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6th Year Gastro MJ > paces > Flashcards

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1
Q

nail signs of abdominal disease

A
  1. clubbing
  2. leukonychia - whitening of nails in hypoalbuminaemic states (liver synthesis albumin)
  3. duptyrens - thickening of palmar aponeurosis, bilateral commonly
  4. koilonychia = spooning of nails, late sign of IDA
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2
Q

causes of clubbing (MIC)

A

Malignancy
IBD
Chronic liver dis

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3
Q

Kocher’s (rooftop) incision

A
  • along costal margin R or L

- biliary or hepatic surgery

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4
Q

Midline laporotomy

A
  • down middle

- any major abdo surgery

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5
Q

Transverse upper abdo incision

A
  • straight line below costal margin on LHS

- splenic surgery

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6
Q

Grid iron incision

A
  • RIF

- appendicectomy

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7
Q

Umbilical/subumbilical

A

-hernia repairs

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8
Q

Point incision marks

A

-laporoscopy ports or drain sites

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9
Q

Rutherford Morrison (hockey stick)

A
  • RIF hooked

- renal transplant

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10
Q

Biliary or hepatic surgery scar

A

Kocher’s rooftop incision along costal margin

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11
Q

Splenic Surgery scar

A

Transverse upper abdo incision

-straight line below costal margin on LHS

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12
Q

Renal transplant surgery scar

A

Rutherford Morrison hockey stick scar

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13
Q

Liver transplant surgery scar

A

Mercedez-Benz incision

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14
Q

Gynae surgery scar

A

Pfannestiel incision / low transverse

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15
Q

Hernia repair/vascular access surgery

A

Inguinal incision

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16
Q

How to differentiate between SPLEEN vs Kidney

A
  • moves down with inspiration
  • you cannot get above it
  • has a notch
  • dull to percussion
  • not ballotable
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17
Q

Causes of hepatomegaly - VANNIC

A

Cancer - mets, HCC
Cirrhosis (early ALD - late cirrhosis –> shrivels)
Cardiac - CCF , Constrictive pericarditis
Infiltration - viral hepatitis, inflammation, NAFLD, haemochromatosis, amyloidosis, sarcoidosis

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18
Q

Causes of splenomegaly - 2 Hs 2 Is

A

Hypertension (portal) - signs of CLD
Haem- myelofibrosis, CML, haemolytic anaemia, lymphoma
Infection - TB, Malaria, Leishmaniasis, Schisto, Inf Mono
Infiltrative - Sarcoid, Gaucher’s disease
(AI - SLE, Felty’s Syndrome)

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19
Q

Causes of large kidneys

A
  • PKD
  • Simple cyst
  • Renal Cancer
  • Infiltrative - sarcoid, amyloid
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20
Q

signs of Chronic STABLE Liver Disease (A-J)

A 
Asterixis (liver flap) - hepatic encephalopathy
Bruising
CLUBBING
DUPUTYREN'S contracture
Erythema (Palmar) - redness
Fetor
GYNAECOMASTIA
Hair loss
Jaundice
Leuconychia - hypoalbuminaemia (decreased liver function)
\+ testicular atrophy 
\+ SPIDER NAEVI >5
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21
Q

signs of abdo dis - arms, hands, neck

A 
AV fistulae
Anaemia
Jaundice
Skin: excoriation, spider naevi
Oral: pigmentation, gum hypertrophy (ciclosp)
Lymphad
22
Q

signs of abdo dis - chest

A

Gynaecomastia
Hair loss
Excoriation marks
Spider naevi

23
Q

signs of abdo dis - abdo

A

abdo distension

caput medusae = distended superficial abdo veins (dtn of flow in veins below umbilicus is towards legs)

24
Q

Liver failure signs

A 
Jaundice
Leuconychia (low protein)
Bruising (clotting / fibrinogen) 
Ascites
Encephalopathy (?nitrogenous)
25
Q

Portal hypertension signs

A

Splenomegaly
Ascites
Dilated veins on abdo (blood goes away from umbilicus)
(Haematemesis/ maleana)

26
Q

IVCO signs

A

Ascites
Dilated veins on abdo (blood travels upwards)
- to differentiate IVCO

27
Q

Causes of ascites

A 
Transudate & Exudate causes:
Exudative - 
Portal HTN/ thrombosis
IVC/ Hepatic vein obstruction 
Constrictive pericarditis 
Peritoneal secondaries / TB
Ovarian malignancy

Transudate - Hypoproteinaemic states: - nephrotic syndrome - liver failaure - malabsorpiton

28
Q

signs of cholestasis

A 
itching
pale stools
dark urine (negative for urobilinogen)
jaundice
xanthelasmata
eg PBC, AMA+, high IgM
Chronic active hepatitis, ANF +, IgG
29
Q

abdo bloods

A 
FBC
U+E
CRP
LFT
Amylase
Coag
G+S
Cultures - if septic 
ABG or VBG for lactate - if req
30
Q

foregut regions + blood supply

A

—- lower part of duodenum to first 1/3 of asc colon

31
Q

midgut regions + blood supply

A

Ascending colon and proximal 2/3 of the transverse colon
-superior mesenteric artery

–The ascending colon receives arterial supply from two branches of the superior mesenteric artery; the ileocolic and right colic arteries. The ileocolic artery gives rise to colic, anterior cecal and posterior cecal branches – all of which supply the ascending colon.

  • -The transverse colon is derived from both the midgut and hindgut, and so it is supplied by branches of the superior mesenteric artery and inferior mesenteric artery:
  • Right colic artery (from the superior mesenteric artery)
  • Middle colic artery (from the superior mesenteric artery)
  • Left colic artery (from the inferior mesenteric artery)
32
Q

hindgut regions + blood supply

A

Distal 1/3 of the transverse colon, descending colon and sigmoid colon
-inferior mesenteric artery

–The descending colon is supplied by a single branch of the inferior mesenteric artery; the left colic artery. The sigmoid colon receives arterial supply via the sigmoid arteries (branches of the inferior mesenteric artery).

33
Q

marginal artery of drummond

A

The marginal artery (of Drummond) is a clinically important vessel that provides collateral supply to the colon – thereby maintaining arterial supply in the case of occlusion or stenosis of one of the major vessels.

As the terminal vessels of the superior mesenteric and inferior mesenteric artery approach the colon, they split into many branches, which anastomose with each other. These anastomoses form a continuous arterial channel which extends the length of the colon – the marginal artery. Long, straight arterial branches (called vasa recta) arise from the marginal artery to supply the colon

34
Q

relation between arterial supply + lymphatic supply

A

both follow same path SO
lymphatic draining of ascending + transverse = SMA
lymphatic drainage of descending + sigmoid = IMA
-then–> intestinal lymph trunks –> on to the cisterna chyli –> THORACIC DUCT

35
Q

venous drainage of ascending colon

A

ileocolic and right colic veins, which empty into the superior mesenteric vein.

36
Q

venous drainage of transverse colon

A

middle colic vein, which empties into the superior mesenteric vein.

37
Q

venous drainage of desc colon

A

left colic vein, which drains into the inferior mesenteric vein.

38
Q

venous drainage of sigmoid colon

A

drained by the sigmoid veins into the inferior mesenteric vein

39
Q

where do sup mesenteric + inf mesenteric veins ultimately empty into

A

HEPATIC PORTAL VEIN –> TOXINS absorbed from colon processed by liver for detoxification

40
Q

neurovascular supply of colon

A
  • linked to embryological origin
  • Ascending colon and proximal 2/3 of the transverse colon – derived from the midgut.
  • Distal 1/3 of the transverse colon, descending colon and sigmoid colon – derived from the hindgut.
41
Q

Where is the transpyloric plane of addison

A

horizontal line between the suprasternal notch + pubic symphisis

42
Q

what lies at the transpyloric plane (classic surgical q)

A
  1. End of SC
  2. L1 vert
  3. Origin of SMA
  4. Origin of portal vein
  5. neck of pancreas
  6. pylorus of stomach
  7. D2
  8. Sphincter of Odii
  9. Hilum of each K
  10. DJ flexure
  11. Fundus of GB
  12. Tip of 9th costal cartilage
43
Q

Describing scars

A

Imagine examiner hasn’t seen the scar before
1.Size
2.Shape - transverse, longitudinal, oblique
3.Site
4.Surgical health + age - ie. well healed/ dehisced/ inf + fresh vs old
SUGGESTIVE OF (name scar)
SURGICAL ACCESS (what organs does it provide access to and to what blood vessels or just say the blood vessels that supply them)
SURGERY + SURGICAL INDICATION
BRING IN OWN KNOWLEDGE

44
Q

example of describing a kocher incision

A

1.10cm
2.OBLIQUE scar
3.Under the R costal margin
4.Old + well healed
Suggestive of a Kocher scar
Provides access to the liver + GB + their vascular supply
This may be necessary for an open cholecystectomy eg for cholecystitis or ascending cholangitis or acute pancreatitis secondary to GS

I know that most cholecystectomies are typically performed laparoscopically so reasons to convert to OPEN would be DIFFICULT ANATOMY or a HAEMODYNAMICALLY UNSTABLE PT

45
Q

if they have an ILEOSTOMY - what are 3 imp things to comment on

A
  1. Location - RIF
  2. Spouted (to prevent irritation from high enzyme contents)
  3. Watery contents drained
46
Q

If they have an END (single lumen) ILEOSTOMY what ops have they had

A 
Sub total colectomy (anus intact)
Pan proctocolectomy (closed anus)
47
Q

If they have had a LOOP (double lumen) ILEOSTOMY what ops have they had

A

Anterior resection (removed part of sigmoid colon and rectum. anus open as anal sphincters not invovled)
- STOMA formed
+ Anastomosis formed !!

48
Q

if they have a COLOSTOMY - what are 3 imp things to comment on

A
  1. Location - LIF
  2. Not spouted / flat / flush to skin
  3. Faecal matter drained
49
Q

If they have an END (single lumen) COLOSTOMY what ops have they had

A 
Hartmann's (sigmoid colectomy)
AP resection (sigmoid colectomy + anus closed)
50
Q

are LOOP COLOSTOMY often seen

A

V RARE

51
Q

what are important complications of STOMA

A

IMMED - infection, bleeding, necrosis (stoma too tight/ under tension <24h often)

EARLY - high output (up to 1.5L normal) , obstruction

LATE - retraction, prolapse, stenosis, parastomal hernias

6th Year Gastro MJ (4 decks)

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