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Year 6 - Surgery > Passmed: GI > Flashcards

Passmed: GI Flashcards

1
Q

Ddx of hyperamylasaemia

A 
Acute Pancreatitis
Pancreatic Pseudocyst
Mesenteric Infarct
Perforated Viscus
Acute Cholecystitis
DKA
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2
Q

What does the H in GET SMASHED include?

A

Hypertriglyceridaemia
Hyperchylomicronaemia
Hypercalcaemia
Hypothermia

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3
Q

Which drugs can cause acute pancreatitis?

A 
Azathioprine
Mesalazine
Didanosine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium Valproate
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4
Q

Ddx of acute pancreatitis

A

Perf peptic ulcer, gastritis, atypical MI

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5
Q

What are the general mx principles of pancreatitis? (3)

A

NBM, fluid resus, analgesia

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6
Q

Typical hx of chronic pancreatitis

A

Abdo pain following meals, takes pancreatic enzymes, steatorrhoea, diabetes, chronic alcohol abuse

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7
Q

Ix for chronic pancreatitis

A

Faecal elastase and CT pancreas w IV contrast

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8
Q

What disease does chronic pancreatitis put you at risk of? Annual ix?

A

Type 3c diabetes ie pancreatogenic therefore annual HbA1c measurements

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9
Q

The Modified Glasgow Score

A 
PaO2
Age
Neutrophilia
Calcium
Renal Function
Enzymes
Albumin
Sugar

> =3 ?ITU

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10
Q

Biliary Colic vs Cholecystitis vs Cholangitis

A

Not sys unwell just colicky pain

Sys unwell and murphy’s pos

Charcot’s triad (fever, jaundice, RUQ pain) - Reynolds pentad (w altered mental status and shock)

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11
Q

What are a/w pigmented gallstones?

A

Sickle cell anaemia

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12
Q

What typically has pain that radiates to the interscapular region?

A

Biliary colic NOT peptic ulcers

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13
Q

Most common causative organism of ascending cholangitis

A

E coli then klebsiella and enterobacter

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14
Q

What can pts commonly get following a cholecystectomy?

A

Common bile duct stone or injury: wks vs days

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15
Q

Tx of acute cholecystitis

A

Analgesia, IV fluids and abx, early lap cholecystectomy within wk of dx

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16
Q

What ultrasound finding is a strong RF for cholangiocarcinoma?

A

A Porcelain GB ie intramural wall calcification

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17
Q

Which test is useful when considering Wilson’s disease?

A

Ceruloplasmin

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18
Q

What is the radiological sign of surgical emphysema?

A

The air outlines the pec major resulting in the ginkgo leaf sign

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19
Q

What are the comps of a gastrectomy?

A

Dumping syndrome, early satiety, wt loss, osteoporosis, IDA, vit B12 def, subacute combined degen of spinal cord, inc risk of gastric ca and GS

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20
Q

What is Beck’s triad?

A

Cardiac tamponade pts: hypotension, raised JVP, muffled heart sounds

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21
Q

Whats is Cushing’s triad?

A

Raised ICP: hypertension, bradycardia, irr/dec RR

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22
Q

Ddx of rectal bleeding

A

Fissure
Haemorroids
IBD
Cancer

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23
Q

What is nocturnal diarrhoea and incontinence typical of?

A

IBD

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24
Q

What do all pts presenting w rectal bleeding require?

A

DRE and procto-sigmoidoscopy, if clear view cannot be obtained bowel prep w enema and flexible sigmoidoscopy, altered bowel habit colonoscopy and XS pain EUA

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25
Q

What typically causes anal ca?

A

HPV infection therefore those immunocompromised are most at risk

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26
Q

What type is anal ca on biopsy?

A

Squamous Cell Carcinoma

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27
Q

Tx of Anal Cancer

A

Chemoradiotherapy

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28
Q

What does a biopsy report showing fibromuscular obliteration suggest?

A

Solitary rectal ulcer syndrome where extensive collagenous deposits are often seen

29
Q

Mx of Haemorrhoids

A

Consrv: dietary advice +/- topical analgesics and bulk forming laxatives

Non-Op: rubber band ligation or injection sclerotherapy

Surgical: excisional haemorrhoidectomy or stapled haemorrhoidopexy

30
Q

Which part of the bowel is often spared from diverticular disease?

A

The rectum as it lacks taenia coli

31
Q

What is the Hinchey classification of complicated diverticulitis?

A

I - paracolonic abscess

II - pelvic abscess

III - purulent peritonitis

IV - faecal peritonitis

32
Q

Outline Dukes Classification

A

A: confined to bowel

B: invading bowel wall

C: lymph node mets

D: distant mets

33
Q

Anterior vs Abdominal Perineal Resection

A

If the malignancy is >5cm from the anal verge, anterior, temporary loop ileostomy

If the malignancy is <5cm from the anal verge, AP, permanent end colostomy

34
Q

What is Hartmann’s procedure?

A

Similar to a high anterior resection in that the rectal stump is retained but usually in emerg setting when high risk of anastomotic breakdown and a temporary end colostomy is formed instead

35
Q

Comps of bowel resection

A

I: haemorrhage, injury to spleen and ureter, anaesthetic risks

E: haemorrhage, infection, pain, anastomotic leak, blood clots

L: hernia + adhesions

36
Q

Urostomy vs Ileostomy vs Colostomy

A

Urostomy: RIF, sprouted, urine drains via an ileal conduit

Ileostomy: RIF, sprouted, liquid faecal effluent

Colostomy: LIF, flushed, semisolid faecal effluent

37
Q

Temporary loop vs end ileostomy

A

A temp end ileostomy is formed when it is considered unsafe to form an anastomosis at that time

38
Q

Why is a loop ileostomy better than a loop colostomy following a colonic anastomosis?

A

Small bowel heals well vs the reversal of a loop colostomy carries the same risk of anastomotic leak as the original surgery

39
Q

Comps of a stoma

A

Itself: early (haemorrhage, ischaemia, retraction) + late (fistulae and prolapse)

Around: early (abscess) + late (parastomal hernia and dermatitis)

Systemic: early (obstruction, dehydration, hypoK) + late (sepsis and psych)

40
Q

What is toxic megacolon seen in?

A

UC

41
Q

Which volvulus is more common?

A

Sigmoid 8:2 Caecal

42
Q

Mx of Sigmoid Volvulus

A

Use a rigid sigmoidoscopy and insert a rectal tube unless there’s bowel obstruction and peritonitis go straight to an urgent midline laparotomy

43
Q

Mx of Caecal Volvulus

A

A right hemicolectomy is often required

44
Q

Which enema is used to ix anastomosis healing as it’s less toxic if there is a leak?

A

Gastrografin > Barium

45
Q

Ix for >60yo pt w tiredness and IDA

A

Colonoscopy (diagnostic) > faecal occult blood (screening)

46
Q

How do thrombosed haemorrhoids px?

A

Sx: sig pain preceded by straining

Signs: purplish, oedematous, tender s/c perianal mass

47
Q

Tx for Thrombosed Haemorrhoids

A

Within 72hrs consider excision otherwise analgesia, ice pack and stool softeners

48
Q

What analgesia should be avoided postoperatively following major abdo surgery in pts w resp disease?

A

Opioid

49
Q

Anaesthesia: Epidural > Spinal

A

It can be topped up and titrated

50
Q

When should you give blood following an upper GI bleed?

A

If there’s signs of grade III/IV shock OR Hb <70

51
Q

Mx of Anal Fissure

A

Consrv: dietary advice, bulk forming laxative, lubricants before defecation, 5% lidocaine ointment, analgesia

Medical: if presenting >1wk sx then add 0.2-0.4% GTN ointment or topical diltiazem

Surgical: if above ineffective after 8wks then refer for botulinum toxin injection or lateral partial internal sphincterotomy

52
Q

Where are 90% of anal fissures found?

A

On the posterior midline therefore consider an underlying cause if they’re found elsewhere

53
Q

What are the RFs and mx for urinary incontinence?

A

Types: stress, urge, mixed, overflow, functional

Both: exclude DM/UTI, bladder diaries, urodynamic testing, encourage reduction of caffeine/fizzy drinks, optimise wt

Stress RFs: age, obesity, children, traumatic delivery, pelvic surgery

Stress Mx: 1. 3m pelvic floor exercises 2. SNRI eg duloxetine OR surgical eg burch colposuspension

Urge RFs: age, obesity, smoking, DM, FHx

Urge Mx: 1. 6w bladder training 2. antimuscarinic eg oxybutynin 3. beta-3 agonist eg mirabegron 4. surgical eg botox injection

54
Q

What imaging should pts whose tumours lie below the peritoneal reflection have to evaluate their mesorectum?

A

MRI

55
Q

What does an anastomosis require to heal?

A
  1. Adequate blood supply 2. Mucosal apposition 3. No tissue tension
56
Q

What are the causes of chronic pancreatitis?

A

Common: Alcohol; Smoking; AI

Rarely: Cystic Fibrosis; Haemochromatosis; Duct Obstruction; Pancreas Divisum

56
Q

What are the ddx for pain following a meal?

A
  1. Gastric Ulcer 2. Biliary Colic 3. Pancreatitis
56
Q

Ix for Chronic Pancreatitis

A

US +/- CT

57
Q

Cholecystitis vs Cholangitis

A

Jaundice

58
Q

Tx of Cholangitis

A

IV Abx + ERCP

59
Q

How are haemorrhoids graded?

A

I: remain in the rectum

II: prolapse on defecation but spontaneously reduce

III: prolapse on defecation but require digital reduction

IV: remain persistently prolapsed

60
Q

What are solitary rectal ulcer a/w?

A

Chronic straining and constipation

61
Q

Ix for Solitary Rectal Ulcer

A

Once biopsied to exclude malignancy workup includes endoscopy, defecating proctogram, ano-rectal manometry studies

62
Q

Who are the typical pts who get a sigmoid volvulus?

A

Older pts w chronic constipation, Chagas disease, Parkinson’s disease, Duchenne muscular dystrophy, schizophrenia

63
Q

Who are the typical pts who get a caecal volvulus?

A

Any Age
Adhesions
Pregnancy

64
Q

What stoma is required for an emergency Hartmann’s procedure?

A

End Colostomy

65
Q

Ix for Rectal Intussusception

A

Defecating Procotogram

66
Q

Where are the three anal cushions located?

A

At 3, 7 and 11 o’clock

67
Q

What is Goodsall’s rule?

A

It determines the path of an anal fistula: if anterior the track is in a straight line vs if posterior the internal opening is always at 6 o’clock

Year 6 - Surgery (27 decks)

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