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Surgery > GI & Endocrine Surgery > Flashcards

GI & Endocrine Surgery Flashcards

1
Q

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

A

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

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2
Q

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

A

Using laparoscopic approach over open surgery

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3
Q

What types of GI surgery are there?

A

Upper GI, Hepatobiliary/pancreatic surgery, colorectal surgery

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4
Q

Who is ulcerative colitis most common in?

A

Anglo-saxon caucasians

peak age of diagnosis is late teens/twenties

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5
Q

What do we see on endoscopy of a UC pt?

A

Granular, hypervascular, and mildly oedematous mucosa

vascular pattern is lost

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6
Q

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

A

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

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7
Q

Where does UC tend to be present?

A

Distal colon & rectum - spreads proximally in a continuous pattern

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8
Q

What are the 3 main classifications of UC?

A
  • Proctitis
  • Left-sided colitis
  • Pancolitis
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9
Q

What are the clinical features of proctitis?

A

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

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10
Q

What kind of bowel movements do pts with proctitis get?

A

Bloody mucus mixed with loose stools

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11
Q

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

A

Up to the splenic flexure

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12
Q

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

A

Extensive bloody mucus in stools leading to bloody diarrhoea

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13
Q

What does pancolitis mean?

A

Disease involving the entire colon

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14
Q

What is backwash ileitis?

A

Mild inflammation of the ileum that sometimes occurs secondary to pancolitis

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15
Q

What symptoms is pancolitis associated with?

A

Systemic features such as fever, malaise, anorexia, tachycardia

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16
Q

What clinical features is pancolitis associated with?

A

Anaemia
Hypoalbuminaemia
Hypokalaemia

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17
Q

What % of the population have thyroid lumps?

A

5%

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18
Q

What is the most common type of thyroid cancer?

A

papillary carcinoma

19
Q

Who is papillary carcinoma of the thyroid most common in?

A

Women, and people aged 40-50

20
Q

What are the risk factors for thyroid cancer?

A 
Female
FHx
Radiation exposure as a child
Full body radiotherapy
Hashimoto's disease
21
Q

Do thyroid cancers always present with a lump?

A

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

22
Q

WRT thyroid cancers, what are the red flags?

A 
Pain
Rapid growth
Cough/hoarse voice/stridor
Multiple enlarged lymph nodes
Tethering of lump
23
Q

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

A

Thyroid lumps are usually benign!!

24
Q

How should pts with neck lumps be investigated initially?

A

Thyroid function tests

25
Q

What TFTs indicate a toxic nodule?

A

Low TSH or raised T3 or T4

26
Q

Which blood test can we use to monitor medullary carcinoma?

A

Serum calcitonin

27
Q

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

A

US thyroid scan

28
Q

What features on USS of thyroid are suspicious?

A

Microcalcifications
Hypo-echogenicity
Irregular border

29
Q

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

A

Fine needle aspirate

30
Q

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

A

MDT

31
Q

What surgical treatments are available for thyroid malignancy?

A
  • Hemi-thyroidectomy
  • Total thyroidectomy
  • Neck dissection
32
Q

What does a hemi-thyroidectomy involve?

A

Half the thyroid is removed

33
Q

What is neck dissection in thyroid surgery?

A

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

34
Q

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

A

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

35
Q

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

A

If open used 1st time use laparoscopic this time, and vice versa.

Reduced risk of adhesions -> complications

36
Q

What is the best imaging modality for upper GI problems?

A

Endoscopy

37
Q

What re the 4 main types of upper GI endoscopy?

A

Gastroscopy
Endoscopic Ultrasound
ERCP
Ileoscopy

38
Q

What is the full name for gastroscopy?

A

Oesophago-gastro-duodenoscopy

39
Q

Why is OGD useful?

A

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

40
Q

When is OGD indicated?

A

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
41
Q

How should a patient be prepared for OGD?

A
  • 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

42
Q

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

A
  • 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
43
Q

What are the risks associated with an OGD?

A
  • Perforation
  • Bleeding
  • Oversedation (respiratory depression)

Surgery (11 decks)

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