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5th Year > GI Surgery Stuff > Flashcards

GI Surgery Stuff Flashcards

1
Q

What is the most common causative organism of ascending cholangitis?

A

E. coli

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2
Q

What is the 2nd most common causative organism of ascending cholangitis?

A

Klebsiella

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3
Q

What is the causative organism in Lemierre’s syndrome?

A

Fusobacterium necrophorum

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4
Q

What is Lemierre’s syndrome?

A

Thrombophlebitis of internal jugular vein following bacterial throat infection, usually in young healthy adults

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5
Q

What is the causative organism of diarrhoea in immunodeficient patients?

A

Mycobacterium avium complex

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6
Q

What is the history of a patient with CBD stones post-cholecystectomy?

A

Symptoms will disappear post-cholecystectomy for a few weeks then return as they were prior to removal, including jaundice

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7
Q

What is the classical symptom of gallstones?

A

RUQ colicky pain, worse after fatty foods

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8
Q

Where is the pilonidal sinus?

A

Midline sinus between buttocks, just above coccyx

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9
Q

Who gets pilonidal cysts?

A

Hirsute patients

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10
Q

What is the definitive treatment of a pilonidal cyst?

A

Bascom or Karydakis procedures

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11
Q

What kind of stoma is required if bowel continuity is the end goal?

A

Loop ileostomy

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12
Q

Where are loop ileostomies often located?

A

RIF

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13
Q

When are loop ileostomies generally used?

A

Cancer resections and UC colectomies

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14
Q

When are end ileostomies generally used?

A

Complete colectomies

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15
Q

What is the psoas stretch sign?

A

Extend right hip passively with the knee extended while patient is lying on side

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16
Q

What does the poses stretch sign test for?

A

Acute retrocaecal appendicitis

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17
Q

How do giant cell tumours appear on X-rays?

A

Radiolucent ‘soap bubble’ appearance

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18
Q

What is the calcium profile of someone with osteomalacia?

A

Low calcium

Low urinary calcium

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19
Q

What are the features of Ewing’s sarcoma?

A

Lytic lesion with ‘onion type’ periosteal reaction on XR
Most have mets on presentation
5-10% 5yr prognosis

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20
Q

Who gets Ewing’s sarcoma?

A

10-25 yr old males

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21
Q

What is the treatment for a chronic anal fissure?

A

Topical GTN/Diltiazem
2nd line = botox
3rd line = sphincterectomy

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22
Q

What is the classical presentation of diverticulitis?

A

LLQ colicky pain and fever

Raised WCC and CRP

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23
Q

Describe a Grade I haemorrhoid

A

No prolapse

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24
Q

Describe a Grade II haemorrhoid

A

Prolapse when bearing down

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25
Q

Describe a Grade III haemorrhoid

A

Prolapse requiring manual reduction

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26
Q

Describe a Grade IV haemorrhoid

A

Unreducible

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27
Q

What type of cancer makes up the majority of colorectal cancer?

A

Adenocarcinoma (90%)

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28
Q

Where are colorectal cancers most commonly located?

A

40% rectal

30% sigmoid

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29
Q

What is the screening programme for colorectal cancer in the UK?

A

Faecal occult blood 60-74yrs

One-off flexible sigmoidoscopy at 55yrs

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30
Q

What is dumping syndrome?

A

Gastric contents empty too quickly

Common post-gastrectomy

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31
Q

What are the issues with dumping syndrome?

A
  1. Hyperosmolar load in jejunum draws water into lumen -> swelling and diarrhoea -> cramps pain
  2. Large sugar volume stimulates large insulin release -> hypoglycaemic symptoms (eg. dizziness)
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32
Q

Which gastrectomy technique gives the best functional outcomes?

A

Roux en Y reconstruction

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33
Q

Describe a Roux en Y reconstruction

A

Attach the jejunum to small stomach push, therefore bypassing the majority of the stomach and duodenum
The duodenum is attached to allow bile and digestive enzymes etc to drain into jejunum

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34
Q

Describe Hartmann’s procedure

A

Removal of rectosigmoid colon with colostomy formation and closure of rectal stump
Non-functioning rectal stump (Hartmann’s pouch) is closed and left inside abdomen

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35
Q

Is Hartmann’s procedure used often?

A

No

Rarely used beyond emergencies and terminal patients

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36
Q

What is the management of acute cholecystitis? (4)

A

Analgesia
Fluids
IV Antibiotics
Laparoscopic cholecystectomy within 1 weeks of diagnosis

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37
Q

How often is the Faecal Immunochemical Test (FIT) performed?

A

Every 2yrs 60-74yrs (50-74yrs in Scotland)

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38
Q

Is an ileostomy flat or spouted?

A

Spouted

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39
Q

Why is an ileostomy spouted?

A

Prevents skin coming into contact with alkaline enzyme secretions

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40
Q

Is a colostomy flat or spouted?

A

Flat

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41
Q

What is the likely diagnosis for a young female with a history of spondylolysis presenting with sudden severe back pain and bilateral leg weakness?

A

Spondylolythesis

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42
Q

What is the difference between spondylolysis and spondylolythesis?

A 
Spondylolysis = separation of pars interarticularis due to stress fracture
Spondylolythesis = spondylolysis with anterior displacement of vertebra
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43
Q

What are the Dukes’ stages?

A 
A = mucose
B = wall invasion
C = LNs
D = mets
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44
Q

What is the Blatchford score used for?

A

Score the severity of upper GI bleeds and whether to endoscopy

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45
Q

What dose a Blatchford score of 0 mean?

A

Manage as an outpatient

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46
Q

What is the Rockall score used for?

A

Assessing the prognosis of an upper GI bleed at endoscopy

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47
Q

What is Charcot’s triad?

A

Fever
Jaundice
RUQ pain
= Ascending cholangitis

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48
Q

What is rectal intussusception a symptom of?

A

Obstructed defecation

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49
Q

What investigation is required if rectal intussusception is found?

A

Defecating proctogram

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50
Q

Young man with PAINFUL PR bleeding: what is the diagnosis?

A

Fissure in ano

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51
Q

Where are fissures usually located?

A

6 and 12 o’clock

90% at 6 o’clock

52
Q

Young man with PAINLESS PR bleeding: what is the diagnosis?

A

Haemorrhoids

53
Q

Where are haemorrhoids usually located?

A

3, 7 and 11 o’clock

54
Q

What is the surgical management of fulminant UC?

A

Subtotal colectomy

55
Q

What is the surgical management of medication-resistant UC?

A

Panproctocolectomy with IPAA

56
Q

What is a requirement for a panproctocolectomy with IPAA?

A

Symptoms must be well-controlled as this is an elective operation

57
Q

How may a small bowel obstruction appear on AXR?

A

Valvulae conniventes extend across bowel

58
Q

What is the maximum diameter of small and large bowel?

A 
SB = 35mm
LB = 55mm
59
Q

What is a large risk factor for anal cancer?

A

HPV 16 and 18

Anal intercourse and increased sexual partners increases this risk

60
Q

What percentage of anal cancers are squamous cell carcinomas?

A

About 80%

61
Q

What percentage of anal SCC are associated with HPV?

A

80-85%

62
Q

What diagnosis may be indicated by a centrally dilated bowel in a CD patient?

A

Caecal volvulus

63
Q

What increases the risk of a caecal volvulus?

A

Adhesions secondary to surgery

64
Q

What diagnosis may be indicated by a dilated bowel in a UC patient?

A

Toxic megacolon

65
Q

What are the common locations for a volvulus to occur?

A

80% sigmoid

20% caecal

66
Q

Why isn’t the caecum at risk of a volvulus in the majority of people?

A

Caecum is retroperitoneal in 80% of people so can’t rotate

67
Q

What are the risk factors for a sigmoid volvulus? (4)

A

Eldery (Big)
Chronic constipation
Neuro/psych conditions
Chagas disease

68
Q

What is the AXR appearance of a sigmoid volvulus?

A

Large bowel obstruction with coffee bean sign

69
Q

What is the surgical management of a sigmoid volvulus?

A

Rigid sigmoidoscopy with rectal tube insertion

70
Q

What are the risk factors for a caecal volvulus? (4)

A

Occur at all ages
Adhesions
Pregnancy
CD

71
Q

What is the AXR appearance of a caecal volvulus?

A

Small bowel obstruction - centrally dilated bowel

72
Q

What is the surgical management of a caecal volvulus?

A

Generally right hemicolectomy

73
Q

What is an abdominoperineal resection?

A

Removal of anus, rectum and sigmoid colon

74
Q

When is an abdominperineal resection used?

A

Tumours of distal 1/3 of rectum

75
Q

When is a low anterior resection used?

A

Tumours in upper 2/3 of rectum

76
Q

When is a high anterior resection used?

A

Sigmoid tumours

77
Q

What are the advantages and disadvantages of left-sided resections?

A

More risky

BUT ileo-colic anastomoses are relatively safe and can often be done, even in emergencies

78
Q

What is Borchardt’s triad?

A

Severe epigastric pain
Retching
Inability to pass NG
= Gastric volvulus

79
Q

What is the most important aspect of haemorrhoid management?

A

Increased fibre and fluids

Also stool softeners

80
Q

What score is used to determine the severity of pancreatitis?

A

Modified Glasgow score

81
Q

What are the components of the Modified Glasgow score?

A 
PaO2 <8
Age >55yrs
Neutrophilia, WCC >15
Calcium <2
Renal, urea >16
Enzymes, LDH >600
Albumin <32
Sugar, BM >10
82
Q

Is amylase a useful prognostic indicator in pancreatitis?

A

No

83
Q

What vitamin deficiency may occur post-gastrectomy?

A

B12

Due to reduced intrinsic factor (produced in body and fungus)

84
Q

What is a complication of B12 deficiency?

A

Subacute combined degeneration of the spinal cord

85
Q

What are the features of subacute combined degeneration of the spinal cord?

A

Bilateral reduced lower limb sensation and wide ataxic gait

86
Q

What are the features of solitary rectal ulcer syndrome?

A

Altered bowel habit and extensive collagen deposits on flexi-sig. = ‘fibromuscular obliteration’

87
Q

Are nocturnal diarrhoea and incontinence features of IBS?

A

No, they are features of IBD

88
Q

What do you need to do if LFTs show an isolated hyperbilirubinaemia?

A

FBC - determine whether due to haemolytic or Gilbert’s

89
Q

What is ceruloplasmin used for?

A

Investigating the possibility of Wilson’s disease

90
Q

What will LFTs show in Wilson’s disease?

A

Raised ALT and AST

91
Q

What will LFTs show in obstructive jaundice?

A

Very high ALP

92
Q

What is the management of gastric MALT?

A

H. pylori eradication - 95% associated with H. pylori

80% MALT are low-grade and respond to eradication

93
Q

What does MALT stand for?

A

Mucosa associated lymphoid tissue

94
Q

What is H. pylori eradication?

A

PPI

Amoxicillin/Clarithromycin + Metronidazole 7-14days

95
Q

What is the presentation of cholangiocarcinoma?

A

Obstructive jaundice and weight loss

96
Q

What other condition increases the risk of cholangiocarcinoma?

A

Primary sclerosis cholangitis

97
Q

What conditions are pigmented gallstones associated with?

A

Haemolysis eg. Sickle Cell Disease

98
Q

What investigation is useful if you suspect chronic pancreatitis?

A

CT pancreas with contrast

Can identify calcifications

99
Q

What is a pancreatic pseudocyst?

A

Collection of fluid, typically 4 weeks post-acute pancreatitis

100
Q

Where are pancreatic pseudocysts usually located?

A

Retrogastric

101
Q

What blood test make indicate a pancreatic pseudocyst?

A

75% have persistent mildly raised amylase

102
Q

What is the management of pancreatic pseudocysts?

A

Conservative - 50% resolve within 12 weeks

After 12 weeks or signs of infection, consider FNA

103
Q

What is the management of a diverticulitis flare?

A

72hrs oral Abx

If no improvement, admit for IV ceftriaxone and metronidazole

104
Q

What needs to happen for a 60yr old patient presenting with new iron-deficient anaemia?

A

Urgent colorectal cancer pathway

105
Q

Does a cystic duct/gallbladder blockage cause jaundice?

A

No

106
Q

What is a Whipple procedure?

A

Pancreaticoduodenectomy

Removes head of pancreas, duodenum, gallbladder and bile duct

107
Q

What is the Whipple procedure primarily used for?

A

Head of pancreas tumours

108
Q

What are the symptoms of diverticular disease?

A

Altered bowel habit
PR bleeding
Abdominal pain
Can resemble cancer

109
Q

Where are diverticula usually located?

A

Sigmoid colon

110
Q

What is a common history for a perianal abscess?

A

Severe pain and unable to defecate
May be spiking fevers
PMHx of DM or other immunodeficiency

111
Q

Who gets perianal abscesses?

A

Generally 40yr old men with anorectal abscesses

112
Q

What is the first line management of an unruptured sigmoid volvulus?

A

Flatus tube insertion on rigid sigmoidoscopy - allows decompression

113
Q

What is the second line management of an unruptured sigmoid volvulus?

A

Percutaneous colostomy to allow decompression

Only attempted if flatus tube insertion has failed many times

114
Q

What is one advantage of epidural analgesia in general surgery?

A

Faster return of normal bowel function

115
Q

Why is a gastrografin enema preferred to barium to check anastomoses?

A

Less toxic if leaks into the abdominal cavity

116
Q

Other than checking anastomoses, what else can gastrografin be used for?

A

Oral gastrografin can help in small bowel obstruction secondary to adhesions in conservative management

117
Q

Where are bile salts absorbed?

A

Terminal ileum

118
Q

Why are CD patients at an increased risk of gallstones?

A

Terminal ileum is the most common area of inflammation in CD

Reduced bile salt reabsorption -> increased bile -> increased risk of gallstones

119
Q

What should be done if someone presents with a sigmoid volvulus and signs of peritonitis?

A

Urgent laparotomy to avoid perforation/necrosis

120
Q

When should a sphincterectomy be considered in the management of fissures in ano?

A

After 6 week acute management, followed by 8 week trial of topical GTN

121
Q

How does a sphinctectomy aid the management of fissures in ano?

A

Relieves the spasm of a torn spinster by creating a clean cut to aid healing

122
Q

What are the indications for an OGD? (5)

A
  • Age >55yrs
  • Symptoms lasting >4wks despite Tx
  • Dysphagia
  • Relapsing symptoms
  • Weight loss
123
Q

What are the indications for an urgent OGD? (3)

A
  • All dysphagia
  • All upper abdominal masses
  • > 55yrs with weight loss and either abdo pain/reflux/dyspepsia
124
Q

What are the indications for a non-urgent OGD? (4)

A
  • All haematemesis
  • > 55yrs with Tx-resistant dyspepsia
  • Increased platelets and low Hb with abdo pain/ALARM symptoms
  • Nausea or vomiting with ALARM symptoms
125
Q

What are the ALARM symptoms?

A 
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena/Masses
Swallowing difficulty (dysphagia)

5th Year (8 decks)

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