A

Imiquimod if inflammatory process

Risk of anal cancer if untreatment

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18
Q

What do perianal warts look like?

A

Stratified squamous epithelium with skin appendages

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19
Q

What is anal intraepithelial neoplasia

A

Pre-cancerous condition
Associated with HPV
Leads to anal cancel (squamous cell carcinoma)
Below dentate line

20
Q

Anal cancel clinical features

A 
Rectal pain 
Rectal bleeding
Anal discharge
Pruritis
Presence of palpable mass
21
Q

Imaging of anal cancer

A

Proctoscopy

USS-guided FNA of palpable lymph nodes

22
Q

Pilonidal sinus/abscess

A

Arose from skin of natal cleft
Inflammation/infection of hair follicles at cleft of buttocks-> formation of Sinus
Pilonidal cysts, sinuses, and abscesses contain a next of hairs

23
Q

Risk factors for pilonidal abscess or sinus

A

Young adults
Hirsute men
Sitting for long periods

24
Q

Does a pilonidal sinus communicate with the anal canal?

A

No

25
Q

Organisms in anorectal abscess

A

E.coli
Bacteriodes spp
Enterococcus spp.

26
Q

What is an anorectal abscess

A

Infection of anal glands in intersphincteric space which drain into crypts near the dentate line
Spreads to perianal region (80%), ischiorectal, intersphincteric, supralevator abscess
Communications with anal canal

27
Q

Goodsall rule for fistula in año

Anorectal abscess complication

A

External opening posterior to transverse anal line: fistula tract will follow a curved course to posterior midline
External opening anterior to transverse anal line: fistula tract will follow a straight radial course to the dentate line

28
Q

Parks classification for anorectal abscess

A 
Peri anal 
Intersphincteric
Trans sphincters
Supra sphincteric
Extra sphincteric
29
Q

Management of fistula in ano

A

Wound care
Fistulotomy: secondary intention, laying tract open
Seton: fixed suture, tract for drainage of abscess, no loss of continence

30
Q

What is rectal prolapse

A

Herniation of rectum through pelvic floor
Elderly females
Commonly with defaecation and returns spontaneously
Mucus discharge, bleeding, incontinence

31
Q

Management of rectal prolapse

A

Dextrose to shrink via osmosis

Fixation or resection rectoscopy

32
Q

Rectal prolapse partial and full thickness

A

Partial thickness: rectal mucosa protrudes out of anus

Full thickness: rectal wall protrudes out of anus, rectal fullness, tenesmus, repeated defecation

33
Q

Imaging for GORD

A

Upper GI endoscopy to exclude malignancy

24hr pH monitoring (DeMeester score), oesophageal manometer to exclude dysmotilith

34
Q

What is achalasia?

A

Failure of LOS to relax

Progressive destruction of ganglion cells in myenteric plexus

35
Q

Clinical features of achalasia

A 
Dysphagia
Vomiting
Chest discomfort
Endoscopy
Manometry
36
Q

Management of achalasia

A

CCB/ nitrates, Botox
Endoscopic balloon dilatation, risk of perforation
Laparoscopic Heller myotomy: division of fibres that DONT relax

37
Q

What is diffuse oesophageal spasm?

A

Multi focal high amplitude contractions of the oesophagus
Dysfunction of inhibitory nerves
Can progress to achalasia

38
Q

Manometry of diffuse oesophageal spasm vs achalasia

A

DOS: repetitive, simultaneous, ineffective contractions
Achalasia: abscence of peristalsis, high resting LOS tone, failure of relaxation of LOS

39
Q

Management of oesophageal cancer

A

Squamous cell carcinoma: chemo-radiotherapy

Adenocarcinoma: neoadjuvant chemotherapy or chemo-radiotherapy then oesophageal resection.

40
Q

Oesophagectomy procedures

A

Ivor Lewis procedure

McKeown procedure

41
Q

Boerhaaves syndrome

A

Spontaneous rupture of oesophagus

42
Q

What is the Glasgow-Blatchford score?

A

Upper GI bleeding patients who are low risk and candidates for outpatient management
1 and above is high risk for needing intervention

43
Q

Complete rockall score

A

Patients with clinical upper GI bleeding who have undergone endoscopy
Risk of rebleeding and mortality after upper GI bleeding

44
Q

What is Zollinger-Ellison syndrome?

A

Severe peptic ulcer disease
Gastric acid hypersecretion
Gastrinoma
MEN1 syndrome

45
Q

Management of variceal bleeds

A

Terlipressin
Octreptide
Manage clotting abnormalities
Endoscopic banding

46
Q

What is Troisier sign?

A

Palpable left supraclavicular nod

Gastric cancer

47
Q

What are Crockenbergs tumours?

A

Gastric tumours that can spread transcoelomically to ovaries

General Surgery (2 decks)

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