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Finals Revision > GI/Gen Surgery > Flashcards

GI/Gen Surgery Flashcards

1
Q

Broadly/anatomically, what causes colicky (visceral) pain?

A

Stretching or contracting of a hollow viscus

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2
Q

Anatomically, what causes localised (somatic) pain?

A

Peritoneal irritation

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3
Q

Back pain indicates the pathology is in which location?

A

Retroperitoneal

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4
Q

Abdominal pain out of proportion to the physical signs is suggestive of what?

A

Bowel ischaemia

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5
Q

What blood gas picture does bowel ischaemia give?

A

Metabolic acidosis

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6
Q

‘Free air under the diaphragm seen on CXR’

A

Bowel perforation

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7
Q

‘Dilated, thick oedematous loops of bowel seen on AXR’

A

Ischaemic bowel

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8
Q

‘Sentinel dilated upper jejunum on AXR’

A

Pancreatitis

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9
Q

‘Air in biliary tree on AXR’

A

Cholangitis

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10
Q

‘Dilated, oedematous, featureless colon’

A

Acute colitis

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11
Q

‘Dilated bowel loops, string of pearls sign on AXR’

A

Acute bowel obstruction

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12
Q

‘Coffee bean sign’

A

Sigmoid volvulus

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13
Q

What is Meckels diverticulum?

A

Congenital diverticulum seen in 2% of the population

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14
Q

What symptoms may a Meckel’s diverticulum cause?

A

Abdominal pain (RIF), painless PR bleed, anaemia

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15
Q

How is Meckels diverticulum diagnosed?

A

Radionucleotide scanning

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16
Q

How is Meckels diverticulum managed?

A

Treat complications

Meckels diverticulotomy

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17
Q

What is a sigmoid volvulus?

A

Large loop of bowel becomes distended and twists on mesenteric pedicle to create closed loop obstruction

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18
Q

How does a sigmoid volvulus present?

A

Abdominal distension

Constipation

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19
Q

Who is sigmoid volvulus common in?

A

Elderly people with constipation (have ‘floppy sigmoids’)

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20
Q

How is a sigmoid volvulus treated?

A

Decompression with colonoscopy

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21
Q

What may delay in treating a sigmoid volvulus result in?

A

Increased risk of bowel perforation and ischaemia

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22
Q

What are the two broad causes of bowel obstruction?

A

Mechanical and Ileus

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23
Q

What are mechanical causes of bowel obstruction?

A

Adhesions, hernias, tumours, intussusception, strictures, food bolus, volvulus, strangulation

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24
Q

What are some causes of an aperastaltic bowel (ileus)?

A

Pancreatitis, spinal injury, post-operative, DKA, sepsis

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25
Q

How does small bowel obstruction present?

A

Vomiting, abdominal pain (colicky, peri-umbilical), distention, constipation

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26
Q

How does large bowel obstruction present?

A

Pain (constant, lower abdomen), distention, absolute constipation

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27
Q

What signs would be seen in bowel obstruction on examination?

A

Signs of shock (e.g. weak pulse, cyanosis), abdominal distention, resonant percussion, tinkling or absent bowel sounds

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28
Q

What investigations are important in bowel obstruction?

A

Bloods

AXR

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29
Q

What does AXR show in small bowel obstruction?

A

Central dilated bowel with valvulae coniventes and no gas in large bowel

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30
Q

What does AXR show in large bowel obstruction?

A

Peripherally dilated bowel with haustra

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31
Q

What are the main complications of bowel obstruction?

A

Perforation, hypokalaemia, strangulation

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32
Q

How is bowel obstruction treated?

A

Drip & Suck

Correct electrolyte imbalance

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33
Q

Where does the oesophagus run to and from?

A

From the cricopharyngeus to the lower oesophageal sphincter

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34
Q

What type of epithelium is the oesophagus lined by?

A

Stratified squamous

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35
Q

What is the key symptom in oesophageal pathologies?

A

Dysphagia

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36
Q

What is odynophagia?

A

Painful swallowing

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37
Q

What is gastro-oesophageal reflux disease?

A

Reflux of bile/stomach acid into the oesophagus

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38
Q

What are risk factors for GORD?

A

Hiatus hernia, obesity, gastric acid hypersecretion, LOS hypotonia, overeating, alcohol, smoking, pregnancy, drugs

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39
Q

What are symptoms of GORD?

A

Heartburn, belching, acid brash, excess saliva, painful swallowing, nocturnal asthma, chronic cough, laryngitis

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40
Q

What investigations are done for GORD?

A

Often none needed

Can do upper GI endoscopy to rule out other pathologies/if ongoing/if patient elderly

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41
Q

What are some conservative management options for GORD?

A

Lose weight, smoking cessation, avoiding alcohol, spicy foods etc

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42
Q

What are some medical management options for GORD?

A

Antacids/alginates to relieve symptoms

PPIs if evidence of oesophagitis

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43
Q

What are complications of GORD?

A

Oesophagitis, ulcers, anaemia, strictures, Barretts oesophagus, oesophageal cancer

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44
Q

What is Barrett’s oesophagus?

A

Metaplasia of the lower oesophagus - stratified squamous epithelium replaced with columnar epithelium

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45
Q

What are risk factors for Barrett’s oesophagus?

A

GORD, male sex, smoking, central obesity

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46
Q

What are some symptoms of Barrett’s oesophagus?

A

Disease itself is asymptomatic but patients will often have GORD symptoms

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47
Q

What can be seen on endoscopy in Barrett’s oesophagus?

A

Red velvety mucosa

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48
Q

Is there a risk of malignancy with Barrett’s oesophagus?

A

YES

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49
Q

How is Barrett’s oesophagus monitored?

A

Patients have an endoscopy every 3-5 years with biopsies

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50
Q

How is dysplasia found on endoscopy in Barrett’s oesophagus managed?

A

Endoscopic mucosal resection or radiofrequency ablation

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51
Q

How is Barrett’s oesophagus managed medically?

A

High dose PPI

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52
Q

What type of oesophageal cancer is related to Barrett’s oesophagus?

A

Adenocarcinoma

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53
Q

What type of oesophageal cancer is related to smoking and alcohol?

A

Squamous cell

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54
Q

What are risk factors for oesophageal cancer?

A

Smoking, alcohol, GORD, Barratt’s achalasia, Plummer-Vinson syndrome

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55
Q

What are symptoms of oesophageal cancer?

A

Dysphagia, anorexia, weight loss

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56
Q

How is oesophageal cancer diagnosed?

A

Upper GI endoscopy with biopsies

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57
Q

How is oesophageal cancer managed?

A

Surgically - Ivor Lewis Oesophagectomy

Chemotherapy

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58
Q

What is achalasia?

A

Failure of oesophageal peristalsis and failure of lower oesophageal sphincter to relax

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59
Q

At what age does achalasia usually present?

A

Middle age

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60
Q

What are symptoms of achalasia?

A

Dysphagia of liquids (+/- solids), heartburn, regurgitation

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61
Q

What investigations would you do for achalasia and what would they show?

A

Oesophageal monometry - excessive LOS tone

Barium swallow - birds beak appearance

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62
Q

How is achalasia treated?

A

Balloon dilatation
Heller cardiomyotomy
Botox injections

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63
Q

What is diffuse oesophageal spasm?

A

Uncoordinated contractions of the oesophagus

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64
Q

What are the symptoms of diffuse oesophageal spasm?

A

Intermittant dysphagia, chest pain

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65
Q

What investigation would you carry out for diffuse oesophageal spasm and what would it show?

A

Barium swallow - corkscrew appearance

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66
Q

How is diffuse oesophageal spasm treated?

A

CCBs, PPIs, hyoscine

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67
Q

What can cause a benign oesophageal stricture?

A

GORD, surgery, radiotherapy

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68
Q

How is a benign oesophageal stricture treated?

A

Endoscopic balloon dilatation

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69
Q

What is Plummer-Vinson syndrome also known as?

A

Paterson-Brown-Kelly syndrome

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70
Q

What is the key triad of symptoms in Plummer-Vinson syndrome?

A

Dysphagia (secondary to oesophageal webs)
Glossitis
Iron deficient anaemia

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71
Q

How is Plummer-Vinson syndrome treated?

A

Oesophageal web dilatation

Iron supplements

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72
Q

What is a Mallory-Weiss tear?

A

Mucosal laceration occurring at the gastro-oesophageal junction

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73
Q

What is the common cause of a mallory-weiss tear?

A

Vomiting in alcoholics

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74
Q

What are oesophageal varices?

A

Dilated collateral veins in the lower oesophageal sphincter due to portal hypertension

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75
Q

What symptoms do oesophageal varices cause?

A

Large volume of fresh blood, potential haemodynamic compromise

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76
Q

What prophylactic treatment can be given for oesophageal varices?

A

Betablockers

Endoscopic band ligation

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77
Q

What treatment is used acutely in oesophageal varices bleeds?

A

Vitamin K, FFP
Terlipressin
Endoscopic banding
Balloon tamponade

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78
Q

What is Boorhaeve syndrome?

A

Severe vomiting leading to oesophageal rupture

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79
Q

What are some symptoms of dyspepsia?

A

Epigastric pain, bloating, fullness, heartburn

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80
Q

What are the ALARM Symptoms of dyspepsia?

A 
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Malaena/haematemesis
Swallowing difficulties
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81
Q

Are gastric or duodenal ulcers commoner?

A

Duodenal (4x more common)

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82
Q

Which ulcers are relieved by eating?

A

Duodenal

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83
Q

Which ulcers are worsened by eating?

A

Gastric

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84
Q

Where do the majority of gastric ulcers occur?

A

Lesser curvature of the stomach

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85
Q

What are risk factors for gastric ulcers?

A

H Pylori infection, smoking, NSAIDs, duodenal reflux, delayed gastric emptying

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86
Q

What are the symptoms of a gastric ulcer?

A

Asymptomatic or epigastric pain made worse by eating

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87
Q

What are risk factors for duodenal ulcers?

A

H Pylori infection, NSAIDs, increased gastric acid secretion, increased gastric emptying, blood type O, smoking

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88
Q

What are the symptoms of a duodenal ulcer?

A

Asymptomatic or epigastric pain relieved by eating

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89
Q

What classification of organism is Helicobacter Pylori?

A

Gram negative flagellated bacillus

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90
Q

How is H Pylori acquired?

A

In infancy via faecal-oral or oral-oral spread

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91
Q

What are the consequences of H Pylori infection?

A

Peptic ulcer disease

Gastric cancer

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92
Q

What is the investigation for H Pylori?

A

Urea breath test

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93
Q

What treatment is used to eradicate H Pylori?

A

PPI + amoxicillin + metronidazole (7 days)

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94
Q

How do you test for cure after H Pylori eradication therapy?

A

Repeat urea breath test after 4 weeks

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95
Q

If a patient with dyspepsia is over 55 or has ALARMSymptoms, what should you do?

A

Upper GI endoscopy

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96
Q

What is the first line management for a patient with dyspepsia (under 55 and no ALARMSymptoms)?

A

Stop drugs that may be causing dyspepsia (e.g. NSAIDs)
Lifestyle changes - stop smoking, avoid food triggers
Try OTC antacids
Review in 4 weeks

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97
Q

If after 4 weeks of conservative management a patient with dyspepsia is no better, what should you do?

A

Investigate for H Pylori

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98
Q

If a patient with dyspepsia is negative for H Pylori, how should you manage them?

A

PPI or H2 blocker for 4 weeks

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99
Q

Who is gastric cancer more common in?

A

Elderly males

Japanese

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100
Q

What is seen on histology of gastric cancer?

A

Signet ring cells (filled with mucus)

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101
Q

What are risk factors for gastric cancer?

A

H Pylori infection, blood group A, gastric polyps, penicious anaemia, smoking, salty, spicy diet

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102
Q

What are symptoms of gastric cancer?

A

Often non specific - dyspepsia, weight loss, vomiting, dysphagia, anaemia

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103
Q

What are signs of gastric cancer?

A

Epigastric mass, hepatosplenomegaly, jaundice, ascites

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104
Q

What is Troisiers sign?

A

Enlarged left sided Virchows Node

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105
Q

What investigations should be done for gastric cancer?

A

Gastroscopy and biopsies

Endoscopic ultrasound and CT/MRI for staging

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106
Q

How is gastric cancer managed?

A

Surgery

Chemotherapy

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107
Q

What is Zollinger-Ellison syndrome?

A

Disease with peptic ulcers caused by a gastrinoma tumour

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108
Q

Where is the gastrinoma usually in Zollinger-Ellison syndrome?

A

Pancreas or duodenum

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109
Q

What may Zollinger-Ellison syndrome be associated with?

A

MEN1

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110
Q

Are the tumours in Zollinger-Ellison syndrome malignant?

A

60% are

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111
Q

What are the symptoms of Zollinger-Ellison syndrome?

A

Multiple gastroduodenal ulcers, diarrhoea, malabsorption

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112
Q

How is Zollinger-Ellison syndrome investigated?

A

Fasting gastrin levels

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113
Q

How is Zollinger-Ellison syndrome treated?

A

PPIs + surgical removal of gastrinoma

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114
Q

What is jaundice?

A

Yellow pigmentation of the skin, sclera and mucosa

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115
Q

What is the cause of jaundice?

A

Increased plasma bilirubin

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116
Q

What is the normal bilirubin level?

A

Below 17

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117
Q

What level does bilirubin need to reach for symptoms to manifest?

A

Over 35

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118
Q

What is bilirubin?

A

Waste product from the breakdown of haemoglobin in the spleen

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119
Q

What organ conjugates bilirubin?

A

Liver

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120
Q

What are pre-hepatic causes of jaundice?

A

Haemolytic anaemias (Thalassaemia, Hereditary spherocytosis, sickle cell disease, autoimmune) Gilberts syndrome

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121
Q

What are hepatic causes of jaundice?

A

Viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, paracetamol, poisons, decompensated cirrhosis

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122
Q

What are post-hepatic causes of jaundice?

A

PBC, PSC, strictures, stones, pancreatitis, pancreatic cancer

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123
Q

Which liver enzymes are raised the most in hepatic jaundice?

A

ALT/AST

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124
Q

Which liver enzymes are raised the most in post-hepatic jaundice?

A

Bilirubin and Alkaline phosphatase

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125
Q

What is the commonest cause of liver disease?

A

Non-alcoholic fatty liver disease

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126
Q

What is NAFLD associated with?

A

Metabolic syndrome - obesity, increased lipids, type 3 diabetes

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127
Q

What are some features of NAFLD?

A

Asymptomatic, hepatosplenomegaly, increased liver echogenicity on ultrasound

128
Q

How is NAFLD managed?

A

Lifestyle modification and monitoring

129
Q

What may NAFLD result in?

A

Liver fibrosis and cirrhosis

130
Q

What is the extent of alcoholic fatty liver disease often dependent on?

A

Extent of drinking

Varies between individuals

131
Q

What are some signs of chronic liver disease?

A

Spider naevi, encephalopathy, prolonged PT, decreased albumin

132
Q

What are some signs of portal hypertension?

A

Caput medusa, varices, hypersplenism, thrombocytopenia

133
Q

How is alcoholic fatty liver disease managed?

A

Mainly abstinence

134
Q

How do Hepatitis A and E spread?

A

Faeco-oral

135
Q

Which Hepatitis is the only one which is a DNA virus?

A

Hepatitis B

136
Q

Which hepatitis is commonest in the UK?

A

Hepatitis C

137
Q

When is Hepatitis D found?

A

As a co-infection with Hepatitis B

138
Q

What does HBsAg mean in hepatitis B?

A

Acute or chronic disease

139
Q

What is HbeAg a marker of in hepatitis B?

A

Current infection

140
Q

What does Anti-Hbs indicate in a patient?

A

Immunity to hepatitis B (either through infection or vaccination)

141
Q

What antibody indicates an acute hepatitis B infection?

142
Q

What antibody indicates a past hepatitis B infection?

143
Q

How is hepatitis B treated?

A

Peginteferon

144
Q

How is hepatitis C treated?

A

Protease inhibitors and ribavirin

145
Q

Who does autoimmune hepatitis commonly affect?

A

Young females

146
Q

What antibodies are associated with autoimmune hepatitis?

A

ANA and anti-SM

147
Q

What are some features of autoimmune hepatitis?

A

Chronic liver disease
Acute hepatitis (jaundice, fever etc)
Amenorrhoea

148
Q

What are the investigations for autoimmune hepatitis?

A

Antibodies

Liver biopsy

149
Q

What does liver biopsy show in autoimmune hepatitis?

A

Piecemeal necrosis and inflammation

150
Q

How is autoimmune hepatitis treated?

A

Steroids, immunosuppressants, transplant

151
Q

What is primary biliary cirrhosis?

A

Autoimmune damage of the bile duct due to chronic inflammation

152
Q

What are the symptoms of PBC?

A

Fatigue, itch, xanthelasma, varices, hypersplenism, encephalopathy

153
Q

What antibody is positive in PBC?

A

AMA (anti-mitochondrial)

154
Q

What is the diagnostic criteria for PBC?

A

2 from:
Positive AMA
Cholestatic LFTs
Positive liver biopsy

155
Q

How is PBC treated?

A

Urseodoxycholic acid

156
Q

What can PBC result in?

A

Cholestasis, cirrhosis, portal hypertension. Can need transplant

157
Q

What is primary sclerosing cholangitis?

A

Autoimmune destruction of bile ducts leading to bile getting blocked intra and extra hepatically

158
Q

What is PSC associated with?

A

Ulcerative colitis

159
Q

What are symptoms of PSC?

A

Asymptomatic or itch, fatigue, jaundice, abdominal pain

160
Q

How can PSC be diagnosed?

A

Imaging shows beaded appearance of biliary tree

ANCA +ve

161
Q

What does biopsy of liver show in PSC?

A

Onion skinning fibrosis

162
Q

How is PSC treated?

A

Stents to maintain bile flow, transplant

163
Q

What is haemochromatosis?

A

Inherited disorder of iron metabolism

164
Q

How is haemochromatosis inherited?

A

Autosomal recessive

165
Q

What are features of haemochromatosis?

A

Fatigue, ED, bronzed skin, diabetes, cardiomyopathy, chronic liver disease

166
Q

How is haemochromatosis investigated?

A

Genetic testing

Liver biopsy shows perl staining

167
Q

How is haemochromatosis treated?

A

Venesection

168
Q

What is Wilsons disease?

A

Condition characterised by excess copper deposition

169
Q

What are features of Wilsons disease?

A

Kayser-Flesher rings

Hepatitis, cirrhosis, neurological (basal ganglia deterioration)

170
Q

How is Wilsons disease managed?

A

Penicillamine

171
Q

How is Wilsons disease inherited?

A

Autosomal recessive

172
Q

How is alpha-1-antitrypsin deficiency inherited?

A

Autosomal recessive

173
Q

What organs does alpha-1-antitrypsin deficiency affect?

A

Lungs and liver (causing emphysema and cirrhosis)

174
Q

How is alpha-1-antitrypsin deficiency managed?

A

Stop smoking, supportive care, alpha-1-antitrypsin concentrates IV

175
Q

What is the function of the gallbladder?

A

Stores bile

176
Q

What is bile composed of?

A

Cholesterol, phospholipids, bile salts and bilirubin

177
Q

Why do gallstones occur?

A

An imbalance between the ratios of cholesterol and bile salts

178
Q

What is biliary colic?

A

When the gallstone obstructs the cystic duct

179
Q

How does biliary colic present?

A

Severe RUQ pain radiating around the right costal margin, usually lasting a few hours. Vomiting

180
Q

Does biliary colic cause jaundice?

181
Q

What is the underlying cause of acute cholecystitis?

A

Gallstone impacted in the neck of the gallbladder

182
Q

How does acute cholecystitis present?

A

Continuous RUQ/epigastric pain, vomiting. Murphys sign positive

183
Q

How does chronic cholecystitis present?

A

Vague intermittant RUQ pain, distension, fatty food intolerance

184
Q

Does acute cholecystitis cause jaundice?

185
Q

What is choledocholithiasis?

A

Presence of gallstone in the common bile duct

186
Q

How does choldecholithiasis present?

A

Can be asymptomatic, or epigastric/RUQ pain and jaundice and pale stools

187
Q

What may choledocholithiasis lead to?

A

Biliary colic

Ascening cholangitis

188
Q

Does choledocholithiasis cause jaundice?

189
Q

What is ascending cholangitis?

A

Bacterial infection of the biliary tree secondary to biliary tree obstruction

190
Q

How does ascending cholangitis present?

A

Charcots triad, maybe hypotension or confusion

191
Q

What is Charcots triad?

A

Severe RUQ abdominal pain
Obstructive jaundice
High fever/rigors

192
Q

What is a gallstone ileus?

A

When a gallstone erodes through the gallbladder into the duodenum. May obstruct terminal ileum

193
Q

What is a mucocele in the gallbladder?

A

When gallbladder fills with mucus secondaru to biliary colic

194
Q

What occurs if a mucocele in the gallbladder becomes infected?

195
Q

What are the investigations for gallstones?

A

Bloods - FBC, U&Es, LFTs
USS biliary tree
MRCP if USS is negative

196
Q

How is biliary colic treated?

A

Elective laparoscpic cholescystectomy

197
Q

How is cholecystitis treated?

A

Elective/emergency laparoscopic cholecystectomy

198
Q

How is choledocholilithiasis treated?

A

ERCP/cholecystectomy

199
Q

How is cholangitis treated?

A

IV antibiotics and ERCP

200
Q

What are some complications of ERCP?

A

Pancreatitis, bleeding, cholangitis, duodenal perforation

201
Q

What are the main exocrine functions of the pancreas?

A

Production of digestive enzymes (e.g. amylase/lipase)

202
Q

What do beta cells of the pancreas secrete?

203
Q

What do alpha cells of the pancreas secrete?

204
Q

What do delta cells of the pancreas secrete?

A

Somatostatin

205
Q

What do PP cells of the pancreas secrete?

A

Pancreatitc phospholipid

206
Q

What do enterochromaffin cells of the pancreas secrete?

207
Q

What is acute pancreatitis?

A

Inflammation of the pancreas initiated by an acute injury

208
Q

What are the causes of acute pancreatitis?

A

Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Malignancy, Autoimmune, Scorpion bites, Hypercalcaemia/lipidaemia/parathyroidism, ERCP, Drugs

209
Q

What are the two commonest of these causes of pancreatitis?

A

Gallstones and alcohol

210
Q

What is the pathogenesis of pancreatitis?

A

Pancreatic inflammation secondary to premature and exaggerated response of pancreatic enzymes - AUTOLYSIS

211
Q

What are the symptoms of pancreatitis?

A

Epigastric pain radiating to the back relieved by sitting forward, nausea, vomiting, tachycardia, pyrexia, jaundice

212
Q

What is Grey-Turners sign?

A

Flank bruising

213
Q

What is Cullens sign?

A

Peri-umbilical brusing

214
Q

What bloods is it important to request in pancreatitis?

A

FBC, U&Es, clotting, amylase, lipase, CRP, glucose, calcium, ABGs

215
Q

What may be seen on a CXR in pancreatitis?

A

Pleural effusion

216
Q

What may be seen on AXR in pancreatitis?

A

Sentinel loop

217
Q

What other imaging investigations should you do in pancreatitis?

A

USS to check biliary system

CT for severity

218
Q

What is the Glasgow Score?

A 
Used to assess severity of pancreatitis
PaO2 less than 8
Age >55
Neutrophils - WCC >15
Calcium <2
Renal function - urea >16
Enzymes - LDH >600
Albumin <32g/l
Sugar - glucose >10
219
Q

What score indicates severe pancreatitis on the Glasgow Score?

A

More than or equal to 3

220
Q

How is pancreatitis managed?

A 
IV fluids
Pain relief (morphine/fentanyl PCA)
Oxygen
Antibiotics if cholangitis
ERCP if gallstones
Drainage of fluid/pseudocysts
Pancreatic necrostomy if necrosis
221
Q

What is chronic pancreatitis?

A

Progressive and irreversible damage to the pancreas with permanent loss of function

222
Q

What is the main cause of chronic pancreatitis?

A

Alcoholism

223
Q

How does chronic pancreatitis present?

A

Epigastric pain radiating to the back, weight loss, malabsorption, weight loss

224
Q

What may be seen on AXR and CT in chronic pancreatitis?

A

AXR - calcified pancreas

CT - dilated pancreatic ducts

225
Q

How is chronic pancreatitis managed?

A

Stop alcohol intake and smoking
Pancreatic enzyme replacment
Drainage of cysts
If autoimmune - steroids trial

226
Q

What is the only way to treat chronic pain in pancreatitis?

A

Pancreatectomy

227
Q

What is the main histological type of pancreatic cancer?

A

Adenocarcinomas

228
Q

Where do the majority of pancreatic tumours arise in the pancreas?

229
Q

What are risk factors for pancreatic cancer?

A

Smoking, alcohol, carcinogens, diabetes, chronic pancreatitis

230
Q

What are symptoms of head of pancreas tumours?

A

Painless jaundice, dark urine, pale stools

231
Q

How does pancreatic body/tail cancer present?

A

Epigastric pain, radiating to the back

232
Q

What signs may be present in pancreatic cancer?

A

Palpable gallbladder
Epigastric mass
Jaundice
Hepatosplenomegaly

233
Q

How is pancreatic cancer investigated?

A

CT scan + endoscopic US guided biopsy

234
Q

How is pancreatic cancer managed broadly?

A

Palliative - radiotherapy, chemotherapy and surgery

235
Q

What procedure can be performed for head of pancreas tumours?

A

Whipples Procedure - removal of head of pancreas, gallbladder, bile duct and 1st part of duodenum

236
Q

What is the mean survival time of pancreatic cancer?

237
Q

What is Crohns disease?

A

Inflammatory and ulcerating condition affecting from mouth to anus

238
Q

What are risk factors for Crohns disease?

A

Positive family history, genetics, smoking

239
Q

What are symptoms of Crohns disease?

A

Abdominal pain, diarrhoea, weight loss, malaise

240
Q

What are signs of Crohns disease?

A

Apthous ulcers, abdominal tenderness, RIF mass, perianal abscesses/fistulas, clubbing, erythema nodosum, pyoderma gangrenosum, arthritis, anaemia

241
Q

How is Crohns disease investigated?

A

Bloods (increased CRP, possible anaemia)

Colonscopy

242
Q

What is seen on pathology of Crohns disease?

A 
Transmural inflammation
Segmented disease with skip lesions
Non-caseating granulomas
Cobblestone mucosa
Stricutres
Fissuring ulcers
243
Q

What is the first line drug used in Crohns to induce remission (acute)?

A

Glucocorticoids (prednisolone)

244
Q

What can be used in addition to steroids to induce remission in Crohns?

A

Azaithioprine/Methotrexate/Mercatopurine

Infliximab in refractory disease

245
Q

What are the first line drugs for maintaining remission of Crohns disease?

A

Azaithioprine or mercatopurine

246
Q

What surgery is commonly done for patients with Crohns disease?

A

Ileocaecal resection due to a stricture in the terminal ileum

247
Q

What are complications of Crohns disease?

A

Short bowel syndrome, malabsorption, obstruction, perforation, fistulae, cancer

248
Q

What is ulcerative colitis?

A

Chronic inflammatory condition confined to colon and rectum

249
Q

What is protective against UC?

250
Q

What are symptoms of UC?

A

Diarrhoea (+/- blood, mucus), abdominal pain in LIF, tenesmus, PR bleeding

251
Q

What are signs of UC?

A

Clubbing, erythema nodosum, pyoderma gangrenosum, episcleritis, ankylosing spondyltitis, PSC, arthritis

252
Q

What investigations should you do in UC?

A

Bloods - raised CRP
Stool microscopy to rule out infection
AXR
Colonoscopy

253
Q

What may be seen on AXR in UC?

A

Mucosal thickening

Drainpipe colon

254
Q

What is the pathology seen in UC?

A

Superficial inflammation, crypt abscesses, inflammatory cell infiltrate

255
Q

What is first line for inducing remission in UC (acute)?

A

Mesalazine

Rectal steroids if solely rectal disease

256
Q

What drugs are used for maintaining remission in UC?

A

Mesalazine

Azaithioprine/Mercaptopurine

257
Q

What are complications of UC?

A

Toxic megacolon, perforation, colorectal cancer

258
Q

What is toxic megacolon?

A

Dilation of colon to diameter >6cm

259
Q

Which IBD has granulomas?

260
Q

Which IBD has superficial inflammation?

261
Q

Which IBD has a high cancer risk?

262
Q

Which IBD are fistula common?

263
Q

What are risk factors for bowel cancer?

A

Increased age, male sex, obesity, smoking, alcohol, red meat, low fibre diet, IBD, genetic conditions

264
Q

What is the usualy pathogenesis of bowel cancer?

A

Start from a polyp and progress to a pre-malignant adenoma before becoming an adenocarcinoma

265
Q

Which side are the majority of bowel cancers found?

266
Q

What are some general symptoms of bowel cancer?

A

Abdominal mass, tiredness, weight loss

267
Q

What are some left sided symptoms of bowel cancer?

A

Altered bowel habit, bleeding PR, mucus PR, tenesmus, mass PR, bowel obstruction

268
Q

What are some right sided symptoms of bowel cancer?

A

Iron deficient anaemia, abdominal pain

269
Q

How is colorectal cancer investigated?

A

Bloods - FBC, U&Es, LFTs

Colonoscopy and biopsy - diagnostic

270
Q

How is colorectal cancer investigated for staging?

A

CT chest abdo pelvis

271
Q

What tumour marker is monitored throughout treatment?

272
Q

What staging system is used in colorectal cancer?

A

Dukes Staging

273
Q

What is Dukes stages A-D?

A 
A= confined to bowel wall
B= through bowel wall
C= local lymphatic spread
D= distant mets
274
Q

What surgery is done for tumours in the caecum, ascending colon or proximal transverse colon?

A

Right hemi-colectomy

275
Q

What surgery is done for tumours in the distal transverse or descending colon?

A

Left hemi-colectomy

276
Q

What surgery is done for tumours in the sigmoid?

A

Sigmoid colectomy

277
Q

What surgery is done for tumours in the low sigmoid/upper rectum?

A

Anterior resection

278
Q

What surgery is done for tumours in the low rectum?

A

Anterior resection

279
Q

What surgery is done for tumours at the anal verge?

A

Abdomino-perineal excision of rectum

280
Q

When is radiotherapy used in bowel cancer?

A

Adjuvantly

281
Q

When is chemotherapy used in bowel cancer?

A

For Dukes stages C+. Adjuvant or neoadjuvant

282
Q

What is done for peritoneal disease in bowel cancer?

283
Q

What is Lynch Syndrome?

A

Inherited mutation of DNA mismatch repair genes

284
Q

How is Lynch syndrome inherited?

A

Autosomal dominant

285
Q

What cancers does Lynch syndrome predispose to?

A

Colorectal, endometrial and gastric

286
Q

How are patients with Lynch syndrome monitored?

A

Colonscopy every 2 years from age 25

287
Q

What is Familial Adenomatous Polyposis?

A

Mutation of APC tumour suppresor gene

288
Q

What is the cancer risk in FAP?

289
Q

Who gets bowel screening and how often?

A

People aged 50-74 every 2 years

290
Q

What test is done in bowel screening?

A

Faecal immunoglobulin test

291
Q

If a bowel screening test in positive, what investigation do patients get next?

A

Flexible sigmoidoscopy or colonscopy

292
Q

What is a hernia?

A

Abnormal protrusion of a viscous outwith its normal body cavity

293
Q

What is a hiatus hernia?

A

Herniation of the stomach above the diaphragm

294
Q

How may a hiatus hernia present?

A

GORD symptoms

295
Q

How is a hiatus hernia diagnosed?

A

Barium swallow

296
Q

What predisposes to hernias?

A

Obesity, ascites, heavy lifting, coughing, constipation, surgical wounds, increased age

297
Q

What signs are often found with hernias?

A

Palpable lump, cough impulse, pain

298
Q

When does an incisional hernia occur?

A

Post-surgery

299
Q

Where is a paraumbilical hernia found?

A

Above or below the umbilicus

300
Q

Where is an umbilical hernia found?

A

Directly below the umbilicus (commoner in kids)

301
Q

What does an epigastric hernia arise from?

A

Congenital weakness of the linea alba

302
Q

Which hernia is below and lateral to the pubic tubercle?

A

Femoral hernia

303
Q

Which hernia is above and medial to the pubic tubercle?

A

Inguinal hernia

304
Q

What is an incarcerated hernia?

A

Unable to be reduced

305
Q

What is an obstructed hernia?

A

Hernia containing bowel becomes compressed causing bowel obstruction

306
Q

What is a strangulated hernia?

A

Compression around hernia prevents blood flow

307
Q

Where does a direct inguinal hernia protrude through?

A

Hesselbachs triangle

308
Q

Is a direct inguinal hernia medial or lateral to the inferior epigastric vessels?

309
Q

What is a direct inguinal hernia caused by?

A

Defect or weakness in fascia

310
Q

Who commonly gets direct inguinal hernias?

311
Q

Where does an indirect inguinal hernia protrude through?

A

Inguinal ring

312
Q

Is an indirect inguinal hernia medial or lateral to the inferior epigastric vessels?

313
Q

What is an indirect inguinal hernia caused by?

A

Failure of closure of processus vaginalis

314
Q

Who commonly gets indirect inguinal hernias?

315
Q

What is a herniotomy?

A

Excision of hernial sac but no wall repair (indirect inguinal hernia)

316
Q

What is herniorraphy?

A

Repair of the defect in the wall by either stitching healthy sides together or mesh

Finals Revision (22 decks)

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