SB Disease Flashcards
What is the most common type of hernia? What are the subtypes? How can you tell them Apart?
Inguinal - abdo cavity contents -> inguinal canal
- direct 20% bowel through weakness posterior wall (Hesselbach’s triangle) older
Medial to epigastric vessels (at surgery) - indirect 80% bowel enters through deep In ring (incomplete closure processus vaginalis) congenital
Lateral to Epi V
Reduce -> place pressure deep in ring -> cough - if protrudes indicates direct,unreliable
Borders of the inguinal canal
Roof - IO & TA
Anterior wall - aponeurosis EO
Posterior wall - transversalis fascia
Floor - inguinal ligament
Complications of hernias
Normally reducible - disappear minimal pressure/ lying down, cough impulse
- incarcerated painful, tender, erythematous
- bowel obstruction
- strangulation (blood supply compromised, irreducible, pain out of proportion to signs +/- obstruction)
✅urgent surgical exploration
Inguinal vs femoral hernia location
Inguinal - superomedial to pubic tubercle
Femoral - inferolateral PT
What are femoral hernias? Who gets them?
Abdominal viscera/ omentum -> femoral ring -> femoral canal potential space
Women 3:1
Multiparous
Chronic constipation/ heavy lifting etc
Older
Borders of the femoral canal
Anterior - Inguinal L
Posterior - pectineus
Lateral - femoral V
Medial - lacunar L
Superior - femoral ring
How are femoral hernias managed?
All need surgical intervention
Routine pre-op investigations:
USS
CT abdo pelvis
Doubt - surgically explored
2WW surgery:
High risk strangulation (3months 22%, 21months 45%)
Borders of femoral triangle
Contents
Superior - Inguinal ligament
Lateral - Medial sartorius
Medial - Medial adductor longus
Lateral-> medial
NAVEL
Where does an epigastric hernia occur?
Upper midline through linea Alba
Typically secondary raised IAP
Midline mass disappears lying back
Not to be confused with divarication of recti (linea Alba stretched & weakened but intact)
Where does a paraumbilical hernia occur? Who gets umbilical hernias?
Through linea Alba in umbilical region
Typically secondary raised chronic IAP
Generally contain pre-peritoneal fat, can contain bowel
Umbilical hernias - children mostly, omohalocele/ gastroschisis
Viral causes of gastroenteritis
Norovirus - RNA, most common, abdo cramps, watery diarrhoea, vomiting 1-3days
Rotavirus - DS RNA, 1st infants
<1 week
Adenovirus - DNA, children
Bacterial causes of gastroenteritis
Campylobacter - gram -ve bacillus
Most common cause food poisoning
Fatigue, fever, myalgia, cramps, D, N
Can: reactive arthritis, GBS, haemolytic ureamic syndrome, thrombocytopaenic purpura
E.Coli - gram -ve bacillus, food/ animals/ ppl, most common travellers diarrhoea
Salmonella - gram -ve, bacillus, fever, N&V, cramps, bloody diarrhoea
Shigella - gram -ve bacillus, fever, pain, rectal pain, bloody D
Bacterial toxin causes of gastroenteritis
Symptoms last <24hrs
- staphylococcus aureus
Cooked meat/ cream - bacillus cereus
Reheated rice, rapid N&V - clostridium perfringes
D
-vibrio cholera
Water, watery D
Parasitic causes of gastroenteritis
Cryptosporidium
Watery D, cramps
Entamoeba histolytica
Blood D, pain, fever
-> amoebic liver abscess
Giardia intestinalis
Schistosoma
Contaminated water
Month after initial infection
Fever, malaise, pain, bloody D, hepatosplenomegaly, eosinophilia
Most common cause hospital acquired gastroenteritis & treatment
C. Difficult
Gram +ve
Following broad spec ABs
✅IV fluid
Oral metronidazole
Non infective causes of gastroenteritis
Radiation colitis
IBD
Microscopic colitis
Chronic ischaemic colitis
Important causes of dysentery
Campylobacter
Shigella
Salmonella
Norovirus
What is angiodysplasia, how does it present?
Formation arteriole nouns malformations
Most commonly caecum/ ascending colon
- 6% lower GI bleeds (haematochezia)
- 8% upper GI bleeds (haematemesis/ melena)
- 2nd common cause Pr bleed >60yr
- AS incidentally colonoscopy 10%
- painless occult PR bleed majority
- acute haemorrhage 10-15%
- anaemia
Acquired - reduced submucosal V drainage -> loss pre capillary sphincter competency
Congenital
Management angiodysplasia
10% major bleed - managed
Conservatively - rest, IV fluid, tranexamic acid
Persistent/ severe:
Endoscopy + coagulation
Mesenteric angiography + catheterisation & embolisation
Minority surgery:
Resection, anastomoses
What are gastroenteropancreatic neuroendocrine tumours?
Tumours originating from neuroendocrine cells (receive input from neurotransmitters -> release hormones) in tubular GI tract & pancreas
How do gastroenteropancreatic tumours present?
Non-specific symptoms
Vague abdo pain, N&V, abdo distension
Some cases bowel obstruction
WL
Palpable abdo mass
Underlying inherited disorder
Carcinoid syndrome - metastasis -> oversecrete bioactive mediators -> flushing, abdo pain, D, wheezing, palpitations
