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Lower GI diseases (surgery) Flashcards

1
Q

Anastomosis

A

a connection between 2 structures

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2
Q

Dissect

A

to separate 2 structures

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3
Q

…centesis

A

incision and drainage

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4
Q

…ostomy

A

a new permanent opening

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5
Q

…orrhaphy

A

surgical repair or suture

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6
Q

…opexy

A

surgical fixation

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7
Q

…oplasty

A

surgical repair or reconstruction

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8
Q

Meckel’s diverticulum usually presents symptomatically, and at about 2 years old. True/false?

A

False
Usually asymptomatic
BUT if symptomatic, presents at 2yrs

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9
Q

Atresia is the most common congenital deformity of the GI tract. True/false?

A

False

Meckel’s diverticulum

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10
Q

Meckel’s diverticulum

A

Persistence of the vitelline duct which forms an outpouching (diverticulum) of the ileum - kindof like a second appendix

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11
Q

In Meckel’s diverticulum, some contain gastric mucosa, which can secrete ——– and cause ———–

A

Secrete HCl and cause ulceration.

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12
Q

Vitelline duct

A

tube between the yolk sac and the primitive midgut - usually disappears during embryonic development

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13
Q

Vitelline duct is also called ————

A

omphalomesenteric duct, omphaloenteric duct, yolk stalk

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14
Q

Meckel’s diverticulum is twice as common in males. True/false?

A

True

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15
Q

Condition that mimics appendicitis.

A

Meckel’s diverticulum

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16
Q

Appendicitis - symptoms

A 
Abdominal pain
Guarding (abdominal muscles tense to protect the inflamed structure)
Nausea
Fever
Tachycardia
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17
Q

Meckel’s diverticulum - complications

A

Ulceration, perforation and haemorrhage ( in the presence of gastric mucosa)
Diverticulitis (acute inflammation)
Obstruction
Malignant change (rare)

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18
Q

Meckel’s diverticulum should be surgically removed if complications arise. True/false?

A

True

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19
Q

The rule of 2’s is associated with which GI condition?

A

Meckel’s DIverticulum

  • 2% of the population
  • 2 inches (5cm) long
  • 2 feet (60cm) from ileocecal valve
  • 2 years of age
  • Twice as often in males
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20
Q

Atresia

A

Congenital absence or abnormal closure of a body cavity

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21
Q

Atresia is usually due to ——-

A

problems in GI tract development

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22
Q

Atresia - types

A

Oesophageal atresia
Intestinal atresia
Biliary atresia

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23
Q

Atresia presents in newborns. True/false?

A

True

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24
Q

Swallowing or breathing difficulties in a newborn suggests oesophageal atresia. True/false?

A

True

oesophagus abnormally connects to trachea

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25
Q

Green (bile) vomit and swollen abdomen in a newborn suggests biliary atresia. True/false?

A

False.
This would be intestinal atresia.
Biliary atresia = jaundice

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26
Q

Meconium Ileus

A

Intestinal obstruction caused by meconium that is difficult to pass because it is too sticky

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27
Q

Meconium

A

a newborn’s first stool

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28
Q

90% of patients with meconium ileus have ——-

A

CF

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29
Q

Meconium Ileus - symptoms

A

Green (bile) vomit

Swollen abdomen

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30
Q

Omphalocele

A

Intestinal loop does not return to the abdomen during development, and herniates out into the umbilical cord (and is contained in the peritoneal layer of the cord).

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31
Q

Gastroschisis

A

Protrusion of the abdominal contents through a defect (hole) in the anterior abdominal wall lateral to the umbilical cord
Not covered in peritoneum

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32
Q

Gastroschisis occurs when a loop of bowel herniates into the umbilical cord. True/false?

A

False.
This is an omphalocele.
Gastroschisis = protrusion lateral to umbilical cord

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33
Q

What part of the small intestine is the vitelline duct found in?

A

Ileum

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34
Q

Intestinal malrotation

A

A congenital issue in which the intestines are twisted into the gut incorrectly, due to incorrect connection to the back wall.

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35
Q

A volvulus is a rare complication that can occur in intestinal malrotation. True/false?

A

False

Volvulus is very common in intestinal malrotation, but can happen to anyone.

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36
Q

Major risk factors for volvulus include ———-

A

abdominal anatomy abnormalities
colonic enlargement
pregnancy
abdominal adhesions

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37
Q

Intestinal malrotation can be accompanied by abnormal tissue called ——–

A

Ladd’s bands

these can cause obstructions in the small intestine

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38
Q

Why is intestinal malrotation dangerous?

A

The twisting can obstruct the lumen of the intestine or block off the blood supply
There can be other complications e.g. a volvulus

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39
Q

Volvulus

A

when a loop of intestine is wrapped around its own mesentery

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40
Q

Malrotation is most commonly diagnosed in teenagers. True/false?

A

False.

Malrotation is in kids, with 90% diagnosed by age 1

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41
Q

Most people with malrotation will have other associated deformities of the GI tract. True/false?

A

True

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42
Q

Intestinal malrotation +/- volvulus symptoms

A

Follow an obstructive pattern

e.g. bile vomiting (green), abdominal pain, abdominal distension, failure to thrive

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43
Q

Bilious vomiting in babies should be taken as intestinal atresia until proven otherwise. True/false?

A

False

Should be taken as MALROTATION

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44
Q

Intestinal malrotation - management

A

Ladd’s procedure - Ladd’s bands are dissected off

+ prophylactic appendectomy

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45
Q

Intussusception

A

When one segment of the intestine “telescopes” inside another

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46
Q

Intussusception is a mechanism of intestinal blockage. True/false?

A

True

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47
Q

Intussusception can occur anywhere but is commonly at the sigmoid colon. True/false?

A

False.

commonly at the ileocaecal junction

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48
Q

———— is a large risk factor for intussusception in adults

A

Previous abdominal surgery

polyps/tumours and long term inflammation due to IBD are risk factors; but scar tissue (adhesions) is a major risk

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49
Q

Malrotation is the most common cause of bowel obstruction in children under 3. True/false?

A

False

Intussusception is most common

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50
Q

“(red)currant jelly” stools in newborns

A

Intussusception

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51
Q

Intussusception - symptoms

A

Blood and mucus stool
Vomiting and diarrhoea
Lethargy
Abdominal mass

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52
Q

90% of intussusception cases can be fixed with an enema. True/false?

A

True

surgery = 2nd line

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53
Q

Anal fissures

A

A small tear in the mucosa (soft skin) that lines the anus (can be very small to severe)

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54
Q

Anal fissures - causes

A

Traumatic: passing large/hard stools, recurrent straining, chronic diarrhoea, anal intercourse, childbirth
Non traumatic: IBD, anal cancers, HIV, TB, Syphilis

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55
Q

Anal fissures - symptoms

A

Pain during or after bowel movements
Bright red blood on paper after wiping
A visible crack in the skin or small lump/tag

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56
Q

Anal fissures - treatment

A

Topical nitroglycerin
Topical anaesthetic (lidocaine)
Botox injection
Surgical treatment (lateral internal sphincterotomy)

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57
Q

Why is nitroglycerin used to treat anal fissures?

A

Promotes blood flow and promotes healing; it also relaxes the sphincter which reduces further damage

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58
Q

Why is botox used to treat anal fissures?

A

Botox paralyses the sphincter muscles to reduce damage

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59
Q

Colorectal cancer - risk factors

A

red meat, low fiber diet, smoking, IBD

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60
Q

Familial adenoma polyposis causes the development of 1/10 of adenoma polyps through the GI tract. True/false?

A

True

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61
Q

Lynch syndrome is another genetic condition that increases the risk of cancers through the entire GI tract but mostly in the ileocaecal region

A

False

Lynch syndrome is also known as hereditary nonpolyposis colorectal cancer.

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62
Q

How does colorectal cause anaemia?

A

By gastrointestinal bleeds or by malabsorption.

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63
Q

Duke’s criteria can be used for staging colorectal cancer. True/false?

A

False
Duke’s criteria = infective endocarditis
Duke’s system = colorectal cancer

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64
Q

Adhesions are a massive problem in large colonic surgery. True/false?

A

True

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65
Q

What does it mean for the intestines to be anastomosed functionally during a surgery?

A

To assure the patient still has a functional digestive tract it must be watertight and the mucosa must be arranged in such a way that no external tissue is exposed to the lumen as this can cause functional problems.

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66
Q

Colorectal cancer surgery
removal of part of a colonic segment =
full removal of a colonic segment =

A 
part = hemicolectomy
full = colectomy
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67
Q

Colorectal cancer can involve the perineum. True/false?

A

False

Anorectal cancer involves perineum.

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68
Q

Cancers of the anus can be either adenocarcinomas from the colon or SCC from the adjacent skin. True/false?

A

True

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69
Q

Structural Lower GI Conditions

A 
Diverticular disease and diverticulitis
Colonic polyps
Hernias
Haemorrhoids
Rectal varices
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70
Q

Diverticulum

A

an outpouching of the gut wall

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71
Q

Diverticulosis

A

presence of diverticula

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72
Q

Diverticular disease

A

diverticula which are symptomatic

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73
Q

Diverticulitis

A

inflammation of a diverticulum

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74
Q

Complicated diverticular disease/complicated diverticulitis

A

diverticulitis with complications

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75
Q

Uncomplicated diverticular disease/uncomplicated diverticulitis diverticulitis without complications

A

diverticulitis without complications

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76
Q

Diverticular disease is the presence of diverticula. True/false?

A

False
Diverticulosis = diverticula
Diverticular disease = symptomatic diverticula

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77
Q

Diverticula are caused by a diet with excessive fibre. True/false?

A

False

Low fibre diet

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78
Q

What causes diverticula?

A

Low fibre diet
Colon has to work harder to move faeces → higher pressure in the lumen → diverticula form as mucosa herniates through the muscle layer to form an outpouching

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79
Q

Diverticula are most common in the ascending colon. True/false?

A

False.

Most common in the sigmoid colon because it is already the narrowest part of the colon

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80
Q

Diverticula - patient group/risk factors

A

Western lifestyle → processed foods with low fibre diet

Older patients

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81
Q

Colic

A

fluctuating abdominal pain

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82
Q

Altered/erratic bowel habit and left iliac fossa colic is most likely IBS. True/false?

A

False.

Possibly IBS, but left iliac fossa pain points to diverticular disease

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83
Q

Fever, tachycardia, and tenderness and guarding of the left side of the abdomen on examination is likely appendicitis. True/false?

A

False
Appendicitis = right
Diverticulitis = left

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84
Q

Diverticular disease - investigations

A

Colonoscopy/sigmoidoscopy

Barium enema

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85
Q

Diverticulitis - investigations

A

↑ESR and ↑CRP (inflammatory markers)

CT

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86
Q

Sigmoidoscopy should be used to investigate diverticulitis. True/false?

A

False.
DON’T DO SCOPE in acute attack (can cause perforation
Use CT instead

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87
Q

Diverticulitis can be acute or chronic. True/false?

A

True

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88
Q

What are the CT findings of diverticulitis?

A

Diverticula present and signs of inflammation like wall thickening, any abscesses present

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89
Q

Complicated diverticulitis - symptoms

A

Perforation (peritonitis, abscess)
Haemorrhage
Fistula (bladder, vagina, another part of the bowel)
Stricture

90
Q

How can diverticulitis cause peritonitis?

A

If diverticulitis progresses to complicated diverticulitis&raquo_space; can result in perforation&raquo_space; abscess formation, then rupture - causing peritonitis OR no abscess formation, and the peritoneum is directly irritated/contaminated by the contents of the perforation (e.g. faecal matter)

91
Q

Massive amount of painless rectal bleeding is a sign of complicated diverticulitis. True/false?

A

True.

Haemorrhage is a sign

92
Q

Hinchey classification is used for ———

A

acute diverticulitis
(based on CT findings and used to determine the best treatment in diverticulitis complicated by abscess formation and peritonitis)

93
Q

Surgery is usually required to treat uncomplicated diverticulitis. True/false?

A

False.

94
Q

Diverticular disease - management

A 
Balanced diet (enough fibre/fluid intake)
Analgesia for pain (paracetamol)
Bulking laxative (if diarrhoea/constipation persist)
95
Q

Uncomplicated diverticulitis - management

A

Analgesia (paracetamol) if necessary
Systemically well = watchful waiting
Suspected infection = antibiotics (co-amoxiclav + metronidazole)
Systemically unwell, comorbidities = IV fluids, IV antibiotics and bowel rest

96
Q

Complicated diverticulitis - management

A

Percutaneous drainage of large abscess
Laparoscopic peritoneal lavage and drainage
Hartmann’s procedure (sigmoid colon removed)
Primary resection/anastomosis

97
Q

Colonic polyps

A

abnormal growth of tissue projecting from the colonic mucosa

98
Q

Colonic polyps - types

A

***Adenoma (dysplastic = premalignant)
Serrated
Inflammatory (IBD)
Hamartomatous (Peutz-Jeghers syndrome)

99
Q

Al adenoma polyps are premalignant. True/false?

A

True

All are dysplastic

100
Q

Serrated polyps are found in Peutz-Jeghers syndrome. True/false?

A

False.

Hamartomatous polyps

101
Q

Inflammatory polyps are the most common type of colonic polyp. True/false?

A

False.
Adenoma polyps are most common.
Inflammatory polyp = IBD

102
Q

What type of cancer can adenoma polyps become?

A

Adenocarcinoma

103
Q

What is FAP?

A

Familial adenomatous polyposis

Mutation in the APC gene (tumour suppressor)

104
Q

FAP is caused by Mutation in DNA mismatch repair gene. True/false?

A

False.
This would be Lynch syndrome
FAP = APC gene mutation (tumour suppressor)

105
Q

What is Lynch Syndrome (HNPCC)?

A

Adenomas - usually polyps on the right side.

Mutation in DNA mismatch repair gene

106
Q

What cancer is Lynch Syndrome associated with?

A

Colorectal as well as others e.g. gastric, endometrial

107
Q

What does HNPCC stand for?

A

Hereditary non-polyposis colon cancer
(Lynch syndrome)
MISLEADING - there are polyps present

108
Q

Which hereditary cancer results in 100-1000s of adenomatous polyps, with the risk of developing colonic cancer almost 100%?

A

FAP

109
Q

What are the defining factors of Peutz-Jeghers syndrome?

A 
Mucocutaneous hyperpigmentation (regions in the body where mucosa transitions to skin)
Hamartomatous polyps
110
Q

Colonic polyps are usually asymptomatic. True/false?

A

True

111
Q

Colonic polyps - signs/symptoms

A 
Often asymptomatic - incidental finding
Can have:
Rectal bleeding → anaemia
Mucus in stool
Abdominal pain
Diarrhoea or constipation
112
Q

The transformation of polyp to cancer is about 3-5 years. True/false?

A

True.

113
Q

Which patients groups are screened with a colonoscopy for polyps?

A

FAP, Lynch syndrome
People with adenomatous polyps removed before
People who have IBD for 10+ years

114
Q

If polyps are found during a colonoscopy, they are removed. True/false?

A

True.

All adenomas need removed due to cancer risk - hence, polypectomy at the point of colonoscopy

115
Q

A colectomy is rarely performed as a prophylactic surgery for patients with FAP. True/false?

A

False.

All patients with FAP should have a colectomy performed in their late teens/early 20s

116
Q

In FAP, a screening is still done even if the colon is removed. True/false?

A

True.

Upper GI endoscopy is done to look for polyps in the remainder of the tract

117
Q

Hernia

A

Protrusion of an organ or tissue out of the body cavity it is supposed to be in

118
Q

What two factors cause hernias?

A

Structural weakness + increased pressure

119
Q

Examples of structural weakness that can lead to herniation.

A

Normal anatomical weakness
Congenital abnormality (e.g. collagen disorders)
Surgical scar

120
Q

Examples of increased pressure that can lead to herniation.

A

Strenuous activity
Chronic cough
Pregnancy
Straining e.g. bowel movements or urination

121
Q

Hernias are often seen in structures that have openings for vessels etc to pass through. True/false?

A

True.
This is an example of normal anatomical weakness, resulting in structural weakness
e.g. diaphragm, inguinal canal, femoral canal

122
Q

Reducible hernia =

Irreducible hernia =

A 
Reducible = hernia can be pushed back into the abdomen
Irreducible = hernia can’t be pushed back into the abdomen
123
Q

Incarcerated hernia

A

The contents of the hernia are stuck inside it by adhesions - so it is irreducible.

124
Q

Obstructed hernia

A

Hernia causes bowel obstruction and bowel contents are unable to pass - but blood supply still viable.
Can progress to strangulation

125
Q

Obstructed hernias can progress to strangulation. True/false?

A

True.

126
Q

Strangulated hernia

A

Vascular supply to the hernia contents is compromised → ischaemia occurs and surgery is needed

127
Q

Hernia - signs/symptoms

A

Swelling in a particular location (depends on type of hernia)
Patient may be able to reduce the hernia
May protrude on coughing or standing
Pain and tenderness at the site of hernia (in strangulation)

128
Q

Irreducible hernias, incarceration, strangulation and obstruction are complications that can arise from hernias. True/false?

A

True.

129
Q

Inguinal hernia

A

Part of the abdominal contents protrudes through the inguinal canal.

130
Q

An indirect inguinal hernia occurs when the bowel herniates through a weakness in the floor of the inguinal canal and out the superficial ring. True/false?

A

False.
This is a direct inguinal hernia.
Direct = through floor weakness&raquo_space; superficial ring
Indirect = through deep ring&raquo_space; superficial ring

131
Q

On examination, how can you tell the difference between a direct and indirect inguinal hernia?

A

Lump reappears after reduction = direct

Lump doesn’t reappear after reduction = indirect

132
Q

It is important to know whether the inguinal hernia is direct or indirect because the management is different for each. True/false?

A

False.

Management is the same

133
Q

Hassel Bach’s Triangle

A

Marks an area of potential weakness in the abdominal wall through which direct inguinal herniation can occur
Borders = rectus abdominis, inferior epigastric artery, inguinal ligament.

134
Q

Hiatal hernia

A

Herniation of the stomach through the diaphragm (at oesophageal hiatus)

135
Q

Sliding hiatus hernia =

Paraoesophageal hernia =

A

Sliding hiatus hernia = gastro-oesophageal junction + part of the stomach SLIDE into chest
Paraoesophageal hernia = part of stomach herniates up into the chest ALONGSIDE the oesophagus

136
Q

Hiatal hernia - presentation

A

Reflux (reduced efficacy of the LOS) - can lead to GORD

137
Q

Hiatal hernia - management

A 
Conservative = lose weight, treat GORD
Surgical = persistent symptoms despite medical treatment, complications of GORD
138
Q

Epigastric hernia

A

Fascial defect in the linea alba in the epigastric region that the bowel herniates through

139
Q

Spigelian hernia

A

Hernia through the spigelian fascia

140
Q

Midline lump between xiphoid and umbilicus, usually asymptomatic (can be painful). What hernia?

A

Epigastric

141
Q

Reflux, sometimes progressing to GORD.

What hernia?

A

Hiatal

142
Q

Lump below and lateral to the umbilicus.

What hernia?

A

Spigelian

143
Q

Lump in groin, that doesn’t reappear after reduction.

What hernia?

A

Indirect inguinal

144
Q

Spigelian hernias must be treated surgically. True/false?

A

True.

145
Q

Lump in the upper medial thigh.

What hernia?

A

Femoral

146
Q

Lump in the back.

What hernia?

A

Lumbar

147
Q

Femoral hernia

A

Herniation through the femoral canal

148
Q

Lumbar hernia

A

Herniation through the lumbar triangles

149
Q

Inguinal and femoral hernias are more common in males. True/false?

A

False
Inguinal = males
Femoral = females

150
Q

Incisional hernia

A

Hernia post-surgery

151
Q

Lump along line of previous incision.

What hernia?

A

Incisional

152
Q

How are incisional hernias treated?

A

Surgical (mesh)

153
Q

Parastomal hernia

A

Hernia through abdominal wall defect created when a stoma is formed

154
Q

Lump at site of stoma

What hernia?

A

Parastomal

155
Q

Paraumbilical

A

Herniation occurs through an acquired weakness of the abdominal wall around the umbilicus

156
Q

Lump at/near the umbilicus, often painful.

What hernia?

A

Paraumbilical

157
Q

Lump at the umbilicus.

What hernia?

A

Umbilical

158
Q

Umbilical hernia

A

Herniation occurs due to congenital weakness from the persistence of an abdominal wall defect at the site of the umbilicus

159
Q

Umbilical hernias usually resolve spontaneously. True/false?

A

True.

Some cases need surgical treatment though

160
Q

How is an umbilical hernia different from an omphalocele?

A

Umbilical hernias are covered with skin

161
Q

Painless, bright red bleeding PR
Perianal itch
(no change in bowel habit or weight)
Diagnosis?

A

Haemorrhoids

162
Q

Haemorrhoids

A

Enlargement of the vascular cushions (rectal venous plexuses) in the wall of the anus and rectum due to increased pressure
(also called piles)

163
Q

Haemorrhoids are the common cause of rectal bleeding. True/false?

A

True

164
Q

In what cases is a flexible sigmoidoscopy performed to investigate haemorrhoids?

A

In patient > 50 to rule out other pathology

165
Q

Haemorrhoids - complications?

A

Can become strangulated causing pain

166
Q

Haemorrhoids - management

A 
Conservative = increased fluid/fibre to prevent constipation, bulking laxatives/analgesia if necessary, anal hygiene.
Non-surgical = sclerosation therapy (medicine injected), rubber band ligation
Surgical = haemorrhoidectomy, stapled haemorrhoidectomy (avoids open wound), HALO/THD procedure (artery ligation)
167
Q

Rectal varices are caused by ———-

A 
portal hypertension
(when portal venous system resistance increases, the blood will travel through the path of least resistance, through anastomoses into systemic circulation - there are also no valves in these veins so blood flows both ways)
168
Q

Haemorrhoids and rectal varices both cause ——–

A

PR bleeding

169
Q

Diverticular disease is diagnosed by ————

while diverticulitis is diagnosed by ————-

A

Diverticular disease = colonoscopy, barium enema

Diverticulitis = CT, raised inflammatory markers

170
Q

Appendicitis

A

Inflammation/infection of the appendix

171
Q

Appendicitis infection is most commonly viral. True/false?

A

False.

Infection is most commonly bacteria

172
Q

Appendicitis - complications

A

Rupture of the appendix

which can, rarely, spread the infection and potentially cause peritonitis

173
Q

Appendicitis - patient group

A

Anyone!

exam classic = young child (7/8 Yo) or teenager (15/16 Yo)

174
Q

Rovsing sign

A

pressing on the LIF causes pain on the RIF

175
Q

Psoas sign

A

patient keeps right hip flexed

176
Q

Obturator sign

A

flexing and internally rotating hip causes pain

177
Q

McBurney’s sign

A

point of max pain

178
Q

Abdo pain that starts in the umbilical and shifts to RIF.

Diagnosis?

A

Appendicitis

179
Q

McBurney’s point

A

⅓ the distance of the ASIS to the pubic synthesis

180
Q

Appendicitis should always be investigated with USS. True/false?

A

False.

Only for women (as some gynaecological emergencies present like appendicitis) and children.

181
Q

Why are CRP and WCC bloods done in appendicitis?

A

to distinguish infectious from inflammatory appendicitis

182
Q

Management of appendicitis - presurgical

A

Analgesia (NSAIDs)
Antipyretics (NSAIDs)
Antibiotics (normal surgical prophylaxis)

183
Q

Bowel obstruction is a blockage of the bowel, leading to ————

A

accumulation of fluid/gas, ischaemia or perforation

184
Q

Tumours and Crohn’s can both lead to intraluminal obstruction. True/false?

A

False.

These are causes of luminal obstruction

185
Q

Intraluminal bowel obstruction - causes

A

Gallstones, food/faeces, bezoar

186
Q

Luminal bowel obstruction - causes

A

tumours, Crohn’s, radiation

187
Q

Extraluminal bowel obstruction - causes

A

adhesions, herniation, masses

188
Q

Colicky central abdo pain, absolute constipation, vomiting and borborygmus.
Diagnosis?

A

bowel obstruction

189
Q

Absolute constipation

A

no flatulence or bowel movements

190
Q

In bowel obstruction, vomiting shows ——

A

late stage obstruction or proximal obstruction

191
Q

In bowel obstruction, feculent vomiting shows ——

A

obstruction of the ileum

192
Q

Bowel obstruction - management

A

AXR or contrast CT
ABGs and bloods (metabolic distress)
Laparotomy (if suspected complication)

193
Q

Tinkling bowel sounds

A

Bowel obstruction

194
Q

Ischaemic colitis is the commonest problem of bowel ischaemia. True/false?

A

True.

195
Q

Why is ischaemic colitis “abdominal angina”?

A

As it is inflammation but not total tissue death due to ischemia, most commonly due to atherosclerotic narrowing is intestinal blood vessels.

196
Q

What is the most commonly affected vessel area in ischaemic colitis?

A

the splenic flexure

197
Q

Apart from atherosclerosis, what are the other causes of ischaemic colitis?

A

hypotension, obstruction, cocaine & meth, iatrogenic

198
Q

Those with coagulopathy or AF may also suffer ischemic colitis due to ———–

A

throwing clots

199
Q

Why do intra-abdominal masses compressing arteries not always cause total ischaemia?

A

Because of the collateral circulation

200
Q

Abdominal pain/cramping, fresh blood in the stool, urgency, diarrhoea, nausea.
Diagnosis?

A

Likely ischaemic colitis

201
Q

Ischaemic colitis - investigations

A

USS/AXR/CT (view the bowel)
CT/MRI angiography
Colonoscopy

202
Q

Mild cases of ischaemic colitis are treated with embolectomy (bypass of the afflicted artery). True/false?

A

False.
Mild cases = self-resolve (analgesia, treat cause)
Major cases = embolectomy or colectomy (if non-salvageable)

203
Q

What is the difference between true bowel ischemia and ischaemic colitis?

A

In true bowel ischemia, the bowel is dead/necrotic whereas ischemic colitis it is damaged by ischemia but not dead.
Bowel ischaemia = “ACS”
Ischaemic colitis = “angina”

204
Q

Bowel ischaemia/infarction is most often caused by obstruction. True/false?

A

False.

Most often due to an atherosclerotic event

205
Q

Bowel ischaemia/infarction - symptoms

A

Sudden (often severe) abdominal pain
Blood in the stool
Forceful/painful bowel movements

206
Q

When is an MRI angiography done to investigate bowel ischaemia/infarction?

A

Second-line to CT angiography.

Used if the patient has renal problems or is intolerant to the contrast needed for CT

207
Q

Bowel ischaemia/infarction - treatment

A

Colectomy to remove the infarcted tissue

Restore the vasculature best as possible (by embolectomy, bypass, grafting)

208
Q

Classification of surgical complications
Immediate =
Early =
Late =

A 
Immediate = within 24hr
Early = within 2-3 weeks
Late = any subsequent period after discharge from hospital
209
Q

Tachycardia, hypotension and oliguria following a surgery. Diagnosis?

A

Post-op complication: haemorrhage

210
Q

Cardiovascular post-op complications

A

MI, haemorrhage, DVT

211
Q

Respiratory post-op complications

A

Atelectasis, pneumonia, PE

212
Q

GI post-op complications

A

Ileus, anastomotic dehiscence, adhesions, short gut syndrome.

213
Q

Ileus

A

Paralysis of intestinal motility

214
Q

Anastomotic dehiscence

A

Breakdown of anastomosis

215
Q

Adhesions

A

Formation of scar tissue that can cause organs/tissues to stick to each other
Can cause bowel obstruction

216
Q

Short gut syndrome

A

Malabsorption due to insufficient residual small bowel (after small bowel surgery)
Leads to metabolic abnormalities

217
Q

Wound - post-op complications

A

Infection
Dehiscence (rupture)
Hernia (incisional)

218
Q

Urinary post-op complications

A

Retention of urine
UTI
Urethral stricture
AKI (acute kidney injury)

219
Q

Neurological post-op complications

A

Confusion (lots of causes)
Stroke
Peripheral nerve injury

220
Q

Pyrexia post-op causes

A

5 W’s
Wind → atelectasis or pneumonia (24-48hrs)
Water → UTI (3-5days)
Wound → wound infection (4-6days)
Walking → DVT (5-7days)
Wonder drugs → drug-induced fever (anytime)

GI (9 decks)

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