Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS IV - CCT Preparation > Surgery - General Surgery (Abdomen) > Flashcards

Surgery - General Surgery (Abdomen) Flashcards

1
Q

Causes of Generalised abdominal pain

A

Peritonitis
Ruptured abdominal aortic aneurysm
Intestinal obstruction
Ischaemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of RUQ pain

A

Biliary colic
Acute cholecystitis
Acute cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of epigastric pain

A

Acute gastritis
Peptic ulcer disease
Pancreatitis
Ruptured abdominal aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of central abdominal pain

A

Ruptured abdominal aortic aneurysm
Intestinal obstruction
Ischaemic colitis
Early stages of appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of right iliac fossa pain

A 
Acute appendicitis
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
Meckel’s diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of left iliac fossa pain

A

Diverticulitis
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of suprapubic pain

A

Lower urinary tract infection
Acute urinary retention
Pelvic inflammatory disease
Prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of loin to groin pain

A 
Renal colic (kidney stones)
Ruptured abdominal aortic aneurysm
Pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of Testicular pain

A

Testicular torsion

Epididymo-orchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of peritonitis

A

Spontaneous bacterial peritonitis (ascites, liver disease)

Generalised peritonitis (abdominal organ perforation)

Localised peritonitis (underlying organ inflammation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations for acute abdomen

A 
CBC
Urea and electrolytes 
LFTR
CRP 
Amylase 
INR 
Lactate 
Arterial blood gas 
Blood culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Imaging for acute abdomen

A

Abdominal X-ray: bowel obstruction
Chest X-ray: air under diaphragm for intra-abdominal perforation/ pneumoperitoneum
Ultrasound: gallstones, biliary duct dilatation and gynaecological pathology
CT abdomen: acute abdomen and determine correct management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Initial management of acute abdomen

A 
Nil by mouth 
NG tube 
IV resuscitation 
IV antibiotic coverage 
Analgesia

Venous thromboembolism risk assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define McBurney’s point

A

area one third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Classical features of appendicitis

A

Loss of appetite (anorexia)
Nausea and vomiting
Rovsing’s sign (palpation of the left iliac fossa causes pain in the RIF)
Guarding on abdominal palpation
Peritonitis: Rebound tenderness in the RIF, Percussion tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ddx of acute appendicitis

A

Ovarian Cysts - pelvic and iliac fossa pain
Meckel’s Diverticulum - malformation of the distal ileum, inflamed, rupture or cause a volvulus or intussusception
Mesenteric Adenitis - inflamed abdominal lymph nodes, preceding URTI acute
Appendix Mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of acute appendicitis

A

Open Appendicectomy

Laparoscopic appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications of appendectomy

A

Bleeding, infection, pain and scars
Damage to bowel, bladder or other organs

Anaesthetic risks
Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of IO

A

Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)

Volvulus (large bowel)
Diverticular disease
Strictures (e.g., secondary to Crohn’s disease)
Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of intestinal adhesion

A

Abdominal or pelvic surgery (particularly open surgery)
Peritonitis
Abdominal or pelvic infections (e.g., pelvic inflammatory disease)
Endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of closed-loop obstruction

A

Adhesion
Hernia
Volvulus
Ileocaecal valve competency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of IO

A

Vomiting (particularly green bilious vomiting)
Abdominal distention
Diffuse abdominal pain
Absolute constipation and lack of flatulence
“Tinkling” bowel sounds may be heard in early bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Upper limits of normal bowel diameter

A

3 cm small bowel
6 cm colon
9 cm caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Distinguish small and large bowel on X-ray

A

Valvulae conniventes and central - small bowel

Haustration and peripheral - large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Complications of IO

A

Hypovolaemic shock due to fluid stuck in the bowel rather than the intravascular space (third-spacing)
Bowel ischaemia
Bowel perforation
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Initial management of IO

A

Nil by mouth
IV fluid resuscitation
NG tube with free drainage

Abdominal x-ray
Erect chest x-ray
Contrast abdominal CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Surgical intervention for IO

A

Conservative management as first instance in stable patients with obstruction secondary to adhesions or volvulus

Exploratory surgery in patients with an unclear underlying cause
Adhesiolysis to treat adhesions
Hernia repair
Emergency resection of the obstructing tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of ileus

A

Injury to the bowel
Handling of the bowel during surgery
Inflammation or infection in, or nearby, the bowel (e.g., peritonitis, appendicitis, pancreatitis or pneumonia)
Electrolyte imbalance (e.g., hypokalaemia or hyponatraemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

S/S of ileus

A

Vomiting (particularly green bilious vomiting)
Abdominal distention
Diffuse abdominal pain
Absolute constipation and lack of flatulence
Absent bowel sounds (as opposed to the “tinkling” bowel sounds of mechanical obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of ileus

A

Nil by mouth or limited sips of water
NG tube if vomiting
IV fluids to prevent dehydration and correct the electrolyte imbalances
Mobilisation to helps stimulate peristalsis
Total parenteral nutrition (TPN) may be required whilst waiting for the bowel to regain function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

2 major types of volvulus

A

Sigmoid volvulus

Caecal volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Major cause of sigmoid volvulus

A

chronic constipation and lengthening of the mesentery attached to the sigmoid colon. The sigmoid colon becomes overloaded with faeces, causing it to sink downwards causing a twist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Risk factors for volvulus

A 
Neuropsychiatric disorders (e.g., Parkinson’s)
Nursing home residents
Chronic constipation
High fibre diet
Pregnancy
Adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Presentation of volvulus

A

Vomiting (particularly green bilious vomiting)
Abdominal distention
Diffuse abdominal pain
Absolute constipation and lack of flatulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Imaging for volvulus

A

Abdominal x-ray can show the “coffee bean” sign in sigmoid volvulus
contrast CT scan for Dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management for volvulus

A

Laparotomy (open abdominal surgery)
Hartmann’s procedure for sigmoid volvulus (removal of the rectosigmoid colon and formation of a colostomy)
Ileocaecal resection or right hemicolectomy for caecal volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Complications of hernias

A

Incarceration of bowel > obstruction and strangulation of the hernia

Obstruction > vomiting, generalised abdominal pain and absolute constipation

Strangulation > ischemic bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

General management of abdominal wall hernias

A

Conservative management: hernia has a wide neck (low risk of complications)

Tension-free repair (surgery): mesh over the defect in the abdominal wall, sutured to the muscles and tissues on either side of the defect, tissues grow into the mesh

Tension repair (surgery): surgical operation to suture the muscles and tissue on either side of the defect back together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Ddx for lump in the inguinal region

A 
Femoral hernia
Lymph node
Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
Femoral aneurysm
Abscess
Undescended / ectopic testes
Kidney transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Direct inguinal hernia:

  • Location, boundaries
  • Reducibility
A

Hesselbach’s triangle: (RIP mnemonic):

R – Rectus abdominis muscle – medial border
I – Inferior epigastric vessels – superior / lateral border
P – Poupart’s ligament (inguinal ligament) – inferior border

Pressure over the deep inguinal ring will not stop the herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Femoral hernia

- Explain the high risk of bowel complications (incarceration, obstruction, strangulation)

A

Involves herniation of bowel content through femoral canal

Opening of femoral ring is narrow, and femoral canal is long and narrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Boundaries of femoral canal

A

Boundaries of the femoral canal (FLIP mnemonic):

F – Femoral vein laterally
L – Lacunar ligament medially
I – Inguinal ligament anteriorly
P – Pectineal ligament posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Boundaries of femoral triangle

A

SAIL mnemonic:

S – Sartorius – lateral border
A – Adductor longus – medial border
IL – Inguinal Ligament – superior border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Contents of the femoral canal

A

NAVY-C mnemonic

N – Femoral Nerve
A – Femoral Artery
V – Femoral Vein
Y – Y-fronts
C – Femoral Canal (containing lymphatic vessels and nodes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Spigelian hernia

- Location

A

Spigelian hernia occurs between the lateral border of the rectus abdominis muscle and the linea semilunaris. At the site of the spigelian fascia, which is an aponeurosis between the muscles of the abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Cause of diastasis recti

A

widening of the linea alba, the connective tissue that separates the rectus abdominis muscle

congenital (in newborns)
weakness in the connective tissue, for example following pregnancy or in obese patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Obturator hernia

  • Location
  • Causes
  • Presentation
A

through the obturator foramen at the bottom of the pelvis

defect in the pelvic floor and are more common in women, particularly in older age, after multiple pregnancies and vaginal deliveries

may present with irritation to the obturator nerve: Howship–Romberg sign: pain extending from the inner thigh to the knee when the hip is internally rotated

48
Q

Hiatus hernia presentation

A

Hiatus hernias present with dyspepsia (indigestion), with symptoms of:

Heartburn 
Acid reflux
Reflux of food
Burping
Bloating
Halitosis (bad breath)
49
Q

Repair of hiatus hernia

A

laparoscopic fundoplication

tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

50
Q

Risk factors for haemorrhoids

A

pregnancy, obesity, increased age and increased intra-abdominal pressure (e.g., weightlifting or chronic coughing), constipation

51
Q

4 degrees of haemorrhoids

A

1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently

52
Q

Symptoms of haemorrhoids

A

onstipation and straining.

painless, bright red bleeding, typically on the toilet tissue or seen after opening the bowels. The blood is not mixed with the stool

Sore / itchy anus

Feeling a lump around or inside the anus

53
Q

Examination for 2 types of haemorrhoids

A

External (prolapsed) haemorrhoids are visible on inspection as swellings covered in mucosa

Internal haemorrhoids may be felt on a PR exam

Prolapse if the patient is asked to “bear down” during inspection

54
Q

Ddx of rectal bleeding

A 
Haemorrhoids 
Anal fissures
Diverticulosis
Inflammatory bowel disease
Colorectal cancer
55
Q

Topical treatment of haemorrhoifs

A 
Anusol (contains chemicals to shrink the haemorrhoids – “astringents”)
Anusol HC (also contains hydrocortisone – only used short term)
Germoloids cream (contains lidocaine – a local anaesthetic)
Proctosedyl ointment (contains cinchocaine and hydrocortisone – short term only)
56
Q

Non-surgical treatment of haemorrhoids

A

Rubber band ligation (fitting a tight rubber band around the base of the haemorrhoid to cut off the blood supply)

Injection sclerotherapy (injection of phenol oil into the haemorrhoid to cause sclerosis and atrophy)

Infra-red coagulation (infra-red light is applied to damage the blood supply)

Bipolar diathermy (electrical current applied directly to the haemorrhoid to destroy it)

57
Q

Surgical options for haemorrhoid

A

Haemorrhoidal artery ligation - involves using a proctoscope to identify the blood vessel that supplies the haemorrhoids and suturing it to cut off the blood supply.

Haemorrhoidectomy - involves excising the haemorrhoid. Removing the anal cushions may result in faecal incontinence.

Stapled haemorrhoidectomy - involves using a special device that excises a ring of haemorrhoid tissue at the same time as adding a circle of staples in the anal canal. The staples remain in place long-term.

58
Q

1 complication of haemorrhoids

Presentation

A

Thrombosed Haemorrhoids

caused by strangulation at the base of the haemorrhoid, resulting in thrombosis

appear as purplish, very tender, swollen lumps around the anus.

59
Q

Define diverticulum, diverticulosis, diverticulitis

A

diverticulum (plural diverticula) is a pouch or pocket in the bowel wall

Diverticulosis refers to the presence of diverticula, without inflammation or infection.

Diverticulitis refers to inflammation and infection of diverticula

60
Q

Risk factors of diverticulosis

A

increased age. Low fibre diets, obesity and the use of NSAIDs

61
Q

Typical presentation of diverticulosis

Management

A

Presentation: lower left abdominal pain, constipation or rectal bleeding

Mx: increased fibre in the diet and bulk-forming laxatives, weight loss

62
Q

Presentation of acute diverticulitis

A

Pain and tenderness in the left iliac fossa / lower left abdomen
Fever
Diarrhoea
Nausea and vomiting
Rectal bleeding
Palpable abdominal mass (if an abscess has formed)

63
Q

Complications of acute diverticulitis

A

Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage requiring blood transfusions
Fistula (e.g., between the colon and the bladder or vagina)
Ileus / obstruction

64
Q

Define foregut, midgut and hindgut blood supply

A

The foregut includes the stomach and part of the duodenum, biliary system, liver, pancreas and spleen. This is supplied by the coeliac artery.

The midgut is from the distal part of the duodenum to the first half of the transverse colon. This is supplied by the superior mesenteric artery.

The hindgut is from the second half of the transverse colon to the rectum. This is supplied by the inferior mesenteric artery.

65
Q

Chronic mesenteric ischaemia

  • cause
  • typical triad of presentation
  • Diagnosis
A

Cause: narrowing of the mesenteric blood vessels by atherosclerosis

  • Central colicky abdominal pain after eating (starting around 30 minutes after eating and lasting 1-2 hours)
  • Weight loss (due to food avoidance, as this causes pain)
  • Abdominal bruit may be heard on auscultation

Diagnosis is by CT angiography.

66
Q

Risk factors for Chronic mesenteric ischaemia

A 
Increased age
Family history
Smoking
Diabetes
Hypertension
Raised cholesterol
67
Q

Surgical Management of chronic mesenteric ischaemia

A 
Endovascular procedures first-line (i.e. percutaneous mesenteric artery stenting)
Open surgery (i.e endarterectomy, re-implantation or bypass grafting)
68
Q

Acute mesenteric ischaemia

  • Cause
  • Presentation
  • Complication
  • Diagnosis
A

rapid blockage in blood flow through the superior mesenteric artery, thrombus or embolus

acute, non-specific abdominal pain

shock, peritonitis and sepsis, necrosis of the bowel tissue and perforation, metabolic acidosis and raised lactate

Contrast CT is the diagnostic test

69
Q

Risk factors for CRC

A

Family history of bowel cancer
Familial adenomatous polyposis (FAP)
Hereditary nonpolyposis colorectal cancer (HNPCC),
Inflammatory bowel disease (Crohn’s or ulcerative colitis)

Increased age
Diet (high in red and processed meat and low in fibre) 
Obesity and sedentary lifestyle
Smoking
Alcohol
70
Q

Red flag signs for CRC

A

Change in bowel habit (usually to more loose and frequent stools)
Unexplained weight loss
Rectal bleeding
Unexplained abdominal pain
Iron deficiency anaemia (microcytic anaemia with low ferritin)
Abdominal or rectal mass on examination

71
Q

Screening test for CRC

A

Faecal immunochemical tests (FIT)

72
Q

Investigations for CRC

A

Colonoscopy is the gold standard

Sigmoidoscopy (for rectal bleeding only presentation)

CT colonography

Staging CT scan involves a full CT thorax, abdomen and pelvis (CT TAP) - metastasis

Carcinoembryonic antigen (CEA) - tumour marker

73
Q

Surgical treatment options for CRC

A

Open or Laparoscopic

74
Q

5 types of colon resection

A

Right hemicolectomy - removal of the caecum, ascending and proximal transverse colon.

Left hemicolectomy - removal of the distal transverse and descending colon.

High anterior resection - removing the sigmoid colon (may be called a sigmoid colectomy).

Low anterior resection - removing the sigmoid colon and upper rectum but sparing the lower rectum and anus.

Abdomino-perineal resection (APR) - removing the rectum and anus (plus or minus the sigmoid colon) and suturing over the anus

75
Q

Complication of bowel surgery

A 
Bleeding, infection and pain
Damage to nerves, bladder, ureter or bowel
Post-operative ileus
Anaesthetic risks
Laparoscopic surgery converted during the operation to open surgery (laparotomy)
Leakage or failure of the anastomosis
Requirement for a stoma
Failure to remove the tumour
Change in bowel habit
Venous thromboembolism (DVT and PE)
Incisional hernias
Intra-abdominal adhesions
76
Q

4 types of stoma, compare function and differences

A

Colostomy - LIF, flush to skin, solid stool

Ileostomy - RIF, sprouted, liquid stool

Gastrostomy (PEG) - feeding directly into stomach

Urostomy - RIF, ileal conduit, after cystectomy

77
Q

Surgeries that precede end ileostomy/ end colostomy

A

End colostomies are permanent after resection of abdomino-perineal resection (APR) - entire rectum and anus removed

End ileostomies are permanent after a panproctocolectomy (total colectomy with removal of the large bowel, rectum and anus)

78
Q

Function of loop colostomy/ loop ileostomy

A

temporary stoma used to allow a distal portion of the bowel and anastomosis to heal after surgery

“covering” or “defunctioning” loop colostomy or ileostomy, as they allow faeces to bypass the distal, healing portion of bowel until healed and ready to restart normal function.

79
Q

Complications of stomas

A

Psycho-social impact
Local skin irritation
Parastomal hernia
Loss of bowel length leading to high output, dehydration and malnutrition
Constipation (colostomies)
Stenosis
Obstruction
Retraction (sinking into the skin)
Prolapse (telescoping of bowel through hernia site)
Bleeding
Granulomas causing raised red lumps around the stoma

80
Q

Risk factor for gallstones

A

F – Fat
F – Fair
F – Female
F – Forty

81
Q

Typical presentation of gallstones

A

biliary colic

Severe, colicky epigastric or right upper quadrant pain
Often triggered by meals (particularly high fat meals)
Lasting between 30 minutes and 8 hours
May be associated with nausea and vomiting

82
Q

Complications of gallstones

A

Acute cholecystitis
Acute cholangitis
Obstructive jaundice (if the stone blocks the ducts)
Pancreatitis

83
Q

Investigations and treatment for gallstones

A

Ultrasound (first-line) - diagnostic only

A magnetic resonance cholangio-pancreatography (MRCP) - diagnostic only

endoscopic retrograde cholangio-pancreatography (ERCP) - diagnostic and therapeutic

Cholecystectomy (open or laproscopic) - therapeutic only

84
Q

Complications of ERCP

A

Excessive bleeding
Cholangitis (infection in the bile ducts)
Pancreatitis

85
Q

Procedures performed through ERCP

A

Inject contrast and take x-rays to visualise the biliary system and diagnose pathology (e.g., stones or strictures)
Perform a sphincterotomy on the sphincter of Oddi if it is dysfunctional (blocking flow)
Clear stones from the ducts
Insert stents to improve bile duct drainage (e.g., with strictures or tumours)
Take biopsies of tumours

86
Q

Complications of cholecystectomy?

A

Bleeding, infection, pain and scars
Damage to the bile duct including leakage and strictures
Stones left in the bile duct
Damage to the bowel, blood vessels or other organs
Anaesthetic risks
Venous thromboembolism (deep vein thrombosis or pulmonary embolism)
Post-cholecystectomy syndrome

87
Q

Define post-cholecystectomy syndrome

A

Symptoms after cholecystectomy, may be attributed to changes in the bile flow after removal of the gallbladder

Diarrhoea
Indigestion
Epigastric or right upper quadrant pain and discomfort
Nausea
Intolerance of fatty foods
Flatulence
88
Q

Acute cholecystitis

  • Causes (2)
  • Typical presentation
A

gallstones (calculous cholecystitis) - 95%
acalculous cholecystitis - functional disability due to TPN or long fasting periods

right upper quadrant (RUQ). This may radiate to the right shoulder.
Fever
Nausea
Vomiting
Tachycardia (fast heart rate) and tachypnoea (raised respiratory rate)
Right upper quadrant tenderness
Murphy’s sign
Raised inflammatory markers and white blood cells

89
Q

Specific sign for acute cholecystitis

A

Murphy’s sign is suggestive of acute cholecystitis:

  • Place a hand in RUQ and apply pressure
  • Ask the patient to take a deep breath in
  • The gallbladder will move downwards during inspiration and come in contact with your hand
  • Stimulation of the inflamed gallbladder results in acute pain and sudden stopping of inspiration
90
Q

Investigations for acute cholecystitis

A

1) abdominal ultrasound scan:
Thickened gallbladder wall
Stones or sludge in gallbladder
Fluid around the gallbladder

2) Magnetic resonance cholangiopancreatography (MRCP)

91
Q

Management of acute cholecystitis

A 
Conservative management involves:
Nil by mouth
IV fluids
Antibiotics (as per local guidelines)
NG tube if required for vomiting

Endoscopic retrograde cholangio-pancreatography (ERCP)

Cholecystectomy

92
Q

Complications of acute cholecystitis

A

Sepsis
Gallbladder empyema
Gangrenous gallbladder
Perforation

93
Q

2 main causes of acute cholangitis

Common pathogens (3)

A

Obstruction in the bile ducts
Infection introduced during an ERCP procedure

Escherichia coli
Klebsiella species
Enterococcus species

94
Q

Triad of symptoms for acute cholangitis

A

Right upper quadrant pain
Fever
Jaundice (raised bilirubin)

95
Q

Acute management and initial investigations of acute cholangitis

A

1) Acute management of sepsis and acute abdomen, including:
Nil by mouth
IV fluids
Blood cultures
IV antibiotics (as per local guidelines)
Involvement of seniors and potentially HDU or ICU

2) Imaging to diagnose common bile duct (CBD) stones and cholangitis
Magnetic resonance cholangio-pancreatography (MRCP)
Endoscopic ultrasound

96
Q

Treatment of acute cholangitis

A

endoscopic retrograde cholangio-pancreatography (ERCP): contrast, stone removal, balloon dilatation, stenting, biopsy

Percutaneous transhepatic cholangiogram (PTC) involves radiologically guided insertion of a drain through the skin and liver, into the bile ducts

97
Q

Cholangiocarcinoma

  • Histological type
  • Location (most common)
  • Risk factors
A

adenocarcinomas inside the liver (intrahepatic ducts) or outside the liver (extrahepatic ducts)

most common site is in the perihilar region

Ulcerative colitis
Primary sclerosing cholangitis
Liver flukes (a parasitic infection)

98
Q

Presentation of cholangiocarcinoma

A

Obstructive jaundice:
Pale stools
Dark urine
Generalised itching

Unexplained weight loss
Right upper quadrant pain
Palpable gallbladder (swelling due to an obstruction in the duct distal to the gallbladder)
Hepatomegaly

99
Q

Explain courvoisier’s law

A

palpable gallbladder along with jaundice is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic head cancer.

100
Q

Investigations for cholangiocarcinoma

A

Diagnosis is based on imaging (CT or MRI) plus histology from a biopsy.

Staging CT scan involves a full CT thorax, abdomen and pelvis (CT TAP)

CA 19-9 (carbohydrate antigen) is a tumour marker that may be raised in cholangiocarcinoma. It is also raised in pancreatic cancer

Magnetic resonance cholangio-pancreatography (MRCP)

Endoscopic retrograde cholangio-pancreatography (ERCP)

101
Q

Management of cholangiocarcinoma

A

Stents inserted to relieve the biliary obstruction
Surgery to improve symptoms (e.g., bypassing the biliary obstruction)
Palliative chemotherapy
Palliative radiotherapy
End of life care with symptom control

102
Q

Pancreatic cancer

- Typical presentation

A 
- Painless obstructive jaundice:
Yellow skin and sclera
Pale stools
Dark urine
Generalised itching
  • other presenting features:
    Non-specific upper abdominal or back pain
    Unintentional weight loss
    Palpable mass in the epigastric region
    Change in bowel habit
    Nausea or vomiting
    New‑onset diabetes or worsening of type 2 diabetes
103
Q

Trousseau’s sign of malignancy?

A

refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic adenocarcinoma

104
Q

Investigations for pancreatic cancer

A

imaging (usually CT scan) plus histology

Staging CT scan involves a full CT thorax, abdomen and pelvis (CT TAP)
CA 19-9 (carbohydrate antigen)
Magnetic resonance cholangio-pancreatography (MRCP)
Endoscopic retrograde cholangio-pancreatography (ERCP)
Biopsy under US or CTG

105
Q

Management of pancreatic cancer (4 types of surgical treatment)

A

Total pancreatectomy

Distal pancreatectomy

Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)

Radical pancreaticoduodenectomy (Whipple procedure)

106
Q

Palliative treatment for pancreatic cancer

A

Stents inserted to relieve the biliary obstruction

Surgery to improve symptoms (e.g., bypassing the biliary obstruction)

Palliative chemotherapy (to improve symptoms and extend life)

Palliative radiotherapy (to improve symptoms and extend life)

End of life care with symptom control

107
Q

Describe extent of organ removal in whipple procedure

A

Whipple procedure (pancreaticoduodenectomy)

Head of the pancreas
Pylorus of the stomach
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes
108
Q

Describe modified whipple procedure

A

pylorus-preserving pancreaticoduodenectomy (PPPD).

Removing:
Head of the pancreas
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes
109
Q

3 most common causes of acute pancreatitis

A

Gallstones (bile reflux back into pancreas)
Alcohol (direct toxicity)
Post-ERCP

Others: 
S – Steroids
T – Trauma
A – Autoimmune
M – Mumps
110
Q

Typical presentation of acute pancreatitis

A 
Severe epigastric pain
Radiating through to the back
Associated vomiting
Abdominal tenderness
Systemically unwell (e.g., low-grade fever and tachycardia)
111
Q

Investigations for acute pancreatitis

A 
- Glasgow score:
FBC (for white cell count)
U&E (for urea)
LFT (for transaminases and albumin)
Calcium
ABG (for PaO2 and blood glucose)
  • Severity:
    serum amylase 3x upper limit of normal

CRP

Ultrasound

CT abdomen for complications (such as necrosis, abscesses and fluid collections)

112
Q

Criteria for Glasgow score

A

PANCREAS mnemonic (1 point for each answer):

P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
113
Q

Management of acute pancreatitis

A

Management involves:

Initial resuscitation (ABCDE approach)
IV fluids
Nil by mouth
Analgesia
Careful monitoring
Treatment of gallstones in gallstone pancreatitis (ERCP / cholecystectomy)
Antibiotics if there is evidence of a specific infection (e.g., abscess or infected necrotic area)
Treatment of complications (e.g., endoscopic or percutaneous drainage of large collections)

114
Q

Complications of acute pancreatitis

A 
Necrosis of the pancreas
Infection in a necrotic area
Abscess formation
Acute peripancreatic fluid collections
Pseudocysts (collections of pancreatic juice) can develop 4 weeks after acute pancreatitis
Chronic pancreatitis
115
Q

Complications of chronic pancreatitis

A 
Chronic epigastric pain
lack of pancreatic enzymes 
Loss of insulin, leading to diabetes 
strictures resulting in obstruction of pancreatic juice and bile
pseudocysts or abscesses
116
Q

Management of chronic pancreatitis

A

Abstinence from alcohol and smoking

Analgesia

Replacement pancreatic enzymes (Creon)

Subcutaneous insulin regimes

ERCP with stenting

Surgery for complications (chronic pain, biliary obstruction, abscess…)

117
Q

Contraindication for liver transplant

A

Significant co-morbidities (e.g., severe kidney, lung or heart disease)
Current illicit drug use
Continuing alcohol misuse (generally 6 months of abstinence is required)
Untreated HIV
Current or previous cancer (except certain liver cancers)

MBBS IV - CCT Preparation (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions