Miscellaneous Gastroenterology Flashcards

Question

Vitamin C

Answer 1

Ascorbic acid Deficiency (scurvy) - gingivitis, loose teeth, poor wound healing, bleeding from gums, haematuria, epistaxis, general malaise, echymosis, easy bruising, Sjogrens, arthralgia

Answer 2

Syndrome caused by excess gastrin Usually a duodenal or pancreatic tumour MEN1 Diagnosis- fasting gastric levels Features- gastric duodenal ulcers, diarrhoea, malabsorption

Answer 3

Right iliac fossa Spouted Liquid

Answer 4

Often LHS Flushed to skin (not spouted) Solid output

Answer 5

Used to de function colon following resection eg. Rectal cancer surgery Does not decompress colon Usually right iliac fossa Reversible The bowel is partially opened and folded so that there are two openings on the skin side-by-side, attached in the middle. NB- wouldn't be created after a pancolectomy (as there is nothing to attach the ileum to after reversal has been carried out- only used when there is colon left that can be re-attached after a certain time)

Answer 6

Following complete excision of colon Reversal difficult

Answer 7

Reversible Serves to defunction and decompress a distal segment of colon in obstructing cancers

Answer 8

Perianal pain Perianal bleeding Palpable lesion Faecal incontinence

Answer 9

DRE, anoscopy with biopsy, check inguinal lymph nodes Imaging Check HIV status

Answer 10

Constipation IBD STI- HIV, syphilis, herpes

Answer 11

Painful, bright red rectal bleeding 90% occur on the posterior midline, if they are in alternate location, think of another cause eg, Crohn’s disease

Answer 12

Soften stool- dietary advice, bulk forming laxative Lubricants before defeacation Topical anaesthetic or analgesia

Answer 13

Same measures as acute fissure Topical GTN IF GTN doesn’t work after 8 weeks- sphincterectomy or Botox

Answer 14

Itchy anus

Answer 15

Usually due to a previous anorectal abscess

Answer 16

Associated with childbirth and rectal intussception Internal or external

Answer 17

Chronic straining and constipation

Answer 18

Tumour Volvulus Diverticula disease Adhesions Hernias Strictures NB- not ileus as there is no obstruction in ileus, just a lack of peristalsis/movement

Answer 19

Symptoms and signs of underlying cause eg. CRC Absence of flatus and stool Abdominal pain and distension Nausea and vomiting (green bilious vomit) Peritonism if perforation Tinkling” bowel sounds may be heard in early bowel obstruction

Answer 20

Acute abdomen investigations, A-E assessment etc. Abdominal x ray CT scan

Answer 21

NBM, NG tube, IV fluids Conservative management for 72 hours can be trialled if no perforation Surgery (resection etc.) + IV antibiotics

Answer 22

Pain around the anus, worse on sitting Hardened tissue in the anal region Pus like discharge from anus Long-standing- may have systemic features Associated with crohns, DM, underlying malignancy

Answer 23

Incision and drainage Antibiotics if systemic symptoms

Answer 24

Significant pain and tender lump Purple, oedematous perianal mass If within 72 hours- excision. Otherwise, stool softeners, ice packs, analgesia

Answer 25

Twisting of the colon around itself Constipation Abdominal pain and bloating Nausea and vomiting

Answer 26

Refer to general surgeons Sigmoid- rigid sigmoidoscopy with rectal tube insertion Caecal- operative (right hemicolectomy sometimes required)

Answer 27

Anaesthetic risk Vasovagal (bradycardia) in response to abdominal distension Surgical emphysema Injury to GI tract Injury to blood vessels

Answer 28

Observations and abdominal examination Bloods- FBC UE LFT clotting screen CRP ESR etc. RUQ USS of liver and biliary tree CT abdomen or ERCP/MRCP

Answer 29

Laxative abuse

Answer 30

Metoclopramide

Answer 31

Take an ascitic culture prior to giving antibiotics Usually treated with an IV cephalosporin such as cefotaxime

Answer 32

Hepatorenal syndrome occurs in liver cirrhosis. Hypertension in the portal system leads to dilation of the portal blood vessels, stretched by large amounts of blood pooling there. This leads to a loss of blood volume in other areas of the circulation, including the kidneys. This leads hypotension in the kidney and activation of the renin-angiotensin system. This causes renal vasoconstriction, which combined with low circulation volume leads to starvation of blood to the kidney. This leads to rapid deteriorating kidney function.

Answer 33

a condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops. It may be referred to as paralytic ileus or adynamic ileus.

Answer 34

a condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops. It may be referred to as paralytic ileus or adynamic ileus.

Answer 35

Injury to the bowel Handling of the bowel during surgery Inflammation or infection in, or nearby, the bowel (e.g., peritonitis, appendicitis, pancreatitis or pneumonia) Electrolyte imbalance (e.g., hypokalaemia or hyponatraemia)

Answer 36

Akin to obstruction, namely; Vomiting (particularly green bilious vomiting) Abdominal distention Diffuse abdominal pain Absolute constipation and lack of flatulence Absent bowel sounds (as opposed to the “tinkling” bowel sounds of mechanical obstruction)

Answer 37

Supportive- will resolve on its own eg. Nil by mouth or limited sips of water NG tube if vomiting IV fluids to prevent dehydration and correct the electrolyte imbalances Mobilisation to helps stimulate peristalsis Total parenteral nutrition (TPN) may be required whilst waiting for the bowel to regain function

Answer 38

a condition where the bowel twists around itself and the mesentery that it is attached to (either sigmoid or caecal- X ray shows either coffee bean or foetus sign)

Answer 39

Neuropsychiatric disorders (e.g., Parkinson’s) Nursing home residents Chronic constipation High fibre diet Pregnancy Adhesions

Answer 40

Akin to bowel obstruction, namely; Vomiting (particularly green bilious vomiting) Abdominal distention Diffuse abdominal pain Absolute constipation and lack of flatulence

Answer 41

Conservative- same as obstruction eg. fluids, analgesia, NBM, NG tube etc. Surgical- endoscopic resection for sigmoid volvulus (no peritonitis), or laparotomy/ colectomy etc.

Answer 42

Psycho-social impact Local skin irritation Parastomal hernia Loss of bowel length leading to high output, dehydration and malnutrition Constipation (colostomies) Stenosis Obstruction Retraction (sinking into the skin) Prolapse (telescoping of bowel through hernia site) Bleeding Granulomas causing raised red lumps around the stoma

Answer 43

Cancer arising from the bile ducts. Key risk factors include; Primary sclerosing cholangitis Liver flukes (a parasitic infection)

Answer 44

Obstructive jaundice Unexplained weight loss Right upper quadrant pain Palpable gallbladder (swelling due to an obstruction in the duct distal to the gallbladder) Hepatomegaly

Answer 45

Flexible sigmoidoscopy, not colonoscopy

Answer 46

ovarian pathology – ovarian cyst/benign tumour, ovarian cancer tubal pathology – tubo-ovarian abscess, tubal malignancy (treat as ovarian) uterine pathology – pregnancy, fibroids/benign tumour, uterine cancer urological pathology – distended bladder, pelvic kidney, transplanted kidney GI pathology – the 6 Fs: fat, fluid, flatus, faeces, fetus, filthy big tumour other abdominal pathology – primary peritoneal cancer, retroperitoneal sarcoma.

Answer 47

sliding: accounts for 95% of hiatus hernias, the gastroesophageal junction moves above the diaphragm rolling (paraoesophageal): the gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus Features heartburn dysphagia regurgitation chest pain Investigation barium swallow is the most sensitive test given the nature of the symptoms many patients have an endoscopy first-line, with a hiatus hernia being found incidentally Management -all patients benefit from conservative management e.g. weight loss -medical management: proton pump inhibitor therapy -surgical management: only really has a role in symptomatic paraesophageal hernias

Answer 48

inferolateral to the pubic tubercle cough impulse is often absent More common in women Incarceration- where the herniated tissue cannot be reduced Strangulation- high risk in femoral hernias (repair is a necessity, no hernia belts)

Answer 49

superior and medial to the pubic tubercle disappears on pressure or when the patient lies down treat medically fit patients even if they are asymptomatic(hernia belt if not fit for surgery) -unilateral inguinal hernias are generally repaired with an open approach -bilateral and recurrent inguinal hernias are generally repaired laparoscopically anatomical differences between indirect (hernia through the inguinal canal) and direct hernias (through the posterior wall of the inguinal canal) following an open repair patients return to non-manual work after 2-3 weeks and following laparoscopic repair after 1-2 weeks NB- indirect inguinal hernias may occur in infants (others are more common in adults) NB- congenital inguinal hernias should be surgically repaired soon after diagnosis as at risk of incarceration NB- indirect inguinal hernias can be in the scrotum (NOT A SCROTAL HERNIA- ITS indirect INGUINAL)

Answer 50

May develop significant volume depletion, electrolyte and acid-base disturbances (metabolic acidosis) if the ileostomy output increases or if dietary intake is disrupted or altered

Answer 51

CT abdomen

Answer 52

seen lateral to the umbilicus