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Year 6 Passmed > GI and Gensurg > Flashcards

GI and Gensurg Flashcards

1
Q

What are the non EtOH causes of chronic pancreatitis?

A

Cystic fibrosis Hereditary haemochromatosis Ductal obstruction

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2
Q

What are the complications of gastrectomy?

A

Dumping syndrome Weight loss Early satiety IDA Osteoporosis B12 deficiency Gallstones Gastric cancer

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3
Q

What is a good way to distinguish btween acute cholecystitis and biliary colic?

A

Patients with cholecystitis are typically systemically unwell

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4
Q

What is the most common cause of ascending cholangitis?

A

E coli

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5
Q

What is the typical presentation of a pancreatic pseudocyst?

A

Presents 6 weeks after an episode of acute pancreatitis Retrogastric fluid collection is seen Abdo pain, fullness

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6
Q

What is the best imaging technique to diagnose chronic pancreatitis?

A

CT pancreas with IV contrast

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7
Q

What might cause RUQ pain and jaundice in a post cholecystectomy patients 4 weeks post op having previously recovered?

A

Common bile duct stone

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8
Q

What electrolyte abnormality indicates severity of pancreatitis?

A

Hypocalcaemia

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9
Q

What investigation is useful in determining whether an isolated hyperbilirubinaemia is due to Gilbert’s syndrome?

A

FBC - would show signs of haemolysis

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10
Q

What is the management of acute cholecystitis?

A

Analgesia IV fluids IV Abx Lap Chole within 1 week of diagnosis

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11
Q

What respiratory pathology is a recognised complication of acute pancxreatitis?

A

ARDS

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12
Q

What is the management of choice in the case of an unresectable pancreatic carcinoma?

A

Palliative biliary stenting

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13
Q

What is the initial treatment of gastric MALT lymphoma?

A

H pylori eradication therapy

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14
Q

Blockages of which structures of the biliary tree does not cause jaundice?

A

Gallbladder Cystic duct

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15
Q

What condition is associated with pigmented gallstones?

A

Sickle cell disease (due to ghaemolysis)

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16
Q

In what part of the large bowel are diverticulae most commonly seen?

A

Sigmoid colon

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17
Q

What are the typical symptoms of diverticular disease?

A

Altered bowel habit Bleeding Abdo pain

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18
Q

What is the management of acute diverticulitis?

A

INcrease fibre intake Mild - abx Sev/recurrent - consider resection

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19
Q

60 year old man presents with IDA, what is the next step in his investigations?

A

Colonoscopy

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20
Q

What type of stoma do colostomies warrant, and what type are seen with ileostomies?

A

Colostomy - flush Ileostomy - spouted

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21
Q

What type of procedure is done for CRC at the: caecum, ascending or proximal transverse colon?

A

Right hemicolectomy

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22
Q

What type of procedure is done for CRC at the: distal transverse or descending colon?

A

Left hemicolectomy

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23
Q

What type of procedure is done for CRC at the: sigmoid colon?

A

High anterior resection

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24
Q

What type of procedure is done for CRC at the: upper rectum?

A

Anterior resection

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25
Q

What type of procedure is done for CRC at the: lower rectum?

A

Low anterior resection

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26
Q

What type of procedure is done for CRC at the: anal verge?

A

Abdomino-perineal resection

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27
Q

What is the management of a non-ruptured sigmoid volvulus?

A

1st - Decompression via rigid sigmoidoscopy and flatus tube insertion 2nd - Percutaneous colostomy tubing to decompress the volvulus

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28
Q

What is the typical presentation of a sigmoid volvulus?

A

An elderly man with chronic constipation and Parkinson’s disesae (on medication) with constipation, bloating, abdo pain and N/V

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29
Q

What are the risk factors for caecal volvulus?

A

Previous surgery IBD Adhesions Pregnancy

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30
Q

What are the referral guidelines for colorectal cancer?

A

Colonoscopy in: >=40 with wt loss and abdo pain >=50 w undexplained bleeding >=60 w IDA or change in bowel habit Urgent referral if: Rectal/abdo/anal mass <50 w bleeding and any of: pain change in bowel habit wt loss IDA

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31
Q

What tumour marker is used for CRC?

A

CEA

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32
Q

What is the current NHS colorectal cancer screening programme?

A

Individuals aged 60-74 undertake FOB testing every 2 years, and are offered colonoscopy if abnormal In addition, a one off flexi-sig is available at age 55 to detect and treat polyps

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33
Q

What procedure is offered for refractory anal fissures?

A

Sphincterotomy

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34
Q

What is a seton and when is it used?

A

A type of stitch used to promote healing of anal fistulae

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35
Q

What investigation should be used to confirm anastomosis has formed successfuly?

A

Gastrografin enema (less toxic than barium)

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36
Q

What is the nature of bleeding seen in haemorrhoids?

A

Post defecatory painless rectal bleeding noticed in pan and paper

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37
Q

What is the typical bleeding pattern of anal fissures?

A

Painflu rectal bleeding often with a sentinel skin tag

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38
Q

What is the difference between an anterior and posterior sited fissure?

A

Posterior are more common and are associated with the passage of hard stools Anterior fissures are typically linked to an underlying organic disease

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39
Q

What is the benefit of giving post op analgesia via an epidural over other methods?

A

It accelerates the return of normal bowel function

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40
Q

What is the single strongest risk factor for anal cancer?

A

HPV 16/18

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41
Q

What is typically found on DRE in haemorrhoids?

A

Nothing…!

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42
Q

What are anal fistulae typically secondary to, and what might they present with?

A

Ano-rectal sepsis Foul smelling discharge

43
Q

What are some classical anorectal/bleeding features of UC?

A

Bright red blood mixed in with stool Diarrhoea Weight loss Nocturnal iuncontinence Mucous passage Proctitis

44
Q

What is the typical presentation of solitary rectal ulcer syndrome?

A

History of IBS presents with bright red rectal bleeding - flexi sig shows fibromuscular obliteration

45
Q

If a SCC is found in the anorectal region, where is it likely to have arisen from?

A

Anus Rectal cancers are very rarely SCC

46
Q

What are the features of a gastric volvulus?

A

Borchardt’s triad: Vomiting Epigastric pain Failed attempts at NGT

47
Q

What surgery? A 22-year-old man presents with his first presentation of ulcerative colitis. Despite aggressive medical management with steroids, azathioprine and infliximab his symptoms remain unchanged and he has developed a megacolon.

A

Sub total colectomy This is used over a panproctocolectomy, as patients with fulminant UC with rectal resection carry a very high risk of complications

48
Q

What surgery? A 22-year-old lady has a long history of severe perianal Crohns disease with multiple fistulae. She is keen to avoid a stoma. However, she has progressive disease and multiple episodes of rectal bleeding. A colonoscopy shows rectal disease only and a small bowel study shows no involvement with Crohns.

A

Proctectomy Severe rectal Crohns that has developed complications such as haemorrhage and multiple fistulae is usually best managed with proctectomy. Although a diverting stoma may reduce the risk of local sepsis it is unlikely to reduce the bleeding. She is keen to conserve a rectum, however, an ileoanal pouch in this setting is unwise.

49
Q

Roughly outline the Duke’s staging system

A

A - Confined to mucosa B - Invading bowel wall C - Lymph node mets D - Distant mets

50
Q

Which heals better, loop ileostomy or loop colostomy?

A

Ileostomy

51
Q

Are end stomas Reversible?

A

No

52
Q

Where would you find a loop ileostomy and what is its role?

A

RIF - to defunction the colon following surgery

53
Q

What is the role of an end ileostomy?

A

Usually following a panprotocolectomy

54
Q

What is the role and siteof a loop colostomy?

A

May be anywhere in the abdomen depending on the colonic segment used Defunctions distal segment of colon

55
Q

What patients typically get rectal prolapses, and how do they present?

A

Post partum women- presents with obstructed defectaion

56
Q

A 72-year-old male has been diagnosed with rectal carcinoma. He is due to undergo a lower anterior resection. The aim of the resection is to restore intestinal continuity. Which is the most appropriate type of stoma?

A

Loop ileostomy This would defunction the large bowel giving time for formation of colo-anal anastamosis to heal

57
Q

What should be done on discovery of a colovesicular fistula?

A

Abdo CT to look for other complications which may have occured

58
Q

What investigation? A 72-year-old man is admitted with large bowel obstruction and CT scan suggests diverticular stricture in the sigmoid colon.

A

Laparotomy

59
Q

What is the non-eponymous name for a Hartmann’s procedure?

A

Protosigmoidectomy

60
Q

What is the management of a sigmoid volvulus with signs of peritonism?

A

Urgent laparotomy

61
Q

What is the management of a mild diverticulitis flare?

A

Send home with oral Abx Advise to attend AnE if no improvement in 72 hours

62
Q

What type of injury do patients in RTAs who incorrectly position their seatbelts get?

A

Carotid artery laceration

63
Q

What are the blood film features of hyposplenism?

A

Howell Jolly bodies Pappenheimer cells Target cells

64
Q

What are the ECG features of hyperkalaemia, and which is the most concerning?

A

Peaked T waves Flat P waves Broad QRS Sinusoidal wave pattern - pre-terminal

65
Q

Side of lesion in tongue/uvular lateralisation?

A

Tongue goes Towards Uvula goes Uver way

66
Q

What are the indications for splenectomy?

A

Uncontrollable splenic bleeding Hilar vascualr injury Devascularised spleen

67
Q

When would you do a thoracotomy for haemathorax?

A

>1.5L initially OR >200ml/hour for >2 hours

68
Q

What AXR finding is consistent with SBO, and how is this different to LBO?

A

In SBO you see valvulae conniventes which extend all the way across the bowel. In contrast, haustra seen in LBO only extend around 1/3 of the way across the bowel

69
Q

Aside from GTN, what other agent may be used topically for anal fissures before consideration of sphincterotomy?

A

Diltiazem

70
Q

What are the borders of the femoral canal?

A

Lateral - femoral vein Medial - lacunar ligament Anterior - inguinal ilgament Posterior - pectineal ligament

71
Q

Where would you find a femoral hernia?

A

Inferolateral to the pubic tubercule

72
Q

Are femoral herniae likely or unlikely to strangulate?

A

Likely - require urgent repair

73
Q

What are the complications related to TPN?

A

Sepsis Refeeding syndrome Hepatic dysfunction (deranges LFTs)

74
Q

How might an ilioinguinal nerve injury present?

A

Pain over the inguinal ligament which radiates to the lower abdomen and tenderness on compression of the inguinal canal

75
Q

What is the presentation of femoral nerve injury?

A

Loss of hip flexion Loss of knee extension Loss of quadriceps tendon reflex Loss of anteromedial thigh sensation

76
Q

What nerve is commonly damaged in carotid endarterectomy?

A

Hypoglossal

77
Q

Aside from haemorrhagic shock, what type of shock may present following trauma, and how?

A

Spinal shock secondary to spinal cord transection which causes loss of sympathetic outflow resulting in hypotensive bradycardia with warm peripheries due to inadequate vasoconstriction

78
Q
A

Rigler’s sign (double walling) indicating pneurmoperitoneum

79
Q

What is the pathophysiology of a TRALI?

A

Acute noset non cardiogenic pulmonary oedema which occurs as a result of leucocyte antibodies in transfused plasma which cause aggregation and degranulation of host leukocytes in lung tissue -> pulmonary infiltrates

80
Q

What are the vast majority of bladder cancers, and how do they present?

A

Transitional cell carcinoma presenting with painless haematuria

81
Q

A 45-year-old woman presents with haematuria and loin pain. She has a temperature of 37 oC and is found to have a Hb 180 g/l and a creatinine of 156 umol/l. Her urine dipstick shows 3+ blood. Blood and urine cultures are negative.

A

Renal vein thrombosis secondary to renal cell carcinoma

82
Q

How much fluid should be given to a burns patient weighing 80kg with 10% burns in the first 8 hours?

A

1.6L

10*80*4=3.2L in 24hours with half given in the first 8

83
Q

A 30-year-old woman presents with pain and swelling of the left shoulder. There is a large radiolucent lesion in the head of the humerus extending to the subchondral plate.

A

Giant cell tumour - have ‘soap bubble appearance’ on X-ray, and typically present as pain or pathological fractures.

84
Q

Which blood vessel is most commonly implicated in the rupture of a peptic ulcer?

A

Gastroduodenal - supplies the posterior aspect of the second part of the duodenum

85
Q

Which shocks cause warm peripheries and which cause cool peripheries?

A

Warm: Neurogenic, septic, anaphylactic

Cool: Cardiogenic, spinal, hypovolaemic

86
Q

What aer the features of a hepatic haemangioma?

A

Sommonly silent but may present due to mass effect

Hyperechoic on liver USS

87
Q

What type of cancer does achalasia increase the risk of?

A

Squamous cell carcinoma of the oesophagus

88
Q

What tumour marker is used for HCC?

A

AFP

89
Q

Name 3 TNF alfa inhibitors and their uses

A

Adalimumab

Infliximab

Etanercept

Used in Crohns and Rheumatoid disease

90
Q

What is the MOA of Trastuzumab and when would you use it?

A

HER receptor used in breast cancer

AKA- Herceptin

91
Q

What is Basiliximab and when would you use it?

A

IL2 inhibitor used in renal transplant patients

92
Q

What is a useful marker of disease recurrence in medullary thyroid cancer?

A

Serum calcitonin

93
Q

What is a useful marker of disease recurrence in papillary thyroid cancer?

A

Thyroglobulin antibodies

94
Q

What is a retractile testis?

A

A testis which appears only in warm conditions or can be brought down on clinical examination

95
Q

A 68 year of man presents with recurrent episodes of left sided ureteric colic and haematuria. Investigations show some dilatation of the renal pelvis but the outline is irregular.

A

TCC - It is a urothelial cancer not just arising from the bladder

96
Q

Which patient group is most commonly affected by spondylolisthesis?

A

Young athletic females with a background of spondylolysis

97
Q

What is the classical feature of pseudomyxoma peritonei and where does it most commonly arise from?

A

Abundant mucin/gelatinous secretions, typiucally arising from the appendix

98
Q

What is the anatomical definition of ‘upper GI’?

A

Proximal to the ligament of Treitz, the suspensory muscle of the duodenum at the duodenojejunal flexure

99
Q

What should be done on detection of a congenital inguinal hernia?

A

Refer for surgery as they have a high rate of complications

100
Q

What is a Richter’s hernia and how might it present?

A

A herniation of the antimesenteric border of the bowel ONLY herniates through an abdominal wall fascial defect.

It typically presents with symptoms of strangulation but NOT obstruction

101
Q

What are the borders of Hesselbach’s triangle, and what does this mean for whether a hernia is direct or indirect?

A

Medial - Recus abdominis

Lateral - Inferior epigastric vessels

Inferior - Inguinal ligament

Herniae within the griangle are direct, and those outside are indirect

102
Q

What is the annual risk of strangulation of a direct inguiunal hernia without surgery?

A

<5%

103
Q

What is the best indication for a stable patient with an anal fistula?

A

Pelvic MRI to track the course and structure of the fistula

104
Q

A 17-year-old male is admitted with lower abdominal discomfort. He has been suffering from intermittent right iliac fossa pain for the past few months. His past medical history includes a negative colonoscopy and gastroscopy for iron deficiency anaemia. The pain is worse after meals. Inflammatory markers are normal.

A

Meckel’s diverticulum - acid secretion causes bleeding and ulceration

Year 6 Passmed (22 decks)

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