GI & Endocrine Surgery

Question 1

After colorectal surgery, why should pts have epidural analgesia rather than PO?

Answer 1

Faster return to normal bowel transit - lots of evidence in a 2016 Cochrane review

Question 2

How can the risk of adhesion formation be significantly reduced (surgical method)?

Answer 2

Using laparoscopic approach over open surgery

Question 3

What types of GI surgery are there?

Answer 3

Upper GI, Hepatobiliary/pancreatic surgery, colorectal surgery

Question 4

Who is ulcerative colitis most common in?

Answer 4

Anglo-saxon caucasians

peak age of diagnosis is late teens/twenties

Question 5

What do we see on endoscopy of a UC pt?

Answer 5

Granular, hypervascular, and mildly oedematous mucosa

vascular pattern is lost

Question 6

If the inflammation is more severe with a UC patient, what may be present?

Answer 6

Ulcers - confluent with islands of inflammed mucosa -> “pseudopolyposis”

Question 7

Where does UC tend to be present?

Answer 7

Distal colon & rectum - spreads proximally in a continuous pattern

Question 8

What are the 3 main classifications of UC?

Answer 8

• Proctitis
• Left-sided colitis
• Pancolitis

Question 9

What are the clinical features of proctitis?

Answer 9

Rectal involvement (unless on topical treatment) causing frequency and urgency symptoms due to rectal irritability

Question 10

What kind of bowel movements do pts with proctitis get?

Answer 10

Bloody mucus mixed with loose stools

Question 11

Where does the disease extend to in left-sided colitis?

Answer 11

Up to the splenic flexure

Question 12

What kind of bowel movements do pts with left-sided colitis get?

Answer 12

Extensive bloody mucus in stools leading to bloody diarrhoea

Question 13

What does pancolitis mean?

Answer 13

Disease involving the entire colon

Question 14

What is backwash ileitis?

Answer 14

Mild inflammation of the ileum that sometimes occurs secondary to pancolitis

Question 15

What symptoms is pancolitis associated with?

Answer 15

Systemic features such as fever, malaise, anorexia, tachycardia

Question 16

What clinical features is pancolitis associated with?

Answer 16

Anaemia
Hypoalbuminaemia
Hypokalaemia

Question 17

What % of the population have thyroid lumps?

Answer 17

5%

Question 18

What is the most common type of thyroid cancer?

Answer 18

papillary carcinoma

Question 19

Who is papillary carcinoma of the thyroid most common in?

Answer 19

Women, and people aged 40-50

Question 20

What are the risk factors for thyroid cancer?

Answer 20

Female
FHx
Radiation exposure as a child
Full body radiotherapy
Hashimoto's disease

Question 21

Do thyroid cancers always present with a lump?

Answer 21

No - can be a single lump, multiple lumps, or be picked up incidentally

Question 22

WRT thyroid cancers, what are the red flags?

Answer 22

Pain
Rapid growth
Cough/hoarse voice/stridor
Multiple enlarged lymph nodes
Tethering of lump

Question 23

Why is it very important to think about differentials with suspected thyroid cancer?

Answer 23

Thyroid lumps are usually benign!!

Question 24

How should pts with neck lumps be investigated initially?

Answer 24

Thyroid function tests

Question 25

What TFTs indicate a toxic nodule?

Answer 25

Low TSH or raised T3 or T4

Question 26

Which blood test can we use to monitor medullary carcinoma?

Answer 26

Serum calcitonin

Question 27

After blood tests, how do we investigate neck lumps ?thyroid malignancy?

Answer 27

US thyroid scan

Question 28

What features on USS of thyroid are suspicious?

Answer 28

Microcalcifications Hypo-echogenicity Irregular border

Question 29

If a thyroid nodule is found to be high risk of malignancy, what should the next step be?

Answer 29

Fine needle aspirate

Question 30

Who should the management of thyroid cancers ultimately be decided by?

Answer 30

MDT

Question 31

What surgical treatments are available for thyroid malignancy?

Answer 31

- Hemi-thyroidectomy - Total thyroidectomy - Neck dissection

Question 32

What does a hemi-thyroidectomy involve?

Answer 32

Half the thyroid is removed

Question 33

What is neck dissection in thyroid surgery?

Answer 33

Removal of groups of lymph nodes in case of locally advanced disease

Question 34

When consenting a pt for thyroidectomy, what potential complications do you need to make them aware of?

Answer 34

Haematoma formation, hypocalcaemia, vocal cord paralysis/hoarse voice (if unilateral RL nerve damage)

Question 35

If a pt has previously has a hernia repair, but it needs doing again, what approach should be used, and why?

Answer 35

If open used 1st time use laparoscopic this time, and vice versa. Reduced risk of adhesions -> complications

Question 36

What is the best imaging modality for upper GI problems?

Answer 36

Endoscopy

Question 37

What re the 4 main types of upper GI endoscopy?

Answer 37

Gastroscopy Endoscopic Ultrasound ERCP Ileoscopy

Question 38

What is the full name for gastroscopy?

Answer 38

Oesophago-gastro-duodenoscopy

Question 39

Why is OGD useful?

Answer 39

It facilitates visualisation of pathology, taking of biopsies, and administration of some treatments e.g. injections

Question 40

When is OGD indicated?

Answer 40

To investigte: - dysphagia - dyspepsia/reflux disease/upper abdo pain - upper GI bleeding - Iron deficiency anaemia alongside colonoscopy Therapeutic interventions: - balloon dilatation - stenting - bleeding prevention - resection of early cancerous lesions

Question 41

How should a patient be prepared for OGD?

Answer 41

- Stop taking medication for reflux 2 weeks before procedure | - Do no eat for 6 hours before procedure, and clear fluids up to 2 hours before procedure

Question 42

What can be given for an OGD to help the patient tolerate it?

Answer 42

- Lidocaine throat spray is always given - Sedative may be given e.g. IV midazolam - Young children or those who may be confused by the procedure may undergo GA - assessed by the surgeon

Question 43

What are the risks associated with an OGD?

Answer 43

- Perforation - Bleeding - Oversedation (respiratory depression)