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CP3 SURGERY > UGI/CR - Gastric pathology + Acute Abdomen > Flashcards

UGI/CR - Gastric pathology + Acute Abdomen Flashcards

1
Q

What is a peptic ulcer caused by?

A

Imbalance between luminal acid and mucosal defences

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2
Q

Causes peptic ulcer (6)

A 
H pylori 
NSAIDs 
Zollinger-Ellison syndrome 
RF e.g. smoking, coffee, hepatic/renal failure 
Steroid use
Stress
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3
Q

What is Zollinger-Ellison syndrome

A

Excessive acid secretion due to non-insulin secreting Islet cell tumour of pancreas secreting a gastrin like hormone –> XS ulceration

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4
Q

Sx peptic ulcer

A

Epigastric pain (related to eating)
Nausea
Anorexia /W loss
Haematemesis/melaena

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5
Q

Ix peptic ulcer

A

Urgent OGD if ALARMS 55

If resolves w/ Antacids + no ALARMS 55 - No Ix needed

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6
Q

H pylori Ix (2)

A

C13 urea breath test

Gastric biopsy + phenol red

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7
Q

What can give false -ves C13 urea breath test (2)

A

Abx within 4 weeks of test

PPIs within 2 weeks of test

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8
Q

Complications of peptic ulcer

A

Bleeding (anaemia)
Perforation
Stricture

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9
Q

Gastric VS Duodenal ulcer: acid secretion

A

G: Normal
D: Increased

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10
Q

Gastric VS Duodenal ulcer: age

A

G: Elderly
D: <40 y/o

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11
Q

Gastric VS Duodenal ulcer: M:F

A

G: 2:1
D: 4:1

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12
Q

Gastric VS Duodenal ulcer: location

A

G: mainly < curvature
D: 90% within 2cm pylorus

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13
Q

Gastric VS Duodenal ulcer: epigastric pain

A

G: After eating
D: nocturnal/hunger pain

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14
Q

Gastric VS Duodenal ulcer: vom

A

G: Not uncommon
D: Rare

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15
Q

Gastric VS Duodenal ulcer: other Sx

A

G: W loss, loss appetite
D: Nil

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16
Q

Gastric VS Duodenal ulcer: biopsy

A

G: Edge ulcer - excl malignancy
D: Antral biopsy - H pylori

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17
Q

Gastric VS Duodenal ulcer: relieved by

A

Antacids

Eating/drinking milk

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18
Q

Gastric VS Duodenal ulcer: Tx

A

G: H.pylori eradication if present
+ 4 weeks PPI
D: Hpylori eradication only

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19
Q

Where does H pylori mainly occur

A

In the antrum

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20
Q

If H pylori occurs in the body of the stomach, what can occur

A

Atrophic gastritis –> metaplasia

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21
Q

Why is smoking bad for peptic ulcer (2)

A

Impairs gastric mucosal healing

Nicotine increases acid secretion

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22
Q

XR appearance of peptic ulceration that is an emergency

A

Pneumoperitoneum
HENCE
Perforation

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23
Q

Mx peptic ulcer disease if no ALARMS 55 present (3)

A

Lifestyle nod
Meds - PPI/H2RA
Stop NSAIDs

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24
Q

Mx peptic ulcer disease (ALARMS Sx/H pylori)

A

Triple therapy

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25
Q

Triple therapy - Non Penicillin allergy

A 
PPI 
\+ 
Amoxicillin 
\+ 
Clarithromycin/metronidazole 
7 days
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26
Q

Triple therapy - Penicillin allergy

A

PPI
+ Clarithro
+ metronidazole
7 days

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27
Q

Mx of triple therapy resistant cases peptic ulcer disease

A

Bismuth chelate + 2 Abx for 14 days

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28
Q

Who gets peptic ulcer surgery?

A

COmplications

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29
Q

3 types of peptic ulcer surgery

A

Highly selective vagotomy

Vagotomy + pyloroplasty Gastrectomy

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30
Q

Causes UGI bleed (6)

A 
Peptic ulcer
 Gastroduodenal erosions 
Oesophagitis 
Mallory-Weiss syndrome 
Varices 
UGI Malignancy
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31
Q

What is Mallory-Weiss syndrome

A

Tear in G-O junction

Due to violent vomiting

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32
Q

Sx UGI Bleed (4)

A

Haematemesis
Melaena
Haematochezia (rare)
Abdo pain

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33
Q

Assessment GI bleed using

A

Glasgow Blatchford score

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34
Q

What does a score of >6 in the Glasgow Blatchford score indicate

A

Mortality >50%

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35
Q

Mx acute GI haemorrhage (6)

A 
Mx as per haemorrhagic shock 
Calculate Blatchford score 
Inset NGT + early UGI endoscopy 
Then Rockall score 
IV omeprazole 80mg stat
Definitive surgery/embolization if endoscopy doesn't work
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36
Q

RF - Gastric cancer (8)

A 
H.pylori 
High salt/NO3 
Smoking 
Alcohol 
Genetic factors 
Pernicious anaemia 
Adenomatous polyps 
Low SE status
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37
Q

Sx gastric cancer (6)

A 
Often non-specific 
Epigastric pain 
N
V
Dysphagia (if near fundus)
Anorexia/W loss
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38
Q

Signs gastric cancer (4)

A

Palpable epigastric mass
large L supraclavicular LN (Virchows)
Hepatomegaly/jaundice/ascites
Acanthosis nigricans

39
Q

Ix gastric cancer (3)

A

OGD + multiple rolled ulcer edge biopsy
Endoscopic uSS/CT (staging)
Staging laparoscopy

40
Q

Who gets gastric cancer

A

50-70y/o

41
Q

Which population especially is susceptible to gastric cancer

A

Japanese population

42
Q

M:F gastric cancer

A

3:1

43
Q

What type of cancer is the majority of gastric cancer

A

adenocarcinoma

44
Q

When does Leather Bottle stomach occur

A

When submucosal infiltration of tumour w/ marked fibrous reaction –> small but thickened + contracted stomach

45
Q

Mets - gastric cancer (4)

A

Direct invasion abdominal viscera
Lymphatics
Liver - portal dissemination
Transcoelomic –> bilat ovarian tumours

46
Q

What are the bilateral ovarian tumours called caused by 2’ mets of gastric cancer

A

Krukenberg tumours

47
Q

What cells do stromal castric tumours arise from

A

Interstitial cells of Cajal (GIST)

48
Q

5 year survival rate gastric cancer w/ surgery

A

20%

49
Q

5 y survival rate gastric cancer w/o radical surgery

A

<10%

50
Q

Mx gastric cancer

A

Gastrectomy = extensive lymphatic clearance

+ adjunct chemo if T2-4

51
Q

Palliative Mx of gastric cancer

A

Stenting of pylorus

52
Q

Mx of stromal gastric tumours

A

Wide local excision

53
Q

Complications of gastrectomy (5)

A 
Chronic D+V
Dumping syndrome 
Bacterial obergrowth w/ malabsorption 
Anaemia (B12/Fe) 
Osteomalacia
54
Q

Acute abdomen - clinical picture: Inflammatory cause

A

Constant pain
Raised Temp, pulse, leucocytosis
Assoc w/ guarding and rigidity

55
Q

Acute abdomen - clinical picture: Obstructive cause

A

Colicky pain
Pt agitated
May become constant b/c superimposed inflammation

56
Q

Rx visceral pain: foregut

A

Upper abdomen

57
Q

Rx visceral pain: midgut

A

Middle abdomen

58
Q

Rx visceral pain: hind gut

A

Lower abdo

59
Q

What is the foregut

A

Oesophagus to D2

60
Q

What is the midgut

A

D2 to the transverse colon

61
Q

DDx Acute abdomen - Adominal visceral causes (9)

A 
Acute appendictis 
Merkel's diverticulitis 
Intestinal obstruction 
Perforation 
Acute pancreatitis 
Acute cholecystitis/cholangitis 
Renal calculi 
Acute scrotum 
IBD
62
Q

DDx acute abdomen - vascualr causes (2)

A

AAA

Mesenteric thrombosis

63
Q

DDx acute abdomen - medical causes

A

GORD
Rx pain from pneumonia/MI
UTI/pylelonehritis

64
Q

DDx acute abdomen - gynae causes

A

Ruptured ectopic
Torsion/ruptured ovarian cyst
Salpingitis etc

65
Q

Acute abdomen - sudden onset of pain suggests: (4)

A

Perforation
Rupture (aneurysm)
TOrsion
Acute oancreatitis

66
Q

Acute abdomen - back pain suggests (3)

A

pancreatitis
AAA
Renal tract disease

67
Q

Ix acute abdomen (10)

A 
FBC
U+E
LFT
CRP
AMYLASE
ABG
Pregnancy test 
Urinalysis 
Exert CXR/AXR
USS/CT
68
Q

What % of pop will have acute appendicitis?

A

1/6

69
Q

Cause of appendicitis (2)

A

Appendix = obstructed by faecolith/FB

Lymphoid enlargement in wall

70
Q

Sx appendicitis (4)

A

Abdo pain
Constipation/diarrhoea
Anorexia
N+V

71
Q

Abdominal pain progression in appendicitis

A

Starts dull + central

Becomes more sharp + localised in RIF at Mc Burney’s point

72
Q

Where is McBurney’s point

A

1/3 between ASIS + umbilicus (RHS)

73
Q

Signs of appendicitis (8)

A 
Rebound tenderness RIF
Percussion tenderness
Guarding 
\+ve Rosving's sign 
TachyC
Mild fever, flush, fetor oris 
Psoas sign 
Obturator sign
74
Q

What is Rosving’s sign

A

> painful in RIF than LIF when LIF pressed

75
Q

What is Psoas sign

A

Pain on R hip extension

76
Q

What is obturator sign

A

Pain on internal rotation of R hip

77
Q

Ix acute appendicitis

A 
PR
Pelvic exam (F)
Pregnancy test
Bloods - FBC, U+E, CRP/ESR
Urinalysis 
USS/CT if uncertain
78
Q

CRP significance acute appendicitis

A

40 if uncomplicated

95 if ruptured

79
Q

Mx acute appendicitis

A

Resus
IV metronidazole/cephalosporin
Laparoscopic appendectomy

80
Q

Early complications - laparoscopic appendectomy (2)

A

Haematoma

WOund infection

81
Q

Late complications - laparoscopic appendectomy (2)

A

SB obstruction/adhesions

Incisional hernia

82
Q

Complications - perforated appendix

A 
Peritonitis + sepsis 
Appendix mass 
Appendix abscess 
Adhesions 
Infertility
83
Q

What is an appendix mass

A

Inflamed appendix becomes covered w/ omentum

84
Q

What is an appendix abscess

A

Develops if appendix mass fails to resolve

85
Q

Why can appendicitis cause infertility?

A

Tubal obstruction

86
Q

DDx - mass in RIF

A 
Inflamm cause (mass/abscess)
Lymphoma 
Chrons 
Tumour mass
Pelvic kidney
87
Q

Mx - mass in RIF

A

USS/CT - confirm diag
IV cefuroxime + metronidazole
pct drainage if doesn’t resolve

88
Q

What is a Carcinoid tumour?

A

Tumour of argentaffin cells which produce active substances e.g. 5HTP
Hence = neuroendocrine tumour

89
Q

Where can a carcinoid tumour occur in the abdomen

A

Appendix

90
Q

What syndrome are carcinoid tumours assoc w/

A

MEN-1 syndrome

91
Q

What substance do carcinoid tumours take up readily

A

Silver stains

92
Q

PS carcinoid syndrome

A

flushing of face

diarrhoea

93
Q

Prgnosis carcinoid tumours

A

Good

CP3 SURGERY (19 decks)

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