GI Surgery Flashcards
1
Q
pre hepatic, hepatic and post hepatic blood values
A
LEARN THEM BETH FGS
2
Q
GETSMASHED
A
Gallstones
Ethanol
Trauma
Steroids
Malignancy / Mumps
Autoimmune
Scorpion bite
Hypothermia, Hypercalcaemia, Hypergluceride
ERCP
Drugs
3
Q
severe epigastric pain, vomiting and fever
A
acute pancreatitis
4
Q
cullen and grey turners signs
A
in pancreatitis
cullen: periumbilical discoloration
grey turner: flank discolouration
5
Q
immediate management for pancreatitis
A
CT
fluid resus
6
Q
what do you measure in a late presentation of pancreatitis
A
lipase
7
Q
what do you measure for the exocrine function in pancreatitis
A
faecal elastase
8
Q
acute respiratory distress syndrome and pseudocyst are complications of what
A
pancreatitis
9
Q
score to measure the severity of pancreatitis
A
modified glasgow score
10
Q
drugs which can cause pancreatitis
A
azathioprine, mesalasine, thiazides, furosemide, sodium valproate
11
Q
what marker does sodium valproate increase
A
amylase
12
Q
painless jaundice and a palpable gallbladder
A
pancreatic cancer
couvrosiers law
13
Q
double duct sign
A
pancreatic cancer
14
Q
LFT picture in pancreatic cancer
A
cholestatic
15
Q
management of pancreatic cancer if it is obstructing
A
biliary stenting
16
Q
obstructive picture with RUQ pain and history of biliary colic and cholecystitis
A
gallstones
17
Q
management of asymptomatic gallstones
A
reassure
18
Q
scan for gallstones
A
USS
19
Q
2 symptoms of raised bilirubin
A
jaundice and itch
20
Q
gallstones in sickle cell
A
pigmented
21
Q
stones compress the bile duct causing jaundice
A
mirizzi syndrome
22
Q
intermittent RUQ pain after eating and nausea
A
biliary colic
23
Q
stool and urine in obstructive picture
A
pale stool and dark urine
24
Q
LFTs in biliary colic
A
normal
25
management of biliary colic
elective laparoscopic cholecystectomy
26
4 F's for biliary colic
female
fat
fourty
fair
27
patient presents with similar sx to biliary colic but are systemically unwell with RUQ pain which radiates to back/shoulder
acute cholecystitis
28
murphys sign
palpation of RUQ causes inspiratory arrest
29
management of acute cholecysitits
IV ABx and laparoscopic cholecystectomy in 1w
30
charcots triad in cholangitis
(how do you make it reynoulds pentad)
RUQ pain
fever
jaundice (obstructive)
+ hypotension + confusion
31
pathophysiology of cholangitis
infection of the bile duct secondary to gallstones or stagnant bile
32
organism commonly causing cholangitis
e. coli
33
how do you relieve the obstruction in cholangitis
ERCP
34
3 M's in primary biliary cholangitis
IgM
anti Mitochondrial antibody
Middle aged female
35
management of primary biliary cholangitis
ursodeoxycholic acid
36
marker in primary sclerosing cholangitis
p ANCA
37
management of primary sclerosing cholangitis
MRCP
38
complication of primary sclerosing cholangitis
cholangiocarcinoma
39
RUQ mass, abdominal pain, distention, jaundice and vomiting with persistent biliary colic and obstruction
associated with anorexia and weight loss
cholangiocarcinoma
40
tumour marker in cholangiocarcinoma
CA199
41
small bowel obstruction due to gallstone causing pain, abdo distention and vomiting
what does the xray show
gallstone ileus
axr: air in biliary tree
42
what can LT TPN cause
painless non obstructive jaundice due to hepatic dysfunction
43
isolated rise in bilirubin due to physiological stress
gilberts
44
how to differentiate between gilberts and haemolysis
FBC
45
complication of laparoscopic surgery causing a gingko leaf
SC emphysema
46
management of bile acid malabsorption
cholestyramine
47
surgery if BMI above 50
bariatric surgery
48
colicky LLQ pain and diarrhoea with fever and bleeding
diverticulitis
49
most common site of diverticulitis
sigmoid colon
50
scan for diverticulitis
CT
51
vaginal faeces in diverticulitis
fistula
52
general and acute management of diverticulitis
general: increase fibre
acute: ABx (PO then IV cef/met)
53
bright red rectal bleeding post defecation at 3,7 and 11 clock with a history of straining
haemorrhoids
54
2 classes of haemorrhoids and grading
internal (1-4)
external
55
management of haemorrhoids
1. conservative
2. rubber band ligation
3. removal
56
anorectal pain and tender purple lump
thrombosed haemorrhoid
57
management of thrombosed haemorrhoid
ice packs and soften stools
58
painful rectal bleeding post defecation (often posterior)
anal fissure
59
management of a lateral anal fissure
2ww
60
management of acute anal fissure
soften stool, fibre and analgesia
61
management of non-responsive anal fissure
sphincterotomy
62
3 causes of proctitis
c diff
crohns
uc
63
imaging and management of megacolon in UC
AXR
colectomy
64
management of severe rectal crohns
proctectomy
65
management of perianal abscess in crohns
incision and drainage
66
2 organisms that cause ano-rectal abscess
e. coli
s. aureus
67
imaging for anal fistula
MRI
68
2 RF for rectal prolapse
childbirth
intussuception
69
cause of pruritis ani
threadworm
70
chronic straining causing mucosal thickening
rectal ulcer
71
histology of rectal cancer
adenocardinoma
72
presentation of rectal cancer
bright red blood, altered bowel habit and tenesmus
73
histology of anal carcinoma
squamous cell
74
RF for anal cancer
HPV
75
staging for colorectal cancer
Dukes
A (mucosa)
B (bowel wall)
C (lymph nodes)
D (distant mets)
76
tumour marker for colorectal cancer
CEA
77
anastamosis in right and left hemicolectomy and anterior resection
right: ilio-colic
left: colo-colon
anterior resection: colorectal
78
which cancer would you do a right/left hemicolectomy and anterior resection for
right/left: transverse colon
anterior resection: sigmoid/rectum
79
anterior resection with formation of an end colostomy is referred to as what
hartmanns
80
portal htn and lower GI bleed
rectal varices
81
difference between an ileostomy and colonoscopy
ileostomy: RIF, spouted, liquid
colonoscopy: LIF, flushed, solid
82
central abdo pain radiating to RIF with anorexia, tachycardia and fever
appendicitis
83
what is rosvings sign
RIF pain on palpation of LIF
84
enlarged mesenteric lymph nodes due to viral infection with high fever
mesenteric adenitis
85
prevalence and site of meckel's diverticulum
prevalence: 2%
site: 2cm from the ileocaecal valve
86
investigation and management of acute mesenteric ischaemia
LACTATE
immediate laparotomy
87
bleeding and diarrhoea with no pain
colitis
88
most common site of ischaemic colitis
splenic flexture
89
AXR in colitis
featureless colon
90
investigation in colitis
flexible sigmoidoscopy
colonoscopy increases the risk of perforation
91
most common cause of bowel obstruction
malignancy
92
presentation of large bowel obstruction
distension
no stool or flatus
vomiting
tinkling bowel sounds
93
amylase level in small bowel obstruction
raised
94
management of small bowel obstruction
drip and suck
IV fluids and gastric decompression
95
investigation for bowel obstruction
erect CXR
CT abdo
96
management of a sigmoid volvulus with obstruction and peritonitis
urgent laparotomy
97
AV lesion causing a massive bleed from the right colon
angiodysplasia
98
which medication should you avoid in bowel obstruction
metoclopromide (for nausea)
99
SE of metaclopromide
extrapyramidal
100
riglers sign
free air in the abdomen in bowel perforation
101
when does dumping syndrome occur
after gastric bypass
102
management of wound dihiscence
cover wound with saline gauze and give IV ABx
103
presentation of enterovesical fistula
bubbly urine
104
role of epidural anaesthesia after bowel surgery
increases speed of return to normal bowel function
105
most common hernia above and medial to the pubic tubercle in males
strangulation is rare
inguinal
106
hernia below and lateral to the pubic tubercle in multiparous women with high risk of strangulation and obstruction
femoral hernia
surgery
107
symmetrical hernia under umbilicus
umbilical hernia
108
asymmetrical hernia above/below umbilicus
paraumbilical
109
hernia between umbilicus and xiphisternum more common in obese patients with COPD or those who excessively train
epigastric hernia
110
how do obturator hernias present
bowel obstruction in women
111
hernia which causes strangulation with no obstruction
richter
112
patent processus vaginialis causing a hernia in preterm boys with a high risk of strangulation
congenitla inguinal hernia
113
hernia in children with resolves spontaneously
infantile umbilical
114
feature of an incarcerated hernia
non reducible
115
which types of shock have warm and cool peripheries
cool: cardiogenic and hypovolemic
warm: septic, neurogenic, anaphylactic
116
SVR, HR, CO and BP in cardiogenic, hypovolemic and septic shock
cardiogenic and hypovolemic : increased SVR and HR, reduced CO and BP
septic: increased HR and CO, reduced SVR and BP
117
common cause of tension pneumothorax
mechanical ventilation
118
number of fractures to diagnose flail chest
2 fractures in at least 2 ribs
119
what do you need to be careful with in flail chest
level of fluids
120
BECKS TRIAD in cardiac tamponade
reduced heart sounds, reduced BP, increased JVP
121
2 investigations and management of pulmonary contusion
ABG and sats
early intubation
122
ECG in blunt cardiac injury
MI/arrhythmia
123
what is a mediastinal transversing wound
entrance one side of hemithorax and exit on the other
124
incorrect seatbelt placement can cause what
laceration to the carotid artery
125
what can a FAST scan show
free fluid in the abdomen/thorax
126
genetics in ank spond
HLA B27
127
XRAY in ank spond
sacro-ilitis
128
epiphysitis of vetrebral joints in teens causing kyphosis and pain
xray shows plate disturbance and anterior wedging
scheurmann disease
129
define scoliosis
curvature of the spine
130
2 types of scoliosis
non-structural: minor in teen girls
structural: idiopathic, congenital or neuromuscular
131
management of severe scoliosis
bilateral rod stabilisation
132
non fusion of the vertebral arches in embryonic development
spina bifida
133
what is the most severe form of spina bifida
myelomeningocele
134
minor form of spina bifida causing birth mark/patch of hair
occulta
135
deficiency of the neural arch in L4/5 in children
spondyloysis
136
vertebra displaced from vertebral body due to stress fracture/spondylolysis
spondylolisthesis
137
sign of spondylolisthesis on xray
scotty dog
138
management of spondylolisthesis
surgical decompression and stabilisation
139
4 features of the blood film post splenectomy
howell jolly bodies
target cells
irregular erythrocytes
pappenheimer bodies
140
fluid replacement after burns
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
define allograft
transplant from genetically non identical donor
142
define isograft
transplant between identical twins
143
define autograft
transplant from the same individual (e.g. skin)
144
define xenograft
transplant from another species (e.g. porcine heart valves)
