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MB1: Gastrointestinal > Small bowel disease > Flashcards

Small bowel disease Flashcards

1
Q

who is more likely to get appendicitis

A

children

men, up to age 25 then equally males and females affected

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2
Q

cause of appendicitis

A 
faecolith 
bacterial
viral 
parasites 
tumour obstruction
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3
Q

describe the disease process of appendicitis

A 
trigger factor 
inflammation and obstruction 
build up of mucus and exudate 
ischaemia and perforation
peritonitis
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4
Q

who is more likely to have peritonitis as a result of appendicitis

A

immunosuppressed
older people
diabetics
those wit habsent omentum

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5
Q

what is rosvings sign?

A

pressing on the left cause pain on the right

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6
Q

what is psoas sign

A

patient keeps right him flexed to lift appendix off psoas

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7
Q

what is obturators sign

A

hip flexion will cause pain as inflamed appendix is touching obturator infernus

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8
Q

What is MANTRELS score

A 
Migration of pain to RLQ -1
Anorexia -1
Nausea and vomiting -1
Tenderness to RLQ -2
Rebound pain -1
Elevated temp -1
Leukocytosis -2
WCC left shift -1
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9
Q

would an appendix mass be treated with surgery first line?

A

no, antibiotics

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10
Q

complications of appendicectomy

A 
pelvic abscess 
infection 
intra-abdominal abscess
DVT/PE
right sided inguinal hernia 
faecal fistula 
portal pyaemia 
ileus 
respiratory issues post op
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11
Q

what is carcinoid of the appendix

A

tumour of crypts of leiberkuhn

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12
Q

causes of small bowel obstruction

A 
gallstones 
food 
tumour 
chrons 
radiation 
adhesions 
herniation
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13
Q

causes of mesenteric ischaemia

A 
embolus from AF
vasoconstricting drugs 
compression 
hypercoagulable state 
dehydration
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14
Q

complications of meckel’s diverticulum

A

bleed
ulceration
obstruction
malignancy

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15
Q

where can the tip of the appendix be found?

A

convergence of tenia coli, sometimes further away

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16
Q

what is malabsorption

A

defective mucosal absorption

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17
Q

what is coeliac disease

A

mucosal lesion due to exposure to wheat, barley or rye

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18
Q

describe the disease process of coeliac disease

A

HLA-DQ8/HLA-DQ2 causes antigen presenting cells to bind to gluten and activate a T cell response
causes mucosal damage

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19
Q

what is lactose malabsorption

A

deficiency of lactase

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20
Q

what is tropical sprue

A

colonisation of intestine by infection or altered intestinal flora

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21
Q

how is tropical sprue diagnosed

A

biopsy

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22
Q

what causes whipple’s disease and how is it diagnosed

A

tropheryma whipplei

biopsy

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23
Q

how can chron’s disease cause malabsorption

A

extensive ileal involvement
extensive bowel resection
stricure
enterocolic fistulas

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24
Q

how is it possible to catch giardia lamblia

A

swimming/travel to areas of contaminated water

25
Q

what is easy bruising a sign of

A

vitamin C/K deficiency

26
Q

what is dermatitis herpetiformis a sign of

A

coeliac disease

27
Q

acrodermatitis enteropathica is a sign of

A

impaired zinc uptake

28
Q

nail spooning is a sign of

A

iron deficiency

29
Q

glossitis and angular stomatitis are signs of

A

B vitamins and iron deficiency

30
Q

what is malnutrition

A

nutrition that in excess or deficiency

31
Q

cause of malnutrition

A

decreased food intake
impaired digestion/absorption
increased nutrition requirement
increased nutrient loss

32
Q

consequence of malnutrition

A 
infection 
poor wound healing
GI dysfunction 
slow fat loss
decreased hormone levels 
water retention 
prolonged recovery 
impaired immune system 
cardio-respiratory weakness
33
Q

what vitamins are lower in the elderly

A

A, C, D, E and zinc

34
Q

__ and ___ are best ways of identifying malnutrition

A

BMI

% weight loss

35
Q

what biochemical tests may indicate malnutrition

A

albumin

transferrin

36
Q

to who are oral nutrition supplements given to

A 
intractable malabsorption 
dysphagia 
IBD
post total gastrectomy 
SBS
bowel fistulae
37
Q

2 types of ETF

A

NG

NJ

38
Q

indication of ETF

A 
inadequate oral intake 
unconsciousness 
swallow disorder
Upper GI obstruction 
GI dysfunction 
increased nutrient requirement
39
Q

contraindication of ETF

A

lower GI obstruction
prolonged ileus
severe vomiting/diarrhoea
ischaemia

40
Q

complications of ETF

A 
nasal damage 
pharyngeal pouch rupture 
bronchial placement 
bleeding/perf
tube falls out 
oesophagitis 
aspiration 
nausea
pain 
refeeding syndrome 
fluid overload
41
Q

what is parenteral nutrition

A

administration of nutrients via central/peripheral vein

42
Q

what is the most likely cause of refeeding syndrome

A

ETF or PNF

43
Q

metabolic features refeeding syndrome

A 
hypokalaemia 
hypomagnesaemia 
altered glucose metabolism 
fluid overload 
hypophosphataemia
44
Q

physiological features refeeding syndrome

A 
arrhythmia 
altered consciousness level 
seizure 
respiratory failure 
cardiovascular collapse 
death
45
Q

what is intestinal failure

A

inability to maintain adequate nutrition or fluid status via intestines

46
Q

causes of Type 1 IF

A 
ileus 
vomiting 
dysphagia 
pancreatitis 
GI obstruction 
diarrhoea 
malignancy/treatment
47
Q

causes of Type 2 IF

A 
chron's 
SMA
radiation 
adhesions 
fistulae
48
Q

causes of type 3 IF

A

SBS +/- Chron’s/radiation
dysmotility
malabsorption
inoperable obstruction

49
Q

treating type 1 IF

A 
replace fluid and electrolyte 
PNF if cannot tolerate oral >7 days 
PPI
Octreotide 
some enteral feeding
50
Q

treating type 2 IF

A

PNF and some enteral

51
Q

treating type 3 IF

A

parenteral nutrition from home
transplant
Glucaon like peptide-2

52
Q

complications of PNF

A 
sepsis 
SVC thrombosis 
line fracture/leak 
nutrient toxicity 
liver disturbance
53
Q

causes of SBS

A

Small recurrent resection
massive resection
gastric bypass

54
Q

in IBD how many are affected by malnutrition

A

85%

55
Q

most common nutritional deficiencies in IBD

A 
iron
vit D
Weight loss
anaemia 
folic acid 
B12
56
Q

why should you minimise steroid use

A

factor leading to osteoporosis

57
Q

what is EEN

A

withdrawl of all food and drink except water
replaced by enteral nutrition
oral/NG

58
Q

what is FODMAP

A 
fermentable 
oligosaccharides 
disaccharides 
monosaccharides 
and 
polyols

MB1: Gastrointestinal (19 decks)

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