GI Surgery Flashcards
1
Q
What are some of the causes of spontaneous oesophageal perforation
A
Violent vomiting
Malory Weiss tear
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
3
Q
What are the palliative treatments for oesophageal cancer
A
Endoscopic stent
Palliative chemo/radiotherapy
4
Q
Which channel do PPIs inhibit
A
H+-K+-ATPase
5
Q
What are the clinical features of upper GI bleed
A
Haematemesis +/- melena
6
Q
What is dieulafoy syndrome
A
Where a large arteriole in the stomach lining erodes and bleeds
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
8
Q
What are the symptoms of gastric neoplasia
A
Indigestion, Dyspepsia Flatulence Weight loss Vomiting Epigastric or back pain Epigastric mass present
9
Q
How is GI neoplasia diagnosed
A
History and examination Upper GI endoscopy Biopsy Staging CT endoscopic ultrasound Laparoscopy Pet-ct
10
Q
What is the treatment with curative intent for gastric neoplasia
A
Gastrectomy + node removal +/- preop chemo
11
Q
What is the palliative treatment for gastric neoplasia
A
Supportive care
Palliative chemo/radiotherapy
Stenting
Bypass surgery
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
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
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
15
Q
How is variceal bleeding managed
A
Endoscopic ligation banding
Injection sclerotherapy
Surgical portosystemic shunts
16
Q
What is cavernous hemangioma
A
Benign tumour found in lover
17
Q
Do you resect a cavernous haemangioma
A
Only if large and symptomatic
18
Q
How do patients with liver cell adenoma present
A
Left hypochondrial pain
19
Q
What is the danger with liver cell adenoma
A
Can undergo malignant transformation
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
21
Q
What are the results of blood investigations for hcc
A
Deranged LFTs
Alpha fetoprotein raised
22
Q
How do you confirm a hcc
A
Percutaneous needle aspiration biopsy and cytology
23
Q
What imaging techniques can be used to diagnosed hcc
A
USS
CT, MRI
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
25
What are the presenting features of cholangiocarcinoma
Jaundice, pain, enlarged liver
26
What is charcots triad in cholangitis
1) pain
2) pyrexia
3) jaundice
27
What types of stones can be found in gallstones
Cholesterol or pigment stones (calcium bicarbonate)
28
List some of the pathological effects of gallstones
- acute cholecystitis
- chronic cholecystitis
- mucocoele
- gallstone ileus
- biliary colic
- cholangitis
29
What is acute cholecystitis
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
30
What is chronic cholecystitis
Repeated bouts of biliary colic or acute cholecystitis culminating in fibrosis. The gallbladder ceases to function. RUQ pain, no pyrexia
31
What is mucocoele
Distension of a hollow cavity or organ with mucus
32
Why does much ele occasionally develop in patients with gall stones
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
33
If gall stones become stuck, what conditions can they result in
Jaundice
Cholangitis
Acute pancreatitis
34
What is cholangitis
Infection of the bile duct caused by bacteria ascending from its junction with the duodenum
35
What is gallstone ileus
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
36
What is biliary colic
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
37
What are the symptoms of acute cholecystitis
RUQ pain
Radiates to right subscapsular region
Tachycardia, pyrexia, nausea, vomiting, leucocytosis
38
What test may be positive in a patient with acute cholecystitis on examination
Murphy's
39
What is primary biliary cirrhosis
Autoimmune condition of the liver, where interlobular bile ducts are damaged by chronic granulomas.
40
What are the consequences for primary biliary cirrhosis
Progressive cholestasis
Cirrhosis
Portal hypertension
41
What liver marker is raised in primary biliary cirrhosis
ALK PHOS
42
How does primary biliary cirrhosis present
Lethargy
Pruritus
Hepatomegaly
43
What are some of the complications of primary biliary cirrhosis
Portal hypertension
Ascites
Hepatic encephalopathy
HCC
44
What does biopsy of the liver of patients with primary biliary cirrhosis show
Granulomas around the bile ducts, progressing to cirrhosis
45
How is primary biliary cirrhosis treated
Symptomatic treatment for pruritus with colestyramine
Ursodeoxycholic acid
Liver transplant last resort
46
What is primary sclerosing cholangitis
A non malignant, non bacterial inflammation, fibrosis and strictures of intra and extra-hepatic bile ducts
47
What does primary sclerosing cholangitis lead to
Liver failure and death
48
What are the symptoms of primary sclerosing cholangitis
Often found incidentally
| Jaundice, pruritus, abdo pain, fatigue
49
Which liver enzyme is increased in primary sclerosing cholangitis
ALK PHOS
50
Wht re the signs of primary sclerosing cholangitis
Jaundice, hepatomegaly, portal hypertension
51
What do patients with primary sclerosing cholangitis have a huge risk of developing
Cholangiocarcinoma
52
What is the management of primary sclerosing cholangitis
Liver transplant is the only effective treatment
Colestyramine for pruritus
Ursodeoxycholic acid improves cholestasis
53
What are the clinical features of tumours of the biliary tract
```
Progressive obstructive jaundice
Mucocoele
Empyema
Pruritus
Anorexia and weight loss
```
54
What is the management for rumours of the biliary tract
Whipped procedure if in lower CBD
| Palliative stents in some cases
55
Where does the pancreas lie anatomically
Retroperitoneally, behind the lesser sac and the stomach . The head lies in the loop of the duodenum
56
What is the blood supply to the pancreas
Coeliac and superior mesenteric artery
57
What is the blood supply to the tail of the pancreas
Splenic arteries (lies in front of splenic artery)
58
What are the most common causes for pancreatitis
Alcohol and gallstones
59
What is the effect of gall stones impacting on the pancreatic duct
Leads to intracellular activation of pancreatic enzymes, acinar cell damage, pancreatic inflammation
60
What are the GET SMASHED aetiological causes of pancreatitis
```
Gallstones
Ethanol
Trauma
Scorpion venom
Mumps
Autoimmune
Steroids
Heryperlipidaemia/hypercalcaemia
ERCP
Drugs
```
61
What is more common - sliding or rolling hernia
Sliding (stomach cardia involved)
62
How would you distinguish between gallstone and alcoholic cause of pancreatitis
Ultrasound scan
63
What is ercp used for
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)
64
What are the clinical features of acute pancreatitis
- severe epigastric pain, or right hypochondrium
- radiates to back
- nausea, vomiting, retching
- tachycardia, tachypnoea
- jaundice may be present
65
How is acute appendicitis diagnosed
Measuring serum amylase (3x upper reference), serum lipase
| Ct abdo if doubt
66
Lost two severity score for acute pancreatitis
- APACHE II
| - Glasgow prognostic score
67
What is the conservative management for acute pancreatitis
Iv fluids, analgesia, gradual reintroduction of diet
Antibiotic prophylaxis
Treat underlying cause e.g. gallstones
68
What are the possible complications of pancreatitis
- infected pancreatic necrosis
- pancreatic pseudocyst
- abscess
- GI bleeding
- GI ischaemia, fistula
69
How is infected pancreatic necrosis treated
Surgical debridement or Percutaneous drainage
70
What is a pancreatic pseudocyst
Collections of pancreatic secretion and inflammatory exudate enclosed in a wall of fibrous or granulation tissue
71
What is chronic pancreatitis
Chronic inflammatory condition characterised by fibrosis and destruction of exocrine pancreatic tissue. Blockage of flow of pancreatic juices
72
What is the most common aetiological cause of chronic pancreatitis
Alcohol
73
What are the clinical features of chronic pancreatitis
Characteristic epigastric pain, radiating to back and often relived by leaning forward
Hot water bottles may help relive pain
74
What are some of the other manifestations of chronic pancreatitis except the usual symptoms
Steatorrhoea
| Diabetes mellitus
75
What imaging investigations can you do to diagnose chronic pancreatitis
CT - may see speckled calcification
| MRCP - to look at pancreatic duct
76
Which non-imaging investigations can you ror form on a patient with chronic pancreatitis
Blood glucose
| Faecal fat content
77
What is MRCP
Imaging technique which uses MRI to visualise the biliary and pancreatic ducts non-invasively
78
Which blood tests in particular are important for the investigation of a patient with gallstones
FBC - ?neutrophilia
Bilirubin increased
Alkaline phosphatase increased
79
When is gas seen surrounding the billiary tree
If fistula is present
80
How is amo pen cholecystectomy performed
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
81
How is laparoscopic cholecystectomy performed
Cannulae inserted into anterior abdo wall and co2 insufflation
Same structures ligated as in cholecystectomy
82
What are some of the complications that may occur in cholecystectomy
Infective complications - strep faecalis, e. Coli
| Bile leakage
83
How is infection from organisms such as E. coli prevented in cholecystectomy patients
Prophylaxis with cephalosporin
84
How is acute cholecystitis managed conservatively initially
Iv fluids, analgesia, broad spectrum antibiotic such as a cephalosporin, nbm
85
Is the non surgical approach to acute cholecystitis effective
No - gall stone dissolution
86
How is acute cholangitis managed
Resusc, administration of appropriate antibiotics, decompression of biliary tree with ercp, cholecystectomy
87
What is the conservative management for chronic pancreatitis
Abstinence from alcohol
Pain relief
Treat endocrine and exocrine insufficiency - supplements
88
What are the endoscopic and surgical treatments for chronic pancreatitis
Endoscopic duct stents if there is a stricture
Surgical drainage
of obstructed pancreatic duct
89
What is Courvoisier's law?
In the presence of a non tender palpable gall bladder, painless jaundice is unlikely caused by gallstones
90
What are some of the neuronendocrine tumours found in the pancreas
Gastrinomas (Zollinger Ellison syndrome), insulin as, glucagonomas, somatostatinoma
91
What histological type of cancer is cholangiocarcinoma
Adenocarcinoma
92
Where do pancreatic Adenocarcinomas tend to metastasise commonly
Liver and lung
93
What are some of the symptomatic features of pancreatic cancer
Painless jaundice, weight loss, poor appetite
94
What is the management of pancreatic cancer
Surgical resection via whipped procedure (pancreaticoduodenectomy)
Palliative treatment with relief from obstructive jaundice, pruritus, biliary drainage, chemo
95
What does pancreaticoduodenectomy/whipples procedure involve
Resection of head of pancreas, distal half of stomach, duodenum, gallbladder, CBD
96
What does the red pulp of the spleen contain
Macrophages
97
What does the White pulp of the spleen contain
Lymphoid tissue - lymphocytes, macrophages and plasma cells
98
How is a splenectomy performed
Via left subcostal incision, with division of the short gastric vessels and mobilisation from surrounding structures
99
List the indications for splenectomy
- trauma
- haemolytic anaemia
- hyperslenism
- ITP
- abscess
- splenic artery aneurysm
- as part of resection of other organs
100
What are the lifelong prophylactic antibiotics given to patients who have had a splenectomy
Erythromycin or phenoxymethylpenicillin
101
What immunisation is given to patients who have had a splenectomy
Pneumococcal, H influenzae type B, meningococcal group c infection immunisation
102
What are some of the causes of appendicitis
Inflammation may be due to faecoliths, lymphoid hyperplasia, foreign bodies, carcinoid tumours, strictures
103
List some begging tumours of the small intestine
- adenomatous polyps
- hamartomas
- lipomas
- haemangiomas
104
What is a hamartoma
Abnormal formation of normal tissue
105
What is peutz-jehgers syndrome
Inherited disorder where there are multiple hamartomatous polyps in the GIT, as well as pigmentation in the patients lips
106
List some malignant tumours of the small intestine
- GIST - GI stromal tumour
- Adenocarcinoma of the small bowel
- lymphoma
- carcinoid tumour
107
What is Lynch Syndrome also known as
Hereditary non-polyposis colorectal carcinoma
108
What is the inheritance pattern of lynch syndrome/hereditary nonpolyposis colorectal carcinoma
Autosomal dominant
109
What is the risk that comes with HNPCC/lynch syndrome
High risk of colon cancer
| As well as endometrial cancer
110
What hereditary conditions may be associated with small bowel Adenocarcinoma
FAP, Lynch syndrome
111
Which cancers are patients with peutz jehgers syndrome susceptible to
Colorectal, gastric, pancreatic, breast, ovarian tumours
112
What is the management of peutz jehgers syndrome
Laparotomy, polypectomy
113
What is me kelps diverticulum
Remnant of Vitello-intestinal duct
114
How may me kelps diverticulum cause problems in affected patients
Intusussecption, volvulus, obstruction
115
How is me kelps diverticulum treated
Excised if symptomatic, if not, should be left alone
116
What are the symptoms of radiation enteritis
Watery diarrhoea, lower abdo pain, tenesmus, rectal bleeding, mucous discharge
117
What may diverticulae in the jejunum cause in terms of symptoms
Inflammation, malabsorption, occasionally perforation and impaction of material in the diverticulae
118
If small bowel diverticulae are symptomatic, how should they be treated
Iv fluid resuscitation, antibiotics
119
What is small bowel ishcaemia usually due to
Atheromatous occlusion and thrombosis in the superior mesenteric artery
120
What are spathe predisposing factors for small bowel ishcaemia
```
Thrombophilia
Hyperviscosity
Dehydration
Hypovolaemia
Hypoperfusion of gut
```
121
List some causes of Hypoperfusion of the gut
Trauma, cardiogenic shock, cardiac arrhythmia, septic shock, arterial emboli,
122
What does small bowel ishcaemia progress to
Necrosis of all the bowel layers with gangrene and perforation
123
How is small bowel ishcaemia managed
Resusc, resection of gangrenous bowel; and anticoagulation; In some instances, can be restored by embolectomy, thomobolectomy
124
What is chronic mesenteric ischaemia
Repeated bouts of colicky Central abdo pain typically 20-30 mins after eating, weight loss. Angiogrpaphy
125
What are the clinical feature of small bowel ischaemia
- Central abdo pain and tenderness
- previous weight loss
- guarding and rigidity (late signs)
126
What may plain films show in painted with small bowel ischaemia
Calcified atheroma in mesenteric arteries,
| Dilated Andy hi kneed small bowel loops
127
What are the most common causes of small bowel obstruction
- adhesions (60%)
- obstructed hernia (20%)
- malignancy
128
What are the most common causes of large bowel obstruction
- colorectal cancer (>70%)
- stricturing diverticular disease (10%)
- sigmoid volvulus
129
What are the signs and symptoms of obstruction in the proximal jejunum
Anorexia, vomiting, severe upper abdo pain, minimal distension, limited (if any) change in bowel habit
130
What are the symptoms and signs of distal small bowel obstruction
Colicky midgut pain, distension, vomiting, recent absolute constipation
131
What are the signs and symptoms with colonic obstruction
- insidious
- hindgut abdo pain and discomfort
- weight loss
- pronounced abdo distension
- altered bowel habit with little or no vomiting
132
How does gut motility change with obstruction
Initially the bowel proximal to he obstruction contracts vigorously in an attempt to overcome impedance
Eventually peristalsis subsides and paralytic ileus ensues
133
Why may a patient with paralytic ileus become toxic
Bacteria enter the portal system if ileus not resolved
134
What are some of the possible consequences to paralytic ileus
Perforation
Strangulation
Peritonitis
135
How do you manage bowel obstruction
Iv and electrolyte therapy
Erect CXR, AXR
Laparotomy
136
What are some for eh causes of paralytic ileus
- after surgery
- secondary to peritonitis
- electrolyte imbalances
- tca's, lithium, opiates
137
Which electrolyte ambormalities can cause paralytic ileus
```
Hypokalaemia
Hyponatraemia
Diabetic ketoacidosis
Uraemia
Hypocalcaemia
```
138
How is paralytic ileus managed
Correction of blood electrolytes
Stimulant enemas
Iv erythromycin
Laparotomy
139
Whatis the definition of a hernia
Abnormal protrusion of a cavity's contents (e.g. Viscera) through a weakness in the wall of the cavity that usually contains it.
140
What is the risk in hernias that are irreducible
May strangulate or become obstructed
141
What passes through the inguinal canal
In males the spermatic cord, and in females, the round ligament
142
Which embryonic structure failing to close properly may predispose to inguinal hernias
Processus vaginalis
143
In which structure is the deep inguinal ring
Transversalis fascia
144
Where is the deep inguinal ring
About 1 cm above the mid point of the inguinal ligament
145
What is medial to the deep inguinal ring
Inferior epigastric vessels
146
Where does an indirect inguinal hernia enter to herniate
The deep inguinal ring
| Can pass down into the scrotum
147
Where is an inguinal hernia usually found in relation to the pubic tubercle
Above and medial
148
What are the clinical features of inguinal hernias
Discomfort in groin, esp when lifting or straining
| Lump, especially visible when coughing or standing up
149
Where does an direct femoral hernia go through
Hesselbachs triangle- weakness in abdominal wall, protrudes through transversalis fascia
150
What is the a agreement for inguinal hernias
Surgical
herniotomy and tightening of the deep ring for indirect hernias, and mobilisation of hernia for direct hernias which is strengthened by sutures
151
Where do femoral hernias project through
Femoral ring and pass down the femoral canal, may progress down to the saline ours opening in the deep fascia of the thigh
152
What is medial and lateral to the femoral canal
Medial - lacunar ligament
| Lateral - femoral vein
153
What do femoral hernias usually contain
Small bowel or omentum
154
Where are femoral hernias seen
Inner upper aspect of the thigh
155
Where are femoral hernias in relation to the pubic tubercle
Below and lateral to pubic tubercle
156
What is the repair for femoral hernias
Surgical
157
What causes parImbilical hernias
Gradual weakening of tissues around the umbilicus - obese, multiple pregnancies etc.
158
When may groin pain be felt in patients with femoral hernias
During exercise
159
How is para stromal hernia best treated
With reversal of stoma if possible
160
What are the obstructive symptoms of hernias that indicate surgical repair is needed
Abdo pain, vomiting, distension
161
What is dysphagia
Difficulty swallowing
162
What does sudden onset dysphagia indicate
Foreign body
163
Which conditions have dysphagia to solids and which to liquids
Solids - carcinoma
| Liquids - achalasia, motility disorders, stroke
164
What is odynophagia
Pain on swallowing
165
What may cause odynophagia
Oesophagitis
| Oesophageal spasm
166
What is dyslepsia
Describes symptoms of indigestion - epigastric pain, belching, heartburn, nausea, early satiety, reduced appetite
167
What are alarm symptoms in dyspepsia
```
Weight loss
Progressive dysphagia
Iron deficiency
Mass
Vomiting
```
168
Where in the world is diverticular disease prevalent
Developed countries
169
Which component of the diet is related to diverticular disease
Low fibre
170
Wh in part of the GI system is most commonly affected by diverticular disease
Sigmoid colon (related to intraluminal pressure)
171
What are the symptoms of diverticular disease
- intermittent lower abdo/left iliac fossa pain
- altered bowel habit
- rectal bleeding
- urgency of defaecation
172
List some of the imaging investigations for diverticular disease
- barium enema
- colonoscopy/sigmoidoscopy
- CT
173
How do you manage uncomplciTed diverticular disease
High fibre diet, bulk laxatives, antispasmodics such as mebeverine
174
When is surgical resection of affected segment indicated in patients with diverticular disease?
Persistent symptoms or when cancer cannot be excluded
175
What symptoms may you find in a patient with colonic diverticular disease which has perforated
```
Septic shock
Dehydration
Marked abdo pain
Tenderness
Distension
```
176
How is perforated diverticular disease treated
Resuscitation, iv broad spectrum antibiotics, reception of affcted bowel + peritoneal lavage
177
What complications can persistent infections in diverticular disease due to still stasis etc, lead to
Necrosis and formation of abscess. This may go on to perforate
178
What are the symptoms and clinical features of diverticulitis
Pyrexia, leucocytosis, nausea, vomiting, altered bowel habit
Pain and tenderness in LIF
179
How is diverticulitis diagnosed
CT
180
How is an episode of diverticulitis treated
Fasting, clear fluids, bed rest
Iv fluids
Broad spectrum antibiotics
Certain circumstances may require surgery, e.g. Abscess
181
Give some examples of broad spectrum antibiotics used in the treatment of diverticulitis
Cephalosporins, gentamicin, metronidazole
182
What are some of the complications of diverticular disease a
- strictures
- obstruction
- infection and inflammation
- fistula
- bleeding
183
What is a common organ that diverticulae form fistulas with
The bladder - colovesicular fistula
184
If a colovesicular fistula is preset in a patient with diverticulosis, what are some of the urinary symptoms that may be present
Dysuria, passage of cloudy urine, bubbling on micturition (pneumoturia)
185
How is a fistula in diverticular disease diagnosed
Barium enema
| Cystoscopy if colovesicular fistula
186
How is a colovesicular fistula treated
Sigmoid colectomy with synchronous repair of the bladder
187
What are the differentials of pe bleeding in diverticular disease
Haemorrhoids, polyps, IBD, cancer,angiodysplasia
188
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
Resection or affected bowel, even total colectomy
189
What is the pathophysiology of large intestinal ischaemia
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
190
What are the clinical features and symptoms of ischaemic colitis or the large intestine
Lower abdo pain, nausea, vomiting, bloody diarrhoea
Tenderness and guarding
Pyrexia and leucocytosis
191
What is seem or radiography of a patient with ischaemic colitis of the large bowel
Thickened segment of colon and "thumb printing" due to oedema.
192
How does gangrenous ishcaemic colitis present
Localised or generalised peritonitis
193
How is gangrenous ischaemic colitis treated
Surgery - resection + colostomy
194
How does ischaemic stricture of the colon present
Colicky abdominal pain, constipation and distension following history of an attack of bloody diarrhoea or documented episode of ischaemic colitis.
195
What is IBS
Mixed group of abdominal symptoms for which no organic cause can be found. Most due to disorders of intestinal motility but enhanced visceral perception
196
What are the diagnostic criteria for IBS
```
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
```
197
Which part of the git is commonly affected by volvulus
Sigmoid colon
198
Which mart of the git is rarely affcted by volvulus, but still can be
Caecum
199
What is a volvulus
Twisting of bowel around a narrow origin in the mesentery
200
What is the presentation of a sigmoid volvulus
Presentation as per large bowel obstruction:
- lower abdo pain
- abdo distension
- nausea and vomiting
- absolute constipation
201
How may a patient with perforation due to sigmoid volvulus present
With sepsis
202
What is seen on radiography of a patient with sigmoid volvulus
Coffee bean sign, with a grossly distended colon arising out of pelvis
203
What is the conservative treatment of sigmoid volvulus
Reduction and deflation using rigid or flexible sigmoidoscope + placement of large bore tube into the sigmoid
204
What is the surgical management of sigmoid volvulus
sigmoid colectomy following fill bowel prep
205
Which anatomical landmark does a faecalis volvulus occur around
Superior mesenteric artery
206
What does radiography show in a caudal volvulus
Anticlockwise rotation of dilated small bowel loops, around a grossly distended caecum
207
How can bleeding due to angiodysplasia in the colon be treated
Angiographic embolisation, laser treatment, injection sclerotherapy, resection in emergency laparotomy
208
What is the responsible organism for pseudo membranous colitis
C. difficile
209
What usually is the cause of pseudo membranous colitis
Almost always healthcare related infection due to over use of broad spectrum antibiotics
210
How is C. difficile infection detected
Stool culture or assays for presence of C. difficile toxin in stool or blood
211
What do stools of those affected by C. difficile infection look like
Watery, green, blood stained, foul smelling, often containing fragments of mucosal slough
212
What are the signs and symptoms of pseudo,em famous colitis/c difficile infection
```
Patient profoundly unwell
Fever
Colitis
Sepsis
Dehydration
```
213
How do you manage C. difficile infection
Resusc, iv fluids, side room isolation
| Oral metronidazole or vancomycin for 10 days
214
What severe complication may patients with severe cases of C. difficile infection encounter
Toxic megacolon
215
How is toxic megacolon treated
Emergency Colectomy + ileostomy (ileorectal anastomosis ca be performed at a later date)
216
List the drugs most commonly associated with C. difficile / pseudo,membranous colitis
- ciprofloxacin
- amoxicillin
- clindamycin
- cephalosporins
217
What class of antibiotic is ciprofloxacin
Quinolone
218
What are the features of microscopic colitis on biopsy
Increase in inflammatory cells (esp. Lymphocytes) with an otherwise normal appearance and architecture of colon
219
What is the main presentation of microscopic colitis, and are there any radiological or histological changes
Chronic diarrhoea, normal radiological findings, typical histological findings
220
How is microscopic colitis treated
Avoid caffeine and orb we known aggravators
5-ASA agents in non responders
Anti diarrhoeal agents
221
What causes hirschprungs disease
Absence of ganglion cells in Auerbachs and Meisseners plexuses
222
How does hirschprungs diseases usually present
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
223
What diagnostic investigation confirms hirschprungs disease
Biopsy - confirms lack of ganglia
224
How is ileostomy formed
By bringing out ileum through the abdominal wall, through the rectus muscle in the RIF
Spout fashioned to allow appliances to be fitted
225
Why may an ileostomy be performed
As an adjunct to resectional surgery or as a temporary stoma to allow distal anastomosis to heal
226
When is an end-ileostomy used
When the colon has been removed +/- small part of distal ileum has been removed.
227
Why does colostomy not require a spout like an ileostomy does
The faeces extruded here are not usually irritant to skin
228
Which emergency procedure involves colostomy formation
Hartmanns procedure
229
Liz some indications for colostomy
Hartmanns procedure
Resectional surgery for colon cancer
Faecal incontinence surgery to divert faeces from disease anorectum
Palliation for cancer
230
What is a Hartmann procedure
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
231
What are the distinguishing features between ileostomy and colostomy
Ileostomy - RIF, spout of mucosa
| Colostomy - LIF, closer to the skin and sutured to it
232
What are the indications for nasojejunal feeding
When the patient cannot tolerate feeding into the stomach - severe reflux, vomiting, impaired motility
233
When is gastrostomy (surgical or peg) indicated
Long term - for problems with swallowing e.g. Stroke, oesophageal atresia, tracheosophgaeal fistula
234
When is jejune stormy indicated
Long term, for problems with poor gastric motility, chronic vomiting, high risk of aspiration
235
How may polyps oak syndromes present, considering often they are asymptomatic
Rectus bleeding, large bowel colic, rectal polyps may occasionally prolapse, severe watery diarrhoea, dehydration
236
How cam polyps is syndromes be managed
Colonoscopic polypectomy, electrocautery snare,
237
What is the risk associated with familial adenomatous polyps is
Predisposes to cancer - malignant transformation
238
What is the inheritance pattern for familial adenomatous polypsis
Autosomal dominant
239
There is an >90% chance of colorectal cancer risk in patients with familial adenomatous polypsis, which prophylactic procedure can be undertaken to prevent this
Prophylactic Colectomy
240
What are the extra colonic features of familial adenomatous polyposis
Gastric polyps, ileal adenomas, long bone osteomas
241
How is FAP diagnosed
Sigmoidoscopy/colonoscopy, biopsy, gene mutation screening
242
Where else should be screened in patients with familial adenomatous polyposis
Upper git - polyps and adenomas may also be present here as extra colonic features
243
List some autosomal recessive differentials for FAP, which also have hih risk of colorectal cancer
Meta plastic hyperplasia polyposis
| MUTYH-associated polyposis
244
Which parts of the colon are particularly common sites for colorectal cancer
Sigmoid colon and rectum
245
What are the aetiological factors for colorectal Adenocarcinoma
Male gender, older age, family history, westernised diet, (smoking)
246
Which diets are associated with increased risk of colorectal cancer
Low fibre, high red meat content, high fat
247
What are protective factors against colorectal cancer
No smoking/excess alcohol
Dietary calcium and vitamin d supplements
Hugh fibre diet
Aspirin/other NSAIDs
248
List some gee tic conditions associated with increased risk of colorectal Adenocarcinoma
Hnpcc
Fap
Peutz jehgers
Juvenile polyposis syndrome
249
Which gene function is affcted in HNPCC
Gene participating in ENA mismatch repair
250
What are the clinical features of colorectal carcinoma
- 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
251
What are is the current UK programme for bowel cancer screening
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
252
What imaging investigations would you perform on a patient with ?colorectal cancer
Colonoscopy
Ct colonography
Barium enema
253
What is the treatment with curative intent for colorectal carcinoma
Colorectal resection, excision of colonic mesentery, ligation of arterial supply, lymph node excision, formation of colonic j pouch
254
List some macroscopic appearance types of colorectal Adenocarcinoma
Stenosing
Ulcers ting
Polypoidal
255
What is t1-4 of colorectal cancer
T1- invades submucosal
T2- muscularis propria
T3- subserosa
T4- invades adjacent organs/peritoneum
256
What is n0-3 in colorectal cancer staging
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
257
What is M0 and M1 in TNM staging of colorectal cancer
T0- no distant metastasis
| T1- distant metastasis
258
Why is radiotherapy a good adjuvant therapy
Reduces recurrence rates
259
How are fixed, inoperable colorectal tumours managed
Radical radiotherapy, combined with chemotherapy such as 5-FU
260
How does 5-fu chemo generally work
Inhibit thymidylate synthesis
261
What is the palliative therapy for colorectal cancer
- colostomy to divert faecal stream
- palliative stent
- control pain, mucous discharge, altered bowel habit, bleeding, incontinence
- palliative chemo
262
How is lymphoma of the large intestine treated
Resection followed by chemo and radiotherapy if primary lymphoma
Systematic therapy and targeted radiotherapy if secondary lymphoma
263
What are the two muscle layers in the anorectum
Internal and external sphincterectomy
264
The inner layer of anorectum muscle is a continuation of the git, therefore what inner ages it
Sympathetic and parasympathetic nervous system, arising from the nerve plexuses
265
What function does the continuous inner action of the internal muscle of the anorectum have
Maintains tone and continues to resting pressure inside canal
266
What type of muscle is the external sphincter of the anorectum
Striated
267
What is the inner action of the external anal sphincter
Voluntary
268
Which nerve supplies the external anorectum sphincter
Internal pudendal nerves
269
What type of epithelium lines the internal and external zones of the anal canal
Internal - columnar
| External - stratified squamous (keratinised)
270
What are anal cushions
Specialised vascular structures that lie in the submucosa of the anal canal, above the dentate line
271
What is the function of anal cushions
Aide in fine control of continence
272
What is the lymphatic drainage of the anal canal
Inferior mesenteric, aortic, internal iliac
273
Which lymph nodes does anal cancer frequently metastasise to
Inguinal lymph nodes
274
What are first degree haemorrhoids
Bleed, don't prolapse, seen on proctoscopy
275
What are second degree haemorrhoids
Propose during defaecation but reduce spontaneously
276
What are third degree haemorrhoids
Constantly prolapse but can be reduced manually
277
What are fourth degree haemorrhoids
Irreducibly prolapsed
278
How would you manage first degree haemorrhoids
Encourage patient to not strain during defaecation and avoid constipation
279
How do you manage 2nd degree haemorrhoids
Banding, injection sclerotherapy, haemorrhoidectomy
280
How are third degree haemorrhoids managed
Haemorrhoidectomy
281
Los some causes of severe acute anal pain
- perianal abscess
- anal fissure
- thrombosed haemorrhoids
- perianal haematoma
- anorectal cancer
282
What are haemorrhoids
Enlarged prolapsed anal cushions due to the degeneration of the supporting fibroelastic tissue and smooth muscle (unknown cause)
283
What are the clinical features of haemorrhoids
prolapse
Intermittent bleeding seen on wiping or in the pan
Aching or discomfort on defaecation
Pruritus
284
Is it common for patients with haemorrhoids to present with incontinence
No
285
What are emergency complications of heart hoods
- thrombosed (blue/black) prolapsed piles
| - torrential haemorrhage
286
What is the generic management for piles
- high fibre diet
- bulk laxatives + stool softeners
- band ligation/sclerosant injection/ photocoagulation/ haemorrhoidectomy
287
What is an adverse functional side effect of haemorrhoidectomy
Incontinence
288
What is a fissure-in-ano
A tear in the squamous lining of the lower anal canal, often with a sentinel pile or mucosal tag at the external aspect
289
What is the cause of anal fissures
Hard faeces, making defaecation difficult; spasm may construct inferior rectally artery causing ischaemia and making healing difficult as well as perpetuating the problem
290
Which GI condition are anal fissures often associated with
Crohns disease
291
What is the management for anal fissures
```
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
Lost some conditions that may predispose to perianal abscess
CD, UC, immunosuppression, DM, chemo
293
How do perianal abscesses arise
Initiated by blockage of anal gland ducts,a nd the anal gland becomes secondarily infected with large bowel organisms
294
What are the clinical features of perianal abscesses
Acute anal pain and tenderness, difficulty sitting
| Pus can track and patient may become toxic and pyrexial
295
How are perianal abscesses managed
If it doesn't respond to antibiotics alone, requires surgical drainage under general anaesthetic. Send pus for bacteriological asses,sent for causative organism
296
Which antibiotics are given if a patient with perianal abscess also has ex festive cellulitis
Cephalosporins and metronidazole
297
What is the pathogens is of fistula
Preceded by perianal abscesses,w chin have formed due to blockage of anal gland.
298
What are the clinical features of fistula in ano
- chronically discharging opening perianally
- pruritus
- perianal discomfort
299
What other condition should be excluded when a patient present with fistula in ano
Crohns
300
What is the a management of fistula in ano
- 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
Why is important to gradually lay open a fistula rather than in one operation
It would lead to incontinence; it cuts through the sphincters and gradual lay open allows the sphincter muscle to heal behind it
302
What is the aetiology of fistula in ano
Crohns disease, anorectal trauma, iatrogenic, anorectal carcinoma
303
What are the symptoms of anal warts
Discomfort, pain, pruritus ani
304
Why is there an increased risk of SCC in patients with anal warts
Associated with HPV
305
How are anal warts that do not resolve spontaneously managed
Podophyllotoxin, surgical excision
306
Are anal skin tags usually managed by surgery
No, not unless they cause significant symptoms and complications
307
What are anal skin tags usually a comsquence of
Haemorrhoids
308
Which epithelium does anal cancer usually arise form
Keratinised squamous epithelium of anal margin or non keratinised sum sous epithelium of transitional zone immediately above the dentate line
Very few adenocaricnomas
309
Which types of HPV are strongly associated with anal cancer
16; 18
310
What is the premalignant lesion to anal cancer
Anal Intraepithelial neoplasia (AIN)
311
What are the signs and symptoms of anal cancer
Anal pain, bleeding, discomfort, discharge into underwear, pruritus ani
312
What symptom will a patient with anal cancer wh in has spread to anal sphincters experience
Incontinence
313
How is anal cancer diagnosis confirmed
biopsy
314
What is the management for anal cancer
Lower stage - wide surgical excision
| Later stages - radiotherapy to anal canal + inguinal lymph; surgery in radiotherapy failure
315
What is rector prolapse
Abnormal protrusion of all (fully thickness) or part of the rectal wall (mucosa)
316
What are the most common aetiological factors for rectally prolapse in young people
Chronic constipation, straining, childbirth
317
How is rectus prolapse managed in children (self limiting)
Maintain regular bowel habit, stool softeners, digital reduction by parents
318
How is mucosal (partial) rectal prolapse managed
Submucosal sclerosant injection, photocoagulation, application of bands, limited excision
319
How is full thickness rectal purpose managed
Surgery
320
What are the causes of anal incontinence
- structural muscle damage
- disruption of nerve supply
- urgency e.g. UC
- damage to sphincters e.g. Childbirth
- nerve injury during childbirth
- neurodegenerative disease
321
What questions are import at to ask about she taking a history form a patient presenting with incontinence
- past surgery
- obstetric history
- coexisting disease
- urinary incontinence
- defaecation history
322
What do you examine for in a patient with rental prolapse
Sphincter tone, previous scars, sensation
| Sigmoidoscopy/colonoscopy to exclude other cases
323
What is the conservative management for rectal prolapse?
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
What is the surgical management for rectal prolapse?
Implants graciloplasty
| Permanent colestomy
325
Give some causes for pruritus ani?
Haemorrhoids, fistulae, fissures, incontinence, anal carcinoma, rectal prolapse, dermatological conditions
326
How do you treat pruritus ani?
Treat underlying condition,
discourage scratching, use of perfumed soaps, antiseptics
Gentle cleaning habits
Barrier cream
327
What is pilonidal disease?
Chronic inflammation in one or more sinuses in the midline of the natal cleft that contain hair and debris
328
What is the histology of pilonidal sinuses?
Lined with squamous epithelium but tracts are lined with granulation tissue from chronic infection
329
What are the clinical features of pilonidal disease?
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
What is management for pilonidal disease?
```
Natal cleft hygiene
Depilation
Antibiotics, if abscess
Drainage
Surgery to lay tracts open and remove granulomas
Closure with sutures
```
331
What is the APACHE scoring system
Classification system which rates the severity of patients risk of dying in hospital
332
Give some examples of factors taken into account in the APACHE scoring system
Core temp, he, BP, creat, age, chronic illness...
333
List some conditions which may increase risk in surgery
```
Resp - asthma, COPD
Diabetes
Cardiac - ihd, HF, arrhythmia
Alcoholism
Obesity
Neuro - myasthenia, CVA, Parkinson's, guillain barre, malignant hyperthermia
```
334
Which drugs may people with alcoholism be tolerant to in anaesthesia
BZDs
335
Why is obesity a problem in surgery, what is different in managing these patients
May require high oxygen concentrations
BP measurements less reliable
If access may be more difficult to obtain
336
What is the preop management of diabetes
Measure HbA1C, BP, BMI
Details of complications
Optimise glycemic control
Make plan for surgery
337
How are diabetic patients managed PERIoperatively e.g. Medicine changes
- 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
How do you change the following diabetes drugs for surgery:
- oral hypoglycaemics
- long acting insulin
- 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
How often do you check blood glucose in surgery and post op in patients with diabetes
Surgery - hourly
| Post op - every 2 hours
340
What is the mechanism of action of cyclizine
Anticholinergic / antihistamine
341
What is the dose of cyclizine
50mg tds
342
What is the mechanism of action of ondansetron
5HT3 antagonist
343
What is the mechanism of action of metoclopramide
D2 antagonist
344
What Is the dose of metoclopramide
10mg tds
345
What is the mechanism of action of prochlorperazine
D2 antagonist
346
What is the mechanism of action. Of hyoscine bromide
Anticholinergic
347
What are some of the side effects of 5HT3 antagonists
Dizziness, confusion, tachycardia
348
What is a PICC line
Central venous catheter. Form of iv access used for prolonged period of time e.g. Chemo, abx
349
Los the three types of reasons for confusions in patients undergoing surgery
- delirium
- dementia
- post operative cognitive dysfunction
350
What is post operative cognitive dysfunction
Short term decline in cognitive function lasting few days. Does not have all the typical features of delirium, not the same
351
What is the most common post op arrhythmia
AF
352
What are the characteristics of septic shock initially, then how does this chnage later
Initially - hyperdynamic circulation, fever, rigors, warm dilated peripheries, bounding pulse
Later - BP decreases, peripheral vasoconstriction, Oliguria, multisystemic failure
353
What is a specific complication of endarterectomy
Stroke
354
What are the medical treatments for delirium
Diazepam, vit b
| If extreme agitation - diazepam or haloperidol
355
What Re the features of UTI which may be seen in post op patients
Frequency, dysuria, mild fever, flank pain
356
What are the three components of virchows triad
- increased coagulability
- stasis
- endothelial damage
357
What are the risk factors for venous thrombosis
- obesity
- age
- prolonged immobility
- hip/pelvic surgery
- prolonged surgery
- prev DVT/PE
- malignancy
- pregnancy
- OCP
358
What is the policy for those who take the OCP preop
Stop 4 weeks before surgery and offer alternative contraceptive advice for that time
359
Describe epidural anaesthesia
Continuous local anaesthetic +/- opioid infusion into the epidural space, set to run at a certain rate
360
How many days can an epidural catheter remain in situ before it has to be removed post op
5 days
361
What are the causes for epidural failure
Misplacment, displacement, inadequate analgesia, intolerable side effects, very very rarely permanent neurological damage
362
Why may respiratory distress occur with epidural anaesthesia
Cephalosporins spread of anaesthetic
363
Describe patient controlled analgesia
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
What is the maximum dose of PCA analgesia
1 mg morphine at 5 min intervals
365
What are some of the drawbacks to PCAs
Lack of patient understanding to use it and lack of patient dexterity, correct programming
366
List some agents that may be used for neuropathic pain
- tricyclic antidepressants
- gabapentin/pregabalin
- lidocaine
367
Why do patients get acute renal failure post op
Inadequate perfusion to kidneys; hypovolaemia, water depletion, drugs, sepsis
368
How can acute renal failure be prevented in surgery
Adequate fluid replacement perioperatively
369
What is the MINIMUM urine output
0.5ml/kg/hour
370
Which invasive method can be used to monitor circulating volume and heart preload
CVP line
371
What is the a management of a patient in an extreme case where conservative management persistently fails
Renal replacement therapy
372
Why may airway obstruction occur perioperatively
Decreased level of consciousness and reduced muscle tone
373
List some causes of airway obstruction perioperatively
- 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
Which particular operation has an increased risk of tracheal compression
Thyroid tony- compression by haemorrhage
375
What is the management for airway obstruction
Chin life, jaw thrust, removal of objects, oropharnygeal airway, O2 administration
376
How is the appropriate size chosen for oropharnygeal airways
Measured between first incisors and angle of the jaw
377
What is the definition of reps failure
Inability to maintain normal O2 and co2 pressures in arterial blood,
378
What is normal pa02
>13 kpa
379
What is pao2 is considered resp failure
Less than 6.7 kpa
380
Which post op complications are common in the first four pays after surgery
Acute MI, pyrexia due to atelectasis, CVA
381
Which post op complications are common in the first 7 days after surgery
Renal impairment, post op urinary retention
382
Which complication is common in days 5-10 post op
Delirium tremens
383
Which post op complications are common in days 7-10 after surgery
Chest/wound infection, UTI, secondary haemorrhage
384
Which post op complications are common in patients over 10 days after surgery
DVT, PE, wound dehiscence
385
What is late secondary haemorrhage usually due to post operatively
Infection eroding a blood vessel
386
How are late secondary haemorrhages manged
Re exploration surgery
387
List some Respiraotyr post op complications
- pulmonary collapse
- infection
- resp failure
- ARDS
- pleural effusion
- pneumothorax
388
How are Respiraotyr post op complications managed
Treat underlying cause, administer oxygen, supported ventilation
389
What are some of the complications in iv administration of anaesthesia - what local damage is done
Bruising, haematoma, phlebitis, venous thrombosis, air embolus, site infection
390
How is a post op DVT treated
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
What Are the clinical characteristics of acute reosiratory distress syndrome
Impaired oxygenation, diffuse lung opacification on CXR, decreased lung compliance
392
List some causes of ARDS Periop
Pulmonary or systemic sepsis, massive blood transfusion, gastric contents aspiration
393
What are the signs and symptoms of ARDS
Tachypnoea, increased ventilators effort, restlessness, confusion
394
What is the pathophys of ARDS
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
How are post of pleural effusions managed
Small ones are usually left alone to reabsorb if they don't interfere with inspiration, but large ones require pleural fluid aspiration
396
How do you manage ARDS
Cventilatory support - positive end exploratory pressure (PEEP), treat underlying condition
397
What is a common cause of surgical emphysema
CVP line insertion
398
What are some of the effects anaesthetic agents have witch contribute to pulmonary collapse
- paralysis of cilia
- impaired diaphragmatic movement
- over sedation
- abdominal distension
- wound pain causing patient to not breathe deeply
399
How post op lung collapse be prevented
Breathe deeply, cough, mobilise, regular analgesia, chest physio,
O2, salbutamol, assisted ventilation if hypoxia severe
400
How are patients with post op chest infections due to aspiration managed
Encouraging them to cough, prescribing antibiotics, send sputum for bacteriology,
oxygen if hypoxic, assisted ventilation if resp function deteriorates
401
What are the three steps of the WHO pain ladder
1- non opioids +/- adjuncts
2- mild opioids +/- non opioids, +/- adjuvant
3- opioid +/- non opioids, +/- adjuvant
402
List some opioid analgesics
Morphine, pethididne, sia morohine, codeine phosphate, tramadol
403
List some step 1 WHO ladder analgesics
Aspirin, NSAIDs, paracetamol, selective cox-2 inhibitors
404
List some step 2 WHO ladder analgesics
Codeine phosphate, tramadol, cocodamol
405
What are step 3 WHO ladder analgesics
Morphine, fentanyl
406
What are spathe symptoms of massive PE
Severe chest pain, pallor, shock
407
What agents do you use for fibrinolysis in a massive PE
Streptokinase or urokinase
408
What drug should be started for 6 months after a patient suffers a massive PE
Warfarin
409
If a PE patient cannot be coagulated or sustains further PE despite management, what next step should be considered
Inferior vena caval filter
410
What is evisceration in wound dehiscence
Extrusion of abdo viscera through abdo wound dehiscence
411
What is the total body water content
42 L
412
What is the total ECF and ICF body fluid content
ECF - 14 L
| ICF - 28 L
413
How much ECF is interstitial a pond how much is intravascular
Interstitial - 11-12L(4/5)
| Intravascular - 3L (1/5)
414
What is the total daily fluid input and output into adults
2.6 L input and 2.6 output
415
How much fluid is lost in the urine, faeces, lungs and skin respectively
Urine -1.5 L
Faeces - 100 ml
Lungs - 400 ml
Skin - 600ml
416
List crystalloid fluids
Normal saline, dextrose, combinations, hartmanns
417
Name some colloids
Gelofusin/volplex , starch, albumin, blood products
418
What are the ion requirements in adults
Adults
Na+ 2mmol/kg/day
K+ 1mmol/kg/day
419
Hey are the dialup water reuqirements in adults
40ml/kg/day
420
What is the intracellular and extra cellular potassium requirements
Intracellular - 135 mmol
| Extra cellular - 5 mmol
421
What are the intracellular and extra cellular sodium levels
Intracellular - 9 mmol
| Extra cellular - 143 mmol
422
What are he intracellular and extramedullary cl- levels
Intracellular - 9 mmol
| Extra cellular - 193 mmol
423
What are the intracellular and extra cellular hco3- levels
Intracellular - 9 mmol
| Extra cellular - 24 mmol
424
How would a 5% dextrose fluid solution distribute in the fluid compartments of the body, and how much remains intravascularly
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
How would 0.9% saline distribute within the body fluid compartments, and what volume would therefore remain intravascularly
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
How would colloids distribute throughout the body fluid component,s therefore how many ml would remain within the intravascular space
Would remain entirely intravascularly therefore 1L would remain intravascularly
427
What are the daily sodium and potassium fluids requirements in a 70kg male
```
Na+ = 2x70= 140mmol/day
K+ = 1x70= 70mmol/day
```
428
Calculate the daily fluid requirements of a 70kg male
40x70= 2800 ml/day
429
What three things are taken into account when calculating an adults fluid requirements
Maintenance requirements + pre existing deficit + replacement of ongoing losses
430
Calculate a 22kg child's daily fluid requirements
```
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
List some causes of ongoing looses in fluid
Vomiting, diarrhoea, ugh output stoma, enterocutaneous fistula
432
Which electrolytes Apis diarrhoea rich in
K+ and HCO3-
433
Which electrocutes is vomit rich in
K+, H+, cl-
434
Which antibody and which antigen is present I group a blood
Antibody - b
| Antigen - a
435
Which antibody and which antigen is present in group b blood
Antibody - a
| Antigen - b
436
Which antibody and which antigen is presentin group ab blood
Antibody - none
antigen - ab
Universal receiver
437
Which antibody and which antigen is present in group o blood
Antibody - ab
Antigens - none
universal donor
438
How much is one unit of blood in pints and most
1 unit = 1 pint
| 1 pint = ~450 mls
439
How many units of blood are there the body, therefore how many L
10 units therefore 4.7-5.5 L
440
What is defined as a massive blood transfusion
Transfusing 10units of blood in 24 hours or >50% of patients blood volume in 4 hours in response to massive uncontrolled haemorrhage
441
What are the different type of blood components that can be transfused
- red cells
- platelets
- FFP
- cryoprecipitate
- human albumin
- factor IX and VIII
- prothrombin complex concentrate (berriplex)
442
When is FFP used
Multiple coagulation factor deficiencies
| severe bleeding; those who are over coagulated e,g, warfarin sometimes
443
Which coagulation factors are found in cryoprecipitate
Fibrinogen, factor VIII, XIII, vWf, fibronectin
444
What su the function of factor XIII
Cross links fibrin
445
When is cryoprecipitate transfusion used
When fibrin levels are low e.g. DIC
446
When is human albumin transfused
Conditions with increased vascular permeability e.g. Burns, oedema or ascites resistant to diuretics
447
When are factor IX and VIII infusions used
Haemophilia treatment
448
What factors does prothrombin complex contain (beriplex)
II, IX, X, +/- VII (vit K dependent)
449
When is prothrombin complex concentrate (beriplex) used
Reverse anticoag effect of warfarin when there is major bleeding
450
What tests are performed on blood used for transfusion before use
Grouping
Antibody screening
Cross matching if urgent
Group and save
451
Which liver enzyme is increased in patients with pancreatitis
ALT
452
When are gallstones treated symptomatic ally
If symptomatic
453
What is the "acute abdomen"?
Conditions of the abdomen requiring hospital admission, investigation and treatment and of less than 1 week duration. Primary symptom is abdo pain.
454
What are the 2 main pathological processes involved in the acute abdomen
Inflammation
| Obstruction
455
What is the most common cause of generalised peritonitis?
Perforation of an intra-abdominal viscus
456
What is a hiatus hernia
Abnormal protrusion of the stomach through the diaphragm into the thorax. Can be sliding (more common) or rolling
457
What are the clinical features of hiatus hernia
```
Heartburn
Oesophagitis
Epigastric and lower chest pain
Palpitations
Hiccups (irritation of pericardium and diaphragm)
```
458
How would you manage a hiatus hernia
As per GORD
| obstructive symptoms should be considered for surgical repair, ng tube and endoscopy
459
What are obstructive symptoms for hiatus hernia
Vomiting
Regurg
Breathlessness due to reduced lung capacity
460
What is achalasia
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
What are the clinical features of achalasia
```
Progressive dysphagia (both solids and liquids)
Regurg
retrosternal pain
Weight loss
Regurg
Aspiration pneumonia
```
462
How do you go about managing achalasia
Balloon dilatation of LOS
Surgical myotomy
Laparoscopic Hellers myotomy
463
How does GORD present
```
Heartburn
Acid regurg
Nausea
Hypersalivation (waterbrash)
Epigastric pain
Occasionally vomiting
```
464
What anatomical or physiological factors usually prevent acid reflux
Angle at which oesophagus joins stomach
LOS
Diaphragmatic crus
465
How do you gain a diagnosis of GORD
History
Endoscopy
Ph study
466
What is the lifestyle treatment for GORD
```
Weight loss
Stop smoking
Eat less fatty food
Eat less spicy food
Drink less caffeine and alcohol
```
467
What is the medical treatment of GORD
PPIs
| Metoclopramide, to promote gastric emptying and prevent nausea
468
How is barretts oesophagus diagnosed
Endoscopic biopsy
469
When is antireflux surgery indicated in a patient with GORD
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
What does surgery for GORD involve
Reducing hiatus hernia if it is present and some form of fundoplication/wrapping fungus of stomach around the oesophagus
471
How does fundoplication/antireflux surgery work to prevent acid reflux
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
What is diffuse oesophageal spasm
A condition caused by repetitive irregular peristalsis
473
How is diffuse oesophageal spasm diagnosed
Oesophageal manometry
474
How is diffuse oesophageal spasm treated
CCB, sublingual GTN, PPIs
475
What is Plummer Vinson syndrome
A condition where a web forms, which results in dysphagia
476
What causes is Plummer Vinson syndrome related to
Iron deficiency
| Congenital
477
In a patient with Plummer Vinson syndrome caused by iron deficiency anaemia, what would you expect to see on performing bloods
Hypochromic microcytic anaemia
| Low serum ferritin
478
What investigation can demonstrate a Plummer Vinson syndrome web
Barium swallow demonstrates narrowing in the upper oesophagus
Confirm with endoscopy
479
How do you manage a Plummer Vinson syndrome web
Dilating web endoscopically
| Oral Iron therapy as needed
480
What are oesophageal pouches
Protrusions of mucosa through weak areas in the oesophageal wall
481
What is a common area for oesophageal pouches
Through Killians dehiscence
482
Where is Killians dehiscence in the oesophagus
Between the thyropharyngeus and cricopharyngeus muscle
483
Lis some of the symptoms of a pharyngeal pouch
```
Regurg
Halitosis
Dysphagia
Gurgling in throat
Aspiration
```
484
How would you investigate pharyngeal pouches
With a barium swallow
485
How are pharyngeal pouches managed
Myotomy of cricopharyngeus and resection of pouch
486
What are the aetiological factors for peptic ulcers
H pylori
NSAIDs
Smoking
Genetic factors
487
What is Zollinger Ellison syndrome
Gastrinoma (gastrin secreting tumour), normally found in pancreas, but also in duodenum and stomach
488
How is Zollinger Ellison syndrome diagnosed
Ct and mri to localise tumour
489
How is Zollinger Ellison syndrome managed
Remove tumour
490
What are the clinical features of peptic ulcers
Well localised epigastric pain
Gastric ulcers painful when eating
Duodenal ulcers painful when hungry/at night
491
What factors may patients with peptic ulcer disease say relieve their pain
Food, milk, antacids and vomiting
492
How are peptic ulcers diagnosed
Endoscopy and biopsy
493
How are peptic ulcers managed
Avoid NSAIDs, smoking, excessive alcohol
| Triple therapy of PPIs and amoxicillin/metronidazole and clarithromycin
494
Give some intraluminal causes of oesophageal
| Perforation
Foreign body
| Rigid endoscopy
495
Give some external causes of oesophageal perforation
Penetrating injury
496
What is a Malory Weiss tear
Spontaneous perforation of the oesophagus, usually caused by violent vomiting. Results in haematemesis and pain
497
What are the clinical features of oesophageal perforation
Pain in neck
Vocal tenderness
Surgical emphysema
Mediastinitis and septic shock may result
498
What are some of the investigations for oesophageal perforation
Erect CXR
Ct scan
Contrast swallow
499
How is oesophageal perforation managed
Surgically, with prophylactic antibiotics and antifungals
500
What are the histological types of oesophageal tumour
Benign leiomyomas
Squamous cell carcinoma
Adenocarcinoma
501
What are the clinical features of oesophageal cancer
Progressive dysphagia to solids
| May have metastatic disease signs
502
What are the investigations for oesophageal cancer
Initially barium swallow, blood tests
Endoscopy and biopsy
Staging with ct and pet scans and laparoscopy
503
What is the management of oesophageal cancer
Surgical resection + jejunostomy post op
Radiotherapy and chemo
Palliative - most are non operable
504
What clinical symptoms may you encounter in a patient with perforated duodenal ulcer into the gastro duodenal artery
Acute onset unremitting epigastric pain
Shoulder tip pain
Vomiting
Symptoms of shock
505
What investigations would perform in a patient with perforated ulcer
CXR to show free air under diaphragm
| Ct contrast barium meal
506
How do you manage a perforated ulcer
```
Resusc
O2
Fluids
Broad spectrum abx
Ng tube
IV opiates
PPIs
Urinary catheter
Surgery to close ulcer
```
507
Iist some causes of an upper GI bleed
```
Peptic ulcers
Gastritis
Duodenitis
Erosions
Malory Weiss tear
Reflux oesophagitis
Varices
Angiodysplasia
Carcinoma
Aortoduodenal fistula
Dieulafoy syndrome
Caogulopathies
```
508
What does a FBC show in a patient with haematemesis
Normal initially
Anaemia if bleeding is chronic
Urea high
509
How are gi bleeds investigated
Endoscopy
| Angiography
510
How are gi bleeds treated/managed
Surgically
Injection sclerotherapy
Band ligation
511
Give an example of a benign gastric neoplasm
Adenomatous polyps
512
What is the most common type of gastric carcinoma
Adenocarcinoma
513
What are some less common gastric carcinomas, following Adenocarcinoma
Lymphoma
Carcinoids (neuronendocrine)
Gi stromal tumours
514
Give some aetiological factors for gastric neoplasia
```
Diet
H pylori
Infection
Hereditary
Gastric polyps
Chronic strophic gastritis
Intestinal metaplasia
Gastric dysplasia
```
515
How is gastric neoplasm diagnosed, following history and examination
```
Upper gi endoscopy
Biopsy
Ct staging
Endoscopic USS
Laparoscopy
Pet ct
```
516
How do you manage gastric cancer with curative intent
Gastric tony and removal of nodes +/- preop chemo
517
How would you treat a patient with oesophageal cancer with palliative intent
Chemo and radiotherapy
Stenting
Surgical bypass
518
What are stages t1-t4 of gastric neoplasia
T1- invades lamina propria or submucosa
T2- muscularis propria or subserosa
T3- serosa
T4- adjacent structures
519
How are gastric neoplasms diagnosed
Endoscopy
| Endoscopic ultrasound scan
520
What investigations could you do in a patient with Plummer Vinson syndrome
Bloods - anaemia, ferritin and iron levels
Barium swallow
Endoscopy
521
At which Hb conc is transfusion considered
522
What steps should be taken before transiting blood into a patient
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
List some acute effects of blood transfusion
1) acute haemolytic reaction
2) TRALI
3) febrile non haemolytic transfusion reaction
4) allergic reaction
5) bacterial contamination
6) transfusion related circulatory overload
524
What are some of the delayed transfusion reactions
1) delayed haemolytic transfusion reaction
2) alloimmunisation
3) post transfusion purpura
4) graft vs host disease
5) transfusion transmitted reaction
6) iron overload
525
Why may acute haemolytic transfusion reaction occur
ABO incompatible, intravascular haemolysis
526
What are the signs and symptoms of acute haemolytic transfusion reaction
Chills, fevers, rigors
Hypotension, shock, DIC
ARF
527
Why does TRALI occur
Antibodies in donor blood reacts with recipients leucocytes
528
What are the signs and symptoms of TRALI
Dyspnoea, cough, fever, hypoxia, pulmonary infiltrates
529
Why does febrile M&m haemolytic transfusion occur
Antibodies in patients blood react with blood donors leucocytes
530
What are the signs and symptoms of allergic reactions to transfusion
Urticaria, itch, severe anaphylaxis
531
Why does transfusion related circulatory overload occur
Too much blood affects LV function - failure
532
What are the signs and symptoms of fleshed haemolytic transfusion reactions
Jaundice, fever, haemoglobinuria
533
How do patients with post transfusion haemolysis present
Thrombocytopenia and bleeding
534
How do patients with graft vs host disease after transfusion present
Fever, rash, abnormal LFTs, pancytopenia
535
Which organs can iron accumulate in with iron overload
Liver, heart, pancreas
536
What are the different types of autologous transfusion
- pre op donation
- isovolaemic haemodilution
- cell salvage
537
How does preop donation work in autologous transfusion
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
How does isovolaemic haemodilution work
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
What is cell salvage
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
When is cell salvage not used
Malignancy or sepsis
541
Give some reasons for direct arterial pressure monitoring
- failure of indirect monitoring
- arterial blood sampling
- continuous reactive monitoring
542
List some complications of direct arterial monitoring
Distal ischaemia
543
Why is a central venous catheter used
For monitoring CVP, prolonged drug administration, parenteral administration
544
How can you reduce the risk of damaging collateral structures when inserting a CVP line
Ultrasound scan
545
What are common insertion sites for Central Venous Catheters
SVC, subclavian vein, internal jugular, occasionally peripheral vein in antecubital fossa (PICC)
546
the pressure in which chamber of the heart does a central venous catheter give an indication for
RA
547
What are some of the complication of inserting a central venous catheter
Arterial puncture, haematoma, haemothorax, nerve injury, air embolism, sepsis, PE, cardiac tamponade
548
List the different types of airway ventilation used in surgery and anaesthesia
- jaw thrust, chin lift
- bag and mask ventilation
- LMA
- endotracheal intubation
- surgical airway
- oropharnygeal (Guedel)
- nasopharyngeal
549
Wh in membrane is a surgical airway created through
Cricothyroid membrane
550
What are. The two types of surgical airway
- needle cricothyroidectomy (plastic cannula)
| - surgical cricothyroidectomy (inserting tracheostomy tube)
551
Why would you choose an nasopharyngeal airway over an oropharnygeal airway
Nasopharyngeal used when patient ja co so out and oropharnygeal airway would induce a gag reflex
552
When is an oropharnygeal airway used in cardiac emergency
Airway adjunct in mi
553
Where is the mid inguinal point
Half way between the public symphysis and ASIS
554
Where is the mid point of the inguinal ligament
Half way between the pubic tubercle and ASIS
555
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
556
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
557
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
558
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
559
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
560
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
561
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
562
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
563
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
564
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
565
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
566
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
567
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
568
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
569
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
570
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
571
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
572
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
573
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
574
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
575
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
576
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
577
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
578
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
579
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
580
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
581
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
582
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
583
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
584
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
585
Where does the deep inguinal ring lie anatomically
Mid point of inguinal ligament
586
What anatomical structures are found at the mid inguinal point
Femoral artery
587
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
588
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
589
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
590
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
591
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
592
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
593
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
594
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
595
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
596
What is the difference in location of the inguinal and femoral hernias in relation to the pubic tubercle
Femoral - below and lateral to the pubic tubercle
| Inguinal - above and medial to the public tubercle
597
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
598
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
599
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
600
What are the borders of the femoral triangle
- inguinal ligament superiorly
- sartorius muscle laterally
- adductor longus medially
601
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
602
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
603
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
604
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
605
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
606
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
607
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
608
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
609
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
610
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
611
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
612
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
613
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
614
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
615
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
616
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
617
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
618
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
619
List conditions in he right hypochondrium
- acute cholecystitis
- duodenal ulcer
- hepatitis
- hepatomegaly
- pyelonephritis
620
List the conditions presenting in the epigastric.
- peptic ulcers
- GORD
- gastritis
- epigastric hernia
- MI
- pancreatitis
- AAA
621
List the conditions presenting in the left hypochondrium
- splenomegaly
- splenic rupture
- pancreatitis
- peptic ulcer
- AAA
- perforated colon
- pneumonia (L)
622
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
623
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
624
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
625
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
626
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
627
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
628
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
629
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
630
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
631
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
632
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
633
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
634
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
635
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
636
List some of the conditions in the right flank
- renal calculi
- UTI
- lumbar hernia
637
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
638
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
639
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
640
List some of the conditions presenting in the peri umbilical region
- initial appendicitis
- gastritis
- small bowel obstruction
- umbilical hernia
- IBD
- AAA
641
List some of the conditions presenting in the left flank
- renal calculi
- UTI
- IBD
- diverticular disease
642
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
643
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
644
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
645
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
646
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
647
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
648
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
649
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
650
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
651
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
652
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
653
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
654
List some of the conditions presenting in the right iliac fossa
- appendicitis
- inguinal hernia
- pelvic pain
- salpingitis
- ruptured ectopic pregnancy
- renal calculi
- Crohns
- mesenteric adenitis
- ovarian abscess
655
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
656
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
657
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
658
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
659
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
660
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
661
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
662
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
663
Which infections does splenectomy predispose patients to
Infections from encapsulated bacteria e.g. Strep. pneumoniae, H. Influenzae
664
What is mesenteric adenitis
Inflammation of mesenteric lymph nodes
665
List some of the conduit a presenting in the supra public region
- UTI
- cystitis
- IBD
666
List some of the conditions in the left iliac fossa
- rectal mass
- diverticulitis
- obstruction of large bowel
- inguinal hernia
- diverticular disease
- UC
- ovarian abscess
- ruptures ectopic pregnancy
- saying its
- strangulated hernia
- CD
