Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Periop > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

What are some of the causes of spontaneous oesophageal perforation

A

Violent vomiting

Malory Weiss tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some of the metastatic disease signs seen in patients with oesophageal cancer

A

enlarged cervical lymph nodes, jaundice, hepatomegaly, hoarseness of voice, chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the palliative treatments for oesophageal cancer

A

Endoscopic stent

Palliative chemo/radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which channel do PPIs inhibit

A

H+-K+-ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of upper GI bleed

A

Haematemesis +/- melena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is dieulafoy syndrome

A

Where a large arteriole in the stomach lining erodes and bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the steps in the management of an acute upper GI haemorrhage

A

1) protect airway and give high flow O2
2) 2 large bore cannulae, take bloods
3) IV fluids to restore intravascular pressure while waiting for blood to be cross matched/ O RhD- blood
4) urinary catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of gastric neoplasia

A 
Indigestion, Dyspepsia
Flatulence
Weight loss
Vomiting
Epigastric or back pain 
Epigastric mass present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is GI neoplasia diagnosed

A 
History and examination
Upper GI endoscopy
Biopsy
Staging CT
endoscopic ultrasound 
Laparoscopy
Pet-ct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment with curative intent for gastric neoplasia

A

Gastrectomy + node removal +/- preop chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the palliative treatment for gastric neoplasia

A

Supportive care
Palliative chemo/radiotherapy
Stenting
Bypass surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If a patient has abnormal LFTs and no evidence of biliary disease on USS, what do you investigate next

A
  • exclude drug reaction
  • hepatitis serology
  • immunoglobulins
  • autoantibodies
  • copper and iron studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the next step in investigating/managing a patient with abnormal LFTs and biliary obstructio on USS, but no gallstone disease

A

MRCP
Ct
Biliary stent/surgery indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the next step in managing/investigating a patient with biliary obstruction, abnormal LFTs and gallstone disease

A

Ercp/sphincterectomy

Lap cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is variceal bleeding managed

A

Endoscopic ligation banding
Injection sclerotherapy
Surgical portosystemic shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is cavernous hemangioma

A

Benign tumour found in lover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Do you resect a cavernous haemangioma

A

Only if large and symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do patients with liver cell adenoma present

A

Left hypochondrial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the danger with liver cell adenoma

A

Can undergo malignant transformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How may hepatocellular carcinoma present

A 
Not until late often
Decrease in liver function
Progression of existing liver problems
Abdo pain
Weight loss
Fever
Intraperitoneal haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the results of blood investigations for hcc

A

Deranged LFTs

Alpha fetoprotein raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you confirm a hcc

A

Percutaneous needle aspiration biopsy and cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What imaging techniques can be used to diagnosed hcc

A

USS

CT, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the management of hcc

A

1) Liver resection, esp viable if not cirrhotic
2) If less hepatic reserve, limited resection and systemic chemo
3) Percutaneous ablation with microwaves
4) Liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the presenting features of cholangiocarcinoma

A

Jaundice, pain, enlarged liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is charcots triad in cholangitis

A

1) pain
2) pyrexia
3) jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What types of stones can be found in gallstones

A

Cholesterol or pigment stones (calcium bicarbonate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List some of the pathological effects of gallstones

A
  • acute cholecystitis
  • chronic cholecystitis
  • mucocoele
  • gallstone ileus
  • biliary colic
  • cholangitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is acute cholecystitis

A

RUQ pain and fever occurring from obstruction of the neck of the gall bladder or cystic duct oedema and occasionally gangrene or perforation of the inflamed gall bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is chronic cholecystitis

A

Repeated bouts of biliary colic or acute cholecystitis culminating in fibrosis. The gallbladder ceases to function. RUQ pain, no pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is mucocoele

A

Distension of a hollow cavity or organ with mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Why does much ele occasionally develop in patients with gall stones

A

The outlet of the gall bladder can become obstructed in the absence of infection. Clear mucus continues to be secreted into the distended gall bladder,r forming mucocoele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If gall stones become stuck, what conditions can they result in

A

Jaundice
Cholangitis
Acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is cholangitis

A

Infection of the bile duct caused by bacteria ascending from its junction with the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is gallstone ileus

A

Intestinal obstruction occurring when a a large gallstone becomes impacted in the intestine. Gall stones may have gained access by eroding through the wall of the gallbladder into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is biliary colic

A

Pain due to transient obstruction of the gallbladder from an impacted stone. There is a severe gripping pain often after meals or in the evening. Epigastric / RUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the symptoms of acute cholecystitis

A

RUQ pain
Radiates to right subscapsular region
Tachycardia, pyrexia, nausea, vomiting, leucocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What test may be positive in a patient with acute cholecystitis on examination

A

Murphy’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is primary biliary cirrhosis

A

Autoimmune condition of the liver, where interlobular bile ducts are damaged by chronic granulomas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the consequences for primary biliary cirrhosis

A

Progressive cholestasis
Cirrhosis
Portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What liver marker is raised in primary biliary cirrhosis

A

ALK PHOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does primary biliary cirrhosis present

A

Lethargy
Pruritus
Hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some of the complications of primary biliary cirrhosis

A

Portal hypertension
Ascites
Hepatic encephalopathy
HCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What does biopsy of the liver of patients with primary biliary cirrhosis show

A

Granulomas around the bile ducts, progressing to cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How is primary biliary cirrhosis treated

A

Symptomatic treatment for pruritus with colestyramine
Ursodeoxycholic acid
Liver transplant last resort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is primary sclerosing cholangitis

A

A non malignant, non bacterial inflammation, fibrosis and strictures of intra and extra-hepatic bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What does primary sclerosing cholangitis lead to

A

Liver failure and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the symptoms of primary sclerosing cholangitis

A

Often found incidentally

Jaundice, pruritus, abdo pain, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which liver enzyme is increased in primary sclerosing cholangitis

A

ALK PHOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Wht re the signs of primary sclerosing cholangitis

A

Jaundice, hepatomegaly, portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What do patients with primary sclerosing cholangitis have a huge risk of developing

A

Cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the management of primary sclerosing cholangitis

A

Liver transplant is the only effective treatment
Colestyramine for pruritus
Ursodeoxycholic acid improves cholestasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the clinical features of tumours of the biliary tract

A 
Progressive obstructive jaundice
Mucocoele
Empyema
Pruritus
Anorexia and weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the management for rumours of the biliary tract

A

Whipped procedure if in lower CBD

Palliative stents in some cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Where does the pancreas lie anatomically

A

Retroperitoneally, behind the lesser sac and the stomach . The head lies in the loop of the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the blood supply to the pancreas

A

Coeliac and superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the blood supply to the tail of the pancreas

A

Splenic arteries (lies in front of splenic artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the most common causes for pancreatitis

A

Alcohol and gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the effect of gall stones impacting on the pancreatic duct

A

Leads to intracellular activation of pancreatic enzymes, acinar cell damage, pancreatic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the GET SMASHED aetiological causes of pancreatitis

A 
Gallstones
Ethanol
Trauma
Scorpion venom
Mumps
Autoimmune
Steroids
Heryperlipidaemia/hypercalcaemia
ERCP
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is more common - sliding or rolling hernia

A

Sliding (stomach cardia involved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How would you distinguish between gallstone and alcoholic cause of pancreatitis

A

Ultrasound scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is ercp used for

A

Endoscopy + fluoroscopy to diagnose and treat biliary and pancreatic duct system problems, eg gallstones, bile duct tumours etc.
can be used therapeutically to remove stones, insert stents and dilate strictures (PSC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are the clinical features of acute pancreatitis

A
  • severe epigastric pain, or right hypochondrium
  • radiates to back
  • nausea, vomiting, retching
  • tachycardia, tachypnoea
  • jaundice may be present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How is acute appendicitis diagnosed

A

Measuring serum amylase (3x upper reference), serum lipase

Ct abdo if doubt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Lost two severity score for acute pancreatitis

A
  • APACHE II

- Glasgow prognostic score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the conservative management for acute pancreatitis

A

Iv fluids, analgesia, gradual reintroduction of diet
Antibiotic prophylaxis
Treat underlying cause e.g. gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the possible complications of pancreatitis

A
  • infected pancreatic necrosis
  • pancreatic pseudocyst
  • abscess
  • GI bleeding
  • GI ischaemia, fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How is infected pancreatic necrosis treated

A

Surgical debridement or Percutaneous drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is a pancreatic pseudocyst

A

Collections of pancreatic secretion and inflammatory exudate enclosed in a wall of fibrous or granulation tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is chronic pancreatitis

A

Chronic inflammatory condition characterised by fibrosis and destruction of exocrine pancreatic tissue. Blockage of flow of pancreatic juices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the most common aetiological cause of chronic pancreatitis

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the clinical features of chronic pancreatitis

A

Characteristic epigastric pain, radiating to back and often relived by leaning forward
Hot water bottles may help relive pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are some of the other manifestations of chronic pancreatitis except the usual symptoms

A

Steatorrhoea

Diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What imaging investigations can you do to diagnose chronic pancreatitis

A

CT - may see speckled calcification

MRCP - to look at pancreatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Which non-imaging investigations can you ror form on a patient with chronic pancreatitis

A

Blood glucose

Faecal fat content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is MRCP

A

Imaging technique which uses MRI to visualise the biliary and pancreatic ducts non-invasively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which blood tests in particular are important for the investigation of a patient with gallstones

A

FBC - ?neutrophilia
Bilirubin increased
Alkaline phosphatase increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When is gas seen surrounding the billiary tree

A

If fistula is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

How is amo pen cholecystectomy performed

A

Right subcostal incision with intra operative cholangiography to display the anatomy of Ge duct system
Cystic artery and duct are ligated, gall bladder removed
Abdo drain placed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How is laparoscopic cholecystectomy performed

A

Cannulae inserted into anterior abdo wall and co2 insufflation
Same structures ligated as in cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are some of the complications that may occur in cholecystectomy

A

Infective complications - strep faecalis, e. Coli

Bile leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How is infection from organisms such as E. coli prevented in cholecystectomy patients

A

Prophylaxis with cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How is acute cholecystitis managed conservatively initially

A

Iv fluids, analgesia, broad spectrum antibiotic such as a cephalosporin, nbm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Is the non surgical approach to acute cholecystitis effective

A

No - gall stone dissolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How is acute cholangitis managed

A

Resusc, administration of appropriate antibiotics, decompression of biliary tree with ercp, cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the conservative management for chronic pancreatitis

A

Abstinence from alcohol
Pain relief
Treat endocrine and exocrine insufficiency - supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the endoscopic and surgical treatments for chronic pancreatitis

A

Endoscopic duct stents if there is a stricture
Surgical drainage
of obstructed pancreatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is Courvoisier’s law?

A

In the presence of a non tender palpable gall bladder, painless jaundice is unlikely caused by gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are some of the neuronendocrine tumours found in the pancreas

A

Gastrinomas (Zollinger Ellison syndrome), insulin as, glucagonomas, somatostatinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What histological type of cancer is cholangiocarcinoma

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Where do pancreatic Adenocarcinomas tend to metastasise commonly

A

Liver and lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are some of the symptomatic features of pancreatic cancer

A

Painless jaundice, weight loss, poor appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the management of pancreatic cancer

A

Surgical resection via whipped procedure (pancreaticoduodenectomy)
Palliative treatment with relief from obstructive jaundice, pruritus, biliary drainage, chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What does pancreaticoduodenectomy/whipples procedure involve

A

Resection of head of pancreas, distal half of stomach, duodenum, gallbladder, CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What does the red pulp of the spleen contain

A

Macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What does the White pulp of the spleen contain

A

Lymphoid tissue - lymphocytes, macrophages and plasma cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

How is a splenectomy performed

A

Via left subcostal incision, with division of the short gastric vessels and mobilisation from surrounding structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

List the indications for splenectomy

A
  • trauma
  • haemolytic anaemia
  • hyperslenism
  • ITP
  • abscess
  • splenic artery aneurysm
  • as part of resection of other organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the lifelong prophylactic antibiotics given to patients who have had a splenectomy

A

Erythromycin or phenoxymethylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What immunisation is given to patients who have had a splenectomy

A

Pneumococcal, H influenzae type B, meningococcal group c infection immunisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are some of the causes of appendicitis

A

Inflammation may be due to faecoliths, lymphoid hyperplasia, foreign bodies, carcinoid tumours, strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

List some begging tumours of the small intestine

A
  • adenomatous polyps
  • hamartomas
  • lipomas
  • haemangiomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is a hamartoma

A

Abnormal formation of normal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is peutz-jehgers syndrome

A

Inherited disorder where there are multiple hamartomatous polyps in the GIT, as well as pigmentation in the patients lips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

List some malignant tumours of the small intestine

A
  • GIST - GI stromal tumour
  • Adenocarcinoma of the small bowel
  • lymphoma
  • carcinoid tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is Lynch Syndrome also known as

A

Hereditary non-polyposis colorectal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the inheritance pattern of lynch syndrome/hereditary nonpolyposis colorectal carcinoma

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the risk that comes with HNPCC/lynch syndrome

A

High risk of colon cancer

As well as endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What hereditary conditions may be associated with small bowel Adenocarcinoma

A

FAP, Lynch syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Which cancers are patients with peutz jehgers syndrome susceptible to

A

Colorectal, gastric, pancreatic, breast, ovarian tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is the management of peutz jehgers syndrome

A

Laparotomy, polypectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is me kelps diverticulum

A

Remnant of Vitello-intestinal duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How may me kelps diverticulum cause problems in affected patients

A

Intusussecption, volvulus, obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

How is me kelps diverticulum treated

A

Excised if symptomatic, if not, should be left alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What are the symptoms of radiation enteritis

A

Watery diarrhoea, lower abdo pain, tenesmus, rectal bleeding, mucous discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What may diverticulae in the jejunum cause in terms of symptoms

A

Inflammation, malabsorption, occasionally perforation and impaction of material in the diverticulae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

If small bowel diverticulae are symptomatic, how should they be treated

A

Iv fluid resuscitation, antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is small bowel ishcaemia usually due to

A

Atheromatous occlusion and thrombosis in the superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are spathe predisposing factors for small bowel ishcaemia

A 
Thrombophilia
Hyperviscosity
Dehydration
Hypovolaemia
Hypoperfusion of gut
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

List some causes of Hypoperfusion of the gut

A

Trauma, cardiogenic shock, cardiac arrhythmia, septic shock, arterial emboli,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What does small bowel ishcaemia progress to

A

Necrosis of all the bowel layers with gangrene and perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

How is small bowel ishcaemia managed

A

Resusc, resection of gangrenous bowel; and anticoagulation; In some instances, can be restored by embolectomy, thomobolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is chronic mesenteric ischaemia

A

Repeated bouts of colicky Central abdo pain typically 20-30 mins after eating, weight loss. Angiogrpaphy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What are the clinical feature of small bowel ischaemia

A
  • Central abdo pain and tenderness
  • previous weight loss
  • guarding and rigidity (late signs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What may plain films show in painted with small bowel ischaemia

A

Calcified atheroma in mesenteric arteries,

Dilated Andy hi kneed small bowel loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the most common causes of small bowel obstruction

A
  • adhesions (60%)
  • obstructed hernia (20%)
  • malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What are the most common causes of large bowel obstruction

A
  • colorectal cancer (>70%)
  • stricturing diverticular disease (10%)
  • sigmoid volvulus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What are the signs and symptoms of obstruction in the proximal jejunum

A

Anorexia, vomiting, severe upper abdo pain, minimal distension, limited (if any) change in bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What are the symptoms and signs of distal small bowel obstruction

A

Colicky midgut pain, distension, vomiting, recent absolute constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What are the signs and symptoms with colonic obstruction

A
  • insidious
  • hindgut abdo pain and discomfort
  • weight loss
  • pronounced abdo distension
  • altered bowel habit with little or no vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

How does gut motility change with obstruction

A

Initially the bowel proximal to he obstruction contracts vigorously in an attempt to overcome impedance
Eventually peristalsis subsides and paralytic ileus ensues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Why may a patient with paralytic ileus become toxic

A

Bacteria enter the portal system if ileus not resolved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are some of the possible consequences to paralytic ileus

A

Perforation
Strangulation
Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

How do you manage bowel obstruction

A

Iv and electrolyte therapy
Erect CXR, AXR
Laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What are some for eh causes of paralytic ileus

A
  • after surgery
  • secondary to peritonitis
  • electrolyte imbalances
  • tca’s, lithium, opiates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Which electrolyte ambormalities can cause paralytic ileus

A 
Hypokalaemia
Hyponatraemia
Diabetic ketoacidosis
Uraemia 
Hypocalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

How is paralytic ileus managed

A

Correction of blood electrolytes
Stimulant enemas
Iv erythromycin
Laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Whatis the definition of a hernia

A

Abnormal protrusion of a cavity’s contents (e.g. Viscera) through a weakness in the wall of the cavity that usually contains it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What is the risk in hernias that are irreducible

A

May strangulate or become obstructed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What passes through the inguinal canal

A

In males the spermatic cord, and in females, the round ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Which embryonic structure failing to close properly may predispose to inguinal hernias

A

Processus vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

In which structure is the deep inguinal ring

A

Transversalis fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Where is the deep inguinal ring

A

About 1 cm above the mid point of the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What is medial to the deep inguinal ring

A

Inferior epigastric vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Where does an indirect inguinal hernia enter to herniate

A

The deep inguinal ring

Can pass down into the scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Where is an inguinal hernia usually found in relation to the pubic tubercle

A

Above and medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What are the clinical features of inguinal hernias

A

Discomfort in groin, esp when lifting or straining

Lump, especially visible when coughing or standing up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Where does an direct femoral hernia go through

A

Hesselbachs triangle- weakness in abdominal wall, protrudes through transversalis fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is the a agreement for inguinal hernias

A

Surgical
herniotomy and tightening of the deep ring for indirect hernias, and mobilisation of hernia for direct hernias which is strengthened by sutures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Where do femoral hernias project through

A

Femoral ring and pass down the femoral canal, may progress down to the saline ours opening in the deep fascia of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What is medial and lateral to the femoral canal

A

Medial - lacunar ligament

Lateral - femoral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What do femoral hernias usually contain

A

Small bowel or omentum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Where are femoral hernias seen

A

Inner upper aspect of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Where are femoral hernias in relation to the pubic tubercle

A

Below and lateral to pubic tubercle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the repair for femoral hernias

A

Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What causes parImbilical hernias

A

Gradual weakening of tissues around the umbilicus - obese, multiple pregnancies etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

When may groin pain be felt in patients with femoral hernias

A

During exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

How is para stromal hernia best treated

A

With reversal of stoma if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the obstructive symptoms of hernias that indicate surgical repair is needed

A

Abdo pain, vomiting, distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What is dysphagia

A

Difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What does sudden onset dysphagia indicate

A

Foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Which conditions have dysphagia to solids and which to liquids

A

Solids - carcinoma

Liquids - achalasia, motility disorders, stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What is odynophagia

A

Pain on swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What may cause odynophagia

A

Oesophagitis

Oesophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is dyslepsia

A

Describes symptoms of indigestion - epigastric pain, belching, heartburn, nausea, early satiety, reduced appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What are alarm symptoms in dyspepsia

A 
Weight loss
Progressive dysphagia 
Iron deficiency
Mass
Vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Where in the world is diverticular disease prevalent

A

Developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Which component of the diet is related to diverticular disease

A

Low fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Wh in part of the GI system is most commonly affected by diverticular disease

A

Sigmoid colon (related to intraluminal pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What are the symptoms of diverticular disease

A
  • intermittent lower abdo/left iliac fossa pain
  • altered bowel habit
  • rectal bleeding
  • urgency of defaecation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

List some of the imaging investigations for diverticular disease

A
  • barium enema
  • colonoscopy/sigmoidoscopy
  • CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

How do you manage uncomplciTed diverticular disease

A

High fibre diet, bulk laxatives, antispasmodics such as mebeverine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

When is surgical resection of affected segment indicated in patients with diverticular disease?

A

Persistent symptoms or when cancer cannot be excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What symptoms may you find in a patient with colonic diverticular disease which has perforated

A 
Septic shock
Dehydration
Marked abdo pain
Tenderness
Distension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

How is perforated diverticular disease treated

A

Resuscitation, iv broad spectrum antibiotics, reception of affcted bowel + peritoneal lavage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What complications can persistent infections in diverticular disease due to still stasis etc, lead to

A

Necrosis and formation of abscess. This may go on to perforate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What are the symptoms and clinical features of diverticulitis

A

Pyrexia, leucocytosis, nausea, vomiting, altered bowel habit
Pain and tenderness in LIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

How is diverticulitis diagnosed

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

How is an episode of diverticulitis treated

A

Fasting, clear fluids, bed rest
Iv fluids
Broad spectrum antibiotics
Certain circumstances may require surgery, e.g. Abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Give some examples of broad spectrum antibiotics used in the treatment of diverticulitis

A

Cephalosporins, gentamicin, metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What are some of the complications of diverticular disease a

A
  • strictures
  • obstruction
  • infection and inflammation
  • fistula
  • bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

What is a common organ that diverticulae form fistulas with

A

The bladder - colovesicular fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

If a colovesicular fistula is preset in a patient with diverticulosis, what are some of the urinary symptoms that may be present

A

Dysuria, passage of cloudy urine, bubbling on micturition (pneumoturia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

How is a fistula in diverticular disease diagnosed

A

Barium enema

Cystoscopy if colovesicular fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

How is a colovesicular fistula treated

A

Sigmoid colectomy with synchronous repair of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

What are the differentials of pe bleeding in diverticular disease

A

Haemorrhoids, polyps, IBD, cancer,angiodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

If a patient with divertcular disease is also bleeding, how do you manage it once you pick up the source of bleeding on ct angiography

A

Resection or affected bowel, even total colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

What is the pathophysiology of large intestinal ischaemia

A

Similar to small vowel ischaemia - atheroma at the region of the inferior mesenteric artery resulting in insufficient blood supply from marginal artery.
Progress to gangrene and perforation
Some may have acute bloody diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What are the clinical features and symptoms of ischaemic colitis or the large intestine

A

Lower abdo pain, nausea, vomiting, bloody diarrhoea
Tenderness and guarding
Pyrexia and leucocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What is seem or radiography of a patient with ischaemic colitis of the large bowel

A

Thickened segment of colon and “thumb printing” due to oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

How does gangrenous ishcaemic colitis present

A

Localised or generalised peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

How is gangrenous ischaemic colitis treated

A

Surgery - resection + colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

How does ischaemic stricture of the colon present

A

Colicky abdominal pain, constipation and distension following history of an attack of bloody diarrhoea or documented episode of ischaemic colitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What is IBS

A

Mixed group of abdominal symptoms for which no organic cause can be found. Most due to disorders of intestinal motility but enhanced visceral perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

What are the diagnostic criteria for IBS

A 
Diagnosis of exclusion
Abdo pain/discomfort relived by defaecation OR associated with altered stool form OR bowel frequency 
AND there are 2 or more of:
- urgency
- tenesmus
- bloating/distension
- PR mucus
- worsening of symptoms after food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Which part of the git is commonly affected by volvulus

A

Sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Which mart of the git is rarely affcted by volvulus, but still can be

A

Caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

What is a volvulus

A

Twisting of bowel around a narrow origin in the mesentery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What is the presentation of a sigmoid volvulus

A

Presentation as per large bowel obstruction:

  • lower abdo pain
  • abdo distension
  • nausea and vomiting
  • absolute constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

How may a patient with perforation due to sigmoid volvulus present

A

With sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

What is seen on radiography of a patient with sigmoid volvulus

A

Coffee bean sign, with a grossly distended colon arising out of pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

What is the conservative treatment of sigmoid volvulus

A

Reduction and deflation using rigid or flexible sigmoidoscope + placement of large bore tube into the sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

What is the surgical management of sigmoid volvulus

A

sigmoid colectomy following fill bowel prep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Which anatomical landmark does a faecalis volvulus occur around

A

Superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

What does radiography show in a caudal volvulus

A

Anticlockwise rotation of dilated small bowel loops, around a grossly distended caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

How can bleeding due to angiodysplasia in the colon be treated

A

Angiographic embolisation, laser treatment, injection sclerotherapy, resection in emergency laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

What is the responsible organism for pseudo membranous colitis

A

C. difficile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

What usually is the cause of pseudo membranous colitis

A

Almost always healthcare related infection due to over use of broad spectrum antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

How is C. difficile infection detected

A

Stool culture or assays for presence of C. difficile toxin in stool or blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

What do stools of those affected by C. difficile infection look like

A

Watery, green, blood stained, foul smelling, often containing fragments of mucosal slough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

What are the signs and symptoms of pseudo,em famous colitis/c difficile infection

A 
Patient profoundly unwell
Fever
Colitis 
Sepsis
Dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

How do you manage C. difficile infection

A

Resusc, iv fluids, side room isolation

Oral metronidazole or vancomycin for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

What severe complication may patients with severe cases of C. difficile infection encounter

A

Toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

How is toxic megacolon treated

A

Emergency Colectomy + ileostomy (ileorectal anastomosis ca be performed at a later date)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

List the drugs most commonly associated with C. difficile / pseudo,membranous colitis

A
  • ciprofloxacin
  • amoxicillin
  • clindamycin
  • cephalosporins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

What class of antibiotic is ciprofloxacin

A

Quinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

What are the features of microscopic colitis on biopsy

A

Increase in inflammatory cells (esp. Lymphocytes) with an otherwise normal appearance and architecture of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

What is the main presentation of microscopic colitis, and are there any radiological or histological changes

A

Chronic diarrhoea, normal radiological findings, typical histological findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

How is microscopic colitis treated

A

Avoid caffeine and orb we known aggravators
5-ASA agents in non responders
Anti diarrhoeal agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

What causes hirschprungs disease

A

Absence of ganglion cells in Auerbachs and Meisseners plexuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

How does hirschprungs diseases usually present

A

In childhood, where there is a loss of peristalsis in the affected segment leading to large bowel obstruction with distension of proximal to affcted segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

What diagnostic investigation confirms hirschprungs disease

A

Biopsy - confirms lack of ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

How is ileostomy formed

A

By bringing out ileum through the abdominal wall, through the rectus muscle in the RIF
Spout fashioned to allow appliances to be fitted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

Why may an ileostomy be performed

A

As an adjunct to resectional surgery or as a temporary stoma to allow distal anastomosis to heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

When is an end-ileostomy used

A

When the colon has been removed +/- small part of distal ileum has been removed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

Why does colostomy not require a spout like an ileostomy does

A

The faeces extruded here are not usually irritant to skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Which emergency procedure involves colostomy formation

A

Hartmanns procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

Liz some indications for colostomy

A

Hartmanns procedure
Resectional surgery for colon cancer
Faecal incontinence surgery to divert faeces from disease anorectum
Palliation for cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

What is a Hartmann procedure

A

A procedure performed in emergency bowel obstruction where part of the sigmoid colon and/or rectum is removed along with local blood vessels + lymph nodes. Followed by colostomy if cannot rejoin bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

What are the distinguishing features between ileostomy and colostomy

A

Ileostomy - RIF, spout of mucosa

Colostomy - LIF, closer to the skin and sutured to it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

What are the indications for nasojejunal feeding

A

When the patient cannot tolerate feeding into the stomach - severe reflux, vomiting, impaired motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

When is gastrostomy (surgical or peg) indicated

A

Long term - for problems with swallowing e.g. Stroke, oesophageal atresia, tracheosophgaeal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

When is jejune stormy indicated

A

Long term, for problems with poor gastric motility, chronic vomiting, high risk of aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

How may polyps oak syndromes present, considering often they are asymptomatic

A

Rectus bleeding, large bowel colic, rectal polyps may occasionally prolapse, severe watery diarrhoea, dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

How cam polyps is syndromes be managed

A

Colonoscopic polypectomy, electrocautery snare,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

What is the risk associated with familial adenomatous polyps is

A

Predisposes to cancer - malignant transformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

What is the inheritance pattern for familial adenomatous polypsis

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

There is an >90% chance of colorectal cancer risk in patients with familial adenomatous polypsis, which prophylactic procedure can be undertaken to prevent this

A

Prophylactic Colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

What are the extra colonic features of familial adenomatous polyposis

A

Gastric polyps, ileal adenomas, long bone osteomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

How is FAP diagnosed

A

Sigmoidoscopy/colonoscopy, biopsy, gene mutation screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

Where else should be screened in patients with familial adenomatous polyposis

A

Upper git - polyps and adenomas may also be present here as extra colonic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

List some autosomal recessive differentials for FAP, which also have hih risk of colorectal cancer

A

Meta plastic hyperplasia polyposis

MUTYH-associated polyposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

Which parts of the colon are particularly common sites for colorectal cancer

A

Sigmoid colon and rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

What are the aetiological factors for colorectal Adenocarcinoma

A

Male gender, older age, family history, westernised diet, (smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

Which diets are associated with increased risk of colorectal cancer

A

Low fibre, high red meat content, high fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

What are protective factors against colorectal cancer

A

No smoking/excess alcohol
Dietary calcium and vitamin d supplements
Hugh fibre diet
Aspirin/other NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

List some gee tic conditions associated with increased risk of colorectal Adenocarcinoma

A

Hnpcc
Fap
Peutz jehgers
Juvenile polyposis syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

Which gene function is affcted in HNPCC

A

Gene participating in ENA mismatch repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

What are the clinical features of colorectal carcinoma

A
  • intermittent rectal bleeding
  • blood mixed with mucus
  • altered bowel habit
  • iron deficiency anaemia (microcytic)
  • colicky lower abdo pain
  • tenesmus
  • obstructive symptoms in some cases
  • abdo mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

What are is the current UK programme for bowel cancer screening

A

All M+F 60-75 year olds are sent home kit test for Faecal Occult Blood
An additional one-off scope at 55 years is being introduced in the UK currently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

What imaging investigations would you perform on a patient with ?colorectal cancer

A

Colonoscopy
Ct colonography
Barium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

What is the treatment with curative intent for colorectal carcinoma

A

Colorectal resection, excision of colonic mesentery, ligation of arterial supply, lymph node excision, formation of colonic j pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

List some macroscopic appearance types of colorectal Adenocarcinoma

A

Stenosing
Ulcers ting
Polypoidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

What is t1-4 of colorectal cancer

A

T1- invades submucosal
T2- muscularis propria
T3- subserosa
T4- invades adjacent organs/peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

What is n0-3 in colorectal cancer staging

A

N0 - no regional lymph nodes involved
N1 - metastasis to 1-3 nearby lymph nodes
N2 - to 4 or more nearby lymph nodes
N3 - to lymph nodes near major blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

What is M0 and M1 in TNM staging of colorectal cancer

A

T0- no distant metastasis

T1- distant metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

Why is radiotherapy a good adjuvant therapy

A

Reduces recurrence rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

How are fixed, inoperable colorectal tumours managed

A

Radical radiotherapy, combined with chemotherapy such as 5-FU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

How does 5-fu chemo generally work

A

Inhibit thymidylate synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

What is the palliative therapy for colorectal cancer

A
  • colostomy to divert faecal stream
  • palliative stent
  • control pain, mucous discharge, altered bowel habit, bleeding, incontinence
  • palliative chemo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

How is lymphoma of the large intestine treated

A

Resection followed by chemo and radiotherapy if primary lymphoma

Systematic therapy and targeted radiotherapy if secondary lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

What are the two muscle layers in the anorectum

A

Internal and external sphincterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

The inner layer of anorectum muscle is a continuation of the git, therefore what inner ages it

A

Sympathetic and parasympathetic nervous system, arising from the nerve plexuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

What function does the continuous inner action of the internal muscle of the anorectum have

A

Maintains tone and continues to resting pressure inside canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

What type of muscle is the external sphincter of the anorectum

A

Striated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

What is the inner action of the external anal sphincter

268
Q

Which nerve supplies the external anorectum sphincter

A

Internal pudendal nerves

269
Q

What type of epithelium lines the internal and external zones of the anal canal

A

Internal - columnar

External - stratified squamous (keratinised)

270
Q

What are anal cushions

A

Specialised vascular structures that lie in the submucosa of the anal canal, above the dentate line

271
Q

What is the function of anal cushions

A

Aide in fine control of continence

272
Q

What is the lymphatic drainage of the anal canal

A

Inferior mesenteric, aortic, internal iliac

273
Q

Which lymph nodes does anal cancer frequently metastasise to

A

Inguinal lymph nodes

274
Q

What are first degree haemorrhoids

A

Bleed, don’t prolapse, seen on proctoscopy

275
Q

What are second degree haemorrhoids

A

Propose during defaecation but reduce spontaneously

276
Q

What are third degree haemorrhoids

A

Constantly prolapse but can be reduced manually

277
Q

What are fourth degree haemorrhoids

A

Irreducibly prolapsed

278
Q

How would you manage first degree haemorrhoids

A

Encourage patient to not strain during defaecation and avoid constipation

279
Q

How do you manage 2nd degree haemorrhoids

A

Banding, injection sclerotherapy, haemorrhoidectomy

280
Q

How are third degree haemorrhoids managed

A

Haemorrhoidectomy

281
Q

Los some causes of severe acute anal pain

A
  • perianal abscess
  • anal fissure
  • thrombosed haemorrhoids
  • perianal haematoma
  • anorectal cancer
282
Q

What are haemorrhoids

A

Enlarged prolapsed anal cushions due to the degeneration of the supporting fibroelastic tissue and smooth muscle (unknown cause)

283
Q

What are the clinical features of haemorrhoids

A

prolapse
Intermittent bleeding seen on wiping or in the pan
Aching or discomfort on defaecation
Pruritus

284
Q

Is it common for patients with haemorrhoids to present with incontinence

285
Q

What are emergency complications of heart hoods

A
  • thrombosed (blue/black) prolapsed piles

- torrential haemorrhage

286
Q

What is the generic management for piles

A
  • high fibre diet
  • bulk laxatives + stool softeners
  • band ligation/sclerosant injection/ photocoagulation/ haemorrhoidectomy
287
Q

What is an adverse functional side effect of haemorrhoidectomy

A

Incontinence

288
Q

What is a fissure-in-ano

A

A tear in the squamous lining of the lower anal canal, often with a sentinel pile or mucosal tag at the external aspect

289
Q

What is the cause of anal fissures

A

Hard faeces, making defaecation difficult; spasm may construct inferior rectally artery causing ischaemia and making healing difficult as well as perpetuating the problem

290
Q

Which GI condition are anal fissures often associated with

A

Crohns disease

291
Q

What is the management for anal fissures

A 
May resolve spontaneously so treatment should be reserved for >6 weeks of symptoms 
Stool softeners may help
Diltiazem
Topical nitrates 
Lateral sphincterectomy 
Botulinum toxin injection
292
Q

Lost some conditions that may predispose to perianal abscess

A

CD, UC, immunosuppression, DM, chemo

293
Q

How do perianal abscesses arise

A

Initiated by blockage of anal gland ducts,a nd the anal gland becomes secondarily infected with large bowel organisms

294
Q

What are the clinical features of perianal abscesses

A

Acute anal pain and tenderness, difficulty sitting

Pus can track and patient may become toxic and pyrexial

295
Q

How are perianal abscesses managed

A

If it doesn’t respond to antibiotics alone, requires surgical drainage under general anaesthetic. Send pus for bacteriological asses,sent for causative organism

296
Q

Which antibiotics are given if a patient with perianal abscess also has ex festive cellulitis

A

Cephalosporins and metronidazole

297
Q

What is the pathogens is of fistula

A

Preceded by perianal abscesses,w chin have formed due to blockage of anal gland.

298
Q

What are the clinical features of fistula in ano

A
  • chronically discharging opening perianally
  • pruritus
  • perianal discomfort
299
Q

What other condition should be excluded when a patient present with fistula in ano

300
Q

What is the a management of fistula in ano

A
  • examination under anaesthetic to trace the tract

- seton passed through length of fistula, GRADUALLY laid open + allowed to drain and heal behind the seton

301
Q

Why is important to gradually lay open a fistula rather than in one operation

A

It would lead to incontinence; it cuts through the sphincters and gradual lay open allows the sphincter muscle to heal behind it

302
Q

What is the aetiology of fistula in ano

A

Crohns disease, anorectal trauma, iatrogenic, anorectal carcinoma

303
Q

What are the symptoms of anal warts

A

Discomfort, pain, pruritus ani

304
Q

Why is there an increased risk of SCC in patients with anal warts

A

Associated with HPV

305
Q

How are anal warts that do not resolve spontaneously managed

A

Podophyllotoxin, surgical excision

306
Q

Are anal skin tags usually managed by surgery

A

No, not unless they cause significant symptoms and complications

307
Q

What are anal skin tags usually a comsquence of

A

Haemorrhoids

308
Q

Which epithelium does anal cancer usually arise form

A

Keratinised squamous epithelium of anal margin or non keratinised sum sous epithelium of transitional zone immediately above the dentate line
Very few adenocaricnomas

309
Q

Which types of HPV are strongly associated with anal cancer

310
Q

What is the premalignant lesion to anal cancer

A

Anal Intraepithelial neoplasia (AIN)

311
Q

What are the signs and symptoms of anal cancer

A

Anal pain, bleeding, discomfort, discharge into underwear, pruritus ani

312
Q

What symptom will a patient with anal cancer wh in has spread to anal sphincters experience

A

Incontinence

313
Q

How is anal cancer diagnosis confirmed

314
Q

What is the management for anal cancer

A

Lower stage - wide surgical excision

Later stages - radiotherapy to anal canal + inguinal lymph; surgery in radiotherapy failure

315
Q

What is rector prolapse

A

Abnormal protrusion of all (fully thickness) or part of the rectal wall (mucosa)

316
Q

What are the most common aetiological factors for rectally prolapse in young people

A

Chronic constipation, straining, childbirth

317
Q

How is rectus prolapse managed in children (self limiting)

A

Maintain regular bowel habit, stool softeners, digital reduction by parents

318
Q

How is mucosal (partial) rectal prolapse managed

A

Submucosal sclerosant injection, photocoagulation, application of bands, limited excision

319
Q

How is full thickness rectal purpose managed

320
Q

What are the causes of anal incontinence

A
  • structural muscle damage
  • disruption of nerve supply
  • urgency e.g. UC
  • damage to sphincters e.g. Childbirth
  • nerve injury during childbirth
  • neurodegenerative disease
321
Q

What questions are import at to ask about she taking a history form a patient presenting with incontinence

A
  • past surgery
  • obstetric history
  • coexisting disease
  • urinary incontinence
  • defaecation history
322
Q

What do you examine for in a patient with rental prolapse

A

Sphincter tone, previous scars, sensation

Sigmoidoscopy/colonoscopy to exclude other cases

323
Q

What is the conservative management for rectal prolapse?

A

Dietary advice to avoid exacerbating factors such as caffeine
Stool bulking agents, e.g. Fybogel plus loperamide to induce a degree of constipation
Regular emptying of rectum stimulant suppositories

324
Q

What is the surgical management for rectal prolapse?

A

Implants graciloplasty

Permanent colestomy

325
Q

Give some causes for pruritus ani?

A

Haemorrhoids, fistulae, fissures, incontinence, anal carcinoma, rectal prolapse, dermatological conditions

326
Q

How do you treat pruritus ani?

A

Treat underlying condition,
discourage scratching, use of perfumed soaps, antiseptics
Gentle cleaning habits
Barrier cream

327
Q

What is pilonidal disease?

A

Chronic inflammation in one or more sinuses in the midline of the natal cleft that contain hair and debris

328
Q

What is the histology of pilonidal sinuses?

A

Lined with squamous epithelium but tracts are lined with granulation tissue from chronic infection

329
Q

What are the clinical features of pilonidal disease?

A

Midline natal cleft pits discharging mucopurulent material with mildly offensive smell and maybe blood
Tenderness on pressure
Avoids sitting for long periods
,any become pilonidal abscess

330
Q

What is management for pilonidal disease?

A 
Natal cleft hygiene
Depilation
Antibiotics, if abscess
Drainage
Surgery to lay tracts open and remove granulomas
Closure with sutures
331
Q

What is the APACHE scoring system

A

Classification system which rates the severity of patients risk of dying in hospital

332
Q

Give some examples of factors taken into account in the APACHE scoring system

A

Core temp, he, BP, creat, age, chronic illness…

333
Q

List some conditions which may increase risk in surgery

A 
Resp - asthma, COPD
Diabetes
Cardiac - ihd, HF, arrhythmia 
Alcoholism
Obesity 
Neuro - myasthenia, CVA, Parkinson's, guillain barre, malignant hyperthermia
334
Q

Which drugs may people with alcoholism be tolerant to in anaesthesia

335
Q

Why is obesity a problem in surgery, what is different in managing these patients

A

May require high oxygen concentrations
BP measurements less reliable
If access may be more difficult to obtain

336
Q

What is the preop management of diabetes

A

Measure HbA1C, BP, BMI
Details of complications
Optimise glycemic control
Make plan for surgery

337
Q

How are diabetic patients managed PERIoperatively e.g. Medicine changes

A
  • put first on list
  • stop oral hypoglycaemics on day of surgery
  • can take long acting insulin day before but not on day of surgery
  • if late on list, give morning dose with breakfast
  • sliding scale VRIII
  • give 0.45% NaCl, 5% dextrose, KCl
  • measure blood glucose every 1 hour
338
Q

How do you change the following diabetes drugs for surgery:

  • oral hypoglycaemics
  • long acting insulin
A
  • oral hypoglycaemics - stop on day of surgery

- long acting insulin - have dose night before if early on list; if late on list take dose with breakfast as normal

339
Q

How often do you check blood glucose in surgery and post op in patients with diabetes

A

Surgery - hourly

Post op - every 2 hours

340
Q

What is the mechanism of action of cyclizine

A

Anticholinergic / antihistamine

341
Q

What is the dose of cyclizine

342
Q

What is the mechanism of action of ondansetron

A

5HT3 antagonist

343
Q

What is the mechanism of action of metoclopramide

A

D2 antagonist

344
Q

What Is the dose of metoclopramide

345
Q

What is the mechanism of action of prochlorperazine

A

D2 antagonist

346
Q

What is the mechanism of action. Of hyoscine bromide

A

Anticholinergic

347
Q

What are some of the side effects of 5HT3 antagonists

A

Dizziness, confusion, tachycardia

348
Q

What is a PICC line

A

Central venous catheter. Form of iv access used for prolonged period of time e.g. Chemo, abx

349
Q

Los the three types of reasons for confusions in patients undergoing surgery

A
  • delirium
  • dementia
  • post operative cognitive dysfunction
350
Q

What is post operative cognitive dysfunction

A

Short term decline in cognitive function lasting few days. Does not have all the typical features of delirium, not the same

351
Q

What is the most common post op arrhythmia

352
Q

What are the characteristics of septic shock initially, then how does this chnage later

A

Initially - hyperdynamic circulation, fever, rigors, warm dilated peripheries, bounding pulse
Later - BP decreases, peripheral vasoconstriction, Oliguria, multisystemic failure

353
Q

What is a specific complication of endarterectomy

354
Q

What are the medical treatments for delirium

A

Diazepam, vit b

If extreme agitation - diazepam or haloperidol

355
Q

What Re the features of UTI which may be seen in post op patients

A

Frequency, dysuria, mild fever, flank pain

356
Q

What are the three components of virchows triad

A
  • increased coagulability
  • stasis
  • endothelial damage
357
Q

What are the risk factors for venous thrombosis

A
  • obesity
  • age
  • prolonged immobility
  • hip/pelvic surgery
  • prolonged surgery
  • prev DVT/PE
  • malignancy
  • pregnancy
  • OCP
358
Q

What is the policy for those who take the OCP preop

A

Stop 4 weeks before surgery and offer alternative contraceptive advice for that time

359
Q

Describe epidural anaesthesia

A

Continuous local anaesthetic +/- opioid infusion into the epidural space, set to run at a certain rate

360
Q

How many days can an epidural catheter remain in situ before it has to be removed post op

361
Q

What are the causes for epidural failure

A

Misplacment, displacement, inadequate analgesia, intolerable side effects, very very rarely permanent neurological damage

362
Q

Why may respiratory distress occur with epidural anaesthesia

A

Cephalosporins spread of anaesthetic

363
Q

Describe patient controlled analgesia

A

Use of programmed pump delivers small predetermined dose of drug (usually opiate) with miminum time (lock out period) between doses to minimise risk of reps distress etc

364
Q

What is the maximum dose of PCA analgesia

A

1 mg morphine at 5 min intervals

365
Q

What are some of the drawbacks to PCAs

A

Lack of patient understanding to use it and lack of patient dexterity, correct programming

366
Q

List some agents that may be used for neuropathic pain

A
  • tricyclic antidepressants
  • gabapentin/pregabalin
  • lidocaine
367
Q

Why do patients get acute renal failure post op

A

Inadequate perfusion to kidneys; hypovolaemia, water depletion, drugs, sepsis

368
Q

How can acute renal failure be prevented in surgery

A

Adequate fluid replacement perioperatively

369
Q

What is the MINIMUM urine output

A

0.5ml/kg/hour

370
Q

Which invasive method can be used to monitor circulating volume and heart preload

371
Q

What is the a management of a patient in an extreme case where conservative management persistently fails

A

Renal replacement therapy

372
Q

Why may airway obstruction occur perioperatively

A

Decreased level of consciousness and reduced muscle tone

373
Q

List some causes of airway obstruction perioperatively

A
  • decreased muscle tone
  • obstruction by tongue
  • foreign bodies e.g. Dentures
  • laryngeal spams
  • laryngeal oedema e.g, traumatic attempts at intubation
  • bronchospasm/bronchial obstruction
374
Q

Which particular operation has an increased risk of tracheal compression

A

Thyroid tony- compression by haemorrhage

375
Q

What is the management for airway obstruction

A

Chin life, jaw thrust, removal of objects, oropharnygeal airway, O2 administration

376
Q

How is the appropriate size chosen for oropharnygeal airways

A

Measured between first incisors and angle of the jaw

377
Q

What is the definition of reps failure

A

Inability to maintain normal O2 and co2 pressures in arterial blood,

378
Q

What is normal pa02

379
Q

What is pao2 is considered resp failure

A

Less than 6.7 kpa

380
Q

Which post op complications are common in the first four pays after surgery

A

Acute MI, pyrexia due to atelectasis, CVA

381
Q

Which post op complications are common in the first 7 days after surgery

A

Renal impairment, post op urinary retention

382
Q

Which complication is common in days 5-10 post op

A

Delirium tremens

383
Q

Which post op complications are common in days 7-10 after surgery

A

Chest/wound infection, UTI, secondary haemorrhage

384
Q

Which post op complications are common in patients over 10 days after surgery

A

DVT, PE, wound dehiscence

385
Q

What is late secondary haemorrhage usually due to post operatively

A

Infection eroding a blood vessel

386
Q

How are late secondary haemorrhages manged

A

Re exploration surgery

387
Q

List some Respiraotyr post op complications

A
  • pulmonary collapse
  • infection
  • resp failure
  • ARDS
  • pleural effusion
  • pneumothorax
388
Q

How are Respiraotyr post op complications managed

A

Treat underlying cause, administer oxygen, supported ventilation

389
Q

What are some of the complications in iv administration of anaesthesia - what local damage is done

A

Bruising, haematoma, phlebitis, venous thrombosis, air embolus, site infection

390
Q

How is a post op DVT treated

A

SC LMWH and warfarin. LMWH is stopped once fully anticoagulated with warfarin. Warfarin continues for 3-6 months and inr maintained at 2-3

391
Q

What Are the clinical characteristics of acute reosiratory distress syndrome

A

Impaired oxygenation, diffuse lung opacification on CXR, decreased lung compliance

392
Q

List some causes of ARDS Periop

A

Pulmonary or systemic sepsis, massive blood transfusion, gastric contents aspiration

393
Q

What are the signs and symptoms of ARDS

A

Tachypnoea, increased ventilators effort, restlessness, confusion

394
Q

What is the pathophys of ARDS

A

Unclear, but thought to be due to inflammatory reaction with release of cytokines, damaged vascular endothelium, capillary leakage. Leads to interstitial and alveolar oedema

395
Q

How are post of pleural effusions managed

A

Small ones are usually left alone to reabsorb if they don’t interfere with inspiration, but large ones require pleural fluid aspiration

396
Q

How do you manage ARDS

A

Cventilatory support - positive end exploratory pressure (PEEP), treat underlying condition

397
Q

What is a common cause of surgical emphysema

A

CVP line insertion

398
Q

What are some of the effects anaesthetic agents have witch contribute to pulmonary collapse

A
  • paralysis of cilia
  • impaired diaphragmatic movement
  • over sedation
  • abdominal distension
  • wound pain causing patient to not breathe deeply
399
Q

How post op lung collapse be prevented

A

Breathe deeply, cough, mobilise, regular analgesia, chest physio,
O2, salbutamol, assisted ventilation if hypoxia severe

400
Q

How are patients with post op chest infections due to aspiration managed

A

Encouraging them to cough, prescribing antibiotics, send sputum for bacteriology,
oxygen if hypoxic, assisted ventilation if resp function deteriorates

401
Q

What are the three steps of the WHO pain ladder

A

1- non opioids +/- adjuncts
2- mild opioids +/- non opioids, +/- adjuvant
3- opioid +/- non opioids, +/- adjuvant

402
Q

List some opioid analgesics

A

Morphine, pethididne, sia morohine, codeine phosphate, tramadol

403
Q

List some step 1 WHO ladder analgesics

A

Aspirin, NSAIDs, paracetamol, selective cox-2 inhibitors

404
Q

List some step 2 WHO ladder analgesics

A

Codeine phosphate, tramadol, cocodamol

405
Q

What are step 3 WHO ladder analgesics

A

Morphine, fentanyl

406
Q

What are spathe symptoms of massive PE

A

Severe chest pain, pallor, shock

407
Q

What agents do you use for fibrinolysis in a massive PE

A

Streptokinase or urokinase

408
Q

What drug should be started for 6 months after a patient suffers a massive PE

409
Q

If a PE patient cannot be coagulated or sustains further PE despite management, what next step should be considered

A

Inferior vena caval filter

410
Q

What is evisceration in wound dehiscence

A

Extrusion of abdo viscera through abdo wound dehiscence

411
Q

What is the total body water content

412
Q

What is the total ECF and ICF body fluid content

A

ECF - 14 L

ICF - 28 L

413
Q

How much ECF is interstitial a pond how much is intravascular

A

Interstitial - 11-12L(4/5)

Intravascular - 3L (1/5)

414
Q

What is the total daily fluid input and output into adults

A

2.6 L input and 2.6 output

415
Q

How much fluid is lost in the urine, faeces, lungs and skin respectively

A

Urine -1.5 L
Faeces - 100 ml
Lungs - 400 ml
Skin - 600ml

416
Q

List crystalloid fluids

A

Normal saline, dextrose, combinations, hartmanns

417
Q

Name some colloids

A

Gelofusin/volplex , starch, albumin, blood products

418
Q

What are the ion requirements in adults

A

Adults
Na+ 2mmol/kg/day
K+ 1mmol/kg/day

419
Q

Hey are the dialup water reuqirements in adults

A

40ml/kg/day

420
Q

What is the intracellular and extra cellular potassium requirements

A

Intracellular - 135 mmol

Extra cellular - 5 mmol

421
Q

What are the intracellular and extra cellular sodium levels

A

Intracellular - 9 mmol

Extra cellular - 143 mmol

422
Q

What are he intracellular and extramedullary cl- levels

A

Intracellular - 9 mmol

Extra cellular - 193 mmol

423
Q

What are the intracellular and extra cellular hco3- levels

A

Intracellular - 9 mmol

Extra cellular - 24 mmol

424
Q

How would a 5% dextrose fluid solution distribute in the fluid compartments of the body, and how much remains intravascularly

A

Distributes to all body fluid components, therefore as the intravascular space only makes up 1/15 of the total body volume, only 1/15 of 1l dextrose remains within the intravascular space (67ml)

425
Q

How would 0.9% saline distribute within the body fluid compartments, and what volume would therefore remain intravascularly

A

It would distribute within the extra dullard compartments but not the intracellular (needs Na+-K+-ATPase), therefore would remain in the 1/5th intravascular compartment - 1/5 of 1L = 200ml

426
Q

How would colloids distribute throughout the body fluid component,s therefore how many ml would remain within the intravascular space

A

Would remain entirely intravascularly therefore 1L would remain intravascularly

427
Q

What are the daily sodium and potassium fluids requirements in a 70kg male

A 
Na+ = 2x70= 140mmol/day
K+ = 1x70= 70mmol/day
428
Q

Calculate the daily fluid requirements of a 70kg male

A

40x70= 2800 ml/day

429
Q

What three things are taken into account when calculating an adults fluid requirements

A

Maintenance requirements + pre existing deficit + replacement of ongoing losses

430
Q

Calculate a 22kg child’s daily fluid requirements

A 
First 10 kg = 4x10 = 40
Up to 20kg = 2x10 = 20
Last 2 kg = 1x2 = 2
Therefore 40+20+2 = 62ml/hour 
62X24= 1488mls a day
431
Q

List some causes of ongoing looses in fluid

A

Vomiting, diarrhoea, ugh output stoma, enterocutaneous fistula

432
Q

Which electrolytes Apis diarrhoea rich in

A

K+ and HCO3-

433
Q

Which electrocutes is vomit rich in

A

K+, H+, cl-

434
Q

Which antibody and which antigen is present I group a blood

A

Antibody - b

Antigen - a

435
Q

Which antibody and which antigen is present in group b blood

A

Antibody - a

Antigen - b

436
Q

Which antibody and which antigen is presentin group ab blood

A

Antibody - none
antigen - ab
Universal receiver

437
Q

Which antibody and which antigen is present in group o blood

A

Antibody - ab
Antigens - none
universal donor

438
Q

How much is one unit of blood in pints and most

A

1 unit = 1 pint

1 pint = ~450 mls

439
Q

How many units of blood are there the body, therefore how many L

A

10 units therefore 4.7-5.5 L

440
Q

What is defined as a massive blood transfusion

A

Transfusing 10units of blood in 24 hours or >50% of patients blood volume in 4 hours in response to massive uncontrolled haemorrhage

441
Q

What are the different type of blood components that can be transfused

A
  • red cells
  • platelets
  • FFP
  • cryoprecipitate
  • human albumin
  • factor IX and VIII
  • prothrombin complex concentrate (berriplex)
442
Q

When is FFP used

A

Multiple coagulation factor deficiencies

severe bleeding; those who are over coagulated e,g, warfarin sometimes

443
Q

Which coagulation factors are found in cryoprecipitate

A

Fibrinogen, factor VIII, XIII, vWf, fibronectin

444
Q

What su the function of factor XIII

A

Cross links fibrin

445
Q

When is cryoprecipitate transfusion used

A

When fibrin levels are low e.g. DIC

446
Q

When is human albumin transfused

A

Conditions with increased vascular permeability e.g. Burns, oedema or ascites resistant to diuretics

447
Q

When are factor IX and VIII infusions used

A

Haemophilia treatment

448
Q

What factors does prothrombin complex contain (beriplex)

A

II, IX, X, +/- VII (vit K dependent)

449
Q

When is prothrombin complex concentrate (beriplex) used

A

Reverse anticoag effect of warfarin when there is major bleeding

450
Q

What tests are performed on blood used for transfusion before use

A

Grouping
Antibody screening

Cross matching if urgent
Group and save

451
Q

Which liver enzyme is increased in patients with pancreatitis

452
Q

When are gallstones treated symptomatic ally

A

If symptomatic

453
Q

What is the “acute abdomen”?

A

Conditions of the abdomen requiring hospital admission, investigation and treatment and of less than 1 week duration. Primary symptom is abdo pain.

454
Q

What are the 2 main pathological processes involved in the acute abdomen

A

Inflammation

Obstruction

455
Q

What is the most common cause of generalised peritonitis?

A

Perforation of an intra-abdominal viscus

456
Q

What is a hiatus hernia

A

Abnormal protrusion of the stomach through the diaphragm into the thorax. Can be sliding (more common) or rolling

457
Q

What are the clinical features of hiatus hernia

A 
Heartburn
Oesophagitis
Epigastric and lower chest pain
Palpitations
Hiccups (irritation of pericardium and diaphragm)
458
Q

How would you manage a hiatus hernia

A

As per GORD

obstructive symptoms should be considered for surgical repair, ng tube and endoscopy

459
Q

What are obstructive symptoms for hiatus hernia

A

Vomiting
Regurg
Breathlessness due to reduced lung capacity

460
Q

What is achalasia

A

failure of the lower oesophageal sphincter to relax- the oesophagus dilates and peristalsis becomes uncoordinated. Can be due to degeneration of the myenteric plexus

461
Q

What are the clinical features of achalasia

A 
Progressive dysphagia (both solids and liquids) 
Regurg
retrosternal pain 
Weight loss
Regurg
Aspiration pneumonia
462
Q

How do you go about managing achalasia

A

Balloon dilatation of LOS
Surgical myotomy
Laparoscopic Hellers myotomy

463
Q

How does GORD present

A 
Heartburn
Acid regurg
Nausea
Hypersalivation (waterbrash)
Epigastric pain
Occasionally vomiting
464
Q

What anatomical or physiological factors usually prevent acid reflux

A

Angle at which oesophagus joins stomach
LOS
Diaphragmatic crus

465
Q

How do you gain a diagnosis of GORD

A

History
Endoscopy
Ph study

466
Q

What is the lifestyle treatment for GORD

A 
Weight loss
Stop smoking
Eat less fatty food
Eat less spicy food
Drink less caffeine and alcohol
467
Q

What is the medical treatment of GORD

A

PPIs

Metoclopramide, to promote gastric emptying and prevent nausea

468
Q

How is barretts oesophagus diagnosed

A

Endoscopic biopsy

469
Q

When is antireflux surgery indicated in a patient with GORD

A

When symptoms cannot be controlled by medical therapy

Patients who do not wish to take acid reflux therapy for a prolonged time or for life, esp if they’re young

470
Q

What does surgery for GORD involve

A

Reducing hiatus hernia if it is present and some form of fundoplication/wrapping fungus of stomach around the oesophagus

471
Q

How does fundoplication/antireflux surgery work to prevent acid reflux

A

When the stomach contracts, the funds wrapped around the lower oesophagus also contracts, so acid isn’t reflexes into the oesophagus as it is momentarily closed off

472
Q

What is diffuse oesophageal spasm

A

A condition caused by repetitive irregular peristalsis

473
Q

How is diffuse oesophageal spasm diagnosed

A

Oesophageal manometry

474
Q

How is diffuse oesophageal spasm treated

A

CCB, sublingual GTN, PPIs

475
Q

What is Plummer Vinson syndrome

A

A condition where a web forms, which results in dysphagia

476
Q

What causes is Plummer Vinson syndrome related to

A

Iron deficiency

Congenital

477
Q

In a patient with Plummer Vinson syndrome caused by iron deficiency anaemia, what would you expect to see on performing bloods

A

Hypochromic microcytic anaemia

Low serum ferritin

478
Q

What investigation can demonstrate a Plummer Vinson syndrome web

A

Barium swallow demonstrates narrowing in the upper oesophagus
Confirm with endoscopy

479
Q

How do you manage a Plummer Vinson syndrome web

A

Dilating web endoscopically

Oral Iron therapy as needed

480
Q

What are oesophageal pouches

A

Protrusions of mucosa through weak areas in the oesophageal wall

481
Q

What is a common area for oesophageal pouches

A

Through Killians dehiscence

482
Q

Where is Killians dehiscence in the oesophagus

A

Between the thyropharyngeus and cricopharyngeus muscle

483
Q

Lis some of the symptoms of a pharyngeal pouch

A 
Regurg
Halitosis
Dysphagia
Gurgling in throat
Aspiration
484
Q

How would you investigate pharyngeal pouches

A

With a barium swallow

485
Q

How are pharyngeal pouches managed

A

Myotomy of cricopharyngeus and resection of pouch

486
Q

What are the aetiological factors for peptic ulcers

A

H pylori
NSAIDs
Smoking
Genetic factors

487
Q

What is Zollinger Ellison syndrome

A

Gastrinoma (gastrin secreting tumour), normally found in pancreas, but also in duodenum and stomach

488
Q

How is Zollinger Ellison syndrome diagnosed

A

Ct and mri to localise tumour

489
Q

How is Zollinger Ellison syndrome managed

A

Remove tumour

490
Q

What are the clinical features of peptic ulcers

A

Well localised epigastric pain
Gastric ulcers painful when eating
Duodenal ulcers painful when hungry/at night

491
Q

What factors may patients with peptic ulcer disease say relieve their pain

A

Food, milk, antacids and vomiting

492
Q

How are peptic ulcers diagnosed

A

Endoscopy and biopsy

493
Q

How are peptic ulcers managed

A

Avoid NSAIDs, smoking, excessive alcohol

Triple therapy of PPIs and amoxicillin/metronidazole and clarithromycin

494
Q

Give some intraluminal causes of oesophageal

Perforation

A

Foreign body

Rigid endoscopy

495
Q

Give some external causes of oesophageal perforation

A

Penetrating injury

496
Q

What is a Malory Weiss tear

A

Spontaneous perforation of the oesophagus, usually caused by violent vomiting. Results in haematemesis and pain

497
Q

What are the clinical features of oesophageal perforation

A

Pain in neck
Vocal tenderness
Surgical emphysema
Mediastinitis and septic shock may result

498
Q

What are some of the investigations for oesophageal perforation

A

Erect CXR
Ct scan
Contrast swallow

499
Q

How is oesophageal perforation managed

A

Surgically, with prophylactic antibiotics and antifungals

500
Q

What are the histological types of oesophageal tumour

A

Benign leiomyomas
Squamous cell carcinoma
Adenocarcinoma

501
Q

What are the clinical features of oesophageal cancer

A

Progressive dysphagia to solids

May have metastatic disease signs

502
Q

What are the investigations for oesophageal cancer

A

Initially barium swallow, blood tests
Endoscopy and biopsy
Staging with ct and pet scans and laparoscopy

503
Q

What is the management of oesophageal cancer

A

Surgical resection + jejunostomy post op
Radiotherapy and chemo
Palliative - most are non operable

504
Q

What clinical symptoms may you encounter in a patient with perforated duodenal ulcer into the gastro duodenal artery

A

Acute onset unremitting epigastric pain
Shoulder tip pain
Vomiting
Symptoms of shock

505
Q

What investigations would perform in a patient with perforated ulcer

A

CXR to show free air under diaphragm

Ct contrast barium meal

506
Q

How do you manage a perforated ulcer

A 
Resusc
O2
Fluids
Broad spectrum abx
Ng tube
IV opiates
PPIs
Urinary catheter
Surgery to close ulcer
507
Q

Iist some causes of an upper GI bleed

A 
Peptic ulcers
Gastritis
Duodenitis
Erosions
Malory Weiss tear
Reflux oesophagitis
Varices
Angiodysplasia
Carcinoma
Aortoduodenal fistula
Dieulafoy syndrome
Caogulopathies
508
Q

What does a FBC show in a patient with haematemesis

A

Normal initially
Anaemia if bleeding is chronic
Urea high

509
Q

How are gi bleeds investigated

A

Endoscopy

Angiography

510
Q

How are gi bleeds treated/managed

A

Surgically
Injection sclerotherapy
Band ligation

511
Q

Give an example of a benign gastric neoplasm

A

Adenomatous polyps

512
Q

What is the most common type of gastric carcinoma

A

Adenocarcinoma

513
Q

What are some less common gastric carcinomas, following Adenocarcinoma

A

Lymphoma
Carcinoids (neuronendocrine)
Gi stromal tumours

514
Q

Give some aetiological factors for gastric neoplasia

A 
Diet
H pylori
Infection
Hereditary
Gastric polyps
Chronic strophic gastritis
Intestinal metaplasia
Gastric dysplasia
515
Q

How is gastric neoplasm diagnosed, following history and examination

A 
Upper gi endoscopy
Biopsy 
Ct staging
Endoscopic USS
Laparoscopy
Pet ct
516
Q

How do you manage gastric cancer with curative intent

A

Gastric tony and removal of nodes +/- preop chemo

517
Q

How would you treat a patient with oesophageal cancer with palliative intent

A

Chemo and radiotherapy
Stenting
Surgical bypass

518
Q

What are stages t1-t4 of gastric neoplasia

A

T1- invades lamina propria or submucosa
T2- muscularis propria or subserosa
T3- serosa
T4- adjacent structures

519
Q

How are gastric neoplasms diagnosed

A

Endoscopy

Endoscopic ultrasound scan

520
Q

What investigations could you do in a patient with Plummer Vinson syndrome

A

Bloods - anaemia, ferritin and iron levels
Barium swallow
Endoscopy

521
Q

At which Hb conc is transfusion considered

522
Q

What steps should be taken before transiting blood into a patient

A

1) check correct patient and fully label sample
2) complete blood request form
3) before commencing transfusion, must be checked by two individuals
4) check identity of patient, ABO and RhD-, donation no, expiry date, ensure no leaks/haemolysis
5) check patient vital signs before and 15 mins after each unit, and after completion
6) record

523
Q

List some acute effects of blood transfusion

A

1) acute haemolytic reaction
2) TRALI
3) febrile non haemolytic transfusion reaction
4) allergic reaction
5) bacterial contamination
6) transfusion related circulatory overload

524
Q

What are some of the delayed transfusion reactions

A

1) delayed haemolytic transfusion reaction
2) alloimmunisation
3) post transfusion purpura
4) graft vs host disease
5) transfusion transmitted reaction
6) iron overload

525
Q

Why may acute haemolytic transfusion reaction occur

A

ABO incompatible, intravascular haemolysis

526
Q

What are the signs and symptoms of acute haemolytic transfusion reaction

A

Chills, fevers, rigors
Hypotension, shock, DIC
ARF

527
Q

Why does TRALI occur

A

Antibodies in donor blood reacts with recipients leucocytes

528
Q

What are the signs and symptoms of TRALI

A

Dyspnoea, cough, fever, hypoxia, pulmonary infiltrates

529
Q

Why does febrile M&m haemolytic transfusion occur

A

Antibodies in patients blood react with blood donors leucocytes

530
Q

What are the signs and symptoms of allergic reactions to transfusion

A

Urticaria, itch, severe anaphylaxis

531
Q

Why does transfusion related circulatory overload occur

A

Too much blood affects LV function - failure

532
Q

What are the signs and symptoms of fleshed haemolytic transfusion reactions

A

Jaundice, fever, haemoglobinuria

533
Q

How do patients with post transfusion haemolysis present

A

Thrombocytopenia and bleeding

534
Q

How do patients with graft vs host disease after transfusion present

A

Fever, rash, abnormal LFTs, pancytopenia

535
Q

Which organs can iron accumulate in with iron overload

A

Liver, heart, pancreas

536
Q

What are the different types of autologous transfusion

A
  • pre op donation
  • isovolaemic haemodilution
  • cell salvage
537
Q

How does preop donation work in autologous transfusion

A

Collected from patient prior to surgery and stored for up to 35 days preop. Not very effective, reserved for those with rare blood groups

538
Q

How does isovolaemic haemodilution work

A

Blood drawn preop and put in bag containing anticoagulant and replaced by saline to maintain blood volume. The withdraw blood is red fused during surgery or post op

539
Q

What is cell salvage

A

Blood collected from operation site during surgery, and is processed by a cell salvage machine, where it is anticoagulated and the cells are washed to remove clots and debris. The returned to patient.

540
Q

When is cell salvage not used

A

Malignancy or sepsis

541
Q

Give some reasons for direct arterial pressure monitoring

A
  • failure of indirect monitoring
  • arterial blood sampling
  • continuous reactive monitoring
542
Q

List some complications of direct arterial monitoring

A

Distal ischaemia

543
Q

Why is a central venous catheter used

A

For monitoring CVP, prolonged drug administration, parenteral administration

544
Q

How can you reduce the risk of damaging collateral structures when inserting a CVP line

A

Ultrasound scan

545
Q

What are common insertion sites for Central Venous Catheters

A

SVC, subclavian vein, internal jugular, occasionally peripheral vein in antecubital fossa (PICC)

546
Q

the pressure in which chamber of the heart does a central venous catheter give an indication for

547
Q

What are some of the complication of inserting a central venous catheter

A

Arterial puncture, haematoma, haemothorax, nerve injury, air embolism, sepsis, PE, cardiac tamponade

548
Q

List the different types of airway ventilation used in surgery and anaesthesia

A
  • jaw thrust, chin lift
  • bag and mask ventilation
  • LMA
  • endotracheal intubation
  • surgical airway
  • oropharnygeal (Guedel)
  • nasopharyngeal
549
Q

Wh in membrane is a surgical airway created through

A

Cricothyroid membrane

550
Q

What are. The two types of surgical airway

A
  • needle cricothyroidectomy (plastic cannula)

- surgical cricothyroidectomy (inserting tracheostomy tube)

551
Q

Why would you choose an nasopharyngeal airway over an oropharnygeal airway

A

Nasopharyngeal used when patient ja co so out and oropharnygeal airway would induce a gag reflex

552
Q

When is an oropharnygeal airway used in cardiac emergency

A

Airway adjunct in mi

553
Q

Where is the mid inguinal point

A

Half way between the public symphysis and ASIS

554
Q

Where is the mid point of the inguinal ligament

A

Half way between the pubic tubercle and ASIS

555
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

556
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

557
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

558
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

559
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

560
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

561
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

562
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

563
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

564
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

565
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

566
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

567
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

568
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

569
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

570
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

571
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

572
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

573
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

574
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

575
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

576
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

577
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

578
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

579
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

580
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

581
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

582
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

583
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

584
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

585
Q

Where does the deep inguinal ring lie anatomically

A

Mid point of inguinal ligament

586
Q

What anatomical structures are found at the mid inguinal point

A

Femoral artery

587
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

588
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

589
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

590
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

591
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

592
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

593
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

594
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

595
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

596
Q

What is the difference in location of the inguinal and femoral hernias in relation to the pubic tubercle

A

Femoral - below and lateral to the pubic tubercle

Inguinal - above and medial to the public tubercle

597
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

598
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

599
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

600
Q

What are the borders of the femoral triangle

A
  • inguinal ligament superiorly
  • sartorius muscle laterally
  • adductor longus medially
601
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

602
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

603
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

604
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

605
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

606
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

607
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

608
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

609
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

610
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

611
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

612
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

613
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

614
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

615
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

616
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

617
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

618
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

619
Q

List conditions in he right hypochondrium

A
  • acute cholecystitis
  • duodenal ulcer
  • hepatitis
  • hepatomegaly
  • pyelonephritis
620
Q

List the conditions presenting in the epigastric.

A
  • peptic ulcers
  • GORD
  • gastritis
  • epigastric hernia
  • MI
  • pancreatitis
  • AAA
621
Q

List the conditions presenting in the left hypochondrium

A
  • splenomegaly
  • splenic rupture
  • pancreatitis
  • peptic ulcer
  • AAA
  • perforated colon
  • pneumonia (L)
622
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

623
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

624
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

625
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

626
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

627
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

628
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

629
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

630
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

631
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

632
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

633
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

634
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

635
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

636
Q

List some of the conditions in the right flank

A
  • renal calculi
  • UTI
  • lumbar hernia
637
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

638
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

639
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

640
Q

List some of the conditions presenting in the peri umbilical region

A
  • initial appendicitis
  • gastritis
  • small bowel obstruction
  • umbilical hernia
  • IBD
  • AAA
641
Q

List some of the conditions presenting in the left flank

A
  • renal calculi
  • UTI
  • IBD
  • diverticular disease
642
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

643
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

644
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

645
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

646
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

647
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

648
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

649
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

650
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

651
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

652
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

653
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

654
Q

List some of the conditions presenting in the right iliac fossa

A
  • appendicitis
  • inguinal hernia
  • pelvic pain
  • salpingitis
  • ruptured ectopic pregnancy
  • renal calculi
  • Crohns
  • mesenteric adenitis
  • ovarian abscess
655
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

656
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

657
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

658
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

659
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

660
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

661
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

662
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

663
Q

Which infections does splenectomy predispose patients to

A

Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae

664
Q

What is mesenteric adenitis

A

Inflammation of mesenteric lymph nodes

665
Q

List some of the conduit a presenting in the supra public region

A
  • UTI
  • cystitis
  • IBD
666
Q

List some of the conditions in the left iliac fossa

A
  • rectal mass
  • diverticulitis
  • obstruction of large bowel
  • inguinal hernia
  • diverticular disease
  • UC
  • ovarian abscess
  • ruptures ectopic pregnancy
  • saying its
  • strangulated hernia
  • CD

Periop (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions