Pathology Flashcards
Peritonitis
Sx - guarding, rigidity, rebound tenderness, coughing pain, percussion pain
- Localised - inflammation of underlying organ
- Generalised - perforation of abdominal organ leaking into peritoneal cavity
*Spontaneous bacterial peritonitis - associated with ascites
Bowel obstruction
Big 3 - adhesions, hernias, malignancy
Closed loop - 2 points of obstruction in the bowel, squeezing middle section emergency surgery
E.g. volvulus, tumour and competent ileocecal valve
Px - voting (green), distension, pain, constipation, tinkling bowel sounds
Ix - X-ray (3,6,9), valvulae conniventes (small) haustra (large)
- amylase can be raised in small bowel obstruction
Mx - surgical or conservative
- treat hypovolaemic shock
Initially - drip and suck
- nil by mouth, iv fluids, NG tube with drainage
Ileus
- Paralysis of small bowels often post surgery or trauma
Sx - small bowel obstruction sx
Mx- should resolve with supportive care
- nil by mouth, ng tube, fluids, TPN
Volvulus
- Bowels become twisted around themselves and the mesentery (where blood supply is) - ischaemia and bowel perforation
Sigmoid volvulus - more common and affects older people - build up of faeces causing it to sink and twist
Caecal volvulus - less common but occurs in younger people
Px - bowel obstruction sx
Ix - X ray - coffee bean sign for sigmoid colon
- Contrast CT for diagnosis
Mx - drip and suck
- laparotomy and colostomy
Hernias
- Abnormal protrusion of an organ through a weak point in a cavity wall or opening
- Risk of incarceration, obstruction and strangulation
Inguinal - direct - through hesselbackls triangle
- indirect - through deep inguinal ring to superficial ring
* If reduced when fingers on deep ring, then hernia is indirect
**Refered for surgery even if asymptomatic
Femoral
- through femoral canal - containing lymph vessels
- at high risk of incarceration, obstruction and strangulation
Sx - bowel obstruction sx and extreme pain with strangulation (blood cut off)
Mx - conservative or surgical
*Bilateral inguinal - repaired lap with mesh
*Unilateral inguinal - repaired open with mesh
Haemorrhoids
- Enlarged anal vascular cushions - rectal arteries source
- Associated with constipation and straining - obesity, pregnancy, increase in age, increase in abdominal pressure
*Thrombosed - anorectal pain and tender lump on anal margin Mx - stool softeners, ice pack, analgesia
Sx - bright red, painless, after using toilet
- external prolapsed haemorrhoids, internal lumps on exam,
Ix - proctoscopy
Mx - anusol cream
- rubber band ligation
- surgical to ligate artery or remove haemorrhoid
Diverticulitis
- Areas of weakness in the colon occur where vessels penetrate, causing a gap to form in the muscle causing a pouch
Cx - increased age, low fibre, obesity
Ix - colonoscopy or CT
Mx - uncomplicated - co amoxiclav, analgesia, clear liquid
- complicated - IV antibiotics, nil by mouth, IV fluids, analgesia
- Can lead to haemorrhage, formation of an abscess or peritonitis
Mesenteric ischaemia
- Chronic - narrowing of mesenteric vessels due to atherosclerosis (angina of gut)
Sx - intermittent colic pain, weight loss, abdominal bruit
Ix - CT angiography
Mx - treat underlying causes
- revascularisation via stunting first line
Acute - usually due to thrombus
* A fib risk factor
Sx - acute non specific abdominal pain (very bad)
- can cause shock, peritonitis, sepsis
Ix - Contrast CT
- Venous blood gas - metabolic acidosis and raised lactate from ischaemia
Mx - emergency surgery - remove necrotic bowel, bypass or remove thrombus
Bowel cancer
- familial adenomatous polyposis (dominant) affects tumour supressor gene (APC) - resulting in many adenomas along the large intestine that have the potential to become cancerous before 40
*Lynch syndrome (dominant) - at higher risk of colorectal cancer and endometrial cancer - none for little polyps ( young age)
Mx - pranproctocoletcomy -total removal of large bowel
Sx - loose and frequent bowels, weightloss, fresh bleeding, abdominal pain, palpable mass
- iron deficiency anaemia**
Ix - FIT test for haemoglobin in stool, CT, colonoscopy, CEA
Stomas
- Colostomy
- Large intestine brought to the skin (usually flat)
- contains more solid stools
- typically LIF
- Ileostomy
- ileum brought to surface of the skin
- spout present
- drain more liquid stools
- typically RIF
- Gastrostomy - where stomach is connected to the abdominal wall
- allows food to be given to patient that are not meeting nutritional needs by mouth
Gallstones
- Stones made from cholesterol that get stuck in the gallbladder and bile ducts
- causing cholescytitis, cholangitis or paancreatits
Sx - Acute colic pain, epigastric area or RUQ, triggered after meals,
Ix - US, MRCP, ERCP
**fatty foods that enter the digestive system cause the release of cholecystokinin (CCK) which causes the gallbladder to contract - causing colic pain
Acute cholecystitis
- Gallbladder inflammation due to stone being trapped in neck or cystic duct (95%)
- 5% where gallbladder not being stimulated causing build up of pressureE.g. TPN or fasting (acalculous)
Sx - Murphys, fever, nausea, RUQ pain, tachycardia, high resp
Ix - US
- If unable via US, hepatobillary iminodiacetic acid (HIDA)
Mx - ERCP, nil by mouth, antibiotics, NG tube for vomiting, IV fluids
- IV antibiotics, lap cholecystectomy within 1 week
Generally systemically unwell
Acute cholangitis
- Inflammation of bile ducts causing infection of bilary tree
Cx -Ecoli infection in billary tree
Sx - **Charcots triad - RUQ pain, jaundice, fever
Mx - Admit for emergency admission (risk of sepsis)
- Iv antibiotics and ERCP
Ix - US, MRCP,
Cholangiocarcinoma
- Adeoncarcinomas of bile duct, most commonly perhilar region where R and L ducts meet
Risk factor - PSC and UC + liver flukes (se Asia)
Px - painless obstructive jaundice, pale stools, dark urine, itching
Ix - US, CT, biopsy…
***Obstructive jaundice - cholangiocarcinoma or head of pancreas
Mx - surgery, chemo…
Pancreatic cancer
- Often adenocarcinomas and have very late diagnosis so poor prognosis
- Tend to spread early
Sx - obstructive painless jaundice, itching, pale stools, dark urine
** Worsening diabetes despite med adherence and lifestyle management can be a sign of pancreatic cancer
Ix - HRCT…
Mx - surgery
