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Year 3 > GI surgery > Flashcards

GI surgery Flashcards

1
Q

Which volvulus is more common

A

Sigmoid > Cecal

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2
Q

Risk factors for sigmoid volvulus

A

Old, constipation, chagas disease, Neurological disease and mental health condition

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3
Q

Risks for cecal volvulus

A

Adhesion and pregnancy

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4
Q

Sigmoid volvulus leads to

A

Large bowel obstruction; coffee bean sign aka bent inner tube sign on AXR

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5
Q

Caecal volvulus leads to

A

Small bowel obstruction

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6
Q

Management of sigmoid volvulus

A

Colonoscopy decompression aka Rigid sigmoidoscopy

laparoscopic or open sigmoid colectomy

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7
Q

Management of Cecal volvulus

A

laparoscopic or right hemicolectomy
no colonoscopy as can perforate cecum
Caecostomy

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8
Q

Hemorrhage in post-Op

A

Primary: during surgery
Reactive: At the end or early post op
Secondary: >24 hours due to infection

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9
Q

Post-op urinary retention

A

Drugs: opioids, epidural, antiACHM; pain- SNS

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10
Q

Pulmonary Atelectasis post op

A

General anaesthesia relayed, mucus plugging, absorption of distal air and collapse of lung;
Risks: smoking pre-op, Anaesthetic concentration, pain inhibits cough and respiratory excursion

Presents within first 48 hours, mild fever, dyspnea and dull bases with decreased air entry

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11
Q

Wound infections post-op

A

Typically occur 5 to 7 days post-op

S. Aureus and Coliforms

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12
Q

Wound dehiscence

A

10 days post op, preceded by serosanguinous discharge from the wound

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13
Q

Colonic surgery post op

A

Ileus, anastomosis leak, enterocutaneous fistula and abscess

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14
Q

Small bowel surgery Post op

A

Short gut syndrome

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15
Q

Post op pyrexia

A

early: Blood transfusion, physiological (SIRS), atelectasis (24-48h)
Delayed: pneumonia, VTE, wound infection, Anastomotic leak at 7 d

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16
Q

What is the most common cause of secondary peritonitis

A

Acute perforated appendicitis in under 45s

Elderly - Diverticultitis perforated

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17
Q

Investigation of choice in peritonitis

A

Abdominal CT scan

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18
Q

treatment of choice for peritonitis

A

IV metronidazole + Cefuxime

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19
Q

What is a fistula in Ano

A

Abnormal connection between ano-rectal canal and the skin
Presents with anal discharge and pain
May be purulent

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20
Q

Perianal fistula pathogenesis

A

occurs secondary to perianal sepsis and blocked intramuscular gland forming abscess, abscess forms a fistula

Associated to Crohns, Diverticular disease, rectal cancer

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21
Q

High and low Anal fistula

A

High: cross sphincter muscles above the dentate line
Low: below the dentate line

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22
Q

Goodsall’s Rule

A

Fistula anterior to anus track in a straight line

Fistula posterior to anus - has internal opening at 6 oclock position

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23
Q

Investigation in Anal fistula

A

MRI and endoanal USS

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24
Q

Treatment of anal fistula

A

examination under anaesthesia
Fistulotomy and excision - low fistula
High fistula: suture passed through fistula and gradually tightened over months

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25
Q

Treatment of perianal abscess

A

EUA and Incision and drainage
2 intention healing
complication is fistula

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26
Q

Which ulcer pain gets relieved by eating

A

Duodenal ulcer

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27
Q

Which ulcer pain gets worse on eating

A

Gastric; relieved by antacids

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28
Q

What are curling’s ulcers related to

A

Burns

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29
Q

Investigation of Peptic ulcers

A

Breath test, OGD - gold standard (stop PPI 2 weeks)

Gastrin levels for Zollinger-Ellison

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30
Q

Surgical management of peptic ulcers

A

Vagus nerve stimulates acid secretion and also by gastrin (from antral G cells)

  1. Vagotomy: truncal: prevents pyloric sphincter relaxation, combined with pyloroplasty or gastroenterostomy
    Selective- nerves of laterhet left intact
  2. Antrectomy with vagotomy: distal stomach removed

Subtotal gastrctomy with Roux-en-Y: Zollinger-Ellison

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31
Q

Dumpling syndrome

A

Abdo distention, flushing, n/v

hypoglycemia and hypovolemia

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32
Q

H pylori increases the risk of

A

Lymphoma and gastric primary adenocarcinoma

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33
Q

Triple and quadruple therapy - H pylori

A

Bismuth + metronidazole + Tetracycline + PPI
or
Clarithromycin + AMoxicillin + PPI

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34
Q

Gastrinoma located in pancreas, MEN1, hypersecretion of gastrin from tumor in pancreas or duodenum, diarrhea

A

Zollinger-Ellison syndrome

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35
Q

Cushing ulcer triad

A

Hypertension + widening pulse pressure and bradycardia due to ICP

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36
Q

Type A gastritis vs Type B gastritis

A

Type a: autoimmune gastritis, Pernicious anemia, anti-pariteal antibodies

Type b: pylorus and antrum, H, pylori, increased risk of gastric and duodenal adenocarcinoma

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37
Q

painless Jaundice, Dark urine and light stools, Nausea, pain after eating, unintended weight loss, upper abdominal pain, back pain, cachexia, virchow’s nodes, Courvoisers sign and trousseau’s syndrome - Migratory thrombophlebitis

A

Pancreatic cancer

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38
Q

Risks for pancreatic cancer

A

Smoking, inflammation (chronic), high fat diet, Etoh and DM

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39
Q

Signs of pancreatic cancer

A

palpable GB + jaundice + Trousseau + splenomegaly + Ascites

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40
Q

Investigation of pancreatic cancer

A

Cholestatic LFTs + Ca19-9
USS: pancreatic mass, dilated ducts and hepatic metastasis
Endoscopic USS > CT/MRI for staging
CXR: metastasis

ERCP: shows anatomy, allows stent and biopsy

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41
Q

Surgical treatment of pancreatic cancer

A

Whipple’s Pancreaticoduodenectomy

Palliation - P/C or endoscopic stenting
pain relied coeliac plexus block

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42
Q

Lower 3rd oesophagus, GORD related and barretts - cancer

A

Adenocarcinoma

43
Q

upper and middle third, Associated with alcohol and smoking

A

SCC

44
Q

Progressive dysphagia from solids to liquids, weight loss, retrosternal chest pain, lymphadenopathy and upper third hoarseness - recurrent laryngeal nerve and cough and aspiration pneumonia

A

Oesophageal cancer

45
Q

Diagnosis of oesophageal cancer

A

Upper GI endoscopy- biopsy
BA swallow: apple core stricture
Staging: CT/ EUS

46
Q

Surgical treatment of oesophageal cancer

A

Oesophagectomy
Ivor-lewis, McKeown and trans-hiatal

Palliative: laser coagulation, stenting, radiotherapy

47
Q

Following a viral infection, enlargement of LNs causing pain, tenderness and fever
Causes: high temp, tenderness is generalised, lymphocytosis, Post URTI and photophobia

A

Mesenteric adenitis

48
Q

Ileal remnant of vitellointestinal duct that joins the yolk sac to the mid gut

A

Meckel’s diverticulum

49
Q

PC of meckel’s

A

Rectal bleeding, diverticulitis, intussuception, volvulis, malignant change into adenocarcinoma, raspberry tumor

Investigation: Pertechenecate scan
Surgical resection is required

50
Q

Triad of mesenteric ischemia

A

Acute abdominal pain + PR bleeding + shock + No abdominal signs
AF can be seen

51
Q

Imaging in mesenteric ischemia

A

AXR: gas less bowel

Arteriography, CT angi, MRI angio

52
Q

management in ischemic bowel

A

Resection of the necrotic bowel

53
Q

Imaging in bowel onstruction

A

AXR- fluid levels and CT

gastrograffin - mechanical obstruction

54
Q

AXR findings in Obstruction

A

> 3 cm, central, many loops and many short fluid level- SBO

>6cm or >9 cecum, peripheral, haustra, gas present, few loops - LBO

55
Q

Management of Bowel Obstruction

A

NBM, IV fluids, NGT and cathetrise
Surgery: closed loop, neoplasm, strangulation or perforation with peritonitis, failed conservative
LBO: hartmann’s, colectomy, bypass, loop ileostomy or colostomy, caecostomy

56
Q

Strictures, transmural, cobblestone mucosa, granuloma, fistula, aphthous ulcers

A

Crohn’s

57
Q

Mucosal, pseudopolyps, bloody stools, tenesmus, urgency , CRC

A

UC

58
Q

Associations of IBD with systemic diseases

A

Erythema nodusum, pyoderma gang, iritis, arthritis, PSC + cholangiocarcinoma

59
Q

induce Remission in mild to moderate UC

A

5ASA and prednisolone

60
Q

Maintaining remission in UC

A

5ASA Po, azathioprine or Mercaptopurine

Infliximab 3rd line

61
Q

Surgical treatment in UC

A

Emergency: Total or subtotal colectomy with end ileostomy + mucus fistula
panprotocolectomy + end ileostomy

Elective: pan proctocolectomy with end ileostomy

62
Q

Types of hiatus hernia

A

Sliding common - GOJ slides up into chest, associated with GORD
Rolling: Stomach into the chest with oesophagus; stangulation risk

63
Q

Investigation and treatment of hiatus hernia

A

CXR- gas bubble and fluid level
Ba swallow: diagnostic choixe
OGD: oesophagitis

Repair of rolling hernia

64
Q

Surgical repair of inguinal hernia

A 
Lichtenstein repair 
open approach 
laproscopic: bilateral repair and recurrent hernia
primary unilateral - Open
Children- sac excision - hernitomy
65
Q

symptoms of Haemorrhoids

A

Fresh PR bleeding, pruritus ani, lump in perianal area and thrombosis

66
Q

Investigation of hemorrhoids

A

proctoscopy and DRE

67
Q

management of hemorrhoids

A

rubber bind ligation, injection sclerotherapy, excision for acutely thrombosed within 72 hours

68
Q

Metaplasia of squamous epithelium

A

Barretts

69
Q

Metaplasia to dysplasia to adenocarcinoma

A

Cancer

70
Q

Surgical management of GORD

A

nissen fundoplication: severe sxs, refarctory to medical therapy and confirmed reflux on pH monitoring

71
Q

GORD investigation

A

High risk OGD

24 hour manometry and pH

72
Q

Risk factors for gastric cancer

A

Atrophic gastritis, pernicious anemia, nitrates, smoking, BG-A, partial gastrectomy

73
Q

Pathology of gastric cancer

A

adenocarcinoma + H pylori- MALToma

SXS: late pC, weight lost, anorexia, dyspepsia, dysphagia and n/v, acanthosis nigricans

74
Q

Surgical management of gastric cancer

A

Pyloric stenting and bypass procedures
resection endoscopically
total gastrectomy

75
Q

Choice of investigation for biliary colic

A

USS
uncertain- HIDA
dilated ducts seen MRCP

76
Q

Murphy sign

A

pain and breath catch on GB and absent on left

77
Q

Boas’s sign

A

hyperaesthesia below right scapula

78
Q

empyema

A

High fever, RUQ mass and P/C drainage

79
Q

Riger’s triad for gallstone ileus

A

pneumobilia + sbo + RLQ Gallstone

80
Q

Ascending cholangitis

A

1st line USS
1st ERCP
PTC

81
Q

Reynolds pentad

A

fever + RUQ + Jaundice + confusion + hypotension

82
Q

Hypovolemia + retroperitoneal hemorrhage + pancreatic necrosis

A

Acute pancreatitis

83
Q

Causes of acute pancreatitis

A

mostly gallstones
alcohol
others- ethanol, idiopathic, trauma, steroids, mumps, ERCP

84
Q

Modified glasgow scale

A

paO2, age, neutrophils, Calcium low, renal function, LDH, albumin and sugar

85
Q

Imaging in acute pancreatitis

A

US, Contrast CT**

86
Q

treatment in pancreatitis

A

ERCP if gallstones

ERCP + sphincterotomy

87
Q

Surgical treatment in acute pancreatitis

A

Pancreatic necrosis, abscess
laparotomy + necrosectomy
peritoneal lavage

88
Q

Complications of acute pancreatitis

A

ARDS, pleural effusion, shock, DIC

late: necrosis, infection, abscess, pseudocyst, bleeding, thrombosis, fistula

89
Q

pseudocyst of pancreas

A

lesser sac, 4-6 weeks after acute attack, pain and early satiety, infection can occur
persistent raised amylase
PC drainage under US/Ct

90
Q

Chronic pancreatitis causes

A

alcohol is most common

91
Q

Pain into back, steatorrhea, weight loss, polyuria and polydipsia, pseudocyst, elastase and exocrine function

A

CT calcification

92
Q

Surgical treatment of chronic pancreatitis

A

Distal pancreatectomy
whipples
drainage and stenting

93
Q

Hellers cardiomyotomy

A

Achalasia

94
Q

ANal fissure treatment

A

EUA

medical: laxative, lignocaine, GTN, diazepam, and botulinum injection

95
Q

Surgical treatment of anal fissures

A

lateral partial sphincterotomy

96
Q

Hinchey grading

A 
diverticultis 
small confined pericolic abscesses 
large abscess 
Generalized peritonitis 
faecal peritonitis
97
Q

Surgical therapy in diverticulitis

A

Hartmann’s

98
Q

Colon cancer treatment

A

Caecal, ascending, or proximal transverse colon: right hemicolectomy
Distal transverse descending colon: left hemicolectomy
Sigmoid colon: High anterior resection
Upper rectum: anterior resection with TME
low rectum: anterior resection with low TME
anal verge APER

99
Q

Familal adenomatous polyposis

A

Autosomal dominant, APC gene, 100-1000s adenomas by 16 years of age

Variants
Attenuated- <100 >50 CRC
Gardners: TODE- thyroid, osteoma, dental problem, epidermal cysts
treat using prophylactic colectomy before 20

100
Q

Hereditary non-polyposis colorectal cancer

A

Autosomal dominant, commonest CRC
Lynch 1: right sided CRC
lynch 2: CRC + gastric, prostate and breast

101
Q

Peutz-Jeghers

A

Autosomal dominant

increased cancer risk, hyperpigmentations

102
Q

appendicitis pain veretbrae

A

t10-11

103
Q

McBurney’s point

A

Guarding and tenderness

104
Q

psoas sign

A

retrocecal appendix

Year 3 (11 decks)

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