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Abdo Flashcards

1
Q

management for H Pylori

A

Triple eradication therapy 7d

1) high dose PPI taken 30 mins before meals
2) amoxicillin
3) clarithromycin or metronidazole

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2
Q

Management of Ascites

A 
Fluid restrict
Sit up
SAAG and signs of SBP
 MR diuretics > loop diuretics 
Ascitic drain
TIPS
ABx if peritonitis: cef
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3
Q

Management of Variceal Bleed

A

Fluids resus
NBM for OGD

Terlipressin on presentation + PPI

Try and reverse coagulopathy e.g. packed cells, vit K, FFP

Oesophageal varices: band ligation
Gastric varices: Endoscopic scleroptherapy injection of N-butyl-2-cyanoacrylate

IV antibiotics (tazocin)
offer TIPS if not controlled

consider Sengstaken-Blakemore tube as last resort

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4
Q

AI hep management

A

high dose steroids
azathioprine after

2 y duration

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5
Q

Management of peptic stricture

A

Balloon dilatation

PPI if caused by GORD

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6
Q

Management of Wilson’s disease

A

Penicillamine

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7
Q

Crohn’s induce remission

A

mild: oral pred
severe: IV hydrocortisone
consider elemental diet
if first mild presentation in 12m consider 5-asa or budesonide

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8
Q

Crohn’s maintain remission

A 
DMARDs: azathioprine (check TPMT first)
biologic therapies e.g. infliximab
biologic screen before starting
STOP SMOKING = as good as steroids
elemental diet
2nd-line: methotrexate

consider surgery

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9
Q

UC induce remission

A

mild: topical aminosalicylates, oral salicylates, oral steroids
consider elemental diet
Severe: IV hydrocortisone +/- ciclosporin/infliximab if ciclo CI

consider surgery
Add LMWH and D3 for bone protection

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10
Q

UC maintain remission

A

mild/moderate: topical ASA +/- oral
biologic screen before starting

consider azathioprine/mercaptopurine after 2 or more exacerbations in 12m or severe

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11
Q

IBS management

A

lifestyle (stress, depression, diet diary)

mostly diarrhoea/bloating: reduce insoluble fibre

if diarrhoea persists: loperamide

mostly constipation: increase fibre/laxatives

if severe constipation >12m: trial linaclotide

if pain: antispasmodic e.g. mebeverine or alverine citratre, consider trial TCA

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12
Q

Haemorrhoids management

A

medical: increase fibre/stool softener, topical analgesia

non-operative: rubber band ligation, sclerotherapy

operative: haemorrhoidectomy, HALO procedure

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13
Q

Decompensated Liver failure management

A

Empirical antibiotics e.g. tazocin
Laxatives e.g. lactulose aiming for BO 3x/24h (also helps with encephalopathy)
Pabrinex/chlordiazepoxide if alcohol
Diuretics/paracentesis if ascitic
Consider if variceal bleed or renal failure
optimise nutrition +/- NG

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14
Q

Coeliac management

A 
remove gluten
dietician referral
consider e.g. iron, vitamin D etc.
monitor tTG
Consider repeat endoscopy
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15
Q

Management for Appendicitis

A

Prophylactic antibiotics
laparoscopic appendectomy
if perforated: abdominal lavage

if appendix mass: broad spectrum abx, consider drainage and interval appendectomy

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16
Q

investigation for appendicitis

A

CT
consider USS for pregnancy, children, breastfeeding
MRI if pregnant and USS not diagnostic

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17
Q

Management of Acute Cholecystitis

A

IV Abx
Severe pain: Diclofenac or opioid
mild/moderate: paracetamol or NSAID

laparoscopic cholecystectomy on admission OR after 6w

consider percutaneous cholecystostomy if surgery contraindicated at presentation + conservative management unsuccessful

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18
Q

Management of Ascending cholangitis

A

IV Abx

ERCP within 24-48h for placement of stent and removal of stone

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19
Q

Management of gallstones

A

asymptomatic in gallbladder/biliary tree: nothing

asymptomatic in CBD: offer lap cholecystectomy

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20
Q

Difference between biliary colic, acute cholecystitis and cholangitis

A

colic: steady non-paroxysmal pain in epigastrium >30 mins

Acute cholecystitis: + fever and tenderness in RUQ pain

Cholangitis: fever + rigors, jaundice, RUQ pain
Reynold pentad: + neuro and shock

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21
Q

management acute pancreatitis

A

Fluid resus (3-6L)
analgesia
oxygen
IV Abx if infected/associated cholangitis
Enteral nutrition (start oral feeding if possible, otherwise NG tube)

ERCP within 72h
Blood gas for Glasgow-Imrie scoring
consider cholecystectomy if no cholangitis/bile duct obstruction

consider replacing Ca/Mg

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22
Q

Management of chronic pancreatitis

A

acute intermittent: no alcohol/smoking + analgesia

Persistent: as above +
Pancreatin enzyme replacement AND omeprazole

pseudocyt/biliary complications: endoscopic decompression under USS

intractable pain and pancreatic duct calcifications: ESWL

pancreatic head enlargement: distal pancreatectomy

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23
Q

management of acute diverticular disease

A

mild/moderate: 5d co-amoxiclav
if allergic: cefalexin with metronidazole
Paracetamol (avoid NSAIDs and opioids)
fluid replacement

clear liquids only, with a gradual reintroduction of solid food if symptoms improve over the following 2–3 days

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24
Q

investigations for acute diverticular disease

A

lactate
USS abdo pelvis
CT scan (contrast or non-contrast)
urgent colonoscopy if haemorrhage

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25
Management for diverticular disease complications
Percutaneous drainage of large abscesses peritoneal lavage in perforation sigmoid resection and colostomy formation
26
GORD indications for 2ww OGD
``` GI bleed (same day) dysphagia upper abdo mass >55y AND weight loss AND dyspepsia/reflux/upper abdo pain ```
27
Management for dyspepsia
review medications H pylori testing trial full dose PPI
28
management for GORD
PPI for 4-8w if stricture/recurrence continue PPI 2nd line H2RA therapy Nissen fundoplication if severe
29
management of colorectal cancer
resection of bowel heparin for 28d post-surgery +/- chemoradiotherapy
30
management for volvulus
sigmoid: therapeutic sigmoidoscopy decompression with rectal flatus tube insertion surgery: Hartmann's caecal volvulus: laparotomy (often right hemicolectomy and ileocaecal resection)
31
management for Bowel Obstruction
?fluid resus if ischaemia/strangulation, surgery within 6h no peritonitis: Drip and suck + conservative management for 72h can consider adhesiolysis, but causes more adhesions later
32
hernia management
strangulated/incarcerated = emergency surgery inguinal: conservative/routine repair femoral: urgent repair
33
hernia approaches
``` lockwood = low, elective McEvedey = high, emergency ``` incision: Gridiron/Mcburney's or Lanz Lichtenstein mesh repair
34
SBP management
resus if septic empirical Abx e.g. gen 3 ceph large volume paracentesis and albumin replacement
35
perforated peptic ulcer manage
CT scan/ABG CXR if CT not immediate NO endoscopy resuscitation + G&S laparoscopic surgery as soon as possible (open if unstable patients) for primary repair +/- omental patch Antibiotics
36
bleeding peptic ulcer management
G&S and ABG Blatchford score Endoscopy ASAP Rockall score after endoscopy CT if endoscopy not available resuscitation Antibiotics, IV PPI ``` endoscopy can be diagnostic and therapeutic adrenaline + either: mechanical clips thermal coagulation fibrin/thrombin ``` start propranolol for prophylaxis H pylori eradication
37
Abdominal presentations of IBD
``` diarrhoea + constipation + bleeding pancreatitis gallstones kidney stones bowel cancer PSC ```
38
What is the Travis score
if CRP is >45 72h after steroids treatment for IBD, 85% need colectomy
39
Management of Boerhaave's
ALL: fluid resuscitation, antibiotics Primary oesophageal repair through open thoracotomy VATS with fundic reinforcement
40
3 types of ischaemic bowel disease
acute mesenteric chronic mesenteric colonic (most common)
41
3 types of acute mesenteric ischaemia
venous embolic thrombotic
42
Management of ischaemic bowel disease
resus empirical antibiotics open embolectomy OR arterial bypass +/- bowel resection
43
investigation of ischaemic bowel disease
``` CT with contrast/angio lactate bloods sigmoid/colonoscopy will show ischaemia mesenteric angio ```
44
Creatinine changes after starting drug before stopping
>30%
45
management of chronic diverticulosis
increase fluids and fibre add laxative lose weight avoid NSAID and opiates
46
diverticulitis complications
``` haemorrhage abscess formation perforation/peritonitis stricture and fistula obstruction sepsis ```
47
oesophageal cancer management
non-metastatic/regional spread only: oesophagectomy severe: stent, laser treatment palliative chemoradiotherapy
48
sigmoid volvulus X ray
upturned U shape of dilated bowel (coffee bean)
49
severity score for UC
``` Truelove and Witts Frequency of stool blood in stool fever tachycardia anaemia raised ESR ```
50
investigations for flare up of IBD
Blood culture Stool culture Sigmoidoscopy (not colonoscopy as risk of perforation) abdominal radiograph
51
Ulcerative colitis associations
non-smokers (smoking makes better) PSC arthritis colon cancer
52
post splenectomy cautions
vaccines: pneumococcus, meningococcus, hib long term Pen V risk of malaria
53
investigations achalasia
barium swallow upper GI endoscopy (esp for malignancy) manometry needed to confirm diagnosis
54
management of achalasia
balloon dilatation Surgical cardiomyotomy Botox injections Per-oral endoscopic myotomy
55
Barrett's oesophagus treatment
conservative: avoid triggers, lose weight, smaller meals, stop smoking, reduce alcohol, sleep with head raised PPI ranitidine if PPI not helping Surgery: laparoscopic fundoplication radiofrequency ablation
56
glasgow-imrie score
``` Pancreatitis Pao2 Age Neutrophils Calcium Renal function Enzymes Albumin Sugar ```
57
what to monitor in TPN
glucose 4h temp daily electrolytes, inspection of line/dressing fluid balance
58
diagnosis of PSC
history MR cholangiopancreatography (beading of bile duct) Biopsy No specific antibody, but may be ANCA+ will be AMA negative (that's PBC)
59
PSC management
``` Conservative lifestyle optimisation cholestyramide for pruritis Vitamin supplements (D, calcium) bisphosphonates ERCP of any strictures Liver transplant ```
60
difference between femoral and inguinal hernia
femoral hernia is inferior and lateral to pubic tubercle | inguinal is superior and medial
61
difference between indirect and direct inguinal hernia
reduce hernia and press on deep ring (midpoint of inguinal ligament) if direct it will protrude on coughing is very inaccurate
62
``` artery supply of abdomen Stomach and liver Duodenum Ascending colon Transverse Descending/colon ```
Stomach and liver: coeliac trunk (L/R gastrics and hepatic artery) Duodenum: SMA Ascending colon: SMA Transverse: proximal 2/3 SMA distal 1/3 IMA Descending/colon: IMA
63
Acute diverticulitis investigations
No bleeding: contrast CT | Bleeding: Urgent colonoscopy
64
Acute diverticulitis management
Admission and supportive treatment Analgesia: Paracetamol ABx: Co-Amoxiclav or metro+another Abx (e.g. cef) ?Clear liquid diet/low residue diet
65
ERCP complications
pancreatitis cholangitis haemorrhage duodenal perforation

PACES Management (11 decks)

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