GI & Endocrine Surgery Flashcards
After colorectal surgery, why should pts have epidural analgesia rather than PO?
Faster return to normal bowel transit - lots of evidence in a 2016 Cochrane review
How can the risk of adhesion formation be significantly reduced (surgical method)?
Using laparoscopic approach over open surgery
What types of GI surgery are there?
Upper GI, Hepatobiliary/pancreatic surgery, colorectal surgery
Who is ulcerative colitis most common in?
Anglo-saxon caucasians
peak age of diagnosis is late teens/twenties
What do we see on endoscopy of a UC pt?
Granular, hypervascular, and mildly oedematous mucosa
vascular pattern is lost
If the inflammation is more severe with a UC patient, what may be present?
Ulcers - confluent with islands of inflammed mucosa -> “pseudopolyposis”
Where does UC tend to be present?
Distal colon & rectum - spreads proximally in a continuous pattern
What are the 3 main classifications of UC?
- Proctitis
- Left-sided colitis
- Pancolitis
What are the clinical features of proctitis?
Rectal involvement (unless on topical treatment) causing frequency and urgency symptoms due to rectal irritability
What kind of bowel movements do pts with proctitis get?
Bloody mucus mixed with loose stools
Where does the disease extend to in left-sided colitis?
Up to the splenic flexure
What kind of bowel movements do pts with left-sided colitis get?
Extensive bloody mucus in stools leading to bloody diarrhoea
What does pancolitis mean?
Disease involving the entire colon
What is backwash ileitis?
Mild inflammation of the ileum that sometimes occurs secondary to pancolitis
What symptoms is pancolitis associated with?
Systemic features such as fever, malaise, anorexia, tachycardia
What clinical features is pancolitis associated with?
Anaemia
Hypoalbuminaemia
Hypokalaemia
What % of the population have thyroid lumps?
5%
What is the most common type of thyroid cancer?
papillary carcinoma
Who is papillary carcinoma of the thyroid most common in?
Women, and people aged 40-50
What are the risk factors for thyroid cancer?
Female FHx Radiation exposure as a child Full body radiotherapy Hashimoto's disease
Do thyroid cancers always present with a lump?
No - can be a single lump, multiple lumps, or be picked up incidentally
WRT thyroid cancers, what are the red flags?
Pain Rapid growth Cough/hoarse voice/stridor Multiple enlarged lymph nodes Tethering of lump
Why is it very important to think about differentials with suspected thyroid cancer?
Thyroid lumps are usually benign!!
How should pts with neck lumps be investigated initially?
Thyroid function tests
What TFTs indicate a toxic nodule?
Low TSH or raised T3 or T4
Which blood test can we use to monitor medullary carcinoma?
Serum calcitonin
After blood tests, how do we investigate neck lumps ?thyroid malignancy?
US thyroid scan
What features on USS of thyroid are suspicious?
Microcalcifications
Hypo-echogenicity
Irregular border
If a thyroid nodule is found to be high risk of malignancy, what should the next step be?
Fine needle aspirate
Who should the management of thyroid cancers ultimately be decided by?
MDT
What surgical treatments are available for thyroid malignancy?
- Hemi-thyroidectomy
- Total thyroidectomy
- Neck dissection
What does a hemi-thyroidectomy involve?
Half the thyroid is removed
What is neck dissection in thyroid surgery?
Removal of groups of lymph nodes in case of locally advanced disease
When consenting a pt for thyroidectomy, what potential complications do you need to make them aware of?
Haematoma formation, hypocalcaemia, vocal cord paralysis/hoarse voice (if unilateral RL nerve damage)
If a pt has previously has a hernia repair, but it needs doing again, what approach should be used, and why?
If open used 1st time use laparoscopic this time, and vice versa.
Reduced risk of adhesions -> complications
What is the best imaging modality for upper GI problems?
Endoscopy
What re the 4 main types of upper GI endoscopy?
Gastroscopy
Endoscopic Ultrasound
ERCP
Ileoscopy
What is the full name for gastroscopy?
Oesophago-gastro-duodenoscopy
Why is OGD useful?
It facilitates visualisation of pathology, taking of biopsies, and administration of some treatments e.g. injections
When is OGD indicated?
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
How should a patient be prepared for OGD?
- 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
What can be given for an OGD to help the patient tolerate it?
- 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
What are the risks associated with an OGD?
- Perforation
- Bleeding
- Oversedation (respiratory depression)
