GI (late) obstruction,cancers

Question 1

2 types of obstruction

Answer 1

mechanical and pseudo

Question 2

what are investigations for bowl obstruction

Answer 2

bloods
erect CXR (no perforation)
CT - visualize pathology

Question 3

types of mechanical obstruction

Answer 3

adhesion
volvulus
hernia
intususception
tumour

Question 4

types of pseudo mechanical obstruction

Answer 4

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

Question 5

what is types of obstrcutoin in small bowel

Answer 5

adhesions
hernia
cancer

Question 6

obstruction in large bowl

Answer 6

cancer
diverticulitis
volvulus

Question 7

obstruction in ileus (pseudo obstruction = temp paralysis)

Answer 7

post operation
medication
chronic disease

Question 8

what is the buzz word in bowel obstruction

Answer 8

tinkling bowel sounds

Question 9

pattern of bowel sounds in small vs large

Answer 9

small = normal initially, increases then decreases
large = normal then increases then decreases LATER

Question 10

which shows ladder pattern on abdo xray

Answer 10

small bowel

Question 11

which is most common cause of small bowel obstructiuon

Answer 11

adhesions (60%)

Question 12

what is adhesive obstruction

Answer 12

Extra luminal obstruction
post surgery
fibrous bridges between segments of bowel

Question 13

what can lead to volvulus

Answer 13

adhesions

Question 14

where is distension in small bowel obstruct

Answer 14

above the blockage

Question 15

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

Answer 15

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

Question 16

Dx of small bowel obstruction

Answer 16

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

Question 17

what type of obstruction of crohn’s disease

Answer 17

Intramural obstruction

Question 18

What is a volvulus

Answer 18

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

Question 19

what are examples of Intramural obstructions

Answer 19

Crohn’s or Diverticular disease

Question 20

Presentation of small bowel obstruction

Answer 20

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

Question 21

Treatment of SBO

Answer 21

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

Question 22

causes of LBO

Answer 22

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

Question 23

what is Hirschsprung disease

Answer 23

no nerve innervation in distal colon = no/abnormal peristalis

Question 24

pathophysiology of LBO

Answer 24

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

Question 25

Indication of bowel perforation

Answer 25

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

Question 26

Presentation of LBO

Answer 26

``` 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 ```

Question 27

Investigations in LBO

Answer 27

``` sigmoidoscopy fbc - chonic occult blood loss AXR - dilated bowel Electrolytes: Imbalance Contrast enema ```

Question 28

Treatment of LBO

Answer 28

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

Question 29

oesophageal cancer types

Answer 29

squamous and adenocarcinoma

Question 30

where are squamous found and wehre adenocarinoma

Answer 30

``` squamous = upper and middle adenocarcinoma = lower ```

Question 31

which does barrets oesoph predispose to in oesophageal cancer

Answer 31

adenocarcinoma

Question 32

RFs of oesophageal cancer

Answer 32

``` smoking alcohol barrets oesph (adenocarcinoma only) alchalasia - LOS doesnt relax coeliac - Squamous ```

Question 33

Cf of oesophagela cancer

Answer 33

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

Question 34

Dx of oesophageal cancer

Answer 34

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

Question 35

Mx of esoophageal caner

Answer 35

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

Question 36

gastric cancer RFs

Answer 36

H PYLORI Gastritis smoking fam history

Question 37

CFs of gastric cancer

Answer 37

``` 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 ```

Question 38

what is MALT

Answer 38

primary gastri lymphoma - h pylori and non hodkins lymphoma

Question 39

Mx of gastric cancer

Answer 39

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

Question 40

colorectal carinoma RFs

Answer 40

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

Question 41

Cfs of colorectal carcinoma

Answer 41

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

Question 42

what is a sign of colorectal cancer warning redflag

Answer 42

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

Question 43

Ix of CRC

Answer 43

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

Question 44

how is early diagnosis attempted

Answer 44

SCREENING PROGRAMME

Question 45

Mx of CRC

Answer 45

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

Question 46

CFs of a ruptured oesophago gastric varices

Answer 46

haematesis | abdo pain

Question 47

Mx of ruptured varices

Answer 47

``` resus and stabilise variceal banding (endoscopic) ```

Question 48

when does oesophag - gastric vaaricies occur

Answer 48

when pressure in portal system is above 10-12mmHg | compliant system dilates - varices form within systemic venous system (@gastro oesophageal junction)