Random facts 1 Flashcards
Define oliguria
- a reduced urine output
- urine output of less than 0.5 ml/kg/hour
Classical symptoms of ischaemic colitis
Ischaemic colitis
Classic presentation:
- after a meal
- intermittent and severe pain
pain out of proportion to clinical finding
Predisposing factors: increasing age, atrial fibrillation, other causes of emboli: endocarditis, malignancy, cardiovascular disease risk factors: smoking,hypertension, diabetes, cocaine use
Diagnosis: CT
Management
- usually supportive
- surgery may be required in a minority of cases if conservative measures fail. Indications would include generalised peritonitis, perforation or ongoing haemorrhage
Clinical presentation of small bowel obstruction
Small bowel obstruction:
- intermittent pain
- clinical examination and imaging would likely show a distended abdomen
- obstruction on imaging
Presentation of diverticulitis
Diverticulitis:
- PR bleed
- bowel symptoms on top
- pain
Clinical presentation of ruptured ulcer
Ruptured ulcer:
- severe and diffuse abdominal pain
- likely present with epigastric pain at first
bloody emesis
Complications of diverticulosis
What’s the volvulus? (in general)
What are the common sites of it?
Volvulus - it’s torsion of the bowel loop around the mesentery -> obstruction and #blood flow
Types:
A. Sigmoid volvulus -> 80%
B. Coecal volvulus -> 20%
Clinical picture of volvulus
Features
- constipation
- abdominal bloating
- abdominal pain
- nausea/vomiting
Diagnosis of volvulus:
A. Sigmoid
B. Coecal
A. Sigmoid: ‘coffee bean sign’ + large bowel obstruction (large, dilated loop of the colon, often filled with air)
B. Coecal: ‘embryo sign’ + small bowel obstruction
Treatment of volvulus
A. Coecal
B. Sigmoid
A. Coecal -> usually operative e.g. right hemicolectomy
B. Sigmoid -> right sigmoidoscopy + rectum tube insertion
Malignant hyperthermia
- what’s that?
- mechanism of action/cause
- drugs that cause it
Malignant hyperthermia
hyperpyrexia + muscle rigidity following the reaction to anaesthetic drugs
MoA: the excessive release of Ca++ from the endoplasmic reticulum
Cause: defects in chromosome 19
Drugs:
halothane, suxamethonium, other drugs: antipsychotics (neuroleptic malignant syndrome)
*similar aetiology to neuroleptic malignant syndrome
Management of malignant hyperthermia
Management
- dantrolene - prevents Ca2+ release from the sarcoplasmic reticulum
Hartmann’s procedure
- what’s that
- use
Hartmann’s = proctosigmoidectomy
- resection of rectosigmoid colon + formation of end colostomy
- use: management of malignant obstruction of distal colon (when perforation occurs)
MANAGEMENT of sigmoid volvulus
1st endoscopic decompression + flatus tube insertion
2nd surgery - preferably anastomosis (if decompression failed, ischaemia occur)
*in coecal volculus, surgery may be 1st line due to higher chanc of ischaemia
3 most common feeding tube types
- names
- location
Which artery is commonly associated with the GI bleed due to a duodenal ulcer?
Gastro-duodenal (posterior wall, 2nd part of duodenum)
What’s Dieulafoy Lesion?
- presentation
Dieulafoy - abnormally large artery somewhere in the GI tract (it is due to arteriovenous malformation)
- Haematemesis and Malena - often with no prodromal symtpoms
signs of basal skull fracture
Basal skull fracture:
- haemotympanum
- ‘panda’ eyes
- cerebrospinal fluid leakage from the ear or nose
- Battle’s sign
Treatment (medical) of breast Ca that is ER +
- pre-menopausal women
- postmenopausal women
- Pre-menopausal -> Tamoxifen
- Post-menopausal -> Aromatase inhibitors
*In postmenopausal women, Tamoxifen would increase the risk of endometrial cancer
What scoring system is used in the assessment of severity of GI bleed
The Blatchford score is used to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy
What surgical incisions do you know?
- name them + location
- what surgeries to they mean
aim for 12 incisions’ names
What is a lucid interval feature of?
Extradural haemorrhage = lucid period, usually following major head injury.
What type of haemorrhage is fluctuating consciousness feature of?
Subdural = fluctuating consciousness, often following trivial injury in the elderly or alcoholics
