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Gastrointestinal System > Lecture 11.2: Main GI Conditions > Flashcards

Lecture 11.2: Main GI Conditions Flashcards

1
Q

What is Appendicitis?

A

Inflammation of the Appendix

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2
Q

Risk Factors for Appendicitis (4)

A
  • Family History
  • Ethnicity (Caucasians)
  • Environmental (summer months)
  • Diet
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3
Q

Causes of Appendicitis (4)

A
  • Luminal Obstruction
  • Acute Inflammation
  • Ischaemia
  • Necrosis +/-perforation
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4
Q

Pathophysiology of Appendicitis: Luminal Obstruction (4)

A
  • Faecolith
  • Lymphoid Hyperplasia
  • Impacted Stool
  • Appendiceal/Caecal Tumour
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5
Q

Pathophysiology of Appendicitis: Acute Inflammation

A

Multiplication of commensal bacteria

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6
Q

Symptoms of Appendicitis (7)

A
  • Abdominal Pain (migrates from umbilicus to right iliac)
  • Vomiting
  • Fever
  • Anorexia
  • Nausea
  • Diarrhoea
  • Constipation
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7
Q

Signs of Appendicitis (4)

A
  • Rebound tenderness and percussion pain over
    McBurney’s point
  • Guarding
  • Mass in RIF
  • Haemodynamic Changes
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8
Q

What is Rovsing’s Sign?

A

RIF pain on palpation in the LIF

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9
Q

What is Psoas Sign?

A

RIF pain with extension of the right hip

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10
Q

What is Obturator Sign?

A

Internal rotation of the flexed right hip causes pain

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11
Q

What is the Hop Test?

A

Hopping or jumping causes pain

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12
Q

What is the Murphy’s Triad? (3)

A
  • N+V
  • Low-Grade Fever
  • RIF Pain
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13
Q

What Laboratory Tests to do for Appendicitis? (4)

A
  • Urinalysis
  • FBC
  • CRP (elevated suggests inflammation)
  • Urea and Electrolytes
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14
Q

How will Appendicitis appear on an Ultrasound? (5)

A
  • Non-compressible appendix (>6mm)
  • Apendicolith
  • Wall thickening (>3mm) with hyeraemia
  • Free fluid in RIF
  • Echogenicity of the mesenteric fat
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15
Q

Management of Appendicitis (3)

A
  • Appendectomy
  • Antibiotics
  • FLuid Therapy
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16
Q

Complications of Appendicitis (6)

A
  • Delay in presentation
  • Perforation
  • Abscess formation
  • Complications of surgery
  • Bleeding
  • Wound infection
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17
Q

What is Acute Pancreatitis?

A
  • Acute inflammation of the pancreas
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18
Q

Causes of Acute Pancreatitis: GET SMASHED

A
  • Gallstone
  • Ethanol
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune Diseases
  • Scorpion Venom
  • Hypercalcaemia
  • Endoscopic Retrograde CholangioPancreatography
    (ERCP)
  • Drug
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19
Q

Symptoms of Acute Pancreatitis

A
  • Severe upper abdominal pain (Epigastric/LUQ)
  • Pain radiates through to the back
  • Nausea and Vomiting
  • Bloating
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20
Q

Signs of Acute Pancreatitis (7)

A
  • Epigastric tenderness +/- guarding
  • Haemodynamic `instability
  • Cullen’s sign
  • Grey-Turner’s Sign
  • Tetany
  • Jaundice
  • Respiratory signs
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21
Q

What is Cullen’s Sign?

A

Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region

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22
Q

What is Grey-Turner’s Sign?

A

Ecchymosis or discoloration of the flanks

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23
Q

Investigations for Acute Pancreatitis: Lab Tests (7)

A
  • Serum amylase (3x normal)
  • FBC
  • U+E
  • Glucose
  • CRP
  • Bilirubin and LFT
  • Calcium Levels
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24
Q

What Imaging is done for Acute Pancreatitis? (2)

A
  • Contrast Enhanced CT scan
  • Ultrasound
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25
Q

Risk Scoring via The Modified Glasgow Criteria

A
  • PaO2 <8kPa
  • Age >55yrs
  • Neutrophilia: WCC>15×109/L
  • Calcium <2mmol/L (normal: 2.12mmol-2.65mmol/L)
  • Renal function: urea>16mmol/L (normal: 2.5-
    6.7mmol/L)
  • Enzymes: LDH >600iU/L (normal: 70-250iU/L)
  • Albumin <32g/L
  • Sugar: blood glucose >10mmol/L
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26
Q

Treatment of Acute Pancreatitis (5)

A
  • NBM
  • IV fluid resuscitation
  • Catheterisation
  • Analgesia
  • Treat underlying cause
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27
Q

Local Complications of Acute Pancreatitis (5)

A
  • Pancreatic Necrosis
  • Infected Necrosis
  • Fluid Collections/Pseudo-Cysts
  • Pancreatic Abscess
  • Acute Cholecystitis
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28
Q

Systemic Complications of Acute Pancreatitis: Respiratory (4)

A
  • Acute Respiratory Distress Syndrome
  • Pleural Effusions
  • Consolidation
  • Pulmonary Oedema
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29
Q

Systemic Complications of Acute Pancreatitis: GI (2)

A
  • Haemorrhage
  • Ileus
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30
Q

What is Ileus?

A

A temporary lack of the normal muscle contractions of the intestines

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31
Q

Systemic Complications of Acute Pancreatitis: Metabolic (2)

A
  • Hypocalcaemia
  • Hyperglycaemia
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32
Q

What is Weber-Christian Disease?

A

Skin condition that features recurring inflammation in the subcutaneous fat layer of the skin

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33
Q

What are the 3 methods by which a tube can get blocked?

A
  • Blockage within the tube
  • Blockage due to problem with wall of tube
  • Blockage due to external pressure
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34
Q

What can cause blockage within a tube? (3)

A
  • Gallstone ileus
  • Foreign body
  • Faecal impaction
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35
Q

What can cause blockage due to problem with the wall of a tube? (3)

A
  • Cancer
  • Strictures (inflammatory/diverticular)
  • Meckel’s diverticulum
  • Lymphoma
  • Intussusception
36
Q

What can cause blockage due to external pressure in a tube? (4)

A
  • Hernias
  • Adhesions
  • Volvulus
  • Peritoneal metastases
37
Q

What are the most common causes of Small Bowel
Obstructions? (2)

A
  • Hernias
  • Adhesions
38
Q

What are the most common causes of Large Bowel
Obstructions? (3)

A
  • Cancer
  • Strictures (inflammatory/diverticular)
  • Volvulus
39
Q

Symptoms of a Bowel Obstruction (5)

A
  • Abdominal pain (colicky/cramping)
  • Nausea & Vomiting
  • Maybe Faecalent
  • Absolute Constipation
  • Abdominal Distension
40
Q

Signs of a Bowel Obstruction (6)

A
  • Abdominal Distension
  • Abdominal Tenderness
  • Tympanic percussion and tinkling bowel sounds
  • Succusion Splash
  • Haemodynamic Instability
  • Empty Rectum
41
Q

Investigations for Bowel Obstruction: Lab Tests (6)

A
  • FBC
  • U+E
  • CRP
  • LFTs
  • G+S
  • Venous blood gas
42
Q

Investigations for Bowel Obstruction: Imaging (2)

A
  • CT scan with IV contrast
  • AXR
43
Q

Management of Bowel Obstruction (6)

A
  • NBM
  • NG tube
  • IV fluids
  • Urinary catheter
  • Analgesia
  • Laparotomy +/- resection +/- stoma formation
44
Q

Complications of Bowel Obstruction (3)

A
  • Bowel Perforation
  • Bowel Ischaemia
  • Renal Impairment
45
Q

What are the 3 Main Types of Gallstones?

A
  • Pigmented
  • Cholesterol
  • Mixed
46
Q

What Conditions can Gallstones cause? (4)

A
  • Biliary colic
  • Cholecystitis
  • Cholangitis
  • Pancreatitis
47
Q

What are the 5 F’s of Gallstones

A

Fat
Fair
Fertile
Female
Fourty

48
Q

Risk Factors for Gallstones (5)

A
  • 5 F’s
  • Pregnancy
  • Oral Contraceptive
  • Haemolytic Anaemia
  • Malabsorption
49
Q

Symptoms of Gallstones/Cholecystitis (4)

A
  • Constant pain RUQ/epigastrium
  • Fever
  • Lethargy
  • Jaundice
50
Q

Signs of Gallstones/Cholecystitis (2)

A
  • Tender RUQ
  • Positive Murphy’s sign
51
Q

What is a Positive Murphy’s Sign?

A
  • Apply pressure to RUQ
  • Ask patient to inspire
  • Positive sign when inspiration is halted due to pain
52
Q

Investigations for Gallstones/Cholecystitis: Lab Tests (5)

A
  • FBC
  • CRP (inflammatory response)
  • LFTs (raised ALP)
  • Amylase (to exclude pancreatitis)
  • Urinalysis (to exclude UTI and pregnancy)
53
Q

What can be seen on U/S of patient with Gallstones/ Cholecystitis? (3)

A
  • Presence of Gallstones
  • Gallbladder Wall Thickness
  • Bile Duct Dilatation
54
Q

Management of Gallstones (4)

A
  • IV antibiotics
  • Analgesia
  • Antiemetic
  • Surgery (laparoscopic cholecystectomy)
55
Q

Complications of Gallstones (6)

A
  • Mirizzi Syndrome
  • Gallbladder Empyema (pus in gallbladder)
  • Chronic Cholecystitis
  • Cholecystoduodenal Fistula
  • Bouveret’s Syndrome
  • Gallstone Ileus
56
Q

What is Mirizzi Syndrome?

A
  • Obstructive jaundice caused by a stone located in
    Hartmann’s pouch or in the cystic duct
  • Compresses the adjacent CHD
57
Q

What is Diverticulum?

A

Outpouching of the bowel wall

58
Q

What is Diverticulosis?

A

Presence of diverticula, asymptomatic

59
Q

What is Diverticulitis?

A

Inflammation of the diverticula

60
Q

What is Diverticular Bleed?

A

Erosion into a vessel causes large volume painless bleeding

61
Q

Pathophysiology of Diverticultis

A
  • Bowel weakened with aging
  • Movement of stool causes increased luminal pressure
  • Causes out-pouching at weak area
  • Bacterial overgrowth leads to inflammation and
    complications
62
Q

Risk Factors for Diverticultis (6)

A
  • Age
  • Low Dietary Fibre Intake
  • Obesity
  • Smoking
  • Family History
  • NSAID Use
63
Q

Symptoms of Diverticultis (6)

A
  • Acute Abdominal Pain
  • Anorexia
  • Fever
  • Sudden change in bowel habit
  • PR bleeding
  • Dysuria
64
Q

How does Pain due to Diverticultis Present?

A
  • Acute abdominal pain
  • Starts hypogastrium before localising
  • Sharp, localising to the LIF
  • Worse with movement
65
Q

Signs of Diverticultis (4)

A
  • Localised Tenderness
  • Abdominal Distension
  • Haemodynamic Instability
  • Evidence of Perforation
66
Q

Investigations for Diverticultis: Lab Tests (5)

A
  • FBC
  • CRP
  • U+Es
  • Consider Faecal Calprotectin
  • CT Abdomen-Pelvis
67
Q

Management of Diverticultis (5)

A
  • Analgesia
  • Antibiotics
  • IV Fluids
  • Surgery
  • Hartmann’s Procedure
68
Q

Complications of Diverticultis (7)

A
  • Perforation
  • Bleeding
  • Abscess Formation
  • Recurrence
  • Stricture
  • Obstruction
  • Fistula
69
Q

What is Testicular Torsion?

A
  • Spermatic cord and contents twist, this compromises
    blood supply to the testicles
  • This is a surgical emergency
70
Q

Risk Factors for Testicular Torsion

A
  • Age
  • Previous Torsion
  • FHx
  • Undescended Testes
  • Bell-Clapper Deformity
71
Q

What is a Bell-Clapper Deformity?

A

Testis lacks a normal attachment to tunica vaginalis and hangs freely

72
Q

Symptoms of Testicular Torsion (3)

A
  • Unilateral Testicular Pain
  • Referred Abdominal Pain
  • Nausea and Vomiting
73
Q

Signs of Testicular Torsion (3)

A
  • High Swollen/Tender Testis
  • Absent Cremasteric Reflex
  • Prehn’s Sign Negative
74
Q

What is Prehn’s Sign?

A

Alleviation of scrotal pain by lifting of the testicle and is suggestive of the diagnosis of acute epididymitis

75
Q

What is the Cremasteric Reflex?

A
  • This reflex is elicited by stroking or pinching the medial
    thigh, causing contraction of the cremaster muscle,
    which elevates the testis
  • The cremasteric reflex is considered positive if the
    testicle moves at least 0.5 cm
76
Q

Investigations for Testicular Torsion

A
  • USS
  • Urinalysis
77
Q

Management of Testicular Torsion

A

Surgery

78
Q

Renal Colic

A

A severe form of sudden flank pain that typically originates over the costovertebral angle and extends anteriorly and inferiorly towards the groin or testicle

79
Q

Renal Colic is often caused by obstructions in the urinary tract, what are the 3 most common locations of obstructions?

A
  • The ureteropelvic junction (UPJ)
  • The crossing of the ureter over the area of the pelvic
    brim (the iliac vessels)
  • The ureterovesical junction (UVJ)
80
Q

Symptoms and Signs of Renal Colic (4)

A
  • Severe pain, flank to pelvis
  • Nausea & Vomiting
  • Haematuria
  • Tenderness
81
Q

Investigations for Renal Colic (7)

A
  • Urine Dip
  • FBC
  • CRP
  • U+E
  • Urate and Calcium Levels
  • CT KUB
  • USS
82
Q

Management of Renal Colic (6)

A
  • Rehydration
  • Spontaneously pass majority of cases if <5mm
  • Analgesia
  • IV abx if infection
  • Nephrostomy if signs of obstruction
  • ESWL, PCNL, URS if stones cannot pass
83
Q

Symptoms of Ectopic Pregnancy (4)

A
  • Missed Period/Signs of Pregnancy
  • Abdominal Pain
  • Vaginal Bleeding/Discharge
  • Shoulder Tip Pain
84
Q

Signs of Ectopic Pregnancy (3)

A
  • Abdominal Tenderness
  • Signs of Peritonitis
  • Haemodynamically Unstable
85
Q

Investigations for Ectopic Pregnancy (3)

A
  • Urinary pregnancy test
  • USS
  • If not able to visualise will need serum BHCG
86
Q

Management of Ectopic Pregnancy (3)

A
  • Medical
  • Surgical
  • Conservative

Gastrointestinal System (22 decks)

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