Brainscape's Knowledge GenomeTM

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


See full index

Scott's Notes > GI Surgery (upper, HPB, lower, perianal) > Flashcards

GI Surgery (upper, HPB, lower, perianal) Flashcards

1
Q

What are the causes of dysphagia?

A

Inflammatory
Pharyngitis, tonsillitis, oesophagitis

Motility disorders
Local: Achalasia, Diffuse spasm, Bulbar palsy
Systemic: CREST, MG

Mechanical
Luminal: FB
Mural: Benign stricture, web, malignancy, pouch
Extramural: Retrosternal goitre, rolling hiatus hernia, lung Ca, LNs

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

What is the area of weakness which gives to form a pharyngeal pouch?

A

Killian’s dehiscence

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

What is the surgical management of achalasia?

A

Heller’s cardiomyotomy

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

When would you see a corkscrew oesophagus?

A

Diffuse oesophageal spasm

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

What are the features of Plummer Vinson syndrome?

A

IDA
Webbing
Glossitis/cheilosis

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

What are the two types of oesophageal cancer and where do they affect?

A

Adenocarcinoma - 65%
Lower 3rd
Derived from GORD and Barretts

SCC - 35%
Upper and middle 3rd
Assoc with EtOH and smoking

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

What are the different surgical approaches to oesophagectomy and what incisions are used for each?

A

Ivor-Lewis - Vertical abdo incision with right sided thoracotomy

McKeown - Vertical abdo ioncision with right sided thoracotomy and a left neck incision

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

What extra GI symptoms might GORD cause?

A

Nocturnal asthma
Chronic cough
Sinusitis/laryngitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What features would make you do an OGD in a patient?

A

55ALARMS

>55
Anaemia
Loss of weight
Anorexia
Recent onset progression
Melaena
Swallowing difficulty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the surgical management of GORD?

A

NIssen Fundoplication

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

What are the complications of a Nissen Fundoplication?

A

Dysphagia

Inability to belch or vomit

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

Which type of hiatus hernia should be operated on even if symptomatic and why?

A

Rolling - as it may strangulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications following antrectomy/vagotomy for PUD?

A 
Physical
Gastric cancer risk
Reflux
Abdo fullness
Stricture
Stump leakage

Metabolic
Dumping syndrome - Distension, flushing, N/V, fainting
Blind loop syndrome - malabsorption and diarrhoea
Vitamin deficiency due to parietal cell loss
Weight loss

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

What is the Rockall score used for and what are its constituent parts?

A

Used to assess risk of rebleeding in upper GI bleeds

Age (old is worse)
Shock
Comorbidities
Diagnosis
Signs of recent haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some causes of portal hypertension?

A

Pre-hepatic - Portal vein thrombosis
Hepatic - cirrhosis, schisto, sarcoid
Post hepatic - Budd Chiari, RHF, constrictive pericarditis

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

What is the process and aim of the TIPSS procedure?

A

Transjucular intrahepatic portosystemic shunt

Shunt formation between hepatic and portal veins to reduce portal pressure

Used prophylactically or acutely if endoscopic therapy fails to control a variceal bleed

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

What sign would you see on AXR in a ruptured peptic ulcer?

A

Rigler’s sign - pneumoperitoneum

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

What would be seen on the ABG of a gastric outlet obstruction?

A

Hypochloraemic hypokalaemic metabolic alkalosis

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

What type of cancer does H.ylori predispose to?

A

MALToma

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

What do Zollinger Ellison tumours secrete, and what neurocutaneous syndrome are they associated with?

A

Gastrin

MEN1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the surgical management of ZE syndrome?

A

Tumour resection OR

Roux en Y gastric bypass

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

What criteria must be met for bariatric surgery to be considered?

A

BMI>=40 with significant scope for improvement with weight loss
Failure of non surgical techniques
Fit for surgery
Integrated post op programme

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

What are the complications of gallstones?

A

In the gallbladder - colic, a/c cholecystitis, mucocele

In the CBD - obstructive jaundice, pancreatitis, cholangitis

In the gut - gallstone ileus

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

What is the pathogenesis of biliary colic?

A

Gallbladder spasm against a stone impacted in the neck of the gallbladder or CBD

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

What is the presentation of biliary colic?

A

RUQ pain radiating to the back
Sweating, N/V
Precipitated by fatty food
Jaundice only if stone is in CBD

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

What investigations and results would you do for biliary colic?

A 
Urine - bilirubin, urobiliinogen
Bloods - standards
AXR - 10% are radioopaque
Erect CXR  - look for perforation
USS - dilated ducts and GB wall oedema
If dilated ducts seen then do MRCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the pathogenesis of acute cholecystitis?

A

Stone impaction in Hartmann’s leading to chemical or bacterial inflammation

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

What is the presentation of acute cholecystitis?

A

Severe RUQ pain that is continuous (unlike biliary colic)
Fever
Vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

WHat are the examination findings in acute cholecystitis?

A 
Local peritonism
Tachycardia
May be jaundiced
Murphy's positive
Boas sign - hyperaesthesia below right scapula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the non-surgical management of acute cholecystitis?

A 
NBM
Fluid resuscitation
Analgesia
Cef and met
The majority of cases will settle over 1-2 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the features of chronic cholecystitis?

A 
Flatulence
Dyspepsia
Upper abdo discomfort
Distension
Nausea
Exacerbated by fatty foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is going on in a gallstone ileus, and what is Rigler’s triad?

A

Large stone erodes through GB to duodenum through an inflammatory fistula, impacting the distal ileum leading to an obstruction

Rigler’s triad describes:
Pneumobilia
SBO
Gallstone in RLQ

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

What (numerically) causes obstructive janudice?

A

30% stones
30% pancreatic head Ca
30% other - LNs, PBC, PSC, OCP, cholangiocarcinoma

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

What are the features of ascending cholangitis?

A

Charcots 3 - fever, RUQ pain, jaundice

Reynolds 5 - Charcot3, shock, confusion

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

What are the risk factors for pancreatic cancer?

A

SINED

Smoking
Inflammation
Nutrition (high fat)
EtOH
DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the commonest type of pancreatic carcinoma, and where are they most commonly found?

A

90% ductal adenocarcinoma, 60% in the head

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

Cause of acute pancreatitis?

A

GET SMASHED

Gallstones
EtOh
Trauma
Steroids
Mumps
Autoimmune
Scorpions
Hyperlipidaemia
ERCP
~Drugs - thiazides, azathioprine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When would you see Grey Turner’s and Cullen’s signs?

A

Acute pancreatiutis

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

What is the Modified Glasgow Criteria and its component parts?

A

Assess severity and predict mortality of acute pancreatitis

PANCREAS

PaO2
Age >55
Neutrophils
Ca2+ (low)
Renal function
Enxymes
Albumin 
Sugar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the complications of acute pancreatitis?

A

Early - ARDS, shock, renal failure, DIC, hypocalcaemia, hyperglycaemia

Late - Panc necrosis/infection/abscess, splenic artery bleed, thrombosis (BUDCHIARI), pancreato-cutaneous fistula

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

When and how might a pancreactic pseudocysts present?

A

4-6 weeks after an attack with persistent abdo pain and early satiety

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

Which causes chronic pancreatitis - alcohol or gallstones?

A

Alcohol

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

What are the risk factors for cholangiocarcinoma?

A

PSC (/UC)

Hep B/C

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

WHat is the rpesentation of cholangiocarcinoma?

A

Progressive painless obstructive jaundice with steatorrhoea and weight loss

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

What is the management of a cholangiocarcinoma?

A

No curative treatemtn

Palliative ERCP stentinig

46
Q

What is a hydatid cyst?

A

Calcified liver cyst due to parasitic infection presenting commonly silently or with pressure effects

47
Q

What are the different types of small bowel neoplasms?

A

Benign - Lipoma, leiomyoma, neurofibroma, haemangioma, adenomatous polyps

Malignant -
Adenocarcinoma
Carcinoid
Lymphoma

48
Q

What is the origin cell of carcinoid tumours?

A

Enterochromaffin cells

49
Q

What are the commonest sites that carcinoid tumours are found at?

A

Appendic - 45%
Ileum - 30%
Colorectum - 20%

50
Q

What is the presentation of carcinoid syndrome?

A

FIVE HT

Flushing
Intestinal - diarrhoea
Valve fibrosis
whEEze
Hepatic involvement
Tryptophan deficiency (Pelagra)
51
Q

What would you measure to diagnose carcinoid syndrome>

A

Urinary 5-Hydrozyindoleacetic acid

52
Q

What is the management of carcinoid syndrome?

A

Symptoms - Octreotide or loperamide

Curative - Resection

53
Q

What is a carcinoid crisis and how should it be managed?

A

The tumour outgrows its blood supply resulting in massive mediator release - Vasodilation, hypotension, bronchoconstriction, hyperglycaemia

Manage with high dose octreotide

54
Q

What is the commonest cause of appendicitis?

A

Faecolith

55
Q

What are the classical features of appendicitis?

A 
Umbilical -> RIF pain
Anorexia
Nausea
Bowel disturbance
Pyrexia
56
Q

What specific signs might be seen in appendicitis?

A

Rovsigs - Pressure in LIF increases pain in RIF

Psoas - Pain on hip extension

Cope - Flexion and internal rotation of the right hip causes pain

57
Q

What are the complications of acute appendicitis?

A

Appendix mass
Appendx abscess
Perforation

58
Q

What are the complications of UC?

A 
Toxic megacolon
Bleeding
Malignancy (CRC)
Cholangiocarcinoma
Strictures-> Obstruction
VTE
59
Q

What are the complications of Crohns?

A

Fistulae
Obstructive strictures
Abscesses
Malabsorption (Fat, B12, Vit D, protein)

60
Q

What is the Truelove and Witts classification and what are its component parts?

A

Assesses severity of UC flare up

Daily bowel motions
PR bleed
Temperature
HR
Hb
ESR
61
Q

What is the acute management of severe UC flare?

A

Resuscitate
100mg IV hydrocortisone
LMWH
Monitoring

62
Q

What should be done following initial management of an UC flare?

A

If improvement -> Switch to tapering oral pred and a 5-ASA

If no improvement then rescue therapy -
Medical - immunosuppressants
Surgical options considered

63
Q

When would you use topical therapy for UC and what are the options?

A

Mainly in left sided disease

Use suppositories for proctitis and enemas or foams for more proximal disease

64
Q

What is the medical management for remission maintenance in UC?

A

1st - 5ASAs PO
2nd - Axathioprine/mercaptopurine (Measure TPMT first)
3rd - Infliximab/Adalimumab

65
Q

What proportion of UC and Crohns’ patients will require surgery at some point>

A

20% of UC patients

50-80% of Crohn’s patients

66
Q

What is a total colectomy?

A

Resection of the large bowel and anastamosis of the ileum to the rectum

67
Q

What is an end ileostomy

A

When, after removal of the large bowel the ileum is brought to the surface of the abdomen to form a stoma. This may be temporary or permanent

68
Q

What is a proctectomy?

A

Removal of all or part of the rectum

69
Q

What is a panprotocolectomy?

A

Removal of the entire large bowel, rectum and anal canal resulting in a permanent ileostomy

70
Q

What is an ileal pouch anal anastomosis?

A

The restoration of GI continuity after a proctectomy. Also known as a J pouch, the procedure involves pouch formation of the small intestine to recreate the removed rectum

71
Q

What are the emergency surgical options for UC?

A

Total/subtotal colectomy with end ileostomy followed 3 months later by a complete proctectomy and ileal pouch anal anastomosis

Panproctocolectomy with permanent end ileostomy

72
Q

What are the elective surgical options for UC?

A

Panprotocolectomy with end ileostomy or ileal pouch anal anastomosis

Total colectomy with ileorectal anastomosis

73
Q

What are the complications of UC surgery?

A

Abdo - SBO, anastomotic stricture, pelvic abscess

Stoma - retraction, stenosis, prolapse, dermatitis

Pouch - pouchitis (met + Cipro_, faecal leakage

74
Q

What is the main difference in acute management of Crohns’s flare up vs. UC?

A

Antibiotics (metronidazole) are advised in Crohns but not in UC

75
Q

What drugs are used for inducing remission in Crohn’s?

A 
1st - ileocaecal - budesonide
1st - colitis - sulfasalazine
2nd - tapering pred
3rd - methotrexate
4th - infliximab/adalimumab
76
Q

What drugs are used in maintaining remission in Crohns?

A

1st - Azathioprine or mercaptopurine
2nd - Methotrexate
3rd - Adalimu/Infliximab

77
Q

What surgical procedures are commonly used in Crohns?

A

Limited resection e.g. ileocaecal
Stricturoplasty
Temporary loop ileostomy

78
Q

What is a loop ileostomy?

A

When a loop of small bowel is brought to the surface to form a stoma, but the distal protion of bowel is not resected

79
Q

What are the features of short gut syndrome?

A

Steatorrhoea
ADEK and B12 malabsorption
Gallstones
Renal stones

80
Q 
Define the following:
Diverticulum
Diverticulosis
Diverticular disease
Diverticulitis
A

Diverticulum - out pouching of a tubular structure

Diverticulosis - the presence of diverticula

Diverticular disease - symptomatic diverticulosis (Altered bowel habit, nausea, flatulence)

Diverticulitis - Inflammation of diverticula

81
Q

What is the conservative management of diverticular disease?

A

Promote high fibre diet

82
Q

What is the management of acute diverticulitis?

A

Mild - at homw with bowel rest (fluid only) and Abx

Admit if unwell and unable to tolerate fluids/pain

Medical - NBM, IV fluids, analgesia, cefnmet

Surgical - Hartmann’s procedure to resect diseased bowel

83
Q

What are the indications for surgical management of diverticulitis?

A

Perforation
Large haemorrhage
Strictural obstrucion

84
Q

What is a Hartmann’s procedure?

A

AKA - proctosigmoidectomy

Resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.

85
Q

What are the complications of acute diverticulitis?

A 
Perforation (free air on CXR)
Haemorrhage
Abscess
Fistulae
Strictures
86
Q

What are the commonest causes of small and large bowel obstructions?

A

SBO - adhesions

LBO - CRC

87
Q

What are the causes of a mechanical bowel obstruction?

A

Intraluminal - Impacted faeces, intusussception, gallstones

Intramural - benign stricture, neoplasm

Extramural - hernia, adhesions, volvulus, extrinsic compression

88
Q

How would you investigate a bowel obstruction?

A 
Bloods - 
FBC - raised WCC
UnE - off
Amylase - raised if strangulated
VBG - lactate if strangulated
C+S and clotting for surgery

Imaging
Erect CXR
AXR
CT

Gastrograffin studies
Looks for mechanimcal obstruction

Colonoscopy

89
Q

What are the AXR findings in SBO and LBO?

A

LBO is larger diameter
LBO usually peripheral whereas SBO more central
Valvulae conniventes in SBO go completely across, whereas haustra in LBO go partially across
Gas is seen in LBO not SBO
Many loops in SBO vs LBO
many short fluid levels in SBO vs few longer ones in LBO

90
Q

What is the medical management of bowel obstruction?

A

Drip and suck - NGT to decompress the bowel and IV fluids for rehydration. Also catheterise

Analgesia
ABx
Gastrograffin study

91
Q

What is a typical presentation of sigmoid volvulus?

A

Elderly constipated male presents with massive distension

Coffee bean sign

92
Q

What are the causes of a paralytic ileus?

A 
Post op
Peritonitis
Pancreatitis
Poisons - Anti-AchM
Pseudo obstruction
Metabolic
Mesenteric ischaemia
93
Q

What are colonic adernomata, and what are the different types?

A

Benign precursors to CRC with dysplastic epithelium

Tubular - less malignant potential
Tubulovillous
Villous - more malignant potential

94
Q

What factors contribute to risk of CRC?

A 
Diet - low fibre and high animal
I BD
Familial - FAP, HNPCC, P-J
Smoking
Genetics
NSAIDs are protective
95
Q

What is the commonest type of CRC and where is it most commonly found?

A

95% adenocarcinoma

35% rectum
25% sigmoid
20% caecum/ascending colon

96
Q

What tumour marker is used in CRC?

A

CEA

97
Q

What is a high anterior resection?

A

Essentially just a sigmoidectomy with removal of the upper rectum. Treatment for upper rectal carcinoma

98
Q

WHat is a low anterior resection

A

Similar to a high anterior resection but more is removed distally

99
Q

What is an AP resection?

A

Abdominoperitoneal resection is a procedure which removes CRC which crosses the anal verge - more distal than an anterior resection

100
Q

What is the NHS screening programme for CRC?

A

FOB testing aged 60-75 every 2 years -> colonoscopy if +ve

Flexi sig one off for 55-60 year olds

101
Q

WHat is the inheritance pattern of FAP?

A

AD - APC gene on 5q21

102
Q

What is the incidence of CRC in FAP patients?

A

Near 100% by age of 40

103
Q

What is the management of FAP?

A

Prophylactic total colectomy before age of 20

104
Q

What is the inheritance pattern and pathology of HNPCC?

A

AD

Mutated mismatch repair genes

105
Q

What is the 3,2,1 rule for HNPCC diagnosis?

A

> =3 family members affected over 2 generation with 1 under the age of 50

106
Q

WHat is the inheritance pattern and presenting picture of Peutz-Jehgers?

A

AD

10-15 year old
Mucocutaneous hyperpigmentation
GI hamartomatous polyps
CRC, pancreas, other Cas

107
Q

What are the causes of acute mesenteric ischaemia?

A

Arterial - thrombotic or embolic
Splanchnic vasoconstriction 2ary to shock
Venous thrombosis
Trauma, vasculitis

108
Q

What is the classical presentation of acute mesenteric ischaemia?

A

Triad of:
Acute severe abdo pain +_bleeding
Rapid hypovolaemic shock
No abdo signs

Often in AF

109
Q

What is the presentation of chronic small bowel ischaemia?

A

Gut claudication
PR bleeding
Malabsorption
Weight loss

110
Q

Lower GI bleed differentials?

A 
Haemorrhoids
Fissures
Diverticulitis
Cancer
IBD
Infection
Polyps
Ischaemic colitis
111
Q

What are the different degrees of haemorrhoids?

A

1st deg - Never prolapse
2nd - prolapse on defecation but spontaneously reduce
3rd - prolapse on defecation but require digital reduction
4th - permanent prolapse

112
Q

What is the management of haemorrhoids?

A

Conservative - increase fibre and fluid intake

Medical -
Topical hydrocortisone
Topical analgesics
Lactulose
Fybogel

Interventional - banding/cryo

Surgical - haemorrhoidectomy

Scott's Notes (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions