Brainscape's Knowledge GenomeTM

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


See full index

General Surgery > LB Disease > Flashcards

LB Disease Flashcards

1
Q

What causes appendicitis?

A

Direct luminal obstruction
(usually secondary faecolith*, May lymphoid hyperplasia, impacted stool, appendiceal/ caecal tumour)

Lifetime risk 7-8%
2nd/ 3rd decade

*hardened, sometimes calcified stool (worse than impacted)

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

Signs of appendicitis

A

Rebound tenderness/ percussion pain McBurney’s point

  • Rovsing’s sign
    RIF pain on palpation of LIF
  • Psoas sign
    RIF pain with extension of R hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aetiology of colorectal cancers

A

3rd most common cancer UK
2nd highest mortality

Originate epithelial cells, mostly adenocarcinoma
Rarer: lymphoma, carcinoid, sarcoma

Adenoma-carcinoma sequence:
Normal mucosa -> colonic adenoma (polyps) 10+yrs -> 10% invasive adenocarcinoma

Genetics: adenomatous polyposis coli, hereditary non polyposis colorectal cancer

75% sporadic

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

Clinical features of bowel cancer

A 
Change in bowel habit 
Rectal bleeding 
WL
Abdo pain 
Fe deficiency anaemia

Right sided
Abdo pain, occult bleeding/ anaemia, mass RIF, present late

Left
PR bleeding, change BH, tenesmus, mass LIF/ DRE

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

What is anterior resection? What about abdominoperineal resection?

A

High rectal tumours
>5cm from anus
Loop ileostomy (temporary)

Low rectal tumours (<5cm)
Rectum & anus (including sphincter muscles) removed
Stoma (colostomy) permanent

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

What is Hartmann’s procedure?

A

Emergency bowel surgery
Obstruction/ perforation
Complete resection recto-sigmoid colon
-> end colostomy & closure rectal stump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Define:
diverticulum 
Diverticulosis
Diverticula disease
Diverticulitis
A

Outpouching of the bowel wall (most commonly SC)

Presence of diverticula
(50% >50yrs, mostly asymptomatic)

Symptomatic diverticula (diverticula pain - intermittent lower abdo, colicky, relived defecation, altered BH, N, flactulence)

Inflammation of diverticula
(Acute abdo pain, sharp, LIF, worsened movement, loss appetite/ pyrexia/ N)

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

Pathophysiology of diverticula & some complications

A

Weakened bowel -> stool ⬆️luminal P -> outpouching of mucosa

Bacteria can overgrow -> diverticulitis -> perforate -> peritonitis

Chronic cases - fistulae - colovesical (pneumoturia, recurrent UTIs) colovaginal (vaginal discharge, infections)

Diverticula bleed (diverticula, erodes into vessel -> large, painless bleed)

Diverticulitis simple/ complicated
Complicated - abscess (pericolic - ABs, bowel rest-> drainage & washout) / fistula/ stricture (-> bowel obstruction) / free perforation

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

Investigations for diverticular disease & diverticulitis

A

DD:
FBC
CRP
Faecal calprotectin

Diverticulitis:
G&S, routine bloods, VBG, urine dipstick

Imaging:
Uncomplicated DD - flexible sigmoidoscopy (never colonoscopy)
Diverticulitis - CT abdo-pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of Crohn’s disease

A 
Mouth - anus (commonly distal ileum, proximal colon) 
Transmural inflammation (all layers)
Deep ulcers & fissures (cobblestone) 
Skip lesions 
Fistulas

Microscopic: non- caseating granulomatous inflammation

Perianal disease common
Oral aphthous ulcers

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

Clinical features of Crohn’s disease (symptoms)

A 
Abdo pain colicky
Diarrhoea (May blood/ mucous) chronic
MalAise
Anorexia
Pyrexia
Malnourishment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Extra-intestinal features of Crohn’s disease

A

Enteropathic arthritis
Metabolic bone disease
Erythema nodosum (subcut nodules, shins)
Pyoderma gangrenosum (pustules -> deep ulcer, shins)

Episcleritis
Uveitis
Iritis

Primary sclerosis group cholangitis
Cholangiocarcinoma
Gallstones

Renal stones

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

Investigations for Crohn’s disease

A 
Routine bloods
AXR
CT (acute) 
Faecal calprotectin 
Stool sample

Colonoscopy + biopsy
MRI (non acute)
EUA + proctosigmoidoscopy

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

Medical Management of Crohn’s disease

A 
Inducing remission: 
Fluid resus
Nutritional support
Heparin 
Anti embolism stockings 
- corticosteroid 
- immunosuppressives (mesalazine, azathioprine)
- biological agents (infliximab)

Maintaining remission:

  • azathiprine/ mercaptopurine
  • methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Surgical management of Crohn’s disease

A

70-80% require surgery

Failed medical management/ severe complications/ growth impairment

Ileocaecal/ SB/ LB resection
Stricturoplasty

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

Features of ulcerative colitis

A

Continually mucosal inflammation
LB (rectum-> proximal, can get backwash ileitis)

Microscopic:
Crypt abscess
Reduced goblet cells
Non-granulomatous

Macroscopic:
Pseudopolyps
Ulcers

17
Q

Clinical features ulcerative colitis (symptoms)

A

Blood diarrhoea (visible >90%)

Proctitis (inflammation confined rectum)
PR bleed
Mucus discharge 
Change BH
Malaise
Anorexia
Pyrexia
18
Q

Extra intestinal features UC

A

Enteropathic arthritisErythema nodosum

Episcleritis
Uveitis
Iritis

Primary sclerosis cholangitis

19
Q

Investigations UC

A

Routine bloods
Faecal calprotectin (IBD+, IBS -)
Stool sample

Imaging:
Colonoscopy + biopsy
Flex sigmoidoscopy
AXR - mural Thickening, thumb printing, lead pipe colon/ CT (acute)

20
Q

Medical management UC

A 
Inducing remission: 
Fluid resus
Nutritional support
Heparin
- Corticosteroid
- immunosuppression (mesalazine/ azathiprine)
- biological agents (infliximab)

Maintaining remission:
Immunomodulators (mesalazine/ sulfasalazine)
Monoclonal ABs

Colonoscopy survellience

21
Q

Surgical management UC

A

30%

Not responding medical
Toxic megacolon
Bowel perf
Risk carcinoma

Total proctocolectomy curative - ileostomy
Sub total colectomy

22
Q

What is pseudo obstruction/ ogilvie syndrome?

A

Dilation of colon due a dynamic bowel absence mechanical obstruction

Commonly caecum & AC
Rare
Elderly

23
Q

Pathophysiology of pseudo obstruction

A

Interruption ANS supply to colon -> absence smooth muscle action

Increased risk:
Toxic megacolon
Perforation
Bowel ischaemia

Causes:
Electrolyte imbalance / endocrine disorders
Medication (opioids, CCBs, antidepressants)
Recent surgery, severe illness, trauma
Neurological disease

24
Q

Clinical Features of pseudo obstruction

A

Abdo pain
Abdo distension
Constipation
Vomiting

Tympanic abdo

25
Q

Investigations for pseudo obstruction

A

Bloods
Biochemical/ endocrine causes e.g. U&Es, Ca, mg, TFTs

AXR
Abdo pelvis CT + IV contrast (differentiate from mechanical)

26
Q

Management pseudo obstruction

A 
Conservatively 
Underlying cause
Nil by mouth 
IV fluids
NG tube

Do not resolve 24-48hrs:
Endoscopic decompression - flats tube

Non responding:
Segmental resection

27
Q

Where do most volvulioccur? Second most common site? Risk factors

A

Sigmoid colon
Long Mesentery

Caecum - ileocaecal resection

Older
Neuropsychological disorders
Nursing home
Chronic constipation/ laxative 
Male
Previous abdo Ops
28
Q

Clinical features of volvulus & 2 signs on imaging

A

Bowel obstruction features

Vomiting
Colicky pain
Abdo distension severe
Absolute constipation

Rapid onset
Tympanic

Ct abdo pelvis + contrast - whirl sign
AXR - coffee bean sign LIF

29
Q

Management volvulus

A

Conservatively
Decompression - sigmoidoscope & flatus tube

Surgical (colon ischaemia/ perf, failed decompression repeatedly, necrotic bowel)

General Surgery (7 decks)

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