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GI > lower GI diseases - surgical > Flashcards

lower GI diseases - surgical Flashcards

1
Q

incision

A

cutting with a sharp instrument

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2
Q

retract

A

the method of increasing space

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3
Q

suture

A

to join structures with lengths of material

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4
Q

ligate

A

to tie or close a lumen

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5
Q

staple

A

to join structures with metal

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6
Q

anastomosis

A

a connection between 2 structures

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7
Q

dissect

A

to separate 2 structures - often through natural planes

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8
Q

Meckel’s diverticulum pathogenesis/aetiology

A

persistence of the vitelline duct which forms an outpouching of ileum
some contain gastric mucosa which can secrete HCl and cause ulceration

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9
Q

Meckel’s diverticulum patient group

A

symptomatic cases at 2 years
males 2x more likely
can also present in adults

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10
Q

meckels diverticulum signs and symptoms

A

usually asymptomatic and an incidental finding
only symptomatic if complications arise
fresh, painless, rectal bleeding
symptoms mimicking appendicitis

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11
Q

Meckel’s diverticulum complications

A

ulceration, perforation and haemorrhage
diverticulitis
obstruction
malignant change

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12
Q

Meckel’s diverticulum treatment and management

A

surgical removal if complications arise

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13
Q

the rule of 2’s

A 
2% of population 
2 inches long 
2 feet from ileocecal valve 
2 years of age 
twice as often in males
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14
Q

atresia

A

congenital absence or abnormal closure of a body cavity

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15
Q

atresia pathogenesis/aetiology

A 
usually due to problems in GI tract development 
oesophageal 
intestinal 
biliary 
presents in newborns
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16
Q

atresia signs and symptoms

A

oesophageal - US scan increases amniotic fluid, swallowing or breathing difficulties
intestinal - signs of obstruction, green vomit, swollen abdomen
biliary - post hepatic jaundice

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17
Q

meconium ileus pathogenesis/aetiology

A

meconium ileus is a intestinal obstruction caused by meconium that is difficult to pass because it is too sticky
90% of patients have CF

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18
Q

meconium ileus signs and symptoms

A

meconium is slow to pass
symptoms of obstruction
green vomit
swollen abdomen

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19
Q

omphalocele pathogenesis/aetiology

A

intestinal loop does not return to the abdomen during development
it herniates out into the umbilical cord and is contained within the peritoneal layer of the umbilical cord

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20
Q

omphalocele signs and symptoms

A

shiny sac at the base of the umbilical cord

intestines enclosed

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21
Q

gastroschisis

A

protrusion of the abdominal contents through a defect in the anterior abdominal wall lateral to the umbilical cord
not covered in peritoneum

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22
Q

intestinal malrotation +/- volvulus

A

a congenital issue in which the intestines are twisted into the gut incorrectly due to incorrect connection to the brick wall
can be accompanied by Ladd’s bands
twisting can obstruct the lumen of the intestine or block off the blood supply
90% diagnosed before 1

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23
Q

volvulus

A

when a loop of intestine is wrapped around its own mesentery

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24
Q

intestinal malrotation symptoms

A 
obstruction symptoms 
green vomit 
abdominal pain - leg drawing 
abdominal distention 
failure to thrive 
diagnosed by x ray
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25
Q

intestinal malrotation management

A

Ladd’s procedure - open or laproscopic, Ladd’s bands are dissected off

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26
Q

intussusception

A

when a segment of the intestine telescopes inside another
mechanism of intestinal blockage
commonly at ileocaecal junction
more common in children

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27
Q

intussesception symptoms

A

blood and mucus stool
vomiting and diarrhoea
lethargy
abdominal mass

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28
Q

intussesception investigations

A

USS
x-ray / CT
air or barium enema

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29
Q

intussusception management

A

905 can be fixed with an enema

surgical release - RLQ transverse incision , manual reduction, segmental bowel resection

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30
Q

anal fissures

A

a small tear in the mucosa that lines the anus

can be very small to severe

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31
Q

anal fissures risk factors

A

common in very young and very old
traumatic - passing large/hard stools, recurrent straining, chronic diarrhoea, anal intercourse, childbirth
non traumatic - IBD, anal cancers, HIV, TB, syphilis

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32
Q

anal fissures symptoms

A

pain during or after bowel movements
bright red on paper after wiping
visible crack in the skin or small lump/tag

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33
Q

anal fissures investigation

A

good history and direct exam
longer than 8 weeks chronic
scoping - anoscopy, flexible sigmoidoscopy or colonoscopy

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34
Q

anal fissures treatment

A

conservative - topical nitroglycerin, topical anaesthetic, botox injection
surgical - lateral internal sphincterotomy, a small incision is made into the sphincter muscles, not cutting the fissures away

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35
Q

colorectal cancer

A

adenoma/adenocarcinoma

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36
Q

colorectal cancer risk factors

A

red meat, low fibre diet, smoking, IBD, familial adenoma polyposis (FAP), lynch syndrome

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37
Q

colorectal cancer signs and symptoms

A

pain, change in bowel habits, tenemus, abdominal mass

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38
Q

colorectal cancer investigations

A

colonoscopy/flexible sigmoidoscopy, pill endoscopy, CT colonography

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39
Q

colorectal cancer management

A

surgery
chemo has limited use
radiotherapy - adjuvant or post surgery

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40
Q

colorectal cancer surgery

A 
right hemicolectomy 
extended right hemicolectomy 
transverse colectomy 
left hemicolectomy 
sigmoid colectomy 
subtotal colectomy
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41
Q

anorectal cancer

A

adenocarcinomas from colon or SCC from the adjacent skin
investigations and management are same as colorectal, local excision is more often used - also consider function of schincter and cosmesis

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42
Q

diverticulum

A

an outpouching of the gut wall

43
Q

diverticulitis

A

presence of diverticula

44
Q

diverticular disease

A

diverticula which are symptomatic

45
Q

diverticulitis

A

inflammation of a diverticulum

46
Q

complicated diverticular disease/diverticulitis

A

diverticulitis with complications

47
Q

uncmplicated diveticular disease/diverticulitis

A

diverticulitis without complications

48
Q

diverticulitis pathogenesis

A

low fibre diet
colon has to work harder to move feaces - higher pressure in the lumen - diverticula form as mucosa herniates through the muscle layer to form an outpouching
most common in sigmoid colon

49
Q

diverticulitis risk factors

A

western lifestyle
processed fods with low fibre diet
older patients

50
Q

diverticular disease signs and symptoms

A

altered/erratic bowel habit
left iliac fossa colic
similar to IBS

51
Q

diverticulitis signs and symptoms

A 
severe pain in the iliac fossa 
fever 
tachycardia 
tenderness and guarding of the left side of the abdomen on examination 
similar to appendicitis but on the left
52
Q

diverticular disease investigations

A

colonoscopy/sigmoidoscopy

barium enema

53
Q

diverticulitis investigations

A

increase ESR and CRP
CT
don’t scope in acute attack - can cause perforation

54
Q

complicated diverticulitis

A

perforation - peritonitis, abscess
haemorrhage
fistula
stricture

55
Q

acute diverticulitis stage 1 Hinchey classification

A

pericolic abscess

surgery rarely needed

56
Q

diverticulitis stage 2

A

pelvic abscess

may resolve without surgery

57
Q

diverticulitis stage 3

A

purulent peritonitis

surgery required

58
Q

diverticulitis stage 4

A

faecal peritonitis

surgery required

59
Q

diverticular disease management

A

balanced diet with enough fibre and fluid intake
analgesia
bulking laxative

60
Q

uncomplicated diverticulitis management

A

watchful waiting
analgesi
antibiotics
IV fluid, IV antibiotics and bowel rest

61
Q

complicated diverticulitis abscess/peritonitis management

A

percutaneous drainage of large abscess
laparoscopic peritonel lavage and drainage
Hartmann’s procedure
primary resection/anastomosisi

62
Q

colonic polyps

A

abnormal growth of tissue projecting from the colonic mucosa

63
Q

colonic polyps types

A

adenoma
serrated
inflammatory - IBD
hamartomatous - Peutz-Jeghers syndrome

64
Q

colonic polyps pathogenesis

A

adenoma - adenocarcinoma

65
Q

colonic polyps signs and symptoms

A 
asympomatic incidental finding 
rectal bleeding - anaemia 
mucus in stool 
abdominal pain 
diarrhoea or constipation
66
Q

colonic polyps investigations

A

family history - inherited conditions, family history of colon cancer
genetic testing
colonoscopy - screening, incidental
biopsy of removed polyp

67
Q

colonic polyp complications

A

cancer
majority of colonic cancer arise from pre-existing adenomatous polyps
transformation of polyp to cancer - 3-5 years

68
Q

colonic polyps management

A

screening with colonoscopy
all adenomas removed due to cancer risk
FAP - prophylactic surgery - colectomy
lynch syndrome - prophylactic surgery in some cases

69
Q

hernias

A

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

70
Q

hernia aetiology

A

structural - normal anatomical weakness, congenital abnormality resulting in a weakness
surgical scar
increased pressure - strenuous activity, chronic cough, pregnancy, straining

71
Q

hernia classification

A

reducible - can be pushed back in
irreducible - can’t be pushed back
incarcerated - contents of the hernia are stuck inside it by adhesions
obstructed - causes bowel obstruction and bowel contents are unable to pass
strangulated - vascular supply to the hernia contents is compromised

72
Q

hernias signs and symptoms

A

swelling in a particular location
patient may be able to reduce the hernia
may protrude on coughing or standing
pain and tenderness at the site of hernia

73
Q

hernia investigations

A

examination of the swelling

ultrasound

74
Q

hernia complications

A

irreducible
incarceration
strangulation
obstruction

75
Q

hernia management

A

conservative or surgical

76
Q

hernia types

A 
inguinal 
hiatus 
epigastric 
spigelian
femoral
lumbar
incisional 
parastomal 
paraumbilical 
umbilical
77
Q

direct inguinal hernia

A

bowel herniates through a weakness in the floor of the inguinal canal and out the superficial ring

78
Q

indirect inguinal hernia

A

bowel herniates through the deep and out the superficial ring
doesn’t reappear after reduction

79
Q

hasselbach’s triangle

A

area of potential weakness in the abdominal wall through which direct inguinal herniation can occur
inferior epigastric artery
rectus abdominus
inguinal ligament

80
Q

hiatus hernia

A

herniation of the stomach through the diaphragm at the oesophageal hiatus
presents with reflux

81
Q

haemorrhoids

A

enlargement of the vascular cushions in the wall of the anus and rectum due to increased pressure

82
Q

haemorrhoids signs and symptoms

A

painless bright red PR bleeding
perianal itch
no change in bowel habit or weight

83
Q

haemorrhoids complications

A

can become strangulated causing pain

84
Q

haemorrhoids management

A

conservative - increased fluid and fibre to prevent constipation - bulking laxatives and analgesia if necessary, anal hygiene to aid healing
non-surgical - sclerosation therapy, rubber band ligation
surgical - haemorrhoidectomy, stapled haemorrhoidectomy, HALO/THD procedure

85
Q

rectal varices

A

due to portal hypertension

another cause of PR bleeding

86
Q

bowel obstruction

A

blockage of the boel leading to - accumulation of fluid/gas, ischaemia or perforation
intraluminal, luminal, extraluminal

87
Q

bowel obstruction symptoms

A 
colicky central abdomen pain 
absolute constipation 
vomiting 
borborygmus 
abdominal distention
88
Q

bowel obstruction investigation

A

tinkling bowel sounds
AXR or contrast CT
ABGs and bloods

89
Q

ischaemic colitis

A

commonest problem of bowel ischaemia
inflammation but not total tissue death due to ischaemia
atherosclerosis

90
Q

ischaemic colitis symptoms

A

abdominal pain
fresh blood in stool]urgency
diarrhoea
nausea

91
Q

ischaemic colitis investigations

A

USS/AXR/CT
CT/MRI angiography
colonoscopy

92
Q

ischaemic colitis

A

mild - self resolve, analgesi, IV fluid and fix cause

major - embolectomy, bypass of the afflicted artery, colectomy assorted if an area is non salvageable

93
Q

“true” bowel ischaemia/infarction

A

death of colonic tissue due to lack of blood supply
often due to an atherosclerotic event
can be due to obstruction

94
Q

bowel infarction symptoms

A

sudden often severe abdominal pain
blood in stool
forceful/painful bowel movements
confusion can occur in elderly patients

95
Q

bowel infarction investigation

A

exploratory laparotomy

CT/MRI angiography

96
Q

bowel infarction management

A

colectomy to remove the infarcted tissue
embolectomy
bypass
grafting

97
Q

classification of complications

A 
immediate - 24hrs
early - 2-3 weeks
late 
genera - affecting any of the body systems 
local - specific to the operation
98
Q

cardiovascular complication

A

MI
haemorrhage
DVT

99
Q

respiratory complication

A

atelectasis
pneumonia
PE

100
Q

GI complications

A

ileus
anastamosis dehiscence
adhesions
short gut syndrome

101
Q

wound complications

A

infection
dehiscence
hernia

102
Q

urinary complications

A

retention of urine
UTI
urethral stricture
AKI

103
Q

neurological complications

A

confusion
stroke
peripheral nerve injury

104
Q

pyrexia 5 W

A 
wind - atelectasis or pneumonia 
water - UTI
wound - infection 
walking - DVT
wonder drugs - drug induced fever

GI (10 decks)

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