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SMS > GI surgery > Flashcards

GI surgery Flashcards

1
Q

Presentation of gastric ulcer

A

burning epigastric pain. Presents with nausea, vomiting, belching and heartburn. Made worse by eating and relieved by vomiting. Often worse during the day.
Always biopsy

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2
Q

Presentation of duodenal ulcers

A

burning epigastric pain 2-3hrs after eating. Radiates to the back often worst at night with bloating and heart burn. Precipitated by missing a meal- biopsies not needed

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3
Q

first line management of peptic ulcers

A

H. Pylori eradication

- PPIs

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4
Q

Define:

  1. Kocher’s sign
  2. Rovsing’s sign
  3. Psoas sign
  4. Dunphey’s sign
  5. Sitkovsky’s sign
A
  1. periumbilical pain moved to RIF
  2. pain RIF > LIF when LIF is pressed
  3. pain in RLQ on coughing
  4. Pain in RLQ lying on left side
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5
Q

cardinal features of bowel obstruction

A

absolute constipation
vomiting
colicky pain
distension

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6
Q

Management of

a) sigmoid volv
b) caecal volv

A

a) sigmoidoscopy and flatus tube decompression

b) usually requires right hemicolectomy

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7
Q

emergency procedures in diverticulitis

A

Hartmann’s procedure

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8
Q

Presentation of acute mesenteric ischaemia

A 
acute abdominal pain
PR bleed
rapid hypovolaemia
normal abdo exam
Pts usually have AF
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9
Q

investigation of choice in mesenteric ischaemia

A

CT scan

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10
Q

what is ischaemic colitis

A

acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in ‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

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11
Q

management of ischaemic colitis

A

usually supportive

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12
Q

Boas’ sign

A

RUQ/ epigastric pain that radiates to right shoulder

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13
Q

Mirizzi syndrome

A

common hepatic duct obstruction due to impacted stone in cystic duct causing obstructive jaundice

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14
Q

Risk factors for gallstone disease

A 
female
fat
fair
fertile
>40s
crohn's disease
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15
Q

Charcot’s triad

A
  • jaundice
  • fever
  • RUQ pain
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16
Q

Glasgow score

A 
Pa02 <8kPa
Age >55yrs
Neutrophilia (WCC >15)
Calcium <2
Renal failure (urea >16)
Enzymes (LDH >600)
Albumin <32
Sugar >10
17
Q

Causes of acute pancreatitis

A 
idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion bites
Hypercalcaemia/hypothermia/hyprlipidamia
ERCP
drugs (lithium, azathioprine)
18
Q

Presentation of chronic pancreatitis

  • management
  • surgical options
A

severe, constant pain radiates to back with loss of exocrine and endocrine dysfunction

  • oral pancreatic enzymes, ADEK vitamins
  • Whipples
19
Q

Presentation of pancreatic carcinoma

A

painless obstructive jaundice with epigastric pain that radiates to the back
- sudden onset DM in the elderly

20
Q

what is trousseau sign of malignancy

A

migratory thrombophlebitis presents in pancreatic ca

21
Q

sister mary joseph nodule?

A

umbilical mets from gastric ca

22
Q

features of the gastric blatchford bleeding score

A 
urea
Hb
systolic BP
pulse
melaena
syncope
hepatic disease
cardiac failure
23
Q

Definitive diagnosis of coeliac disease

A

OGD & biopsy- subtotal villous atrophy, crypt hyperplasia

24
Q

surgical management of:

a) rectal ca
b) sigmoid ca
3) descending colon ca
4) ascending colon ca

A

a) anterior resection wih temp loop ileostomy
- if <4cm from anal verge use AP resection with end colostomy
b) high anterior resection
c) left hemicolectomy
d) right hemicolectomy

25
Q

FAP

  • inheritance
  • describe
  • management
A
  • autosomal dominant
  • 100s-1000s adenomas in large bowel
  • need prophylactic colectomy
26
Q

HNPCC

  • inheritance
  • other cancers?
  • diagnosis
A
  • autosomal dominant
  • gastric/endometrial/prostate
  • > 3 family members over 2 generations and one <50yrs
27
Q

Peutz-Jegher’s syndrome

  • inheritance
  • features
A
  • autosomal dominant

- mucosal hyperpigmentation, multiple GI polyps, CRC ca

28
Q

Perianal haematoma

  • presentation
  • management
A

subcut bleeding from a burst venule caused by straining

  • tender blue lump at the anal margin
  • analgesia and spon. resolution
29
Q

Proctalgia fugax

  • presentation
  • management
A
  • young anxious men with crampy anorectal pain, worse @ night, not related to defecation
    Rx: reassurance
30
Q

Anal fissure

  • causes
  • presentation
  • management
A
  • usually due to constipation may be due to crohns
  • intense anal pain on defecation with fresh PR, midline ulcer at 6o’clock
  • soften stool, and topical analgesia
31
Q

what is Goodsall’s rule?

A

determines path of fistula tract

  • anterior fistula track in straight line
  • posterior fistula have a curved track with opening in 6 o’clock
32
Q

Perianal abscess

  • associations
  • presentation
  • management
A
  • crohns, DM, malignancy
  • throbbing perianal pain worse on sitting, purulent anal discharge
  • usually require EUA
33
Q

Pilonidial sinus

  • presentation
  • management
A

ingrown hair causing abscess usually in natal cleft, presents with persistent discharge and pain
- Rx: incision and drainage

34
Q

Presentation of gallstone ileus

A

Rigler’s triad

  • pneumobilia (rigler’s sign)
  • small bowel obstruction
  • RUQ pain

SMS (5 decks)

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