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Yr3 - General Surgery > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

What is an inguinal hernia?

A

Abdominal cavity contents enter into the inguinal canal

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2
Q

Define hernia

A

Protrusion of part or whole of an organ or tissue through the wall of the cavity that normally contains it

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3
Q

Define the types of inguinal hernia

A

Direct - through weakness in posterior wall of the canal
- more common in elderly due to abdominal wall laxity or increase in intra-abdominal pressure
Indirect - via deep inguinal ring
- patent processus vaginalis

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4
Q

Risk factors for inguinal hernia

A 
Male 
Increasing age
Raised intra-abdominal pressure
- chronic cough
- heavy lifting
- chronic constipation
Obesity
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5
Q

Clinical features of inguinal hernia

A

Lump in groin
Reducible hernia - disappear with minimal pressure or lying down
Incarcerated - painful, tender and erythematous

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6
Q

Examination of lump in groin

A

Cough impulse
Location
Reducible
Enters scrotum

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7
Q

Investigations of inguinal hernia

A

Clinical diagnosis - explorative surgery
Imaging only considered in patients if diagnostic uncertainty or exclude other pathology
- USS

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8
Q

Management of inguinal hernia

A

Symptomatic should be offered surgical intervention

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9
Q

Surgical management of inguinal hernia

A

Open mesh repair - primary inguinal hernia

Laparoscopic - bilateral or recurrent inguinal hernia

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10
Q

Define an irreducible/incarcerated hernia

A

Contents of hernia are unable to return to their original cavity

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11
Q

Define an obstructed hernia

A

Bowel lumen has become obstructed

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12
Q

Define a strangulated hernia

A

Compression of the hernia has compromised the blood supply, leading to the bowel becoming ischaemic

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13
Q

Complications of inguinal hernia

A

Incarceration
Strangulation
Obstruction

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14
Q

Post-operative complications of hernia repair

A

Pain, bruising and haematoma
Recurrence
Chronic pain
Damage to vas deferens or testicular vessels

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15
Q

Risk factors of femoral hernias

A

Female
Pregnancy
Raised intra-abdominal pressure
Increasing age

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16
Q

Clinical features of femoral hernias

A

Small lump in the groin
Due to the anatomy of the femoral canal 30% present as an emergency
Unlikely to be reducible to due tightness of femoral ring

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17
Q

Inguinal vs femoral hernia location

A

Femoral - found infero-lateral to pubic tubercle

Inguinal - superomedial to the pubic tubercle

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18
Q

Femoral hernia investigations

A

Diagnosed clinically and via USS

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19
Q

Femoral hernia management

A

Surgical - due to risk of strangulation

Reduce hernia and narrow femoral ring with sutures between pectineal and inguinal ligaments

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20
Q

Describe the approaches for femoral hernia repair

A

Low approach - does not interfere with inguinal structures

High approach - emergency intervention due to easy access to compromised small bowel

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21
Q

Define an epigastric hernia

A

Occurs in upper midline through the fibres of the linea alba

Secondary to raised chronic intra-abdominal pressure

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22
Q

Define a paraumbilical hernia

A

Herniation through the linea alba around the umbilical region
Secondary to raised chronic intra-abdominal pressure
Usually contain only pre-peritoneal fat

23
Q

Define a spigelian hernia

A

Occurs at the semilunar line (tendinous lateral border of the rectus where aponeuroses fuse) around level of arcuate line
High risk of strangulation

24
Q

Define an obturator hernia

A

Hernia of the pelvic floor through the obturator foramen into the obturator canal
More common in elderly women

25
Presentation of an obturator hernia
Upper medial thigh mass Features of small bowel obstruction Compression of obturator nerve - positive Howship-Romberg sign
26
Define an Littre's hernia
Herniation of Meckel's diverticulum | Commonly in the inguinal canal - becomes strangulated
27
Define a lumbar hernia
Posterior hernia - spontaneous or iatrogenically following surgery Present as a posterior mass a/w back pain
28
Define a Richter's hernia
Parital herniation of bowel - anti-mesenteric border becomes strangulated - only part of lumen in hernial sac
29
Presentation of a Richter's hernia
Tender irreducible mass at any sight | Obstruction - surgical emergency
30
Define gastroenteritis
Inflammation of the gastrointestinal tract
31
Risk factors of gastroenteritis
Poor food preperation, handling and cooking Immunocompromised Poor personal hygiene
32
Clinical features of gastroenteritis
Cramp-like abdominal pain Diarrhoea Vomiting Pyrexia
33
Management of gastroenteritis
Rehydration - encourage oral intake where possible Education Exclusion from work
34
Viral causes of gasteroenteritis
Norovirus - 1-3 days Rotovirus - children Adenovirus - children
35
Bacterial causes of gasteroenteritis
Campylobacter - gram negative bacillus E. Coli - gram negative bacillus, travellers' diarrhoea Salmonella - gram negative bacillus, bloody diarrhoea Shigella - gram negative bacillus, blood diarrhoea
36
Bacterial toxin causes of gasteroenteritis
Staphylococcus aureus Bacillus cereus Clostridium perfringes Vibro cholera
37
Parasitic causes of gasteroenteritis
Cryptosproidium - self-limiting watery diarrhoea Entamoeba histolyica - liver abscess - RUQ pain, pyrexia, hepatomegaly Giaria intestinalis - chronic diarrhoea Schistosoma - eosinophilia
38
Causes of hospital-acquired gastroenteritis
C.difficile - gram postiive Develops following broad-spectrum antibiotics Produce exotoxins A+B
39
Clinical features of C.difficile infection
Severe bloody diarrhoea | Toxic megacolon
40
Treatment of C.difficle infection
IV fluid rehydration Oral metronidazole Vancomycin in severe disease
41
Non-infective causes of gasteroenteritis
Radiation colitis IBD Microscopic colitis Chronic ischaemic colitis
42
Define angiodysplasia
Vascular abnormality of GI tract Caused by formation of arteriovenous malformations between previous healthy blood vessels Commonly in caecum and ascending colon
43
Types of angiodysplasia
Acquired - reduced submucosal venous drainage due to chronic and intermittent contraction of colon -> dilated and toruous veins - loss of pre-capillary sphincter competency - formaion of arterio-venous communications characterised by small tuft of dilated vessels Congenital
44
Clinical features of angiodysplasia
Rectal bleeding | Anaemia
45
Presentations of angiodysplasia
Asymptomatic - diagnosed incidentally on colonoscopy Painless occult PR bleeding Acute haemorrhage
46
Investigations for angdiodysplasia
``` Blood tests - FBC, U&Es, LFTs and clotting Upper GI endoscopy Colonoscopy Wireless capsule - small bowel bleeds Mesenteric angiography ```
47
Management of angiodysplasia
Conservatively if haemodynamically stable - bed-rest - IV fluid support - tranexamic acid Endoscopy - argon plasma coagulation Mesenteric angiography - small bowel lesions or failure of endoscopy - catherterisation and embolisation of bleeding vessels Surgical - resection and anastomosis
48
Indications for surgical treatment of angiodysplasia
Continuation of severe bleeding despite angiographic and endoscopic management Severe acute life-threatening GI bleeding Multiple angiodysplastic lesions
49
Define GEP-NETs
Gastroenteropancreatic neuroendocrine tumours | Neuroendocreaine tumours originating from neuroendocrine cells in tubular GI tract and pancrease
50
Risk factors for GEP-NETs
Genetic - Multiple Endocrine Neoplasia type 1 - von Hippel-Lindau disease - neurofibromatosis 1 - tuberous sclerosis complex
51
Clinical features of GEP-NETs
``` Non-specific symptoms - vague abdominal pain - N+V - abdominal distention - features of bowel obstruction Unitentional weight loss Carcinoid syndrome ```
52
Investigations for GEP-NETs
``` Chromogranin A and 5-HIAA levels Genetic testing Endoscopy CT enteroclysis Whole body somatostatin receptor scintigraphy ```
53
Management of GEP-NETs
Surgery only curative treatment Resection of localised disease - endoscopic, partial colectomy, regional lymph node clearance Chemotherapy

Yr3 - General Surgery (17 decks)

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