Upper GI/Colorectal Flashcards
how can you tell the difference between small and large bowel obstruction on x ray
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
what patients should be referred urgently for colonoscopy ie within 2 weeks
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
who is bowel screening offered to and what does it test
screening every 2 years to all people aged 50 to 74 years. Patients aged over 74 years may request screening.
types of shock which cause ward peripheries
neurogenic
septic
analphylactic
aka distributive shock
what is in the glasgow scale of pancreatic severity
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
best investgation for anal fistula
MRI
what is a hartman’s procedure
resection of sigmoid colon/rectum with end colostomy formed
usually done in an emergency setting
common cause of a solitary rectal ulcer
constipation
charcots triad
right upper quadrant pain
jaundice
high swinging fever
= ascending cholangitis
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.
rectal intussuseption - associated with rectal prolaspe after childbirth due to prolonged second stage damage to the pelvic floor
best investigation if defecating proctogram
tumour marker used to measure response to treatment in colon cancer
CEA
name of transplant given to an identical twin
isograft
management of acute cholecystitis
fluids antibiotics and cholecystectomy within 1 week
ulcer relieved by eating is
duodenal
complications of gasterectomy
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
which is more sensitive in diagnosisi pancreatitis - lipase or amylase
lipase
investigation to assess anastomoses healing
gastrograffin enema
condition associated with pigmented gallstones
sickle cell disease
ie any haemolysis also associated with liver cirrhosis
grading of internal haemarroids
grade 1 do not prolaps
grade 2 prolapse on defecation and resolve spontanousl
gard3 must be manually resolved
grade 4 always out
management of an acute anal fissure
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
manaement of a chronic anal fissue (>6 weeks)
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
investigation to pick up chronic pancreatitis
CT with contrast
advantage of an epidural as anaethesia after bowel surgery
quicker return to normal bowel function
What are the fat soluble vitamins
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