Tennis gastro tut Flashcards
What is a less likely cause of hypotension and why?
Blood loss- you have to loose 30% of your blood vol to become hypotensive
What is the onset of ruptured AAA?
It can be a few days as it might leak at first then rupture
Usually onset is sudden in exam qs
What are RF for ruptured AAA?
smoking hx
connective tissue disorders (marfans)
What signs of shock do you get in ruptured AAA?
Hypotension
Sweaty
Pale
No fever!!!!
What is the screening programme for AAA?
One USS at age 65 offered to all men
What size is AAA for surgery?
> 5.5cm
What is absolute constipation?
No flatus or faeces passed in the past 12-24 hrs
How is small bowel obstruction managed?
drip and suck: iv fluids and NG tube w drainage
surgery if peritonitis or perforated
can be conservative for 72 hrs but most usually need surgery
What are some reasons small vs large bowel are obstrcuted?
Large= volvulus, malignancy Small= adhesions, strictures (past surgery)
What is SBP? How is it diagnosed?
Bacterial peritonitis
Tap the ascites and it has high neutrophils
What are signs and symptoms of peritonitis?
rebound tenderness
guarding
rigidity
What is a major RF for mesenteric ischaemia?
AF
What happens in mesenteric ischaemia?
Blood clots cut off blood supply to mesentery
What is the character of pain in mesenteric ischaemia?
Severe pain generalised out of proportion to findings
How does mesenteric ischaemia present?
Severe abdo pain put of proportion to findings
May have distention
May have blood in stool
May have some NV
What are RF for mesenteric ischaemia
smoking AF MI heart defects vasculitis age
What ix are done in mesenteric ischaemia and what is seen?
CT w contrast angiogram
Colonoscopy
Lactate will be high
What acid base imbalance does metformin cause?
Metabolic acidosis
How is mesenteric ischaemia managed?
Laparotomy
What imaging done for bowel perforation?
ERECT cxr
What sign is seen in erect cxr in bowel perforation? What is this?
Pneumoperitoneum- free air under the diaphragm
how do you differentiate betwen sigmoid and caecal volvulus on imaging?
Sigmoids volv= coffee bean
Caecal volv= embryo sign
What sign is seen on imaging in sigmoid volvulus?
Coffee bean sign
What is the most common cause of pancreatitis in a men vs women?
Man= alcohol Women= gallstones
What severity scores are used in pacreatitis?
Modified glasgow score
RANSON criteria
What is a marker of chronic pancreatitis?
Faecal elastase
What is a common electrolyte abnormality in pancreatitis? When else is it seen
Hypocalcaemia
Usually not seen in much else
Amylase above what level is diagnostic of pancreatitis?
above 1000
How high is the glasgow score for pancreatitis?
more than 3
What are the 2 main RF for pancreatitis?
gallstones
alcohol
How does onset of pain differ between gastric and duodenal ulcers?
Duodenal= pain better after eating (sphicter closes) Gastric= pain worse right after eating
What are some rf for duodenal ulcers?
antidepressants
h pylori
corticosteroids
bisphosphonates
What medications might cause duodenal ulcers?
Antidepressants
corticosteroids
bisphosphonates
How do you test for h pylori?
carbon urea 13 breath test
CLO stool antigen test
What is GS ix for peptic ulcer disease?
Endoscopy
what are indications for endoscopy in peptic ulcer disease?
If you think its bleeding
You dont need to do it if the ulcer seems really stable
What type of ulcer is more common in peptic ulcer disease?
Duodenal
What abx are given alongside PPI to manage peptic ulcer disease as h pylori eradication?
Clarithromycin
amoxicillin
Why does low fibre cause diverticulitis?
low fibre= low stool bulk= more intraluminal pressure= herniation of mucosa
What is seen on barium enema in diverticulitis?
Saw tooth pattern
How is diverticulitis managed?
abx, fluids, bowel rest
