Lesson 1 Flashcards
Oesophageal carcinoma investigation?
Upper gl endoscopy with biopsy (ist line)
Barium swallow-irregular narrowing +proximally dilated segment
Thyroglossal cyst unique characteristic?
Midline neck swelling which moves with tongue protrusion
Thyroglossal cyst diagnosis.?
Ultrasound is first line and investigation of choice
Rarely requires MRI or CT scan
To rule out ectopic thyroid tissue in wall we can do TC 99 m scan
Gastric cancer signs and risks
Troisier’s sign there is a lump in left supraclavicular region _ virchow’s node
Associated with hepatomegaly and ascites
Risk factors,h pylori infection, smoking, family risk, blood group A
Management of gastric cancer
Screen for nutritional deficiency
Partial or total gastrectomy
Paralytic Ileus signs and when seen after
Definition it is cessation of gastrointestinal tract motility
Main two signs: absent bowel sounds and tympanic on percussion
It is mainly seen after : prolonged abdominal surgery, electrolyte disturbances, anticholinergic or opiate use, immobilisation
What do we sit in paralytic ileus abdominal x-ray?
Air or fluid filled loops of small and or large bowel.
Conservative management of paralytic ileus?
Drip and suck method
Drip- intravenous fluid
Suck -empty stomach with nasogastric tube from fluid and gas.
Correct electrolyte imbalance
Different diagnosis to intestinal obstruction
Similar features as paralytic Ileus. Here, bowel sounds are present (high-pitched) on auscultation.
Urgent surgical referral is required-intestinal obstruction is noisy. Ileus is not.
What is the most common electrolyte imbalance that causes paralytic Ileus?
Hypercalcaemia and hypokalaemia
Hypercalcaemia depresses so would cause depression and decreased bowel activity
Intestinal obstruction, clinical features and investigation
Colicky abdominal pain, vomiting, abdominal distension, tympanic sound on percussion, hyperactive bowel sound on auscultation.
Investigations : abdominal x-Ray (initial)
CT scan
Treatment of intestinal obstruction
IV fluids, analgesia, Nair gastric tube, surgery (usually laparotomy) is reserved for intestinal ischaemia, close loop bowel obstruction or strangulation. If fails to improve with conservative measures usually after 48 hours consider surgery.
Difference in in paralytic ILEUS and intestinal obstruction seen on abdominal x-ray
In paralytic ileus , there is no distinct transition point
Intestinal obstruction clear transition point between distended and collapsed bowel
Investigation for pancreatic cancer
High resolution CT scan(the most initial inappropriate test if suspecting pancreatic cancer).
CA 19-9 (used mostly for prognosis do not use this to screen or to help with diagnosis).
Treatment of pancreatic cancer
Without metastasis-Whipple’s resection
With metastasis-palliative ERCP with stent
Indirect inguinal hernia passage
Passes through the deep inguinal ring and exits through superficial inguinal ring. Can continue to descend to scrotum.
Direct inguinal hernia passage
Passes through the posterior wall of inguinal canal and exit via superficial ring
