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Appendicitis/ Bowel Disease Flashcards

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1
Q

most common acute abdominal condition requiring surgery.

A

Acute appendicitis

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2
Q

Acute appendicitis can occur at any age but is most common in young people aged 10-20 years.

A

true

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3
Q

Acute appendicitis patients often report the pain being worse on

A

worse on coughing or going over speed bumps. Children typically can’t hop on the right leg due to the pain.

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4
Q

Acute appendicitis Abdominal pain is seen where?

A

peri-umbilical abdominal pain

radiating to the right iliac fossa (RIF)

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5
Q

Acute appendicitis mild pyrexia is common

A

true

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6
Q

Acute appendicitis o/e

A

generalised peritonitis - rebound and percussion tenderness, guarding and rigidity

psoas sign: pain on extending hip if retrocaecal appendix

Rovsing’s sign (palpation in the LIF causes pain in the RIF) is now thought to be of limited value

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7
Q

pelvic abscess o/e

A

digital rectal examination may reveal boggy sensation if pelvic abscess is present, or even right-sided tenderness with a pelvic appendix

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8
Q

Acute appendicitis diagnosis?

Bloods

A

neutrophil-predominant leucocytosis is seen in 80-90%

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9
Q

Acute appendicitis diagnosis?

Urinalysis

A

urinalysis may show mild leucocytosis but no nitrites

exclude pregnancy in women, renal colic and urinary tract infection

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10
Q

there are no definite rules on the use of imaging and its use is often determined by the patient’s gender, age, body habitus and the likelihood of appendicitis

A

true

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11
Q

imaging and acute appendicitis

A

Clincial diagnosis - thin males

US - females query pelvic pathology

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12
Q

Mx acute appencititis

A

laparoscopic appendicectomy

prophylactic intravenous antibiotics

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13
Q

patients with perforated appendicitis (typical around 15-20%) require

A

copious abdominal lavage.

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14
Q

appendicitis - be wary in the older patients who may have either an underlying caecal malignancy or perforated sigmoid diverticular disease.

A

true

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15
Q

Angiodysplasia is

A

vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia.

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16
Q

Angiodysplasia is assoc with

A

aortic stenosis

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17
Q

Angiodysplasia is generally seen in

A

elderly patients

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18
Q

Angiodysplasia diagnosis

A

colonoscopy

mesenteric angiography if acutely bleeding

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19
Q

Angiodysplasia mx

A

endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used

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20
Q

Clostridium difficile is a

A

Gram positive rod

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21
Q

Clostridium difficile produces exo/endotoxin

A

exotoxin

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22
Q

Clostridium difficile roduces an exotoxin which causes intestinal damage leading to a syndrome called

A

pseudomembranous colitis

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23
Q

Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics
which abs?

A

Clindamycin

cephalosporins

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24
Q

Leading cause of Clostridium difficile.

A

Second and third generation cephalosporins

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25
C diff Other than antibiotics, risk factors include:
PPIs
26
C diff Features
diarrhoea abdominal pain a raised white blood cell count (WCC) is characteristic if severe toxic megacolon may develop
27
C diff | severity scale?
Mild: Normal WCC Moderate: ↑ WCC ( < 15 x 109/L) Typically 3-5 loose stools per day Severe: ↑ WCC ( > 15 x 109/L) or an acutely ↑ creatinine (> 50% above baseline) or a temperature > 38.5°C or evidence of severe colitis(abdominal or radiological signs) life-threatening: Hypotension Partial or complete ileus Toxic megacolon, or CT evidence of severe disease
28
Clostridium difficile Diagnosis?
is made by detecting Clostridium difficile toxin (CDT) in the stool Clostridium difficile antigen positivity only shows exposure to the bacteria, rather than current infection
29
Management C Diff?
first-line therapy is oral metronidazole for 10-14 days if severe or not responding to metronidazole then oral vancomycin may be used
30
patients who are not responding , particularly those with multiple co-morbidities c diff?
fidaxomicin
31
C Diff for life-threatening infections?
combination of oral vancomycin and intravenous metronidazole should be used
32
It is currently thought there are three types of colon cancer:
sporadic (95%) hereditary non-polyposis colorectal carcinoma (HNPCC, 5%) familial adenomatous polyposis (FAP, <1%
33
Most common form of inherited colon cancer.
HNPCC
34
HNPCC, an autosomal dominant condition
True
35
Around 90% of patients develop cancers, often of the proximal colon
true
36
Colorectal Ca most common genes involved
MSH2 (60% of cases) | MLH1 (30%)
37
Patients with HNPCC are also at a higher risk of other cancers, with what cancer being the next most common association, after colon cancer.
endometrial
38
Colorectal ca | The Amsterdam criteria are sometimes used to aid diagnosis:
at least 3 family members with colon cancer the cases span at least two generations at least one case diagnosed before the age of 50 years
39
what is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years.
FAP
40
FAP is what?
mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.
41
A variant of FAP called Gardner's syndrome can also feature
osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin
42
Diverticulosis is an extremely common disorder characterised by multiple outpouchings of the bowel wall, most commonly in
sigmoid colon.
43
Risk factors diverticulosis
increasing age | low-fibre diet
44
Diverticulosis sx
painful diverticular disease: altered bowel habit, colicky left sided abdominal pain.
45
diverticulosis high fibre diet is usually recommended to minimise symptoms
true
46
One of the diverticular become infected. The classical presentation is:
left iliac fossa pain and tenderness anorexia, nausea and vomiting diarrhoea features of infection (pyrexia, raised WBC and CRP)
47
Diverticulitis mx
mild attacks can be treated with oral antibiotics more significant episodes are managed in hospital. Patients are made nil by mouth, intravenous fluids and intravenous antibiotics (typical a cephalosporin + metronidazole) are given
48
Complications of diverticulitis include:
abscess formation peritonitis obstruction perforation
49
Ischaemia to the lower gastrointestinal tract can result in a variety of clinical conditions. Whilst there is no standard classification it can be useful to separate cases into 3 main conditions
acute mesenteric ischaemia chronic mesenteric ischaemia ischaemic colitis
50
bowel ischaemia Common predisposing factors
increasing age atrial fibrillation - particularly for mesenteric ischaemia other causes of emboli: endocarditis, malignancy cardiovascular disease risk factors: smoking, hypertension, diabetes cocaine: ischaemic colitis is sometimes seen in young patients following cocaine use
51
bowel ischaemia bloods typically show
elevated white blood cell count associated with a lactic acidosis
52
bowel ischaemia diagnosis
CT
53
Ischaemic colitis describes
acute but transient compromise in the blood flow to the large bowel.
54
Ischaemic colitis more likely to occur in
'watershed' areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.
55
Ischaemic colitis Investigations
'thumbprinting' may be seen on abdominal x-ray due to mucosal oedema/haemorrhage
56
Metabolic alkalosis - Causes
``` vomiting / aspiration (e.g. peptic ulcer leading to pyloric stenos, nasogastric suction) diuretics liquorice, carbenoxolone hypokalaemia primary hyperaldosteronism Cushing's syndrome Bartter's syndrome ```
57
Molecular biology techniques
Southern blotting Detects DNA Northern blotting Detects RNA SNOW (South - NOrth - West) DROP (DNA - RNA - Protein)
58
Molecular biology techniques Western blotting detects?
Detects proteins Uses gel electrophoresis to separate native proteins by 3-D structure Examples include the confirmatory HIV test
59
Molecular biology techniques - what is ELISA
a type of biochemical assay used to detect antigens and antibodies a colour changing enzyme is attached to the antibody if looking for an antigen and to an antigen if looking for an antibody the sample therefore changes colour if the antigen or antibody is detected an example includes the initial HIV test
60
Peutz-Jeghers syndrome is
autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract
61
Peutz-Jeghers is assoc with freckles
true | pigmented freckles on the lips, face, palms and soles
62
PJS he polyps themselves don't have malignant potential, around 50% of patients will have died from another gastrointestinal tract cancer by the age of 60 years.
true
63
PJS responsible gene
LKB1 or STK11
64
Peutz-Jeghers syndrome mx
conservative unless complications develop
65
Small bowel bacterial overgrowth syndrome (SBBOS) is
disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.
66
SBBOS risk factors
neonates with congenital gastrointestinal abnormalities scleroderma diabetes mellitus
67
SBBOS many of the features overlap with irritable bowel syndrome
true
68
SBBOS diagnosis
hydrogen breath test | clinicians may sometimes give a course of antibiotics as a diagnostic trial
69
SBBOS mx
correction of underlying disorder | antibiotic therapy: rifaximin
70
Spontaneous bacterial peritonitis | Diagnosis
paracentesis: neutrophil count > 250 cells/ul
71
Spontaneous bacterial peritonitis most common organism found on ascitic fluid culture is
E. coli
72
Spontaneous bacterial peritonitis | Antibiotic prophylaxis should be given to patients with ascites if:
patients who have had an episode of SBP patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
73
Spontaneous bacterial peritonitis which abs
oral ciprofloxacin or norfloxacin
74
Villous adenomas are
colonic polyps with the potential for malignant transformation. They characteristically secrete large amounts of mucous, potentially resulting in electrolyte disturbances.
75
Villous adenomas are mostly asymptomatic
true
76
Villous Adenoma - The vast majority are asymptomatic. Possible features:
non-specific lower gastrointestinal symptoms secretory diarrhoea may occur microcytic anaemia hypokalaemia
77
Whipple's disease is
are multi-system disorder caused by Tropheryma whippelii infection
78
Whipple's disease is more common in?
more common in those who are HLA-B27 positive and in middle-aged men.
79
Whipples disease symptoms
malabsorption: diarrhoea, weight loss large-joint arthralgia lymphadenopathy skin: hyperpigmentation and photosensitivity pleurisy, pericarditis neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus
80
Whipple's disease diagnosis?
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
81
Whipple's disease mx guidelines vary
true guidelines vary: oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin

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