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Finals > Surgery 2 > Flashcards

Surgery 2 Flashcards

1
Q

What is a direct inguinal hernia?

A

passes through Hesselbach’s triangle in the abdominal wall

passes through superficial inguinal ring

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2
Q

What are the borders of Hesselbach’s triangle

A

inguinal ligament at base
lateral border of the rectus sheath
inferior epigastric vessels laterally

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3
Q

What is an indirect inguinal hernia

A

passes through patent process vaginalis through deep inguinal ring

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4
Q

Where is the deep inguinal ring found?

A

midpoint of the inguinal ligament

= between ASIS and pubic tubercle

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5
Q

What is found at the midinguinal point?

A

femoral artery

= between ASIS and pubic symphysis

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6
Q

What is the relation of the inguinal hernias to the inferior epigastric vessels

A 
direct = medial to the inferior epigastric vessels
indirect = lateral to the inferior epigastric vessels
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7
Q

What are the risk factors for inguinal hernias

A 
heavy weight lifting
chronic cough
obesity
chronic constipation
male
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8
Q

what are the signs of an inguinal hernia

A

lump media and superior to the pubic tubercle
positive cough impulse
reducible?
if enters scrotum - can you get above it?

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9
Q

What is the treatment for an inguinal hernia

A

reduction - open or laparoscopic mesh

laparoscopic preferred for bilateral or recurrent inguinal hernias

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10
Q

What are the complications of an inguinal hernia repair

A

early: bruising, wound infection
late: chronic pain, recurrence
damage to vas deferens or testicular vessels

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11
Q

Define hernia

A

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

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12
Q

What are the symptoms and signs of an irreducible or incarcerated hernia

A

painful, tender, and erythematous lump

features of bowel obstruction

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13
Q

What is an irreducible or incarcerated hernia?

A

bowel unable to return to original cavity

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14
Q

What is an strangulated hernia

A

compression of bowel has cut off blood supply to bowel, so ischaemia occurs

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15
Q

How can direct and indirect inguinal hernias be differentiated on examination?

A 
reduce hernia
occlude deep femoral ring at mid point of inguinal ligament
cough impusle
if hernia does not protrude = indirect
if hernia still protrudes = direct
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16
Q

What is the differential diagnosis for an inguinal hernia

A 
Femoral hernia
Saphena varix
Inguinal lymphadenopathy
Lipoma
Groin abscess
Internal iliac aneurysm
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17
Q

What are the differential diagnoses for a mass in the scrotum

A

varicocoele
hydrocoele
inguinal hernia
testicular mass

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18
Q

When is an USS recommended when diagnosing an inguinal hernia

A

if there is diagnostic uncertainty

or to exclude other pathology.

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19
Q

What is the annual risk of strangulation of an inguinal hernia?

A

3%

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20
Q

What is a femoral hernia

A

protrusion of bowel through the femoral ring into the femoral canal

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21
Q

What are boundaries of the femoral ring

A

anterior = inguinal ligament
posterior = pectineal ligament
lateral - femoral vein
medial = lacunar ligament

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22
Q

What are risk factors for a femoral hernia

A

female
multiple pregnancies
obesity
chronic constipation or coughing

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23
Q

What are the signs of a femoral hernia

A

lump in groin
inferior and lateral to the pubic tubercle
below inguinal ligament
medial to femoral pulse

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24
Q

Why are femoral hernias prone to strangulation

A

tight ligament borders of the femoral ring

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25
Q

What are the differential diagnoses in femoral hernia

A 
Low presentation of inguinal hernia
Femoral canal lipoma
Femoral lymph node
Saphena varix
Femoral artery aneurysm
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26
Q

What is the gold standard investigation for femoral hernia

A

USS

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27
Q

Why are all femoral hernias meant to be surgically managed

A

due to high risk of strangulation

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28
Q

What is the surgical management of a femoral hernia

A

reduction of the hernia

surgical narrowing of the femoral ring with the use of interrupted sutures

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29
Q

What is the risk of strangulation of femoral hernia at 3m and 21m after initial diagnosis

A 
3m = 22%
21m = 45%
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30
Q

Describe a hiatus hernia

A

protrusion of the stomach into the thorax through the oesophageal hiatus

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31
Q

What is the difference between a rolling and sliding hiatus hernia

A

sliding = movement of oesophagus and gastroeosophageal junction upwards

rolling = GOJ in same place. fundus moves up to lie next to GOJ

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32
Q

Do you get symptoms of reflux in sliding or rolling hiatus hernia

A

sliding - GOJ compromised

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33
Q

what are teh symptoms of hiatus hernia

A 
GORD
vomiting
weight loss
hiccuping
swallowing difficulties
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34
Q

What are the complications of hiatus hernia

A

incarceration
strangulation
volvulus

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35
Q

What is the conservative management of hiatus hernia

A

PPI
diet modification
weight loss
stop alcohol and smoking

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36
Q

What is the surgical management of hiatus hernia

A

curoplasty = reduction into abdomen

fundoplication = fundus wrapped arounf LOS and stretched to stregthen LOS

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37
Q

When would you consider surgical management of hiatus hernia

A

if conservative failed
if high risk of strangulation
if nutritional failure

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38
Q

What are the signs and symptoms of gastric volvulus

A

Severe epigastric pain
Retching without vomiting
Inability to pass an NG tube

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39
Q

What increases the risk of an incisional hernia

A 
obesity
midline incisions
age
pregnancy
cough
diabetes
steroids
smoking
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40
Q

What is the definition of a peptic ulcer

A

break in the mucosal surface of the stomach or duodenum that extends to the muscularis mucosae

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41
Q

What is the most common location for a peptic ulcer

A

first part of the duodenum

lesser curvature of the stomach

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42
Q

What are the causes of PUD

A 
Helicobacter pylori infecion
NSAIDs
alcohol
smoking
ZE syndrome
steroids
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43
Q

What class of bacteria is H pylori

A

gram negative bacillus
spiral shaped
urease producing

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44
Q

What enable H pylori to survive in the stomach

A

urease: urea to ammonium. creates neutral environment for the bacteria to survive in

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45
Q

Why does H pylori infection leads to PUD

A

causes inflammation of the mucosa
stimulates G cells to secrete gastrin, leading to increased acid production
atrophy
imbalance between acid and protective mucus

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46
Q

Why do NSAIDs cause PUD

A

inhibition of prostaglandin synthesis causes reduction in mucus priduction
imbalance between acid and protective mucus

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47
Q

What are the symptoms of PUD

A 
epigastric pain - worse on eating (gastric) or 2-4h after (duodenal)
nausea
anorexia
weight loss
tiredness
malaena
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48
Q

What are the red flag symptoms for gastric cancer which require urgent OGD

A

new onset dysphagia

> 55 with weight loss
+ abdo pain, reflux or dyspepsia

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49
Q

What investigations should be carried out in suspected PUD

A

FOB
FBC, U+E,
Urease breath test - must stop PPI at least 2 weeks prior

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50
Q

What is the management of PUD

A

lifestyle interventions
PPI for 4-8weeks

if proven H pylori - triple therapy

OGD to check resolution

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51
Q

What are some lifestyle interventions for PUD

A 
stop smoking
less alchohol
small meals
not eating for 3 hours before bed
Lose weight
Avoid any trigger foods, such as coffee, chocolate, tomatoes, fatty or spicy foods.
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52
Q

What is triple therapy for H pylori

A

PPI eg lansoprazole
amoxicillin
clarithromycin

7 days

if penicillin allergic = clarithromycin + metronidazole

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53
Q

What are the complications of PUD

A 
haemorrhage
perforation
gastric outlet obstruction
malignancy - H pylori increases risk
anaemia
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54
Q

What artery is most likely to cause haemorrhage in PUD

A

gastroduodenal

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55
Q

What is an AAA

A

dilation of the abs=dominal aorta >3cm (normal - 1.5cm)

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56
Q

What is the pathophysiology of AAA

A

loss of elastic proteins and extracellular matrix in intima and media of the AA due to proteolytic activity and lymphocytic infiltration

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57
Q

What are the risk factors for AAA

A 
male
age
HTN
hyperlipidaemia
smoking
FH
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58
Q

What are the signs and symptoms of AAA

A

none!
back/.abdo/loin pain
distal emboli
pulsating mass above umbilicus

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59
Q

What is the ddx of AAA

A 
renal colic
IBD/IBS
diverticulitis
appendicitis
GI haemorrhage
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60
Q

Describe the screening programme for AAA

A

abdominal USS for men aged 65

small 3-4.4cm USS every year
medium 4.5-5.4cm USS every 3m
large >5.5cm offer surgery

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61
Q

Define small medium and large AAA

A

small 3-4.4cm
medium 4.5-5.4cm
large >5.5cm

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62
Q

What investigations are done in suspected AAA

A

USS abdomen

CT with contrast if >5.5cm for operative planning

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63
Q

What is the conservative management of AAA

A

stop smoking
weight loss
control BP
statin and aspirin

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64
Q

When should the DVLA be informed of an AAA

A

when it is greater than 6cm

need to stop driving due to risk of rupture

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65
Q

What benefits does stopping smoking have in AAA

A

slows rate of progression

decreases risk of rupture

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66
Q

When is surgery offered in AAA

A

if >5.5cm
if expanding at >1cm/year
if symptomatic

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67
Q

What are the surgical options in AAA

A

endovascular repair

open repair

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68
Q

What are the risks and benefits of endovascular aneurysm repair (EVAR) of AAA

A

risks: endoleak, increased risk of reintervention and rupture. will need regular CT angiograms to monitor
benefits: reduced 30 day mortality, reduced hospital stay

same long term outcomes as open

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69
Q

What is an endovascular leak

A

a leak around a graft used in endovascular repair

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70
Q

State the types of endovascular leak

A 
1 = leak around edge of graft
2 = filling by branch vessel
3 = leak through defect in graft
4 = leak through porous material of graft
5 = no obvious site of leakage, but the aneurysm is expanding
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71
Q

What increases the risk of AAA rupture

A

smoking
female
HTN
FH

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72
Q

What are the symptoms and signs of AAA rupture

A 
back/abdo pain (most are retroperitoneal)
vomiting
syncope
low BP
raised HR
pulsatile abdo mass
abdominal tenderness
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73
Q

how should an AAA rupture be managed

A 
high flow oxygen
2x large bore cannulae
bloods - FBC, amylase, cross match
ECG
o-ve blood
keep BP below 100
CONTACT VASCULAR TEAM
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74
Q

Why does the blood pressure need to be maintained below 100mmHg in AAA rupture

A

prevents excessive blood loss

reduces risk of rupturing contained leak

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75
Q

When should warfarin be stopped pre-operatively?

A

5 days before op

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76
Q

When should clopidogrel be stopped pre-operatively?

A

5 days before op

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77
Q

Why are pre-medications given in surgery

A

decrease gastric volume
decrease post op N+V
decrease anxiety

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78
Q

Define the ASA grades

A 
1 = normal healthy
2 = mild systemic disease 
3 = severe systemic disease
4 = severe systemic disease that is a constant threat to life
5 = moribund who is not expected to survive without op
79
Q

What are the criteria for discharge form the recovery room to the ward

A

patient fully conscious, able to maintain a clear airway
respiration and oxygenation satisfactory
CVS stable - BP, pulse, perfusion
pain and emesis controlled - analgesia and anti=emetics prescribed
temperature within acceptable limitis
o2 and IV fluid therapy prescribed if appropraite

80
Q

What are patient factors that increase the risk of PONV

A

female
motion sickness
prev PONV
non-smoker

81
Q

What are surgical factors that increase the risk of PONV

A

laparascopic
abdominal or pelvic
middle ear o intracranial
long operation

82
Q

What are anaesthetic factors that increase the risk of PONV

A 
NO
opiods
long anaethesia
spinal 
intra op dehydration
overuse of bag+mask
83
Q

What are the main classes of antiemetics

A

antihistamines
dopamine antagonists
5HT3 antagonist

84
Q

What causes nausea

A

visceral stimulation in response to distention/irritation detected by mechano/chemoreceptors

chemoreceptor tigger zone in response to drugs, hormones or toxin in blood

higher neurological inputs in response to psychological stress, CNVIII and CN IX gag reflex

85
Q

What neurotransmitters do the mechano/chemoreceptors in the viscera use?
Where do these act

A

5-HT3 and dopamine

vagus nerve simulates vomiting centre in medulla oblongata

86
Q

Where is the chemoreceptor trigger zone

A

in teh fourth ventricle floor outside blood brain barrier

87
Q

What neurotransmitters does the CTZ use?

A

5-HT3 and dopamine

88
Q

What neurotransmitters does the CTZ use?

Where do these act?

A

ACh, histamine

at CTZ -> vomiting centre

89
Q

How do antihistamines act as an antiemetic

A

block H1 receptor in vomiting centre

90
Q

Give an example of an antihistamine used as an antiemetic

A

cyclizine

91
Q

When is cyclizine best used as an anti-emetic

A

pregnancy

labyrinthine disorders

92
Q

How do dopamine antagonists act as an antiemetic

A

inhibition at CTZ

93
Q

Give an example of an dopamine antagonist used as an antiemetic

A

metaclopramide,

domperidone

94
Q

When are dopamine antagonists best used as an anti-emetic

A

in decreased gut motility (they stimulate)

also for nausea caused by drugs, cytotoxins

95
Q

How do 5HT3 antagonists act as an antiemetic

A

block 5HT3 receptors in gut and CTZ

96
Q

Give an example of a 5HT3 antagonist used as an antiemetic

A

ondansetron

97
Q

When are 5HT3 antagonists best used as an anti-emetic

A

PONV - opiod induced

chemo

98
Q

Describe teh analgesic pain ladder

A

non-opiate
weak opiate eg codeine, tramadol
strong opiate eg morphine, diamorphine

99
Q

What are the main side effects of an epidural

A

decrease BP
loss of bladder control
sickness
headache

100
Q

What layers does an epidural needle go through

A

superficial tissues
supraspinous ligament
interspinous ligament
ligamentum flavum

stops before dura and arachnoid

101
Q

Name the 9 areas of the abdomen

A 
right hypochondrium
epigastrium
left hypochondrium
right flank
periumbilical
left flank
right iliac fossa
suprapubic
left iliac fossa
102
Q

What bacteria are most likely to cause a wound infection

A

staph aureus
strep pyogenes
enterococci

103
Q

What is the antibiotic treatment for a wound infection

A

flucloxacillin

teicoplanin IV if more severe

104
Q

How is C diff treated

A

metronidazole/vancomycin

105
Q

How much of a crystalloid fluid will remian in the intravacular space

A

25%

106
Q

How much a 0.9% dextrose solution will remain in the extravascular space

A

1/12th

107
Q

What is the difference between hypovolaemia and dehydration

A

hypovolaemia = loss of Na+ and water. haemodynamically unstable

dehydraion = loss of water. hypernatraemic, hypertonic plasma

108
Q

How should hypovolaemia be treated?

A

IV fluid bolus

109
Q

How should dehydration be treated?

A

oral fluids

slow IV fluids

110
Q

Whjat are an adult’s daily fluid, glucose and electrolyte requirements

A

25ml/kg/hr water

50g/day glucose

1 mmol/kg/day Na+ and K+

111
Q

What antibodies and antigens does A blood have

A 
antigens = A
antibodies = B
112
Q

What antibodies and antigens does AB blood have

A 
antigens = A B
antibodies = none
113
Q

What antibodies and antigens does B blood have

A 
antigens = B
antibodies = A
114
Q

What antibodies and antigens does O blood have

A 
antigens = none
antibodies = A B
115
Q

What does cross matching of blood involve

A

mixing a bit of the patient’s blood with the donor’s

takes about 40mins

116
Q

What are the indications for O-ve blood

A

blood group unknown

o-ve pt

117
Q

What gauge cannulae are used for blood transfusions

A

Green 18G

Grey 16G

118
Q

What is the definition of a massive blood transfusion

A

replacement of >1x blood volume in 24h
>50% volume in 4 hours
blood volume = 75ml/kg

> 40ml/kg in children

119
Q

What is FFP and what is it used for?

A

fresh frozen plasma

used to correct clotting disorders eg warfarin, DIC, liver disease

120
Q

What is cryoprecipitate and what is it used for?

A

made from FFP. contains fibrinogen, vWF, factors VIII and XIII and fibronectin

used in hypofibrinogenaemia von Willebrand’s disease.

121
Q

What are some early complications of a blood transfusion

A 
pyrexia
anaphylaxis
fluid overload
transfusion related acute lung injury
acute haemolytic reaction
122
Q

What are some late complications of a blood transfusion

A

infection
iron overload
graft versus host disease
post tranfusion purpura

123
Q

What does a CVP monitor measure?

A

central venous pressur emonitor

measures pressure in RA and IVC

124
Q

Which veins can be used for central venous access

A

internal jugular
femoral
subclavian

125
Q

What are the indications for a central line

A

drugs

CVP monitoring

126
Q

What are teh complications of a central line bein ginserted

A 
infection
bleeding from punctured artery
pneumothorax
phrenic nerve palsy
air embolism
thrmobus formation
127
Q

State three features of an obstructed airway

A

unable to speak
no chest wall movement
respiratory distess

128
Q

What can cause an obstructed aiway

A

external compression
swelling of airway
foreing body

129
Q

What manoeuvres can be used to relieve an obstructed airway

A

jaw thrust

head tilt

130
Q

State the colour cannulas in asceinding size

A 
blue - 22G
pink - 20G
green - 18G
grey - 16G
orange - 14G
131
Q

According to days post op, what is the most likely infection?

A 
1-2 = resp
2-5 = urinary
5-7 = surgical site/abscess

any! = IV lines

132
Q

What can cause a post op fever

A

infection
iatrogenic - dtugs, transfusion
VTE
pyrexia of unknown origin

133
Q

What are important questions to ask a patient with post op pyrexia

A 
cough, dyspnoea, chest pain, haemoptysis
urinary freq, dysuria, urgency
wound tenderness or discharge
IV line tenderness or sicharge
calf pain
134
Q

What investifations should be done in a patient with post op fever

A

ECG, urine dipstick
FBC, U+E, CRP,
blood cultures, sputum culture, urine culture, swab culture
CXR ?CT if risk anatamotic leak

calculate Wells

135
Q

What is the antibiotic treatment for a post op LRTI

A

co-amoxiclav 5d

136
Q

What is the antibiotic treatment for a post op LUTI

A

trimethoprim 3d

137
Q

What is the antibiotic treatment for a post op UUTI

A

co-amoxiclav 14d

138
Q

What is the antibiotic treatment for a post op intraabdominal infection

A

cefuroxime + metronidazole IV

139
Q

What is the antibiotic treatment for a post op infection of unkown origin

A

cefuroxime + metronidazole IV

+ STAT does gentamicin

140
Q

How do gallstones causes pancreatitis

A

blockage of common bile duct means pancreatic secretions cannot pass into duodenum
thee secretions remain in the pancreas leading to inflammation and injury
enzyme mediated inflammation

141
Q

Which organs most commonly perforate

A

large bowel
appendix
duodenum

142
Q

Define peritonitis

A

inflammation of the peritoneum

143
Q

What investigation should be performed in suspected peritonitis
what does this show?

if -ve, what test shuld be done next?

A

erect CXR

air under the diaphragm

CT abdo pelvis

144
Q

What are the signs of peritonitis

A 
prostration
shock
lying still
positive cough test - pain on coughing
tenderness - rebound, on percussion
abdominal rigidity
guarding
no bowel sounds
145
Q

How is peritonitis treated?

A

laparotmoy to diagnose and repair perforation

146
Q

What can cause peritonitis

A 
PUD 
perforation of small bowel or large bowel
crohn's
appendicitis
diverticular disease
SBO/LBO
147
Q

Why might you need to form a stoma

A

bowel rest

not enough blood supply to area of bowel needing to be anastamosed

148
Q

Distinguish between an ileostomy and a colostomy

A

ileostomy: spout, RIF, liquid contents, smaller lumen, mucosal folds
colostomy: flush to skin, LIF, solid contents, greater lumen diameter

149
Q

What are the complications of TPN

A

thrombophlebitis
refeeding syndrorme
sepsis
thromobus formation - PE/SVC obstruction

150
Q

When can nasogastric nutrition be used

A

if the oral route is not viable

151
Q

When can nasojejunal nutrition be used

A

when pt at risk of aspiration (pulmonary regurgitation)

152
Q

When can a gastrostomy be used for nutrition

A

if there is oesophageal dysfunction

153
Q

When can a jejunostomy be used for nutrition

A

if the stomach is inaccessible or there is outflow obstruction of the stomach

154
Q

What is a diverticulum

A

outpocketing of teh colonic mucosa through the muscular wall of teh colon at sies of entry of perforating arteries

155
Q

What causes diverticulum to form

A

increased intraluminal pressure leads to weakness of the bowel wall over time

156
Q

Where is it most common for diverticula to form?

A

sigmoid

157
Q

Define diverticulosis

A

presence of diverticula, no sx

158
Q

define diverticular disease

A

presence of diverticular + sx

159
Q

define diverticulitis

A

inflammation of a diverticulum

160
Q

What are the risk factors for diverticular disease

A 
low fibre diet
obesity
smoking
FH
smoking
NSAIDs
161
Q

What are the symptoms of diverticular disease

A

pain in LIF - relieved by defecation
change in bowel habits
Nausea
flatulence

162
Q

What are the symptoms and signs of diverticulitis

A 
pain in LIF
PR bleed
N+V
raised temp
tenderness on palpation
? peritonitis
163
Q

What investigation should be done in diverticular disease/diverticulitis

A 
ECG
FBC, U+E, LFT, ABG if perforation
CT abdo plevis
sigmoidoscopy
AXR and erect CXR if perforation
164
Q

What are the possible complications of diverticular disease

A 
perforation
fistulae
hammorrhage
strictures
abscesses
165
Q

What are the typical features of an abscess

A

swinging pyrexia

leucocytosis

166
Q

How should diverticular disease be managed

A

increase fibre and oral fluids
pain relief - paracetamol NOT NSAIDs or opioids
weight loss
stop smoking

167
Q

How should a mild episode of diverticulitis be managed

A

oral fluids
bowel rest
analgesia
antibiotics

168
Q

How should a severe episode of diverticulitis be managed

A 
admission
analgesia
NBM
IV fluids
IV abx
169
Q

When is an episode of diverticulitis considered severe

A 
pain not controlled with analgesics at home
pt dehydrated
PR bleed
severe comorbidities
presence of peritonitis
>48hrs of symptoms
170
Q

When is surgical treatment recommended in acute diverticulitis

A

perforation
sepsis
failure to improve with conservative management

171
Q

What are the surgical optionsn in the management of acute diverticulits

A

resection - Hartmann’s

laparascopic peritoneal lavage

172
Q

When is elecrtive surgery for diverticular disease recommended

A

stenosis
fistulae
recurrent bleeding

173
Q

What are the common side effects of mesalazine

A

indigestion, nausea, abdo pain
Diarrhoea
Headache, muscle aches and pains

174
Q

Why might mesalazine be contraindicated

A

allergy!

severe hepatic or renal impairment

175
Q

What should be monitored in mesalazine therapy?

A

U+E, eGFR before starting and at 3 months of treatment, and then annually during treatment.

176
Q

What info should be given to a patient before starting mesalazine therapy

A

need to monitor your kidney function
can cause blood disorders - report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment.

177
Q

When is lanzoprazole contraindicated

A

pregnancy and breast feeding

178
Q

How is lansoprazole meant to be taken?`

A

at least 30 minutes before a meal
Do not take indigestion remedies during the two hours before or during the two hours after you take lansoprazole as they can interfere with the way lansoprazole is absorbed by your body.

179
Q

What are the common side effects of lansoprazole

A 
nausea, stomach ache
Diarrhoea	
Constipation	
Headache	
Feeling dizzy or tired
Dry mouth or throat, itchy skin rash
180
Q

What are some important things to remember when prescribing lansoprazole

A

Can increase the risk of fractures due to osteoporosis

; may increase the risk of gastro-intestinal infections (including Clostridium difficile infection);

may mask the symptoms of gastric cancer (in adults)

181
Q

What are the potential causes of haematemesis

A 
PUD
oesophageal varices
Mallory-Weiss
oesophagitis
gastritis
182
Q

What are oesophageal varices

A

portosystemic anastamoses caused by portal HTN

183
Q

What is a Mallory weiss tear

A

tear in oesophageal epithelium

184
Q

What can cause oesophagitis

A

candida
GORD
bisphosphonates

185
Q

What are the important aspects of a history following haematemesis

A

timing, frew, volume
prev dyspeosia, dysphagiaa or odynophagia
? alchohol/smoking
liver disease
NSAIDs, steroids, anticoagulation, bisphosphonates

186
Q

What might be found on examination in a case of haematemesis

A

epigastric pain/tenderness

liver stigmata - hepatosplenomegaly, nodular liver, spider naevi,

187
Q

What investigations should be done in a case of haematemesis

A

FBC, U+E, LFTs, clotting, ABG, G+S, cross match
erect CXR, CT abdomen with IV contrast
OGD

188
Q

What does the Glasgow Blatchford Bleeding score calculate

A

the risk of needing an intervention in haematemesis

189
Q

What does somatostatin do in the management of oesophageal varices

A

decreases sphlanchic blood flow

190
Q

Describe the pathophysiology of achalasia

A

Failure of oesophageal peristalsis and of relaxation of LOS due to degenerative loss of ganglia from Auerbach’s plexus

191
Q

What are the symptom of achalasia

A

dysphagia of sloids and liquids
varibale sx
reflux
regurgitation

192
Q

What investigations hsould be done in achalasia

A

manometry - assess LOS function

barium swallow - see bird’s beak appearance

193
Q

What is the treatment of achalasia

A

intra-sphincteric injection of botulinum toxin

194
Q

What is Boerhaave syndrom

A

transmural perforation of the oesophagus

in Mallory-Weiss syndrome it is a nontransmural esophageal tear

Finals (32 decks)

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