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2a RRS > GI (late) obstruction,cancers > Flashcards

GI (late) obstruction,cancers Flashcards

1
Q

2 types of obstruction

A

mechanical and pseudo

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2
Q

what are investigations for bowl obstruction

A

bloods
erect CXR (no perforation)
CT - visualize pathology

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3
Q

types of mechanical obstruction

A 
adhesion
volvulus
hernia
intususception
tumour
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4
Q

types of pseudo mechanical obstruction

A

myopathy - no peristaltic contractions
neuropathy - no smooth muscle nerve innerv
congenital - Hirchsprung disease = no nerve innervation of distal colon

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5
Q

what is types of obstrcutoin in small bowel

A

adhesions
hernia
cancer

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6
Q

obstruction in large bowl

A

cancer
diverticulitis
volvulus

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7
Q

obstruction in ileus (pseudo obstruction = temp paralysis)

A

post operation
medication
chronic disease

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8
Q

what is the buzz word in bowel obstruction

A

tinkling bowel sounds

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9
Q

pattern of bowel sounds in small vs large

A 
small = normal initially, increases then decreases
large = normal then increases then decreases LATER
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10
Q

which shows ladder pattern on abdo xray

A

small bowel

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11
Q

which is most common cause of small bowel obstructiuon

A

adhesions (60%)

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12
Q

what is adhesive obstruction

A

Extra luminal obstruction
post surgery
fibrous bridges between segments of bowel

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13
Q

what can lead to volvulus

A

adhesions

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14
Q

where is distension in small bowel obstruct

A

above the blockage

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15
Q

how can small bowel obstrcut lead to complications and what are they

A

obstruction - secreton of fluid above distended bowel - bacteria contam in stagnant bowel -
strangulation - impedes blood supply - GANGRENE, PERITONITIS
more dilatiation
mucosual wall oedema
increased pressure - compresses bv = ischaemia and or PERFORATION - SEPSIS

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16
Q

Dx of small bowel obstruction

A

abdo xray - central gas shadow
CT - prev surgery?- adhesionm****
Bloods - fbc = elevates WBC and electrolyte imbalance (dehyrdration)

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17
Q

what type of obstruction of crohn’s disease

A

Intramural obstruction

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18
Q

What is a volvulus

A

Type of SBO extra luminal, occurs when bowel twists around itself in mesentery causing obstruction and can lead to ischemia

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19
Q

what are examples of Intramural obstructions

A

Crohn’s or Diverticular disease

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20
Q

Presentation of small bowel obstruction

A 
Colicky pain, not localised 
vomiting is early sign in SBO - coffe ground 
Constipation is Late sign in SBO 
distension (less than LBO)
Projectile or feculent vomiting

shows signs of peritonitis if rupture

21
Q

Treatment of SBO

A

Fluid resuscitation + Bowel decompression
Analgesia + antiemetics
Antibiotics (ampicillin + Gentamicin)
Surgery, Laparotomy to remove obstruction

22
Q

causes of LBO

A

commonly malignancy 90%
volvulus
diverticular disease
Hirschsprung disease (pseudo ob)

23
Q

what is Hirschsprung disease

A

no nerve innervation in distal colon = no/abnormal peristalis

24
Q

pathophysiology of LBO

A

Obstruction causes proximal dilation. increased pressure.
This reduced mesenteric blood flow causing ischemia which will lead to dehydration and oedema in bowel.

This can progress to perforation

25
Q

Indication of bowel perforation

A

Persistent tachycardia
Fever
Abdominal pain and tenderness, rebound tenderness and Guarding

26
Q

Presentation of LBO

A 
Colicky pain 
constipation, early = 'absolute' constipation
Vomiting, late - goes dark brown
sudden onset of pain= volvulus 
weight loss 
bloat
palpable mass in abdomen  (hernia, distended bowel loop)
fever 
tenderness, rebound , guarding
27
Q

Investigations in LBO

A 
sigmoidoscopy
fbc - chonic occult blood loss
AXR - dilated bowel
Electrolytes: Imbalance
Contrast enema
28
Q

Treatment of LBO

A 
supportive measures: Antibiotics Gentamicin 
IV fluids resus
relieve obstrutcion - stent decomp
potentially transfusion 
Surgery emergency Laparotomy
29
Q

oesophageal cancer types

A

squamous and adenocarcinoma

30
Q

where are squamous found and wehre adenocarinoma

A 
squamous = upper and middle
adenocarcinoma = lower
31
Q

which does barrets oesoph predispose to in oesophageal cancer

A

adenocarcinoma

32
Q

RFs of oesophageal cancer

A 
smoking
alcohol
barrets oesph (adenocarcinoma only)
alchalasia - LOS doesnt relax 
coeliac - Squamous
33
Q

Cf of oesophagela cancer

A 
dysphagia 
WL
anorexia
hoarse voice
vom (haematemis
symptoms of GI bloos loss
ADVANCED 
lymphadenopathy
oesophagela obstruction - cough, aspriation into lungs
34
Q

Dx of oesophageal cancer

A

silent killer
endoscopy nd biopsy
CT for mets
barium swallow - ddx of dysphagias

35
Q

Mx of esoophageal caner

A

endoscopic resection
oesophagectomy
stage 2b and 3 = pre n post op chemo
palliative

36
Q

gastric cancer RFs

A

H PYLORI
Gastritis
smoking
fam history

37
Q

CFs of gastric cancer

A 
WL
dyspepsia
dysphagia 
anaemia
palp mass in epigastric - tender
palp lymph nodes in supraclavic fossa
acanthosis nigricans - dark skin discolouration and thickens in folds and creases - arm pit
38
Q

what is MALT

A

primary gastri lymphoma - h pylori and non hodkins lymphoma

39
Q

Mx of gastric cancer

A

surgery - partial gastrectomy
if early and confined to mucosa - endoscopic musocal resection
plus chemo perioperatively - cisplatin

40
Q

colorectal carinoma RFs

A 
elderly,
IBD 
Fam history (FAP and HNPCC)
smoking
obestiy
low fibre (more time in transit in contact w carcinogen)
41
Q

Cfs of colorectal carcinoma

A

depends on location
L sided - OBSTRUCT - collicky pain, rectal bleed
= TRANSV COLON AND DESC COLON
(MELANA). mass in LIF, change bowel habits
R sided - BLEED - WL, anaemia , haematochezia (fresh blood in stools)
mass in RIF
mets - jaundice and hepatomegaly

42
Q

what is a sign of colorectal cancer warning redflag

A

over 50yo man or post menopausal woman with iron defociency anameia = SIGN

43
Q

Ix of CRC

A

colonoscopy and biopsy and histology
removal of polyps
CT - for staging = DUKES / TNM
2nd = barium enema

44
Q

how is early diagnosis attempted

A

SCREENING PROGRAMME

45
Q

Mx of CRC

A

surgery = curative
rad and chemo post op
endoscopic stents if palliative

46
Q

CFs of a ruptured oesophago gastric varices

A

haematesis

abdo pain

47
Q

Mx of ruptured varices

A 
resus and stabilise
variceal banding (endoscopic)
48
Q

when does oesophag - gastric vaaricies occur

A

when pressure in portal system is above 10-12mmHg

compliant system dilates - varices form within systemic venous system (@gastro oesophageal junction)

2a RRS (26 decks)

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