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General Surgery > Upper GI/Colorectal > Flashcards

Upper GI/Colorectal Flashcards

1
Q

how can you tell the difference between small and large bowel obstruction on x ray

A

SMALL = Maximum normal diameter = 35 mm
Valvulae conniventes extend all the way across

LARGE = Maximum normal diameter = 55 mm
Haustra extend about a third of the way across

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2
Q

what patients should be referred urgently for colonoscopy ie within 2 weeks

A

patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces

'consider' if 
there is a rectal or abdominal mass
there is an unexplained anal mass or anal ulceration
patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
-→ abdominal pain
-→ change in bowel habit
-→ weight loss
-→ iron deficiency anaemia
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3
Q

who is bowel screening offered to and what does it test

A

screening every 2 years to all people aged 50 to 74 years. Patients aged over 74 years may request screening.

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4
Q

types of shock which cause ward peripheries

A

neurogenic
septic
analphylactic

aka distributive shock

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5
Q

what is in the glasgow scale of pancreatic severity

A 
PaO2< 7.9kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L
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6
Q

best investgation for anal fistula

A

MRI

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7
Q

what is a hartman’s procedure

A

resection of sigmoid colon/rectum with end colostomy formed

usually done in an emergency setting

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8
Q

common cause of a solitary rectal ulcer

A

constipation

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9
Q

charcots triad

A

right upper quadrant pain
jaundice
high swinging fever

= ascending cholangitis

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10
Q

38-year-old lady presents with symptoms of obstructed defecation that date back to the birth of her second child by use of ventouse. She passes mucous and suffers from pelvic pain. Digital rectal examination and barium enema are normal.

A

rectal intussuseption - associated with rectal prolaspe after childbirth due to prolonged second stage damage to the pelvic floor

best investigation if defecating proctogram

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11
Q

tumour marker used to measure response to treatment in colon cancer

A

CEA

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12
Q

name of transplant given to an identical twin

A

isograft

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13
Q

management of acute cholecystitis

A

fluids antibiotics and cholecystectomy within 1 week

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14
Q

ulcer relieved by eating is

A

duodenal

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15
Q

complications of gasterectomy

A

Dumping syndrome
early: food of high osmotic potential moves into small intestine causing fluid shift
late (rebound hypoglycaemia): surge of insulin following food of high glucose value in small intestine - 2-3 hours later the insulin ‘overshoots’ causing hypoglycaemia

Weight loss, early satiety
Iron-deficiency anaemia
Osteoporosis/osteomalacia
Vitamin B12 deficiency
increased risk of gallstones
increased risk of gastric cancer
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16
Q

which is more sensitive in diagnosisi pancreatitis - lipase or amylase

A

lipase

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17
Q

investigation to assess anastomoses healing

A

gastrograffin enema

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18
Q

condition associated with pigmented gallstones

A

sickle cell disease

ie any haemolysis also associated with liver cirrhosis

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19
Q

grading of internal haemarroids

A

grade 1 do not prolaps
grade 2 prolapse on defecation and resolve spontanousl
gard3 must be manually resolved
grade 4 always out

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20
Q

management of an acute anal fissure

A

dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics

not topical steroids

21
Q

manaement of a chronic anal fissue (>6 weeks)

A

continue acute treatments and add:
topical glyceryl trinitrate (GTN) is first line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary referral should be considered for surgery or botulinum toxin

22
Q

investigation to pick up chronic pancreatitis

A

CT with contrast

23
Q

advantage of an epidural as anaethesia after bowel surgery

A

quicker return to normal bowel function

24
Q

What are the fat soluble vitamins

A

A D E K

25
Q

outline the dukes classification of colorectal cancer

A

A mucosa
B bowel wall
C lymph nodes
D distant mets

26
Q

what is rigler’s sign

A

double wall sign - indicated pneumoperitoneum

27
Q

drugs that cause pancreatitis

A 
steroids
azathioprine
diuretics
sodium valproate
mesalazine
28
Q

what is seen on AXR in sigmoid volvulus

A

coffee bean sign

29
Q

what things increase your risk/ are associated with sigmoid volvulus

A

age
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia

30
Q

what is associated with caecal volvulus

A

pregnancy

adhesions

31
Q

what is seen on AXR in caecal volvulus

A

may see evidence of small bowel obstruction

32
Q

management of a sigmoid volvulus

A

sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
sometimes requires sigmoidectomy

33
Q

management of a caecal volvulus

A

surgery usually needed - right hemicolectomy

34
Q

causes of a paralytic ileus

A 
post op
pancreatitis
spinal injury
hypokalaemia
hyponatraemia
uraemia
peritoneal sepsis
tricyclics
35
Q

what is pseudo obsturction of the bowel

A

mechanical GI obsturction with no cause found
acute colonic pseudoobstruction= ogilivies syndrome
treat with neostigmine or colonic decompression
occurs after pelvic surgery, post partum, trauma

36
Q

vomiting (then retching)
pain
failed attempt to pass an NG tube

regurg of saliva
dysphagia
noisy gastric peristalsis

A

gastrooesophageal obstruction ie volvulus of the stomach

usually needs urgent laproscopy

37
Q

risk factors for pancreatic cancer

A

ncreasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene

38
Q

presentation of pancreatic cancer

A

classically painless jaundice
however, patients typically present in a non-specific way with anorexia, weight loss, epigastric pain
loss of exocrine function (e.g. steatorrhoea)
atypical back pain is often seen
migratory thrombophlebitis (Trousseau sign of malignancy) is more common than with other cancers

39
Q

side effect of a whipples

A

dumping syndrome

peptic ulcer disease

40
Q

treatment of pancreatic cancr

A

most are inoperable but if they are then whipples
adjuvent chemo
palliation with stent to relieve jaundice

41
Q

how to tell the difference between a direct and indirect inguinal hernia

A

occlude deep inguinal ring (two fingers above midpoint between asis and pubic tubercle)
if hernia appears when coughing = direct
if hernia does not appear = indirect

direct is usually within hasselbachs triangle

42
Q

management of hernias

A

reducible - elective surgery or leave it (e.g. been there 30 years, elderly etc)
irreducible - elective surgery as soon as but not urgetn
strangulated or obstruction - emergency surgery

inguinal hernia in child - needs repaired (if less than 1 year urgently, if older electively)
umbilical hernia in child - leave alone will go away

43
Q

risk factors for incisional hernia

A

wound infection
diabetes
steroids
obestity

44
Q

commn presentation of autoimmune hepatitis

A

amenohrrea and jaundice

45
Q

why do people with coeliac need the pneumococcal vaccine

A

hyposplenism

46
Q

What is the first line endoscopic treatment for gastric varices?

A

injection with N-butyl-2-cyanoacrylate

47
Q

mechanism of action of loperamide

A

μ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut

48
Q

what is the best way to measure liver function in liver cirrhosis

A

prothrombin time and albumin

General Surgery (3 decks)

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