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Pastest > Gill revision > Flashcards

Gill revision Flashcards

1
Q

Inflammation pain vs obstruction pain in tummy?

A

Inflammation –> throbbing
Obstruction –> colic

Patient moving around –> colic
Patient lying still –> inflammation

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2
Q

Tenderness to percussion

A

Peritonism

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3
Q

Appendicitis march of events

A

1st Pain, usually epigastric or umbilical
2nd Anorexia, nausea, or vomiting
3rd Tenderness – somewhere in the abdomen or pelvis
4th Fever
5th Leucocytosis

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4
Q

McBurneys

A

1/3rd of way between ASIS and tummy button

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5
Q

Perforated appendice

A

Generalised pain and guarding with peritonism

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6
Q

Iliopsoas test for appendicitis?

A

Stretching the iliopsoas can elicit pain

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7
Q

Retrocaecal or pelvic appendix may require what?

A

May require rectal examination –> this may be the only way to elicit pain and point of tenderness
Remember that the appendix can be in loads of really weird places
RECTAL EXAMINATION ESSENTIAL IN ANY APPENDICITIS

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8
Q

Cell origin of oesophagus cancers?

A

Squamous cell
Adenocarcinomas in the lower third of the oesophagus are usually gastric in origin or have developed in Barrett’s oesophagus

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9
Q

Where do oesophageal carcinomas spread to?

A

Liver, lungs, bone and lymph glands

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10
Q

Dysphagia without weight loss?

A

Achalasia

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11
Q

Degeneration of the ganglion cells of Auerbach’s mesenteric plexus?

A

Achalasia

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12
Q

Confirming diagnosis of oesophageal carcinoma?

A

Endoscopy with biopsy

barium swallow will demonstrate irregular stricture

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13
Q

Primary investigation for achalasia?

A

Barium swallow
-proximal oesophagus is dilated and tortuous and merges into a smooth cone shaped narrowed segment above the gastro-oesophageal junction

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14
Q

Treatment for achalasia

A

Surgery –> Heller’s cardiomyotomy

Balloon dilatation

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15
Q

A low grade fever with tenderness and guarding over McBurneys point?

A

Acute appendicitis

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16
Q

Complications of appendicitis?

A

Perforation

Appendix mass

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17
Q

Gallstones risk factors

A 
Age > 40
Female
High fat diet
Obesity
Pregnancy
Hyperlipidaemia
Five “Fs”
Bile salt loss (Crohn’s)
Diabetes
Dysmotility of GB
Prolonged fasting 
TPN
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18
Q

Biliary colic

A 
Stone impacts in cystic duct
Gradual build-up pain in RUQ
Radiates to back / shoulder 
May last 2-6 hours
Associated with indigestion / nausea
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19
Q

Severe acute epigastric pain differentials

A 
Biliary colic
Peptic ulcer disease
Oesophageal spasm
Myocardial infarction
Acute pancreatitis
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20
Q

Treatment for acute cholecystitis

A

IV antibiotics and IV fluids
Nil by mouth
US to confirm diagnosis

Urgent cholecystectomy** (asap)

Interval cholecystectomy (drainage of fluid then removal of gallbladder)

21
Q

Cholecystitis

A

Inflammation of the gallbladder

22
Q

Cholangitis

A

Infection of the common bile duct

23
Q

Complications of gallstones

A

Stone may migrate into CBD:

Jaundice
Cholangitis
Acute Pancreatitis

Gallstone Ileus

24
Q

Diagnosis of common bile duct pathology (e.g. if gallstones have passed into common bile duct)

A

Itch, nausea, anorexia
Jaundice
Abnormal LFTs

ERCP:
ES + stone removal

Surgical Exploration: CBD (Open vs Lap)

25
Q

Gallstone ileus

A

Small bowel obstruction –
gallstone impacted in distal ileum .

Fistula gallbladder + duodenum - Large gallstone passes into small intestine.

Moves down SB causing intermittent colic

Present with distal SB obstruction.

26
Q

Acute pancreatitis

A

Alcohol / gallstones

10% mortality AP

Autodigestion of peri-pancreatic tissues by activated enzymes

Cholecystectomy during INDEX admission

ERCP / ES if frail

27
Q

Treatment for gallstone ileus

A

Treatment:

Urgent Laparotomy – SB enterotomy to remove stone

Interval cholecystectomy in 3 months.

28
Q

Clinical presentation of cholangiocarcinoma?

A

Clinical Presentation: Usually late !

	- Jaundice; Weight loss; anorexia; lethargy   
	- 50% lymph node metastases
	- 20-30% peritoneal metastases at diagnosis
29
Q

Staging of cholangiocarcinoma?

A

Staging / Assessment:
Duplex Ultrasound
(Spiral CT / ERCP / PTC)
MRI / MRCP/ MRA

30
Q

Treatment for cholangiocarcinoma?

A

Surgical resection: Bile duct and liver resection

Palliation: insertion of biliary stent

31
Q

Cholangiocarcinoma

A

Cancer of the bile ducts

32
Q

Cholangiocarcinoma grading

A 
I) confined to confluence
II) below the confluence
IIIa) extended into right hepatic duct
IIIb) extended into left hepatic duct
IV) extension into left and right hepatic duct
33
Q

Bilirubin

A

Obstructive jaundice

-Urobiligen is not present in obstructive jaundice

34
Q

What should you perform in all women presenting with acute abdomen?

A

Always perform urinary bHCG to exclude pregnancy in ALL women of childbearing age, however unlikely this is!

35
Q

What do urea and creatinine show?

A

Hydration and renal status

36
Q

What does prothrombin time show?

A

Synthetic function of liver e.g. CBD stone

37
Q

Hydronephrosis

A

When one or both kidneys become stretched and swollen as a result of build up of urine in kidneys

38
Q

Investigation for AAA

A

Ultrasound

39
Q

Investigation for perforation or pancreatitis?

A

CT

40
Q

Investigation for pancreatitis?

A

CT

41
Q

Investigation for obstructive jaundice?

A

ERCP

42
Q

What would you use a water soluble contrast swallow to investigate?

A

Oesophageal rupture

-it will show contrast in mediastinum

43
Q

Grey-turners sign

A

Bruising in the flanks (last rib –> top of hip)

Acute pancreatitis

44
Q

Cullen’s sign

A

Cullen’s sign is yellow blue discolouration of the skin around the umbilicus. It was first reported in ruptured ectopic pregnancy but is more commonly associated with severe, acute pancreatitis.
(looks like a bug bruise around the tummy button)

45
Q

Causes for immediate surgery (<1hour)

A

Bleeding, perforation, incarceration, ectopic pregnancy

46
Q

Causes for urgen surgery (<24 hours)

A

Appendicitis, uncomplicated bowel obstruction

47
Q

Scheduled surgery >24 hours

A

Cholecystitis, adhesive SBO

48
Q

Tests you should definitely do in acute abdomen?

A

urinalysis, bHCG, and PR

Pastest (2 decks)

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