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Yr 5 GI & Breast > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

What is the difference between diverticular disease & diverticulitis?

A

Diverticulitis: Infected diverticular
DD: Symptomatic diverticular

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2
Q

What are the symptoms of diverticular disease?

A 
Altered bowel habits- constipation
Abdo colic (LEFT)- relieved by defecation
Bleeding 
Nausea
Flatulence
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3
Q

What are the symptoms of diverticulitis?

A 
Sx of diverticular disease
Pyrexia 
Anorexia
Tender colon- Painful LIF
Local/generalised peritonitis
Diarrhoea + bleeding
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4
Q

How is diverticular disease investigated?

A

-Bloods
-Colonoscopy/CT Colonoscopy- DIAGNOSTIC
Barium enema

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5
Q

How is diverticular disease managed?

A

High fibre diet
Analgesia
Restart solid food in 2-3days

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6
Q

How is acute diverticulitis treated?

A 
Analgesia
NBM
IV fluids
Abx: Co-Amox OR Cipro + Metronidazole
Recurrence = segmental resection
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7
Q

How is diverticular disease in someone acutely unwell investigated?

A 
Erect CXR
Abdo CT +/- contrast
Exclude malignancy
URGENT ADMISSION- rectal bleeding 
Hinchey Score
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8
Q

What are the signs of appendicitis?

A 
CLASSIC:
Generalised/umbilical abdo pain
N&V&D
Mild fever
Voluntary guarding
LATE:
McBurney's pain
Involuntary guarding
Rovsing's sign- pain in RIF
Psoas sign- Pain extending hip if RETROCAECAL
Cope sign- Pain on flexion & internal rotation of R hip
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9
Q

What are the signs of a retrocaecal appendix?

A

Flank/RUQ pain

↑Tenderness @ R side during DRE

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10
Q

What are the investigations for suspected appendicitis?

A

Diagnosis- on presentation
Urinalysis: Pyuria (↑WCC) + Bacteriuria (↑Nitrites)
Bloods: ↑Neut ↑WCC ↑CRP/ESR
USS

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11
Q

What is the management of appendicitis?

A

IV Fluids
NBM
IV prophylactic Abx
Laparoscopic appendectomy

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12
Q

What are the types of bowel obstruction?

A

Simple: 1 point, no vascular compromise
Closed loop: 2 points, grossly distended bowel typically at caecum
Strangulated: Vascular compromise, toxic patient

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13
Q

What are the causes of small bowel obstruction?

A

Adhesions
Hernias
Volvulus

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14
Q

What are the causes of large bowel obstruction?

A 
Colon Ca
Constipation
Diverticular disease
Stricture
Volvulus
Intussusception
Hernia
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15
Q

What are the signs of bowel obstruction?

A 
N&V: BILIOUS (Small), Faeculent (proximal gut)
Constipation: Complete/partial
Dehydration
Tinkling bowel sounds
Colicky abdo pain
Abdo distension
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16
Q

What are the differences between small & large bowel obstruction?

A 
LARGE= Vomiting later, +++ distension, lower & constant abdo pain
SMALL= Bilious vomiting early, + distension, higher abdo pain
17
Q

How is a bowel obstruction investigated?

A 
DRE
Hernial orifices
AXR
Erect CXR
Bloods: FBC, U&E, Cross-match
Contrast enema CT
18
Q

How is a bowel obstruction managed?

A 
Drip & Suck- Ryles tube
AVOID pro-kinetics
IV Fluids
NBM
EMERGENCY SURGERY: Closed loop or >12cm
19
Q

What are the signs on AXR for obstruction?

A

SMALL: >3cm, central gas shadow, valvular conniventes, no gas in large bowel
LARGE: >6cm colon, >9cm caecum, peripheral gas proximal to blockage, haustra
SIGMOID: Coffee bean volvulus

20
Q

What are the features of a sigmoid volvulus?

A 
Acute abdo pain
GROSS distension
Constipation
Vomiting
↑Resonance 
Palpable mass
21
Q

How is a volvulus investigated?

A

DRE- Any stool/flatus
AXR- Dilated sigmoid loop >9cm (Coffee bean)
Erect CXR- Perforation
CT Abdo- Visualise volvulus & assess for bowel wall ischaemia

22
Q

How is a volvulus managed?

A

NON-SURGICAL: Decompression- sigmoidoscope w/flatus tube to relieve obstruction, leave tube for 24hours
SURGICAL: Resection of redundant sigmoid colon

23
Q

What are the complications of a volvulus?

A

Bowel wall ischaemia = Perforation (Blood stained stool)

24
Q

What are the causes of an ileus?

A

Non-mechanical obstruction commonly paralytic
Usually from physiological stress
Surgery: GI, Thoracic, trauma
Acute illness: Sepsis, Gallstones, MI, peritonitis, pancreatitis
Medication: Analgesia, anaesthetics, anticholinergics

25
Q

What are the Sx of an ileus?

A 
Painless distension
N&V
ABSENT bowel sounds
No flatus/faeces
\+++gas in rectum
26
Q

How is an ileus investigated?

A

Bloods: U&E, FBC, Mg
AXR: Small bowel distension

27
Q

How is an ileus treated?

A

Post-op:
-NBM, IV Fluids, ↓opiates +/- replace w/non-opioid analgesia (Ketorolac), NG tube
Non-surgical:
-NBM, IV Fluids, manage underlying cause, NG tube

Yr 5 GI & Breast (13 decks)

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