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Year 1 - Gastrointestinal (DP) > Surgical Presentations of Abdominal Disease > Flashcards

Surgical Presentations of Abdominal Disease Flashcards

0
Q

Where does gall bladder pain tend to radiate?

A

Through to the back and right

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1
Q

What structures cause pain in the upper three zones?

A

Gall bladder
Stomach and duodenum
Pancreas

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2
Q

Where does gastric and duodenal pain radiate?

A

Straight through to the back

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3
Q

Where does pancreatic pain radiate to?

A

Through to the back and left

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4
Q

What causes throbbing pain?

A

Inflammation

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5
Q

What sort of pain does obstruction cause?

A

Colic

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6
Q

How does a patient suffering colic pain tend to act?

A

They move around

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7
Q

If the patient is lying still, what sort of pathology may be occurring?

A

Inflammation

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8
Q

If the abdomen is moving with respiration, there is general peritonitis. True or false?

A

False.

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9
Q

If there is tenderness to percussion, what term is used?

A

Peritonitis

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10
Q

What are the diagnostic conditions for anorexia nervosa?

A
  1. Significant weight loss (BMI < 17.5)
  2. Weight loss is self induced (Avoiding fatty food, calorie counting)
  3. Core psychopathology (Body image distortion)
  4. Widespread endocrine abnormality
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11
Q

What endocrine abnormalities can result due to anorexia?

A

Amenorrhoea
Loss of sexual interest
Elevated GH/cortisol
Abnormalities of insulin secretion

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12
Q

What are the two types of anorexia?

A

Restricting type

Binge eating/Purging type

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13
Q

What is the aetiology of anorexia and bulimia?

A

Socio-cultural pressures (family dysfunction)
Personal vulnerability
Sexual maturity

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14
Q

What is factitious disorder?

A

Intentional feigning
Either physical or psychiatric
Munchausen Syndrome

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15
Q

What is malingering?

A

Deliberate exaggeration of symptoms

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16
Q

What are the types of antidepressants and what do they do?

A

Tricyclics - enhance mono amine activity in the brain

Selective Serotonin Reuptake Inhibitors - Stimulate 5HT3 receptors

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17
Q

What bowel sounds are present in obese patients?

A

None

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18
Q

When is the plain AXR useful?

A

In obstruction
In colitis
In perforation

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19
Q

What is the gold standard of radiological imaging of the abdomen?

A

CT

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20
Q

How is a sigmoid Volvulus managed?

A

Decompressed with a rigid sigmoidscope

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21
Q

What is the classification of Diverticulitis?

A

Hinchey Classification

  1. Para colic abscess
  2. Pelvic abscess
  3. Purulent abscess
  4. Faecal peritonitis
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22
Q

What is Hartmann’s procedure?

A

Remove sigmoid
Leave rectum
Bring out colostomy

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23
Q

How do haemorrhoids present?

A

Painless bleeding
Fresh, bright red blood, not in stool, on toilet paper
Perianal itchiness
No other symptoms

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24
Q

What investigations can be done in a patient with haemorrhoids?

A

PR exam
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy (Age above 50)

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25
Q

Treatment of haemorrhoids?

A 
Slcerosation therapy (5% phenol in almond oil)
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy
HALO/THD procedure
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26
Q

What part of the rectum prolapses in a partial prolapse?

A

Anterior mucosa

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27
Q

How does a rectal prolapse present?

A

Protruding mass (especially during defaecation)
PR bleeding and mucus
Poor anal tone

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28
Q

Management of complete rectal prolapse?

A 
Bulking agent and education on manual reduction
Delormes procedure
Perineal rectopexy
Abdominal rectopexy
Anterior resection
29
Q

Where are anal fissures typically located?

A

In the midline posteriorly

30
Q

What is the presentation of an anal fissure?

A

Severe acute anal pain (often following constipation)
Pain lasts for 30 mins after defaecation
Bright rectal bleeding

31
Q

What is the treatment of anal fissures?

A 
Dietary advice
Stool softeners
Pharmacological sphyncterotomy
Lateral sphyncterotomy
Botox
32
Q

Where does the bowel dilate in obstruction: Proximally or Distally?

A

Proximally

33
Q

What is the typical presentation of an upper small bowel obstruction?

A 
Acute
Hours of onset
Large volume of vomit
- Gastric secretions
- Pancreatic secretions
- Biliary secretions
34
Q

What is the presentation of a distal small bowel of large bowel obstruction?

A

Colicky abdo pain
Distension
(Faeculent vomiting)

35
Q

What are the general symptoms of bowel obstruction?

A

Vomiting
Pain
Constipation
Distension

36
Q

If vomit contains semi-digested food with no bile, where is the obstruction?

A

Gastric outlet

37
Q

If there is copious bile in the vomitus, where is the obstruction?

A

Upper small bowel

38
Q

What is the character of vomitus in a distal obstruction?

A

Thicker
Brown
Foul-smelling

39
Q

When is back flow of accumulated colonic contents prevented?

A

If the ileocaecal valve remains competent

40
Q

What is a ‘closed loop obstruction’?

A

A caecum that progressively dis tends with swallowed air

Eventually may rupture

41
Q

What happens to the muscle of the bowel wall if obstruction is chronic?

A

It hypertrophies

42
Q

What are the signs of dehydration?

A

Dry mouth

Loss of skin turgor and elasticity

43
Q

What is the appearance of dilated bowel in an AXR?

A

Lie in a central position

Have valvulae coniventes

44
Q

What is the AXR appearance of a distended large bowel?

A

Lies in anatomical position

Has haustra coli

45
Q

Management of intestinal obstruction?

A

NG tube (decompress stomach)
Nil by mouth
Blood sample
IV fluids

46
Q

Examples of mechanical obstruction?

A 
ADHESIONS or BANDS
Incarnated hernia
Volvulus
Tumour
Strictures
Bolus
Intussusception
47
Q

What type of obstruction do inflammatory strictures tend to cause?

A

Incomplete

48
Q

What may cause a bolus obstruction?

A

Food
Impacted faeces
Impacted gallstone
Trichobezoar

49
Q

What is Intussusception?

A

Segment of bowel wall becomes ‘telescoped’ into the segment distal to it

50
Q

When is cholecystitis or biliary colic pain often exacerbated?

A

By eating

51
Q

What is the first line investigation in cholecystitis or biliary colic?

A

Ultrasound

52
Q

How do we further clarify cholecystitis or biliary colic?

A

MRCP and/or ERCP

53
Q

What is the ideal method of imaging in suspected pancreatitis and when is it best performed?

A

CT (to evaluate complications)

1 week following symptom onset

54
Q

What is the investigation of choice in perforation?

A

ERECT CXR

55
Q

How do we investigate appendicitis?

A

Ultrasound

56
Q

What investigation is used in diverticulitis?

A

CT

57
Q

What symptoms may prompt the idea of a urological cause of abdominal pain?

A

Associated urinary symptoms

Haematuria

58
Q

What might prompt you to consider vascular causes of abdominal pain?

A

Sudden onset
Back pain
Hypotension

59
Q

If a patient has a distended abdomen and a bowel source if suspected, what is the first line investigation?

A

AXR

60
Q

If a patient has a distended abdomen and a fluid cause is suspected what is the first line investigation?

A

Ultrasound

61
Q

How is haematemesis investigated?

A

Endoscopy

Allows intervention or biopsy

62
Q

What method of contrast may be given in a patient who is suffering from haematemesis?

A

IV (for CT scan)

63
Q

What radiological investigations are done in a patient with a change in bowel habit?

A

Barium enema

CT virtual colonography

64
Q

When is a small bowel MRI used?

A

In small bowel Crohn’s

In large bowel Crohn’s with suspected small bowel involvement

65
Q

What scan can be used to localise active inflammation in known IBD?

A

Radio-labelled White cell scan

66
Q

How does cirrhosis appear on ultrasound?

A

Small volume of ascites

Nodular contour and course echotexture

67
Q

How do liver metastases appear on an ultrasound?

A

Hypoechoic
Solid
Varying size
‘Target’ appearance

68
Q

How does ischaemic colitis appear histologically?

A

Crypt withering
Pink smudgy lamina propria
Fewer chronic inflammatory cells

69
Q

Explosive fibrinopurulent exudate on surface

A

Pseudomembranous colitis

70
Q

Thickened basal membrane with a patchy appearance and intrepithelial inflammatory cells

A

Collagenous colitis

71
Q

Telangectasia

Bizarre stromal cells

A

Radiation colitis

Year 1 - Gastrointestinal (DP) (8 decks)

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