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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
Q

Presentation of an obturator hernia

A

Upper medial thigh mass
Features of small bowel obstruction
Compression of obturator nerve - positive Howship-Romberg sign

26
Q

Define an Littre’s hernia

A

Herniation of Meckel’s diverticulum

Commonly in the inguinal canal - becomes strangulated

27
Q

Define a lumbar hernia

A

Posterior hernia - spontaneous or iatrogenically following surgery
Present as a posterior mass a/w back pain

28
Q

Define a Richter’s hernia

A

Parital herniation of bowel - anti-mesenteric border becomes strangulated - only part of lumen in hernial sac

29
Q

Presentation of a Richter’s hernia

A

Tender irreducible mass at any sight

Obstruction - surgical emergency

30
Q

Define gastroenteritis

A

Inflammation of the gastrointestinal tract

31
Q

Risk factors of gastroenteritis

A

Poor food preperation, handling and cooking
Immunocompromised
Poor personal hygiene

32
Q

Clinical features of gastroenteritis

A

Cramp-like abdominal pain
Diarrhoea
Vomiting
Pyrexia

33
Q

Management of gastroenteritis

A

Rehydration - encourage oral intake where possible
Education
Exclusion from work

34
Q

Viral causes of gasteroenteritis

A

Norovirus - 1-3 days
Rotovirus - children
Adenovirus - children

35
Q

Bacterial causes of gasteroenteritis

A

Campylobacter - gram negative bacillus
E. Coli - gram negative bacillus, travellers’ diarrhoea
Salmonella - gram negative bacillus, bloody diarrhoea
Shigella - gram negative bacillus, blood diarrhoea

36
Q

Bacterial toxin causes of gasteroenteritis

A

Staphylococcus aureus
Bacillus cereus
Clostridium perfringes
Vibro cholera

37
Q

Parasitic causes of gasteroenteritis

A

Cryptosproidium - self-limiting watery diarrhoea
Entamoeba histolyica - liver abscess - RUQ pain, pyrexia, hepatomegaly
Giaria intestinalis - chronic diarrhoea
Schistosoma - eosinophilia

38
Q

Causes of hospital-acquired gastroenteritis

A

C.difficile - gram postiive
Develops following broad-spectrum antibiotics
Produce exotoxins A+B

39
Q

Clinical features of C.difficile infection

A

Severe bloody diarrhoea

Toxic megacolon

40
Q

Treatment of C.difficle infection

A

IV fluid rehydration
Oral metronidazole
Vancomycin in severe disease

41
Q

Non-infective causes of gasteroenteritis

A

Radiation colitis
IBD
Microscopic colitis
Chronic ischaemic colitis

42
Q

Define angiodysplasia

A

Vascular abnormality of GI tract
Caused by formation of arteriovenous malformations between previous healthy blood vessels
Commonly in caecum and ascending colon

43
Q

Types of angiodysplasia

A

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
Q

Clinical features of angiodysplasia

A

Rectal bleeding

Anaemia

45
Q

Presentations of angiodysplasia

A

Asymptomatic - diagnosed incidentally on colonoscopy
Painless occult PR bleeding
Acute haemorrhage

46
Q

Investigations for angdiodysplasia

A 
Blood tests - FBC, U&Es, LFTs and clotting
Upper GI endoscopy
Colonoscopy
Wireless capsule - small bowel bleeds
Mesenteric angiography
47
Q

Management of angiodysplasia

A

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
Q

Indications for surgical treatment of angiodysplasia

A

Continuation of severe bleeding despite angiographic and endoscopic management
Severe acute life-threatening GI bleeding
Multiple angiodysplastic lesions

49
Q

Define GEP-NETs

A

Gastroenteropancreatic neuroendocrine tumours

Neuroendocreaine tumours originating from neuroendocrine cells in tubular GI tract and pancrease

50
Q

Risk factors for GEP-NETs

A

Genetic

  • Multiple Endocrine Neoplasia type 1
  • von Hippel-Lindau disease
  • neurofibromatosis 1
  • tuberous sclerosis complex
51
Q

Clinical features of GEP-NETs

A 
Non-specific symptoms
- vague abdominal pain
- N+V
- abdominal distention
- features of bowel obstruction
Unitentional weight loss
Carcinoid syndrome
52
Q

Investigations for GEP-NETs

A 
Chromogranin A and 5-HIAA levels 
Genetic testing
Endoscopy
CT enteroclysis
Whole body somatostatin receptor scintigraphy
53
Q

Management of GEP-NETs

A

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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