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Medicine Year 5 > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

pre hepatic, hepatic and post hepatic blood values

A

LEARN THEM BETH FGS

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2
Q

GETSMASHED

A

Gallstones
Ethanol
Trauma
Steroids
Malignancy / Mumps
Autoimmune
Scorpion bite
Hypothermia, Hypercalcaemia, Hypergluceride
ERCP
Drugs

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3
Q

severe epigastric pain, vomiting and fever

A

acute pancreatitis

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4
Q

cullen and grey turners signs

A

in pancreatitis
cullen: periumbilical discoloration
grey turner: flank discolouration

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5
Q

immediate management for pancreatitis

A

CT
fluid resus

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6
Q

what do you measure in a late presentation of pancreatitis

A

lipase

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7
Q

what do you measure for the exocrine function in pancreatitis

A

faecal elastase

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8
Q

acute respiratory distress syndrome and pseudocyst are complications of what

A

pancreatitis

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9
Q

score to measure the severity of pancreatitis

A

modified glasgow score

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10
Q

drugs which can cause pancreatitis

A

azathioprine, mesalasine, thiazides, furosemide, sodium valproate

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11
Q

what marker does sodium valproate increase

A

amylase

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12
Q

painless jaundice and a palpable gallbladder

A

pancreatic cancer
couvrosiers law

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13
Q

double duct sign

A

pancreatic cancer

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14
Q

LFT picture in pancreatic cancer

A

cholestatic

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15
Q

management of pancreatic cancer if it is obstructing

A

biliary stenting

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16
Q

obstructive picture with RUQ pain and history of biliary colic and cholecystitis

A

gallstones

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17
Q

management of asymptomatic gallstones

A

reassure

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18
Q

scan for gallstones

A

USS

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19
Q

2 symptoms of raised bilirubin

A

jaundice and itch

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20
Q

gallstones in sickle cell

A

pigmented

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21
Q

stones compress the bile duct causing jaundice

A

mirizzi syndrome

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22
Q

intermittent RUQ pain after eating and nausea

A

biliary colic

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23
Q

stool and urine in obstructive picture

A

pale stool and dark urine

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24
Q

LFTs in biliary colic

A

normal

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25
Q

management of biliary colic

A

elective laparoscopic cholecystectomy

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26
Q

4 F’s for biliary colic

A

female
fat
fourty
fair

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27
Q

patient presents with similar sx to biliary colic but are systemically unwell with RUQ pain which radiates to back/shoulder

A

acute cholecystitis

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28
Q

murphys sign

A

palpation of RUQ causes inspiratory arrest

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29
Q

management of acute cholecysitits

A

IV ABx and laparoscopic cholecystectomy in 1w

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30
Q

charcots triad in cholangitis

(how do you make it reynoulds pentad)

A

RUQ pain
fever
jaundice (obstructive)

+ hypotension + confusion

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31
Q

pathophysiology of cholangitis

A

infection of the bile duct secondary to gallstones or stagnant bile

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32
Q

organism commonly causing cholangitis

A

e. coli

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33
Q

how do you relieve the obstruction in cholangitis

A

ERCP

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34
Q

3 M’s in primary biliary cholangitis

A

IgM
anti Mitochondrial antibody
Middle aged female

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35
Q

management of primary biliary cholangitis

A

ursodeoxycholic acid

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36
Q

marker in primary sclerosing cholangitis

A

p ANCA

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37
Q

management of primary sclerosing cholangitis

A

MRCP

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38
Q

complication of primary sclerosing cholangitis

A

cholangiocarcinoma

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39
Q

RUQ mass, abdominal pain, distention, jaundice and vomiting with persistent biliary colic and obstruction
associated with anorexia and weight loss

A

cholangiocarcinoma

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40
Q

tumour marker in cholangiocarcinoma

A

CA199

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41
Q

small bowel obstruction due to gallstone causing pain, abdo distention and vomiting
what does the xray show

A

gallstone ileus
axr: air in biliary tree

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42
Q

what can LT TPN cause

A

painless non obstructive jaundice due to hepatic dysfunction

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43
Q

isolated rise in bilirubin due to physiological stress

A

gilberts

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44
Q

how to differentiate between gilberts and haemolysis

A

FBC

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45
Q

complication of laparoscopic surgery causing a gingko leaf

A

SC emphysema

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46
Q

management of bile acid malabsorption

A

cholestyramine

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47
Q

surgery if BMI above 50

A

bariatric surgery

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48
Q

colicky LLQ pain and diarrhoea with fever and bleeding

A

diverticulitis

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49
Q

most common site of diverticulitis

A

sigmoid colon

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50
Q

scan for diverticulitis

A

CT

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51
Q

vaginal faeces in diverticulitis

A

fistula

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52
Q

general and acute management of diverticulitis

A

general: increase fibre
acute: ABx (PO then IV cef/met)

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53
Q

bright red rectal bleeding post defecation at 3,7 and 11 clock with a history of straining

A

haemorrhoids

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54
Q

2 classes of haemorrhoids and grading

A

internal (1-4)
external

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55
Q

management of haemorrhoids

A
  1. conservative
  2. rubber band ligation
  3. removal
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56
Q

anorectal pain and tender purple lump

A

thrombosed haemorrhoid

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57
Q

management of thrombosed haemorrhoid

A

ice packs and soften stools

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58
Q

painful rectal bleeding post defecation (often posterior)

A

anal fissure

59
Q

management of a lateral anal fissure

60
Q

management of acute anal fissure

A

soften stool, fibre and analgesia

61
Q

management of non-responsive anal fissure

A

sphincterotomy

62
Q

3 causes of proctitis

A

c diff
crohns
uc

63
Q

imaging and management of megacolon in UC

A

AXR
colectomy

64
Q

management of severe rectal crohns

A

proctectomy

65
Q

management of perianal abscess in crohns

A

incision and drainage

66
Q

2 organisms that cause ano-rectal abscess

A

e. coli
s. aureus

67
Q

imaging for anal fistula

68
Q

2 RF for rectal prolapse

A

childbirth
intussuception

69
Q

cause of pruritis ani

A

threadworm

70
Q

chronic straining causing mucosal thickening

A

rectal ulcer

71
Q

histology of rectal cancer

A

adenocardinoma

72
Q

presentation of rectal cancer

A

bright red blood, altered bowel habit and tenesmus

73
Q

histology of anal carcinoma

A

squamous cell

74
Q

RF for anal cancer

75
Q

staging for colorectal cancer

A

Dukes
A (mucosa)
B (bowel wall)
C (lymph nodes)
D (distant mets)

76
Q

tumour marker for colorectal cancer

77
Q

anastamosis in right and left hemicolectomy and anterior resection

A

right: ilio-colic
left: colo-colon
anterior resection: colorectal

78
Q

which cancer would you do a right/left hemicolectomy and anterior resection for

A

right/left: transverse colon
anterior resection: sigmoid/rectum

79
Q

anterior resection with formation of an end colostomy is referred to as what

80
Q

portal htn and lower GI bleed

A

rectal varices

81
Q

difference between an ileostomy and colonoscopy

A

ileostomy: RIF, spouted, liquid
colonoscopy: LIF, flushed, solid

82
Q

central abdo pain radiating to RIF with anorexia, tachycardia and fever

A

appendicitis

83
Q

what is rosvings sign

A

RIF pain on palpation of LIF

84
Q

enlarged mesenteric lymph nodes due to viral infection with high fever

A

mesenteric adenitis

85
Q

prevalence and site of meckel’s diverticulum

A

prevalence: 2%
site: 2cm from the ileocaecal valve

86
Q

investigation and management of acute mesenteric ischaemia

A

LACTATE
immediate laparotomy

87
Q

bleeding and diarrhoea with no pain

88
Q

most common site of ischaemic colitis

A

splenic flexture

89
Q

AXR in colitis

A

featureless colon

90
Q

investigation in colitis

A

flexible sigmoidoscopy
colonoscopy increases the risk of perforation

91
Q

most common cause of bowel obstruction

A

malignancy

92
Q

presentation of large bowel obstruction

A

distension
no stool or flatus
vomiting
tinkling bowel sounds

93
Q

amylase level in small bowel obstruction

94
Q

management of small bowel obstruction

A

drip and suck
IV fluids and gastric decompression

95
Q

investigation for bowel obstruction

A

erect CXR
CT abdo

96
Q

management of a sigmoid volvulus with obstruction and peritonitis

A

urgent laparotomy

97
Q

AV lesion causing a massive bleed from the right colon

A

angiodysplasia

98
Q

which medication should you avoid in bowel obstruction

A

metoclopromide (for nausea)

99
Q

SE of metaclopromide

A

extrapyramidal

100
Q

riglers sign

A

free air in the abdomen in bowel perforation

101
Q

when does dumping syndrome occur

A

after gastric bypass

102
Q

management of wound dihiscence

A

cover wound with saline gauze and give IV ABx

103
Q

presentation of enterovesical fistula

A

bubbly urine

104
Q

role of epidural anaesthesia after bowel surgery

A

increases speed of return to normal bowel function

105
Q

most common hernia above and medial to the pubic tubercle in males
strangulation is rare

106
Q

hernia below and lateral to the pubic tubercle in multiparous women with high risk of strangulation and obstruction

A

femoral hernia
surgery

107
Q

symmetrical hernia under umbilicus

A

umbilical hernia

108
Q

asymmetrical hernia above/below umbilicus

A

paraumbilical

109
Q

hernia between umbilicus and xiphisternum more common in obese patients with COPD or those who excessively train

A

epigastric hernia

110
Q

how do obturator hernias present

A

bowel obstruction in women

111
Q

hernia which causes strangulation with no obstruction

112
Q

patent processus vaginialis causing a hernia in preterm boys with a high risk of strangulation

A

congenitla inguinal hernia

113
Q

hernia in children with resolves spontaneously

A

infantile umbilical

114
Q

feature of an incarcerated hernia

A

non reducible

115
Q

which types of shock have warm and cool peripheries

A

cool: cardiogenic and hypovolemic
warm: septic, neurogenic, anaphylactic

116
Q

SVR, HR, CO and BP in cardiogenic, hypovolemic and septic shock

A

cardiogenic and hypovolemic : increased SVR and HR, reduced CO and BP
septic: increased HR and CO, reduced SVR and BP

117
Q

common cause of tension pneumothorax

A

mechanical ventilation

118
Q

number of fractures to diagnose flail chest

A

2 fractures in at least 2 ribs

119
Q

what do you need to be careful with in flail chest

A

level of fluids

120
Q

BECKS TRIAD in cardiac tamponade

A

reduced heart sounds, reduced BP, increased JVP

121
Q

2 investigations and management of pulmonary contusion

A

ABG and sats
early intubation

122
Q

ECG in blunt cardiac injury

A

MI/arrhythmia

123
Q

what is a mediastinal transversing wound

A

entrance one side of hemithorax and exit on the other

124
Q

incorrect seatbelt placement can cause what

A

laceration to the carotid artery

125
Q

what can a FAST scan show

A

free fluid in the abdomen/thorax

126
Q

genetics in ank spond

127
Q

XRAY in ank spond

A

sacro-ilitis

128
Q

epiphysitis of vetrebral joints in teens causing kyphosis and pain
xray shows plate disturbance and anterior wedging

A

scheurmann disease

129
Q

define scoliosis

A

curvature of the spine

130
Q

2 types of scoliosis

A

non-structural: minor in teen girls
structural: idiopathic, congenital or neuromuscular

131
Q

management of severe scoliosis

A

bilateral rod stabilisation

132
Q

non fusion of the vertebral arches in embryonic development

A

spina bifida

133
Q

what is the most severe form of spina bifida

A

myelomeningocele

134
Q

minor form of spina bifida causing birth mark/patch of hair

135
Q

deficiency of the neural arch in L4/5 in children

A

spondyloysis

136
Q

vertebra displaced from vertebral body due to stress fracture/spondylolysis

A

spondylolisthesis

137
Q

sign of spondylolisthesis on xray

A

scotty dog

138
Q

management of spondylolisthesis

A

surgical decompression and stabilisation

139
Q

4 features of the blood film post splenectomy

A

howell jolly bodies
target cells
irregular erythrocytes
pappenheimer bodies

140
Q

fluid replacement after burns

A

4 ml/kg in adults per percentage burn area in 24 hours (3 in paeds)

50% in first 8 hours, 50% in next 16

141
Q

define allograft

A

transplant from genetically non identical donor

142
Q

define isograft

A

transplant between identical twins

143
Q

define autograft

A

transplant from the same individual (e.g. skin)

144
Q

define xenograft

A

transplant from another species (e.g. porcine heart valves)

Medicine Year 5 (27 decks)

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