Upper GI Surgery Flashcards
What is the clinical significance of the Ligament of Treitz?
Marks the duodenojejunal junction
melaena is thought to arise proximally to it
What are the layers of the anterior abdominal wall?
Skin Subcutaneous tissue External oblique Internal oblique Transverse abdominis Extraperitoneal fat Peritoneum
What is the 5-year prognosis of gastric carcinoma?
10%
What causes a succussion splash?
Obstruction of antrum (e.g. gastric cancer)
What are the risk factors for gallstones?
Female Fertile (OCP, HRT) Forty (although most common >50) Fat (obesity) Hyperlipidaemia Haemolytic anaemia Chron's disease
What is Courvoisier’s Law?
Jaundice + palpable gallbladder is unlikely to be due to gallstones
Which carcinoma of the pancreas has the worst prognosis?
Ductal adenocarcinoma
What are the two most common causes of acute pancreatitis?
Gallstones (60%)
Alcohol (20%)
What is Charcot’s Triad and what does it indicate?
Fever/rigors + abdominal pain + jaundice
= ascending cholangitis
What is Reynaud’s Pentad and what does it indicate?
Fever + abdominal pain + jaundice + hypotension + confusion = severe ascending cholangitis
What is Trosier’s sign?
Hard, enlarged left supraclavicular LN (Virchow’s node), suggesting gastric carcinoma spread
What are the types of groin hernias and which is most common?
Inguinal hernias most common overall
Femoral hernias more common in females
Inguinal hernias more common in males
What is the surface anatomy of the femoral artery?
Inferior to midpoint of the inguinal ligament which runs from ASIS to pubic tubercle
What is the difference between a direct and indirect hernia?
Both emerge through superficial inguinal ring
Direct = through weakness in posterior wall of inguinal canal (medial to inferior epigastric artery)
Indirect = through deep inguinal ring (lateral to medial epigastric artery)
Which hernias may be associated with a congenital persistence of the processus vaginalis?
Indirect inguinal hernia
What are the most common causes of small and large bowel obstruction?
Small: adhesions, hernias
Large: colorectal carcinoma, diverticulitis, volvulus
What percentage of patients taking NSAIDs develop PUD?
15-20%
What is the most common small intestine malignancy?
Metastasis from malignant melanoma
What serum marker may be useful in determining whether bleeding is coming from the upper or lower GI system?
Urate may be elevated in an upper GI bleed
absorption of RBC breakdown products
At which serum level of total bilirubin is jaundice usually clinically detectable?
85-120umol/L
Give 5 differential diagnoses for acute cholecystitis.
Perforated peptic ulcer Acute pancreatitis Acute hepatitis Subphrenic abscess Perforation of the hepatic flexure of the colon (e.g. cancer, diverticular disease) Myocardial infarction Right lower lobe pneumonia
