Lecture 11.2: Main GI Conditions Flashcards
What is Appendicitis?
Inflammation of the Appendix
Risk Factors for Appendicitis (4)
- Family History
- Ethnicity (Caucasians)
- Environmental (summer months)
- Diet
Causes of Appendicitis (4)
- Luminal Obstruction
- Acute Inflammation
- Ischaemia
- Necrosis +/-perforation
Pathophysiology of Appendicitis: Luminal Obstruction (4)
- Faecolith
- Lymphoid Hyperplasia
- Impacted Stool
- Appendiceal/Caecal Tumour
Pathophysiology of Appendicitis: Acute Inflammation
Multiplication of commensal bacteria
Symptoms of Appendicitis (7)
- Abdominal Pain (migrates from umbilicus to right iliac)
- Vomiting
- Fever
- Anorexia
- Nausea
- Diarrhoea
- Constipation
Signs of Appendicitis (4)
- Rebound tenderness and percussion pain over
McBurney’s point - Guarding
- Mass in RIF
- Haemodynamic Changes
What is Rovsing’s Sign?
RIF pain on palpation in the LIF
What is Psoas Sign?
RIF pain with extension of the right hip
What is Obturator Sign?
Internal rotation of the flexed right hip causes pain
What is the Hop Test?
Hopping or jumping causes pain
What is the Murphy’s Triad? (3)
- N+V
- Low-Grade Fever
- RIF Pain
What Laboratory Tests to do for Appendicitis? (4)
- Urinalysis
- FBC
- CRP (elevated suggests inflammation)
- Urea and Electrolytes
How will Appendicitis appear on an Ultrasound? (5)
- Non-compressible appendix (>6mm)
- Apendicolith
- Wall thickening (>3mm) with hyeraemia
- Free fluid in RIF
- Echogenicity of the mesenteric fat
Management of Appendicitis (3)
- Appendectomy
- Antibiotics
- FLuid Therapy
Complications of Appendicitis (6)
- Delay in presentation
- Perforation
- Abscess formation
- Complications of surgery
- Bleeding
- Wound infection
What is Acute Pancreatitis?
- Acute inflammation of the pancreas
Causes of Acute Pancreatitis: GET SMASHED
- Gallstone
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune Diseases
- Scorpion Venom
- Hypercalcaemia
- Endoscopic Retrograde CholangioPancreatography
(ERCP) - Drug
Symptoms of Acute Pancreatitis
- Severe upper abdominal pain (Epigastric/LUQ)
- Pain radiates through to the back
- Nausea and Vomiting
- Bloating
Signs of Acute Pancreatitis (7)
- Epigastric tenderness +/- guarding
- Haemodynamic `instability
- Cullen’s sign
- Grey-Turner’s Sign
- Tetany
- Jaundice
- Respiratory signs
What is Cullen’s Sign?
Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region
What is Grey-Turner’s Sign?
Ecchymosis or discoloration of the flanks
Investigations for Acute Pancreatitis: Lab Tests (7)
- Serum amylase (3x normal)
- FBC
- U+E
- Glucose
- CRP
- Bilirubin and LFT
- Calcium Levels
What Imaging is done for Acute Pancreatitis? (2)
- Contrast Enhanced CT scan
- Ultrasound
Risk Scoring via The Modified Glasgow Criteria
- 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
Treatment of Acute Pancreatitis (5)
- NBM
- IV fluid resuscitation
- Catheterisation
- Analgesia
- Treat underlying cause
Local Complications of Acute Pancreatitis (5)
- Pancreatic Necrosis
- Infected Necrosis
- Fluid Collections/Pseudo-Cysts
- Pancreatic Abscess
- Acute Cholecystitis
Systemic Complications of Acute Pancreatitis: Respiratory (4)
- Acute Respiratory Distress Syndrome
- Pleural Effusions
- Consolidation
- Pulmonary Oedema
Systemic Complications of Acute Pancreatitis: GI (2)
- Haemorrhage
- Ileus
What is Ileus?
A temporary lack of the normal muscle contractions of the intestines
Systemic Complications of Acute Pancreatitis: Metabolic (2)
- Hypocalcaemia
- Hyperglycaemia
What is Weber-Christian Disease?
Skin condition that features recurring inflammation in the subcutaneous fat layer of the skin
What are the 3 methods by which a tube can get blocked?
- Blockage within the tube
- Blockage due to problem with wall of tube
- Blockage due to external pressure
What can cause blockage within a tube? (3)
- Gallstone ileus
- Foreign body
- Faecal impaction
What can cause blockage due to problem with the wall of a tube? (3)
- Cancer
- Strictures (inflammatory/diverticular)
- Meckel’s diverticulum
- Lymphoma
- Intussusception
What can cause blockage due to external pressure in a tube? (4)
- Hernias
- Adhesions
- Volvulus
- Peritoneal metastases
What are the most common causes of Small Bowel
Obstructions? (2)
- Hernias
- Adhesions
What are the most common causes of Large Bowel
Obstructions? (3)
- Cancer
- Strictures (inflammatory/diverticular)
- Volvulus
Symptoms of a Bowel Obstruction (5)
- Abdominal pain (colicky/cramping)
- Nausea & Vomiting
- Maybe Faecalent
- Absolute Constipation
- Abdominal Distension
Signs of a Bowel Obstruction (6)
- Abdominal Distension
- Abdominal Tenderness
- Tympanic percussion and tinkling bowel sounds
- Succusion Splash
- Haemodynamic Instability
- Empty Rectum
Investigations for Bowel Obstruction: Lab Tests (6)
- FBC
- U+E
- CRP
- LFTs
- G+S
- Venous blood gas
Investigations for Bowel Obstruction: Imaging (2)
- CT scan with IV contrast
- AXR
Management of Bowel Obstruction (6)
- NBM
- NG tube
- IV fluids
- Urinary catheter
- Analgesia
- Laparotomy +/- resection +/- stoma formation
Complications of Bowel Obstruction (3)
- Bowel Perforation
- Bowel Ischaemia
- Renal Impairment
What are the 3 Main Types of Gallstones?
- Pigmented
- Cholesterol
- Mixed
What Conditions can Gallstones cause? (4)
- Biliary colic
- Cholecystitis
- Cholangitis
- Pancreatitis
What are the 5 F’s of Gallstones
Fat
Fair
Fertile
Female
Fourty
Risk Factors for Gallstones (5)
- 5 F’s
- Pregnancy
- Oral Contraceptive
- Haemolytic Anaemia
- Malabsorption
Symptoms of Gallstones/Cholecystitis (4)
- Constant pain RUQ/epigastrium
- Fever
- Lethargy
- Jaundice
Signs of Gallstones/Cholecystitis (2)
- Tender RUQ
- Positive Murphy’s sign
What is a Positive Murphy’s Sign?
- Apply pressure to RUQ
- Ask patient to inspire
- Positive sign when inspiration is halted due to pain
Investigations for Gallstones/Cholecystitis: Lab Tests (5)
- FBC
- CRP (inflammatory response)
- LFTs (raised ALP)
- Amylase (to exclude pancreatitis)
- Urinalysis (to exclude UTI and pregnancy)
What can be seen on U/S of patient with Gallstones/ Cholecystitis? (3)
- Presence of Gallstones
- Gallbladder Wall Thickness
- Bile Duct Dilatation
Management of Gallstones (4)
- IV antibiotics
- Analgesia
- Antiemetic
- Surgery (laparoscopic cholecystectomy)
Complications of Gallstones (6)
- Mirizzi Syndrome
- Gallbladder Empyema (pus in gallbladder)
- Chronic Cholecystitis
- Cholecystoduodenal Fistula
- Bouveret’s Syndrome
- Gallstone Ileus
What is Mirizzi Syndrome?
- Obstructive jaundice caused by a stone located in
Hartmann’s pouch or in the cystic duct - Compresses the adjacent CHD
What is Diverticulum?
Outpouching of the bowel wall
What is Diverticulosis?
Presence of diverticula, asymptomatic
What is Diverticulitis?
Inflammation of the diverticula
What is Diverticular Bleed?
Erosion into a vessel causes large volume painless bleeding
Pathophysiology of Diverticultis
- Bowel weakened with aging
- Movement of stool causes increased luminal pressure
- Causes out-pouching at weak area
- Bacterial overgrowth leads to inflammation and
complications
Risk Factors for Diverticultis (6)
- Age
- Low Dietary Fibre Intake
- Obesity
- Smoking
- Family History
- NSAID Use
Symptoms of Diverticultis (6)
- Acute Abdominal Pain
- Anorexia
- Fever
- Sudden change in bowel habit
- PR bleeding
- Dysuria
How does Pain due to Diverticultis Present?
- Acute abdominal pain
- Starts hypogastrium before localising
- Sharp, localising to the LIF
- Worse with movement
Signs of Diverticultis (4)
- Localised Tenderness
- Abdominal Distension
- Haemodynamic Instability
- Evidence of Perforation
Investigations for Diverticultis: Lab Tests (5)
- FBC
- CRP
- U+Es
- Consider Faecal Calprotectin
- CT Abdomen-Pelvis
Management of Diverticultis (5)
- Analgesia
- Antibiotics
- IV Fluids
- Surgery
- Hartmann’s Procedure
Complications of Diverticultis (7)
- Perforation
- Bleeding
- Abscess Formation
- Recurrence
- Stricture
- Obstruction
- Fistula
What is Testicular Torsion?
- Spermatic cord and contents twist, this compromises
blood supply to the testicles - This is a surgical emergency
Risk Factors for Testicular Torsion
- Age
- Previous Torsion
- FHx
- Undescended Testes
- Bell-Clapper Deformity
What is a Bell-Clapper Deformity?
Testis lacks a normal attachment to tunica vaginalis and hangs freely
Symptoms of Testicular Torsion (3)
- Unilateral Testicular Pain
- Referred Abdominal Pain
- Nausea and Vomiting
Signs of Testicular Torsion (3)
- High Swollen/Tender Testis
- Absent Cremasteric Reflex
- Prehn’s Sign Negative
What is Prehn’s Sign?
Alleviation of scrotal pain by lifting of the testicle and is suggestive of the diagnosis of acute epididymitis
What is the Cremasteric Reflex?
- 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
Investigations for Testicular Torsion
- USS
- Urinalysis
Management of Testicular Torsion
Surgery
Renal Colic
A severe form of sudden flank pain that typically originates over the costovertebral angle and extends anteriorly and inferiorly towards the groin or testicle
Renal Colic is often caused by obstructions in the urinary tract, what are the 3 most common locations of obstructions?
- The ureteropelvic junction (UPJ)
- The crossing of the ureter over the area of the pelvic
brim (the iliac vessels) - The ureterovesical junction (UVJ)
Symptoms and Signs of Renal Colic (4)
- Severe pain, flank to pelvis
- Nausea & Vomiting
- Haematuria
- Tenderness
Investigations for Renal Colic (7)
- Urine Dip
- FBC
- CRP
- U+E
- Urate and Calcium Levels
- CT KUB
- USS
Management of Renal Colic (6)
- 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
Symptoms of Ectopic Pregnancy (4)
- Missed Period/Signs of Pregnancy
- Abdominal Pain
- Vaginal Bleeding/Discharge
- Shoulder Tip Pain
Signs of Ectopic Pregnancy (3)
- Abdominal Tenderness
- Signs of Peritonitis
- Haemodynamically Unstable
Investigations for Ectopic Pregnancy (3)
- Urinary pregnancy test
- USS
- If not able to visualise will need serum BHCG
Management of Ectopic Pregnancy (3)
- Medical
- Surgical
- Conservative
