Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 Surgery > GI + Colorectal > Flashcards

GI + Colorectal Flashcards

1
Q

What is ‘the acute abdomen’

A

An emergency surgical condition caused by damage to one or more of the abdominal organs due to injury or disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the ‘type’ of pain with inflammatory causes of the acute abdomen?

A

Constant pain supported by a raised temperature, pulse and leucocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What symptoms are seen with peritonitis?

A

Localised pain worse with movement, coughing or inspiration
(patient lies still with shallow breathing)

Often associated with guarding (reflex contraction of abdominal muscles on examination) and rigidity (increased tone at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What ‘type’ of pain is seen with obstructive causes of AA?

A

Colicky
patients often agitated

may become constant with superimposed inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is pain from the foregut referred to?

Midgut?

Hindgut?

A

Upper abdomen

middle abdomen

Lower abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the abdominal causes of the acute abdomen?

A 
Acute appendicitis 
Meckel's diverticulitis 
Intestinal obstruction 
Perforated viscus (acute severe pain and shock)
Acute pancreatitis 
Acute cholecystitis/cholangitis 
Renal calculi
Acute scrotum
Inflammatory bowel disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the vascular causes of the acute abdomen?

A

AAA

Mesenteric thrombosis/embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the medical causes of the acute abdomen?

A 
GORD
referred pain from pneumonia 
MI
UTI
Pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the gynae cases of the acute abdomen?

A

Ruptured ectopic, sorted /ruptured ovarian cysts, salpingitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the other causes of the acute abdomen

A

Non-specific mesenteric adenitis (pain in young children, often following URTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations should be done for the acute abdomen?

A

FBC, U+E, LFTs, CRP, amylase and ABG

Pregnancy test
Urinalysis
Erect CXR, AXR
USS/CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the initial management of the acute abdomen?

A

A-E

Certain presentations require urgent laparotomy: rupture of an organ (spleen/aorta/ectopic)
Peritonitis (perforated ulcer, diverticulum, appendix, gallbladder)

Pancreatitis can mimic these: always check amylase, lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When does appendicitis occur?

A

When the appendix is obstructed by a faecolith (hard bi of poo) or foreign body in the lumen, or lymphoid enlargement in the wall

Bacterial can proliferate in the closed loop of bowel, eventually leading to necrosis and perforation due to raised intraluminal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of acute appendicitis?

A

Abdo pain, starting dull and central before becoming localised and sharp in the RIF at McBurney’s point

Constipation (or sometimes diarrhoea)

Anorexia

N+V (after the pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is McBurney’s point?

A

One third of the way between the ASIS and the umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of acute appendicitis?

A

Rebound (when the examiner moves hand away, tenderness in the RIF)
Percussion tenderness
Guarding
Rosving’s sign

PR painful on the RHS (if pelvis appendix or pus in pouch of Douglas)

Tachycardia
Mild fever, flushing and fetor
Tender mass (occasionally)

PSOAS sign (pain on R hip extension, retroperitoneal, retrocaecal appendix)

Obturator sign (pain on internal rotation of R hip: pelvic appendix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Rosving’s sign?

A

More painful in RIF than LIF when LIF pressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations should be done for Acute appendicitis?

A 
PR
Pelvic examination in females
Pregnancy test
Bloods - FBC, U+E, CRP/ESR
Urinalysis 
USS/CT - if diagnostic uncertainty

AXR/erect CXR - if questioning perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the management of a confirmed appendicitis?

A

Resuscitation:
IV metronidazole/cephalosporin

Laparoscopic appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the complications of appendicectomy?

A

Early - haematoma, wound infections

Late - small bowel obstruction (adhesions) or incisional herniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the complications of a perforated appendix?

A

Peritonitis and sepsis

Appendix mass: inflamed appendix becomes covered with omentum

Appendix abscess: local/pelvic/subhepatic/subphrenic: develop if appendix mass fails to resolve

Adhesions
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the ddx of a mass int the RIF?

A 
Inflammatory mass (appendix mass/abscess)
lymphoma
chron's disease 
tumour mass (caecal / carcinoid 
Pelvic kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the management of a mass in the RIF?

A

USS/CT to confirm diagnosis
Conservative management: IV cefuroxime and metronidazole - marking out the size of the mass to see if it develops into an abscess

If the mass does not resolve, perform percutaneous drainage of the abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a carcinoid tumour?

A

Tumour of argentaffin cells, which produce physically active substances such as serotonin/prostaglandins

usually occurs when metastases are present in the liver and release serotonin into the systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where do carcinoid tumours tend to occur?

A

on the tip of the appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When do carcinoid tumours present?

A

after the fourth decade, with the carcinoid syndrome (flushing of the face and diarrhoea, due to the endocrine products)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the prognosis for carcinoid tumours?

A

Prognosis is generally good, and the tumour is generally resectable, even when there are local deposits in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the cause of a Meckel’s diverticulum?

A

Caused by a remnant of the embryological vitellointestinal duct

Occurs in 2% of the population and 2% of these develop symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the location of the Meckel’s diverticulum?

A

The diverticulum is 2cm long, on the antimesenteric border of the bowel, 20 inches from the ileocaecal valve

May be lined by gastric acid secreting epithelium, or heterotrophic pancreatic tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the clinical presentations of Meckel’s diverticulum?

A

Asymptomatic, or mimics other conditions:

Caecal volvulus: if tethered to the umbilicus

Intussusception: gangrenous by point of operation

Appendicitis: diverticulum becomes inflamed, presenting identical to appendicitis (sometimes also with umbilical cellulitis)

Peptic ulceration: pain around the umbilicus that is related to mealtimes due to ulceration of the gastric acid secreting epithelium

Sinus tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What IX are done for Meckel’s diverticulum?

A

Technetium scan - parietal cells will take up the radiolabelled 99TC

CT will also show the diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe the epidemiology of Chron’s?

A

Prevalence 50/100,000 M=F

Incidence peaks at 15-30 and also again in the 60s

33
Q

What are the risk factors for Chron’s disease?

A

Poor diet
FH
smoking
altered immune states

34
Q

Where does chron’s affect?

A

Any part of the GI tract (mouth to anus)

Most commonly terminal ileum and descending colon
Can affect just one area, or multiple area, leaving normal bowel in between
‘Skip lesions’

35
Q

What is the appearance of affects bowels in Chron’s disease?

A

Narrow bowel due to the thickened wall, with deep ulcers

‘Rose-thorn ulcers’
‘Cobblestone appearance on CT (specific to Chron’s, not seen on XR)
Goblet cells
Granulomas

Inflammation extends through all layers of the bowel

Fistulae and stenosis are common

36
Q

What are the clinical features of Chron’s disease?

A 
Abdominal pain (varying in character) 
Diarrhoea (steatorrhoea in ileal disease, bloody in colonic disease)

Weight loss / FTT
Severe apthos ulceration of the mouth (early sign)
Anal complications (fissure, fistula, haemorrhoids, skin tags, abscesses)

Extra GI manifestations

Can present with acute RIF pain/mass

37
Q

What is the histological appearance of Chron’s disease?

A

transmural inflammation, lymphoid hyperplasia, granulomas

38
Q

Describe the pathology of UC?

A

Inflammation that starts in the rectum, extending proximally along the colon

Proctitis if affects the rectum alone

Inflammation of the distal terminal ileum (backwash ileitis)

Inflammation only affects the mucosa, which is excessively ulcerated. Gives adjacent mucosa the appearance of inflammatory polyps

39
Q

What are the clinical features of UC?

A

Crampy lower abdominal discomfort

Gradual onset diarrhoea (often bloody)
Urgency and tenesmus if disease confined to the rectum
Extra-GI symptoms

40
Q

What is the histological appearance in UC?

A

Mucosal inflammation, crypt abscesses and goblet cell depletion

41
Q

Chron’s vs UC location?

A

Chron’s: Mouth to anus

UC: colon only

42
Q

Chron’s vs UC anal involvement

A

Chron’s often

UC seldom

43
Q

Chron’s vs UC continuity

A

Chron’s - discontinuous ‘skip lesions’

UC: continuous from rectum

44
Q

Chron’s vs UC fistulae?

A

Chron’s common

UC: uncommon

45
Q

Chron’s vs UC histology

A

Chron’s: Transmural inflammation, granulomas, goblet cells present

UC: mucosal inflammation only, crypt abscesses, goblet cell depletion

46
Q

Chron’s vs UC smoking

A

Chron’s: increases risk

UC: protective

47
Q

Chron’s vs UC cure

A

Chron’s: surgery less effective

UC: colectomy

48
Q

What bloods should be done for IBD?

A

FBC, U&E, CRP/ESR, LFT

Serum iron/B12/folate if anaemia

49
Q

What stool studies should be done in ?IBD??

A

Stool chart
MCS/3 to exclude infective causes
calprotectin (may be ordered to rule out IBD in general practice)

50
Q

What radiology should be done in IBD?

A

AXR/CXR: in acute disease

CT in Chron’s: to look for complications

51
Q

What other ix can be done in IBD?

A

endoscopy:
rigid/flexi sigmoidoscopy in UC
Colonoscopy
Endoscopic rectal biopsy may be taken

52
Q

What medication can be given in an acute Chron’s flare?

Mild?

Severe?

A

Mild - oral pred (+ review in clinic)

Severe: admission if systemic or low albumin
Steroids: hydrocortisone 100mg/6hr
NBM with parenteral nutrition

Thiopurines second line
Biological agents used in refractory disease not responding to medical treatment

Once improving - transfer to oral prednisolone as per mild attack

Last resort: surgery

53
Q

What drugs are used in the maintenance of Chron’s?

A

Thiopurines first line: azathioprine or 6-mercaptopurine (check TPMT first)

Methotrexate second line: If thiopurines contraindicated, unsuccessful or if methotrexate was used to induce remission

Oral metronidazole for anal disease

54
Q

What is the management of a mild/moderate UC flare?

A

Mild: <4 stools/day
Mod: 4-6 stools/day
Severe 6+ stools/day + blood + systemic disturbance

Mild/Moderate: topical (rectal) aminosalicylate
if remission is not achieved within 4 weeks, add an oral aminosalicylate
if remission still not achieved add topical or oral corticosteroid
(extensive disease - start with topical and rectal aminosalicylate)

55
Q

What is the management of acute severe/fulminating UC?

A 
MDT 
IV corticosteroids
Assess for ?Surgery
SC heparin
No anti motility drugs

Second line: IV cyclosporin if symptoms worsen or no improvement within 72 hours of steroids

3rd line: biological agents, considered by specialist

56
Q

What is likelihood of surgery in UC suggested by?

A

> 8 motions per day, pyrexia, tachycardia, colonic dilatation, low albumin, low Hb or CRP >45

57
Q

What drugs are given for the maintenance of UC?

A

topical (rectal) aminosalicylate alone (daily or intermittent) or
an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent)

Following a severe relapse or >=2 exacerbations in the past year:

oral azathioprine or oral mercaptopurine

58
Q

What are the general complications of IBD?

A

Bowel perforation
Lower GI haemorrhage
toxic dilatation (more common in UC)
Colonic carcinoma (more in UC) - surveillance colonoscopy if patient has UC with pan colitis

59
Q

What are the features of toxic dilatation?

A

Features of persistent fever, tachycardia, loose blood stained stool

Ix: falling albumin/potassium
AXR shows a dilated >6cm colon with mucosal islands

Perforation is imminent and thus, surgery is often required

60
Q

What complications can occur specifically in Chron’s?

A

Small bowel obstruction
Fistulae (10%)
Abscess formation
B12/Folate / iron studies

61
Q

What are the indications for surgery in Chron’s disease?

A

Never curative
Temporary ileostomies can be used to ‘rest’ distal diseased bowel

Limited resection of the worse areas - short bowel syndrome: malabsorption if <1m small bowel remains

62
Q

What emergency procedures can be done for UC?

A

Emergency procedures: subtotal colectomy + end ileostomy: leaves rectal stump (proctitis and cancer risk), can be anastomosis at a later date

Proctocolectomy and end ileostomy: rectal stump also removed, if patient happy to manage a stoma, and don’t want further surveillance etc

63
Q

What elective procedures can be done for UC?

A

Ulcerative colitis typically only affects the colon and rectum. Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease. The patient is then left with either a permanent ileostomy or something called an ileo-anal anastomosis (J-pouch). This is where the ileum is folded back in itself and fashioned into a larger pouch that functions a bit like a rectum. This “J-pouch” which is then attached to the anus and collects stools prior to the person passing the motion.

colectomy and ileorectal anastomosis:anastomosis formed in single procedure, but the recutm remains (proctitis/cancer risk)

64
Q

What are the extra-colonic manifestations of IBD?

A

Eyes: conjunctivitis, episcleritis, iritis

Joints: arthralgia

Skin: erythema nodosum
pyoderma gangrenosum

Others: venous thrombosis, fatty liver

65
Q

What other conditions can occur in IBD?

A 
Autoimmune hepatitis
gallstones
renal calculi 
PSC (UC)
cholangiocarcinoma (UC)

Ank spond (HLA B27 positive Chron’s)

66
Q

What are the symptoms of malabsorption?

A

Diarrhoea/steatorrhoea
weight loss
lethargy

67
Q

What are the signs in malabsorption (of deficiency)

A 
Anaemia (Fe, B12, folate)
Bleeding disorders (vitamin K)
Oedema (decreased protein)
Osteomalacia (vitamin D)
Neuropathy
68
Q

What are the most common causes of malabsorption?

A

Coeliac disease
Chronic pancreatitis
Chron’s disease

69
Q

What are the rarer causes of malabsorption?

A

Reduced bile (obstruction, cholestyramine, ileal resection)
Pancreatic insufficiency (CF, cancer)
Bacterial overgrowth
Infection

70
Q

What investigations (BLOODS) can be done for malabsorption?

A

bloods: FBC, iron studies, B12 and folate, calcium, magnesium, phosphate, lipid profile, LFTs, TFTs, inflammatory
clotting + coeliac seriology

71
Q

What stool studies can be done for malabsorption?

A

MCS (microscopy, culture, sensitivity)
OCP (ova, cysts and parasites if recent travel

C.diff toxin if recent antibiotics

Faecal elastase (if suspecting chronic pancreatitis)
calprotectin (to rule out IBD)
72
Q

What imaging investigations can be done for malabsorption?

A

Endoscopy: OGD + duodenal biopsy: coeliac disease
Colonoscopy + biopsy: Chron’s disease
ERCP: biliary obstruction / chronic pancreatitis

Breath hydrogen analysis: bacterial overgrowth

73
Q

How does Coeliac disease occur?

A

Inflammation of the jejunal mucosa in response to gluten
TTG enzymes modify ‘alpha-gliandin’

which then activates an autoimmune reaction against the mucosa

74
Q

What does biopsy of duodenal mucosa show in coeliac disease?

A

Flattened mucosa due to loss of the villi

Hyperplasia of the crypts to compensate
There will also be increased intraepithelial lymphocytes

75
Q

What is the presentation of Coeliac disease?

A

1/3 asymptomatic
Non specific features of IDA, weight loss/fatigue or apthous ulcers

There may be diarrhoea, abdominal pain, bloating, nausea and vomiting

Dermatitis herpetiformis

76
Q

What are the positive investigations for Coeliac disease?

A

FBC- anaemia
clotting - prolonged
bone profile: suggestive of osteomalacia

Endomysial antibodies (EMA) and TTG antibodies present 
Duodenal biopsy

Bone densitometry should be performed due to osteoporosis risk

77
Q

What is the management of Coeliac disease?

A

Lifelong gluten free diet (rice, potatoes, oats and sugar are fine)

Verify that gluten free diet is working with endomysial antibody tests

Small increased risk of small bowel lymphoma / adenocarcinoma

78
Q

Describe the pathology of chronic pancreatitis?

A

Most commonly due to high alcohol intake, leading to inappropriate enzyme activity within the pancreas

This leads to precipitation of proteins that plug the pancreatic ducts, providing a nidus for infection, calcification and cause ductal hypertension

End result = fibrosis of the parenchyma and disturbed exocrine function (trypsins, amylases and lipases)

79
Q

What is the presentation of pancreatitis?

A

Epigastric pain, radiating to back - relieved by sitting forwards
Weight loss, bloating and steatorrhoea

Brittle diabetes: insulin dependant DM, characterised by sudden swings in glucose level for no apparent reason

Obstructive jaundice

relapsing symptoms and progressively worse

CP3 Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions