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Medical Finals 2020 > GI Surgery > Flashcards

GI Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

On x-ray, what is the rule for judging abnormalities in the small and large bowel?

A

3/6/9

  • small bowel is dilated is >3cm
  • large bowel is dilated if >6cm
  • sigmoid and caecum shouldn’t be >9cm
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2
Q

What is a sigmoid volvulus?

A

A twisting of the mesentery around the sigmoid colon resulting in ischaemia and infarction risk?

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3
Q

What is your management of a sigmoid volvulus?

A
  • emergency rigid sigmoidoscopy - insert a rectal tube to decompress the volvulus
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4
Q

What is the typical abdominal x-ray sign associated with a sigmoid volvulus?

A
  • coffee bean sign

- may occur chronically, located near acetabulum

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5
Q

How do you recognise a caecal volvulus? What is your management of it?

A
  • occurs in the upper abdomen (sigmoid occurs near the acetabulum of the femur), coffee-bean sign
  • treat with a laparotomy and a right hemicolectomy
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6
Q

What is your acute management of free air under the diaphragm and what is it called? Why is it so bad?

A
  • pneumoperitoneum - indicates a bowel perforation

- A-E and resuscitation, immediate surgical involvement and antibiotics

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7
Q

What is a porcelain gallbladder?

A

Calcification of the gallbladder, often pre-malignant condition and requires a cholecystectomy

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8
Q

A patient post-op presents with a distended abdomen and is complaining of a ‘lump in their groin’. The most likely cause is…?

A
  • an incarcerated hernia
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9
Q

What would you see on x-ray for inflammatory bowel disease?

A
  • thumbprinting, inflamed colon, looks wooly and fluffy
  • can present with diarrhoea, bloody stools, increased frequency, thickened walls
  • bloody stools more likely to be UC, but not differentiatable on XR
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10
Q

Gallstones present on XR not in the gallbladder indicates…?

A
  • Gallstone ileus
  • they’ve passed through to the bowel and are causing a small bowel obstruction
  • there is usually pneumobilia
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11
Q

What are some potential causes of calcification in the kidneys on abdominal x-ray?

A
  • ureter stone
  • staghorn calculus
  • renal calculus
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12
Q

Air present throughout the large bowel indicates…?

A

Pseudo-obstruction

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13
Q

A chest x-ray shows a different projection of texture over the heart - what is the most likely cause?

A

Hiatus hernia

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14
Q

Murphy’s sign is indicative of what…?

A

It is tenderness of gallbladder palpation - it usually indicates cholecystitis

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15
Q

What are the risk factors for gallstones?

A

Fat, Female, Fertile, FOrty

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16
Q

What is your investigation of choice for gallstones/biliary colic?

A

Abdominal USS
MRCP
(bile stones won’t show on CT)

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17
Q

What are the usual defining features of gallstones?

A

Severe RUQ pain radiating to the back, occurs 2hrs after eating food

18
Q

What are your primary management options for gallstones?

A
  • Laparotomy cholecystectomy

- Analgesia and discharge, arrange for return for above

19
Q

What are gallstones made from?

A
  • Bile pigments (broken down Hb)
  • phospholipids

Can be PIGMENT stones, CHOLESTEROL stones or MIXED stones

20
Q

What are some complications of gallstones?

A
  • biliary colic
  • cholecystitis
  • obstructive jaundice
  • cholangitis
  • gallstone ileus
21
Q

What is acute cholecystitis?

A

Impaction in the bile duct resulting in inflammation of the gallbladder

22
Q

How do you differentiate between… biliary colic, acute cholecystitis and cholangitis?

A
  • biliary colic is just RUQ pain
  • acute cholecystitis is pain and inflammation, might be fever
  • cholangitis is pain, fever and jaundice
23
Q

What is the most common presentation of ascending cholangitis?

A
  • acute illness, jaundice
  • RUQ pain
  • fevers
24
Q

What is your best investigation to visualise the biliary tree?

A

NOT CT

  • Abdo USS
  • MRCP
25
Q

What are the principles of management of acute cholangitis?

A
  • fluids
  • antibiotics according the guidelines
  • analgesia
  • lap cholecystectomy within the first 3 months
26
Q

Intolerance of fatty foods may indicate…?

A
  • cholecystitis

- gallstones

27
Q

What is your management of a gallstone ileus?

A
  • operative laparotomy and stone removal
  • treat with antibiotics
  • later cholecystectomy
28
Q

What is your best blood abnormality that may indicate pancreatitis?

A
  • raised amylase
  • raised lipase
  • raised WCC
29
Q

How might pancreatitis present?

A
  • severe upper abdominal pain (epigastric)
  • vomiting
  • rigid and tender on examination
30
Q

What are some points in the clinical history and examination that may suggest cholangiocarcinoma?

A
  • jaundice
  • anorexia
  • WEIGHT LOSS
  • palpable gall bladder and liver edge
  • pale, malnourished
31
Q

What are the post-operative complications that are associated with jaundice?

A
  • haemolysis
  • biliary obstruction due to stones or strictures
  • hepatocyte or biliary epithelial damage
32
Q

What factors decide against major curative surgery in pancreatic cancer?

A

Metastases

33
Q

What are some important questions to ask in a history of PR bleeding?

A
  • normal bowel habit
  • blood - colour, how much, continuous, mucous?
  • WEIGHT LOSS
  • urinary symptoms
  • FEVERS
  • GI system - indigestion, stomach, dysphagia, appetite
34
Q

What are your differentials for PR bleeding?

A
  • hemorrhoids/piles
  • fissures
  • fistulas
  • cancer
  • IBD
  • diverticular disease
35
Q

What are your immediate management and investigation choices in a patient presenting with PR bleeding?

A
  • PR exam and abdominal examination
  • analgesia if pain
  • bloods - FBC, U&E, CRP, lactate, coagulation, (foacal calprotectin)
  • rigid sigmoidoscopy (a bedside examination)
  • consider flexi-sig, CT with contrast, colonoscopy if considering upper GI problem
  • OGD - CHECK THE STOMACH FOR BLEEDS
36
Q

A patient with abdominal pain and AF is at risk of what and why?

A

Ischaemic colitits
AF risks in the showering of emboli resulting in bowel ischaemia. Patients present with abdo pain and pain on defectation. Constipation.

37
Q

Painless PR bleeding is usually…?

A
  • Haemorrhoids
  • fissures are very painful
  • fistula is not that painful
38
Q

What are the grades of haemorrhoids?

A

Graded 1-4

  • 1 + 2 is treated conservatively with anusol cream
  • 3 + 4 is treated with banding or an operation
39
Q

What is the difference between various types of scoping?

A
  • flexible sigmoidoscopy - goes to splenic flexure
  • rigid sigmoidoscopy - anal canal
  • colonoscopy - whole bowel
  • gastrocscopy - goes to stomach
  • oesophageoduodenoscopy - goes to duodenum
40
Q

What are some differentials for appendicitis?

A
  • ectopic
  • mesenteric adenitis
  • cystitis
  • cholecystitis
  • diverticulitis
  • dysmenorrhoea
  • crohn’s
  • perforated ulcer
  • meckel’s diverticulum
  • food poisoning
41
Q

What is your acute treatment of variceal haemorrhage?

A

ABC – resuscitation
Correct clotting – FBC, vitamin K
Terlipressin – in acute bleeds
Propanolol is used prophylactically in varices

42
Q

What are common causative organisms of surgical infections?

A

Staph aureus – abscesses, cutaneous infections, treat with penicillin
Strep pyogenes – gram positive, chains, lancefield group A, beta haemolysis, catalase negative, can cause scarlet fever, penicillin/macrolide treatment
E. coli – gram negative, anaerobe, can result in HUS
C. jejuni – gram negative, curved, diarrhoea + RIF pain, self-limiting
H. pylori – gram neg, helix-shaped rod, flagellated and mobile, risk of peptic ulcer/gastric cancer/MALT lymphoma

Medical Finals 2020 (25 decks)

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