GI surgery Flashcards
commonest causes of pneumoperitoneum
perforated diverticulum and a perforated duodenal ulcer
Free air may persist for several days after abdominal laparotomy.
Which structures cause gas accumulation in the retroperitoneum when they perforate?
3rd part of peritoneum
ascending colon
descending colon
Serum amylase can confirm pancreatitis if above
1000
first steps in management of acute pancreatitis
IV fluids
IV analgesia
Blood gas analysis (for severity scoring)
Start oral feeding
Common complication of pancreatitis
Pancreatic psudocyst
First line method for draining a psudocyst
endoscopic ultrasound
How can you establish the diagnosis of pancreatic exocrine insufficiency?
Faecal elastase measures pancreatic exocrine function, however it is a fairly blunt instrument to determine pancreatic insufficiency. Clinical judgement is just as good.
Calprotectin is a measure of
gastrointestinal inflammation (think of it like CRP for the bowel)
SeHCAT scan measures
bile salt reabsorption, and is a test used to investigate chronic diarrhoea
treatment for pancreatic exocrine insufficiency
oral pancreatic enzyme replacement
initial Ix in bowel obstruction
Supine abdo radiograph to assess the bowel gas pattern.
A rectal examination is mandatory to exclude a rectal lesion.
how to manage sigmoid volvulus initially (if no perforation)
Large bowel decompression with a flatus tube - relieve symptoms and is relatively non-invasive, suffices in some patients
how to manage recurrent sigmoid volvulus / with perforation
sigmoid colectomy
cause of sigmoid volvulus
twisting of the bowel on lax mesentery
Which volvulus has association with large bowel malignancy
Caecal volvulus