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gastro Flashcards

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1
Q

LOS anatomical contributions?

A

left and right crux of diaphragm
phrenosophageal ligament
angle of his - prevents reflux

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2
Q

stages of swallwpoing?

A

stage 0, oral - chewing and saliva, both sphincter closefd
1 , pharyngeal - UOS open reflexively, LOS opened by vasovagal reflex (receptive relaxation reflex)
2 , UO - UOS closes, contractions of circular and long muscles
3 LO - LOS closes

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3
Q

how can oesophageal motility be measured?

A

manometry

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4
Q

normal oesophageal pressures?

A

peristaltic - 40 mmHG
LOS resting - 20 mmHG
LOS receptive relaxation - <5mmHg

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5
Q

what is receptive relaxation mediated by?

A

inhibitory noncholinergic nonadrenergic neurons of myenteric plexus

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6
Q

what do you call pain on swallowing?

A

odynophagia

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7
Q

regurg vs reflux?

A

return of oesophageal contents from above obstruction

passive return of gasproduodenal contents to mouth

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8
Q

what causes oesophageal hypermotilitiy?

A

achalasia

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9
Q

pathophysiology of achalasia?

A

loss of ganglion cells in auerbachs myenteric plexus in LOS wall → ↓ activity of inhibitory NCNA neurones (less relaxation , more contraction) → ↑ resting LOS pressure → food collects in oesphagus → ↑ pressure → dilation → peristalsis stops

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10
Q

causes of achalasia?

A

primary - unknown

secondary - chagas disease, protozoa infection, amyloid, sarcoma, eosinophilic oesophaigtiis

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11
Q

onset of achalasia?

A

insidious

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12
Q

what does acahalsia largely increase the risk of ?

A

oesophageal cancer

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13
Q

treatment options for achalasia?

A

pneumatic dilatation - weakens LOS by stretching or tearing
Hellers myotomy - removal of muscle from stomach and oesophagus
dor Fundoplication - anterior funds folded over oesophagus and sutured to right side of myotomy
peroral endoscopic myotomy

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14
Q

what causes oesophageal hypomotility?

A

scleroderma

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15
Q

pathophysiology of scleroderma?

A

neuronal defects → atrophy of oesophageal smooth muscle → distal peristalsis ceases → ↓ LOS resting pressure → GORD develops

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16
Q

causes of scleroderma?

A

autoimmune

assoicted with CREST syndrome

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17
Q

treatment options for scleroderma?

A

pro kinetics to improve peristalsis force - cisapride

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18
Q

pathophysiology of corkscrew oesophagus?

A

incoordinate contractions → dysphasia and chest pain
pressures of 400-500 mmHg
circular muscle hypertrophy
corkscrew appearance on barium swallow

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19
Q

treatment options for corkscrew oesophagus?

A

forceful pneumatic dilatation of cardia

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20
Q

2 types of vascular anomalies that can. cause dysphagia?

A

dysphagia lusoria - aberrant right subclavian artery

double aortic arch

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21
Q

3 most likely areas of oesophageal perforations?

A

cricopharangeal, aortic & bronchial, diaphragmatic constrictions

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22
Q

cause of osphaegal perforations?

A 
iatrogenic
boerhaaves
foreign body
trauma
intraoperative
malignancy
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23
Q

what procedure is oesophageal perf likely to occur?

A

OGD especially if diverticula or cancer

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24
Q

how can boerhaaves cause oesophageal perf?

A

sudden ↑ in intra oesophageal pressure w negative thoracic pressure (vomitting against closed glottis)

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25
symptoms of traumatic oesophageal perf?
dysphagia blood in salvia haematemsis surgical emphysema
26
how does oesophageal perf usually present?
pain, fever, dysphagia, emphysema
27
oesophageal perf investigations?
CXR CT gastrogaffin swallow OGD
28
management of oesophageal perf?
``` NBM, IV fluids, BS Abs & antifungals ITU/HDU bloods tertiary referal surgery ```
29
when is surgery not default management for oesophageal perf?
if theres minimal contamination, its contained or patient is unfit
30
surgical options for oesophageal perf?
vascularised pedicle flap dor fundoplication drains oesophagectomy
31
what increases LOS pressure?
acetylcholine , a adrenergic agonists, protein food, high intraabdominal pressure → reflux inhibited
32
what decreases LOS pressure?
VIP, B adrenergic antagonists, dopamine, NO, chocolate, fat, smoking → promotes reflux
33
what can causes sporadic reflux?
pressure on full stomach swallowing transient sphincter opening
34
what mechanisms protect the oesophagus following reflux?
volume clearance - oesophageal peristalsis reflex pH clearance - saliva epithelium - barrier properties
35
outline the process of oesophageal protective mechanisms failing (GORD)
↓ sphincter pressure, ↑ transient sphincter opening. ↓ saliva production/buffering capacity, defective mucosa, hiatus hernia → → reflux oesphagitis → epithelial metaplasia → carinoma
36
Ixs for GORD?
OGD manometry 24 hr oesophageal pH recording
37
treatment options for GORD?
lifestyle - wt loss, less EtOH, x smoking PPIs dilatation peptic strictures laparoscopic Nissans fundoplication (wrapping funds around oesophagus)
38
areas of stomach and what they secrete?
cardia & pylorus - mucus body & fundus - mucus, HCl, pepsinogen antrum - gastrin
39
causes of erosive & haemorhagic gastritis?
``` NSAIDS iscahemia trauma alcohol bruns MOF ```
40
what doe erosive & haemorhagic gastritis lead to?
acute ulcer → gastric bleeding/perforation (anywhere in stomach)
41
cause of nonerosive chronic active gastritis?
H pylori (antrum)
42
Tx for H pylori gastritis?
amoxicillin. clarithromycin and pantoprazole for 7-14/7
43
pathophysiology of atrophic fundal gland gastritis?
autoantibodies against parts and products of parietal cells in fundus → parietal cells atrophy → ↓ acid & IF secretion (( → ↑ gastrin secretion → ECL hyperplasia → carcinoid )) ((→ pernicious anaemia)
44
what stimulates gastric secretions?
acetylcholine from vagus ps fibres gastrin from antrum g cells histamine from ECL and mast cells
45
what inhibits gastric secretions?
secretin in SI somatostatin prostaglandins, TGF-a, adenosine (decreased by NSAIDs)
46
how does the mucosa protect against acid?
mucus film HCO3- secretion (requires prostaglandins) epithelial barrier (tight junctions) mucosal blood perfusion (will take away any H ions that get through)
47
mechanisms of repairing epithelial defects?
migration of epithelial cells - close gap cell growth - stimulated by EGF, TGF-a, IGF1, gastrin leukocytes and macrophages remove necrotic cells, angiongesis, ECM regeneration, cell division.
48
what can cause an ulcer formation?
``` increased HCl secretion h pylori reduced HCO3- secretion ↓ cell formation ↓ blood perfusion ```
49
treatment options for ulcers?
PPI/H2 blocker amoxicillin, clarithromycin, pantoprazole 7-14/7 elective sx
50
if ulcers don't heal w medcial tretamet what do you do?
``` should heal in 12 weeks, if not change medication check serumgastrin (g cell hyperplasia or gastronoma) OGD ```
51
when should sx be considered for ulcers?
``` intractability of medical therapy haemorrhage obstrucion perforation relative eg. need of nsaids or steroids ```
52
what is riglers sign?
free intraperitoneal air from perforated viscus
53
what is indicative of perforated viscus on x ray?
free intraperitoneal and subdiaphrgamatuic air
54
most common site of ulcers in GIT?
first part of duodenum / pylorus
55
what criteria is used to assess acute pancreatitis?
modified glasgow criteria PANCREAS score ≥3 within 48hrs onset = severe pancreatitis (or CRP ≥200)
56
acute pancreatitis management?
``` fluid resus analgesia pancreatic rest ± nutritional support determine cause severe → HDU ```
57
level and structure at subcostal plane?
L3 - IMA
58
level and structure at supracristal plane?
l4 - bifurcation of aorta
59
foregut , midgut and hindgut locations?
f - distal oesophagus to 2nd part of duodenum m - distal 2nd half of duodenum to primal 2/3 transverse colon h - distal2/3 transverse colon to rectum
60
differences between visceral and parietal pian?
v - dull, crampy, burning, autonomic, embryological origin p - sharp, ache, well-localised, somatic
61
foregut , midgut and hindgut innervation and pain site?
f - t5-t9, epigastrium m - t10-t11, umbilical h - l1-l2, suprapubic
62
constant vs colicky pian?
constant - inflammation, worse with movement, spleen, kidney, liver tubular obstruction - fluctuates in severity, move to try get comfort, ureter, gallbladder, bowel
63
colicky pain that becomes constant suggests?
ischemia
64
what is the most potent stimulus for drinking water?
plasma osmolality increase
65
where does ADH act?
aquaporin 2 channels in CD
66
where are osmoreceptors found?
hypothalamus - organum vasculosum of lamina terminals and subfornical organ
67
how do osmoreceptors lead to ADH release?
concentrated plasma → cells shrink → ↑ proportion of cation channels → membrane depolarises & ↑ firing frequency → ↑ signals to post pitutuirary → ↑ ADH produced → fluid retention and drinking
68
what are the effects of angiotensin II?
vasoconstriction ↑ sympathetic activity thirst stimulate aldosterone release from adrenal cortex zona glomerulosa water retention via na absorption and k excretion adh secretion
69
structure and function of arcuate nucleus?
in hypothalamus has incomplete BBB allows access to peripheral hormones stimulatory neurons - NPY & Argp (orexigenic) inhibitory neurons - POMC (anorexigernic) regulation food intake by integrating central and peripheral signals
70
which neuorones does leptin stimulate and inhibit?
stim - POMC | inhibit - NPY & ARGP
71
what happens when POMC neurons are stimulated?
release a-MSH which stimulates MC4R in the paraventricular nucleus → ↓ food intake
72
what happens when ARGP neurons are stimulated?
MC4r in paraventrivcular nucleus is inhibited → ↑ food intake
73
what can cause morbid obesity?
MC4R mutations | POMC deficiency
74
what is the adipostat mechanism?
adipostat hormone produced from fat → detected b y hypothalamus → alters neuropeptides to increase/decrease food intake
75
what is leptin?
hormone made by adipocytes and circulates in plasma acts on hypothalamus to regulate appetite and thermogenesis eg ↑ leptin → ↓ decreased appetite & ↑ energy expenditure
76
obesity in relation to leptin?
obese people have ↑ leptin but also have leptin resistance so has no effect
77
what gut hormones regulate appetite?
ghrelin → stims appetite and gastric emptying peptide YY → ↓ food intake
78
when are ghrelin levels highest?
just before meals
79
ghrelin functions?
``` ↑ gastric motility ↑ acid secretion stimulate ARGP & NPY neurons inhibit POMC neurons increase appetite ```
80
where and when is PYY released?
terminal ileum and colon in reposing to feeding
81
function of PYY?
↓ appetite inhibits NPY release stimulates POMC neurons
82
what is dysbiosis?
when theres altered microbiota composition in the gut eg more pathobionts
83
what can cause dysbiosis/
``` infection diet xenobioitcs hygiene genetics ```
84
what are the physical barriers to pathogens in the gut?
epithelial barrier peristalis enzymes acidic pH
85
immunological tissues of the gut?
Mucosa associated and gut associated lymphoid tissue
86
how does the epithelial barrier defend against pathogens?
goblet cells produce a mucus layer monolayer with tight junctions preventing entyr paneth cells in crypts of Lieberkuhn → antimicrobial peptides/defensins and lysozyme
87
structure and location of MALT?
submucosa below epithelium lymphoid mass containing follicles surrounded by HEV post capillary venues → easy passage of lymphocytes found in oral cavity
88
what cells does GALT contain?
B & T lymphocytes , macrophages, APC, specific epithelial lymphocytes
89
types of GALT?
unorganised : intraepithelial and lamina propria lymphocytes | organised : Peyers patches (SI) , caecal patches (LI), isolated lymphoid follicles, mesenteric lymph nodes
90
structure and location of peyers patches? how do they facillitate antigen uptake?
submucosa of SI , distal ileum aggregated lymphoid follicles covered in follicle associated epithelium no goblet cells, microvilli or IgA organised collecting of naive T&B cells M cells in FAE take up antigens M cells have IgA receptors to transfer IgA-bacteria complex into patch
91
how do antigens enter peyers patches?
m cells have IgA receptors which can help transfer antigen-iga complex into patch OR transepithelial dendritic cells can take up antigens
92
outline the B cell adaptive response in peyers patches?
T cells an epithelial cells influence B cell maturation via cytokines naive B cells express IgM and then switch to IgA upon antigen presentation populate lamina propria
93
function of secretory IgA?
secreted by B cells | binds luminal antigens → prevent adhesion and invasion
94
why do enterocytes have a rapid turnover?
~36hrs can be directly affected by toxins in diet turnover diminishes any negative effects
95
outline pathogens is of cholera infection?
vibrio cholera → releases cholera enterotoxin → ↑ adenylate cyclase activity → ↑cAMP → ↑ active transport of ions into gut lumen → ↑ water secretion → diarrhoea
96
symptoms of cholera?
``` dehydration watery diarhoea vomiitng nasuea abd pain ```
97
how is cholera diagnosed?
bacterial culture from stool sample on selective agar | or dipstick
98
cholera treatment?
oral rehydration
99
vaccine against cholera?
dukoral
100
most common cause of watery diarrhoea in children?
rotavirus
101
vaccination against rotavirus?
rotarix
102
viral causes of infectious diarrhoea?
rotavirus | norovirus
103
bacterial causes of infectious diarrhoea?
salmonella e coli Campylobacter jejuni - undercooked meat, untreated water and milk, azithromycin clostridium difficile
104
management for c diff diarrhoea?
isolation stop current Abs giver metronidazole / vancomycin faeceal microbiota transplantation
105
medical condition causes of secondary polydipsia?
``` diabetes insipidus and mellitus kidney failure conns syndrome Addisons disease sickle cell anaemia ```
106
what medications can cause secondary polydipsia?
laxatives diuretics antidepressants
107
causes of primary polydipsia?
mental illness - schizophrenia , depression, anxiety, anorexia, drugs brain injuries organic brain damage
108
systemic effects of polydipsia?
``` kidney and bone damage headache nasuae cramps slow refelxes slurred speech low energy confusion seizures ```
109
types of eating disorders?
``` binge eating anorexia nervosa bulimia nervosa pica rumination syndrome avoidant/restrcitve eating ```
110
how is anorexia staged?
mild BMI≥17 moderate 16-16.99 severe 15-15.99 extreme ≤15
111
what neurotransmitter is involved in anorexia?
serotonin
112
how is obesity defined?
BMI ≥30 or BMI ≥25 + comorbidity/risk factor
113
when is surgical treatment indicated for people with obesity? options?
BMI ≥40 or ≥35 + comorbidity gastric bypass & sleeve gastrectomy remission of diabetes and OSA
114
how does bariatric sx help with obesity?
reduces ghrelin → less appetite (stomach becomes full w less food) ↑ GLP1&2 (L cells) & PYY → ↑ insulin release . ↓ glucagon , ↑ satiety
115
causes of non infectious diarrhoea?
``` antibioitcs IBD post infectious IBS microscopic or iscahemic colitis coeliac disease haemorrhoids ```
116
how is dirhaoea classified?
non-severe - WCC < 15, creatine <150 severe WCC ≥ 15, creatinine ≥150 fulminant colitis - hyoptension/shock/ileus/toxic megacolon
117
antibiotics for diarhoea?
vancomycin fidaxomicin metronidazole
118
how is toxic megacolon seen ion X-ray?
dilated small and large bowel
119
when is surgery indicated for fulminant colitis?
``` colonic perf necrosis or full thickness ischaemia intra abd hypertension / abd compartment syndrome signs of peritonitis end organ failure ```
120
what is pseudomembranous colitis?
associated w c diff severe colonic disease yellow white plaques that form pseudomembranes on mucos confirmed with endoscopy ± biopsy
121
what would suggest non infectious diarrhoea instead of infectious?
chronicity
122
ulcerative colitis management?
steroids mesalazine immunosuppressants - azathioprine, methotrexate biologics - anti-TNF
123
impacts of malnutrition?
``` greater postoperative mortality poorer clinical outcomes functional decline ↑ hospital stay pressure sores re-admssions public health cost ```
124
causes of malnutrition in hospital?
``` co-morbidites repeated NBM mealtime inflexibility poor dentition dysphagia low mood poly pharmacy disease related ```
125
indications for nutrition support?
BMI < 18.5 unintentional weight loss ≥10% in last 3-6/12 BMI < 20 and unintentional weight loss ≥5% in last 3-6/12 eaten little/nothing for ≥5days poor absorptive capacity/high nutrient losses
126
types of artificial nutrition support?
enteral (superior) | parenteral when GI tract isnt functional/accessible
127
types of enteral feeding?
NGT - gastric feeding possible NDT/NJT - gastric outlet obstructions longer than 3 months - gastrostomy/jejunostomy
128
complications of enteral feeding?
``` misplacement/blockage hyperglycaemia deranged electrolytes aspitation pian laryngeal ulceration vomting diarrhoea ```
129
why is albumin low during ↑ inflammation?
cytokines act on liver to down regulate production
130
what is refeeding syndrome?
occurs in malnourished or starved patient on the reintroduction of oral, enteral, parental nutrition starvation → glycogenolysis, gluconeogensis → protein, fat, electrolyte ↓↓ → refeeding with fluids salts nutrients → ↑ insulin → protein and glycogen synthesis → ↑ glucose and electrolyte uptake → hypokalamia, magnesaemia, phosphataemia , ↓ thiamaine, oedema
131
what are the consequences of refeeding syndrome?
``` arrhythmia tachycardia heart failure resp depression encephalopathy wernickes encephalopathy ```
132
what is an early indicator of adequate nutritional support?
hand grip strength
133
target stoma output?
<1.5L/day
134
two types of oesophageal cancers?
squamous cell carcinoma - upper 2/3, acetaldehyde pathways, more common in less developed world adenocarcinoma - metaplastic columnar epithelium, lower 1/3, acid reflux, more in developed countries
135
what is the progression from reflux to oesophageal cancer?
oesophagi's → barret's oesophagus (metaplsia) → low grade dysplasia → high grade dysplasia → adenocarcinoma (neoplasia)
136
what are the barret's surveillance guidelines?
no dysplasia → every 2-3 years low grade dysplasia → every 6 month high grade → intervention
137
how can oesophageal cancer present→?
late presentation dyspahgia wt loss
138
radical surgery option for oesophageal cancer?
neo-adjuvant chemo→ oesophagectomy (Ivor lewis approach)
139
causes of colorectal cancer?
sporadic - older people familial hereditary syndrome , eg familial adenomatous polyposis
140
how can caecal and right sided colon cancer present?
iron deficiency anaemia change of bowel habit eg diarhoea distal ileum obstruction palpable mass
141
how can sigmoid and left sided colon cancer present?
pr bleeding mucus thin stool
142
rectal carcinoma presentation?
PR bleeding, mucus tenesmus anal, perineal, sacral pain
143
presentations of colorectal cancer that has metastasised?
``` jaundice, hepatomegaly cough, monophonic wheeze bone pain regional lymph nodes sister Mary Joseph nodule - peritoneum ```
144
examinations of primary colorectal cancer?
abdominal mass felt on DRE rigid sigmoidoscopy abdo tenderness and distension
145
investigations for colorectal cancer?
faecal occult blood using faecal immnochemical test (FIT) (avoid red meat, nsaids, vit c before test) blood tests : FBC, tumour marker (CEA useful for monitoring) colonoscopy - can see lesions<5mm and remove small polyps CT colonoscopy/graphy - can see lesions ≥5mm , less invasive MRI pelvis - rectal cancer CT chest/abdo/pelvis for staging
146
colorectal cancer management?
right sided/transverse : resection (right hemicolectomy) and primary anastamosis left sided : hartmanns procedure (proximal end colostomy) , primary anastomosis, palliative stent
147
what is the commonest form of pancreatic cancer?
pancreatic ductal adenocarcinoma
148
risk factors for pancreas canc er?
chronic pancreatitis T2DM smoking family hx
149
how do PDAs evolve?
non-invasive neoplastic precursor lesions (pancreatic intraepithelial neoplasias) acquire genetic and epigetnic alterations
150
what are the clinical presentations of carcinoma of the head of the pancreas?
``` jaundice (invasion/compression of CBD) palpable gallbladder (courvoisiers sign) weight loss (malabsorption, diabetes) pain - epigastric, can radiate to back persistent vomitting if duodenal obstruction GI bleeding ```
151
how does carinoma of body&tail of pancreas differ to that of the head?
less common at diagnosis they are often more advanced back pain more common & marked wt loss jaundice is uncommon
152
investigations for pancreatic cancer?
``` tumour marker CA19-9 ultrasonography dual phase CT /MRI - mets, respectability MRCP ERCP - biopsies, bilary stenting EUS - vascular invasion, small tumours laparoscopy ± US - liver & peritoneal mets PET ```
153
what is tumour marker CA19-9 used for and when is it unreliable?
pancreatic cancer | is elevated in pancreatitis, hepatic dysfunction, obstructive jaundice
154
what is the primary liver cancer?
hepatocellular carcinoma | associated with underlying cirrhosis and aflatoxin exposure
155
what is gallbladder cancer assoicted with?
gallstones porcelain gall bladder calcification) chronic typhoid infection
156
aetiology of cholangiocarcinoma?
primary sclerosing cholangitis ulcerative colitis liver flukes choledochal cyst (dilation of bile duct)
157
from what cancer do secondary liver metastases come from?
colorectal cancer
158
causes of microcytic anaemia?
iron deficiency anaemia chronic disease thallasaemia sideroblastic
159
causes of normocytic anaemia?
``` aplastic bkeeding chronic disease destruction - haemolysis endocrine - hypothyroidism/adrenalism ```
160
causes of macrocytic anaemia?
``` foetus alcohol thyroid disorders reticulocytosis B12/folate deficiency cirrhosis ```
161
2 GIT malignant causes of iron deficiency anaemia?
colonic adenocarcinoma | gastric carcinoma
162
how can bowel ischaemia present?
sudden onset crampy abdo pain bloody loose stool (currant jelly) fever signs of septic shock
163
risk factors for bowel ischaemia?
``` age≥65 arrythmias atherosclerosis thrombophilia vasculitis sickle cell disease shock causing hypotension ```
164
differences between acute mesenteric iscahemia and ischaemic colitis?
AMI - small bowel, thromboemboli, sudden onset, abdo pain out of proportion IC - large bowel, low flow states/atherosclerosis, mild gradual onset, moderate pain and tenderness
165
what bloods would you do for bowel ischemia and what would they show?
FBC - neutrophilic leukocytosis | VBG - lactic acidosis
166
imaging for bowel ischamia?
CTAP/CT angiogram | detects disrupted blood flow, vascular stenosis
167
management for mild/moderate ischemic colitis?
``` IV fluids bowel rest/nbm bs abx NG tube anticoagulation serial abdo exams and repeat imaging ```
168
what are the indication for surgery for bowel ischaemia?
``` small bowel ischemia peritonitis/sepsis signs haemodynamic instability massive bleeding fulminant colitis with toxic megacolon ```
169
surgical options for bowel ischemia?
exploratory laparotomy - resect necrotic bowel ± surgical embolectomy/mesenteric arterial bypass endovascular revascularisation - ballon angioplasty/thrmobectomy
170
presentation of acute appendicitis?
``` periumblical pain that migrates to RLQ in 24hrs anorexia nausea vomitting low grade fever bowel changes ```
171
investigations for acute appendicitis and results?
FBC - neutrophilic leukocytosis, ↑ CRP, electrolyte imbalances urinalysis - pyuria/haematuria CT - gold standard USS - child, pregnant, breastfeeding MRI - pregnancy if US inconclusive diagnostic laparoscopy
172
what can be used to assess likeliness of appendicitis?
alvarado score ≤4 = unlikely 5-6 = possible ≥7 = likely
173
conservative management of acute appendicitis?
iv fluids, analgesia, ABx access, phlegmo, sealed perf → drainage indicated in uncomplicated appendicitis & negative imaging
174
surgical management of acute appendicitis?
laparoscopic appendicectomy (less pain, less infection, reduced hospital stay, better QoL)
175
two types of bowel obstruction?
paralytic ileus | mechanical
176
causes of small bowel obstruction?
adhesions neoplasia incarcerated hernia crohns disease
177
causes of large bowel obstruction?
``` colorectal carcinoma (esp LHS) volvulus diverticulitis faecal impaction Hirschsprung disease ```
178
difference in presentations between small and large bowel obstructions?
abdo pain - colicky central VS colicky/constant vomitting - early onset, billions VS late onset, billions → faecal constipation - late sign VS early sign abdo distention - less significant VS early significant sign both : dehydration, high pitched → absent bowel sound, diffuse abdo tenderness
179
what suggests a strangulated bowel obstrcution?
``` colicky to continuous pain tachycardia pyrexia peritonism absent/reduced bowel sounds leucocytosis ↑ CRP ```
180
bowel =obstruction investigations?
``` bloods - -↑wcc/crp = strangulation/perf -elctorlyte imbalance VBG -metabloic alkalosis if vomitting -metabolic acidosis if strangulation ``` erect cxr/axr - dilated bowel loops CT abdo/pelvis
181
bowel obstruction conservative management & indications?
no signs of iscahemia/clinical deterioration NBM IV fluid resus analgesia, antiemetics, electrolyte correction NG tube and urinary catheter stool evacuation for faecal impaction rigid sigmoidoscopic decompression for volvulus oral gastrograffin for SBO
182
bowel obstruction surgical management & indications?
``` haemodynacim instability signs of sepsis complete BO w ischaemia closed loop obstrcution persistent BO despite conservative managemtn ``` exploratory laproscopy/laparotomy restore intestinal transit bowel resection with anastomosis or stoma
183
presentation of a GI perforation?
sudden onset severe abdo pain w distention diffuse guarding, rigidity, rebound tenderness pain worse w movement nausea, vomitting, constipation fever, tachycardia, tachpnoea, hypotension ↓ / absent bowel sounds
184
where does the pain from a perf peptic ulcer get referred to?
shoulder
185
investigations for a GI perf?
FBC - neutrophilic leukocytosis VBG - lactic acidosis erect CXR - sub diaphragmatic free air CT abdo/pelvis - pneumoperitoneum, free gI content, localised mesenteric fat stranding
186
differential diagnoses for GI perf?
acute pancretaitis appendicitis acute cholecystitis MI
187
conservative management for GI perf?
``` NBM NG tube IV fluid resus BS Abx IV PPI analgesia and antiemetics urinary catheter ```
188
surgical management for GI perf?
for generalised peritonitis ± sepsis ``` exploratory laproscopy/otomy primary closure of perf ± omental patch resection w anastomosis/stoma obtain intrabdominal fluid for cultures peritoneal lavage ```
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conservative management for a sigmoid volvulus?
sigmoidoscope with soft rubber rectal tube → untwists volvulus
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what will be raised in acute mesenteric iscahemia?
serum lactate
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investigations for AMI?why?
CT abdo pelvis with contrast can show thrombus in mesenteric vessels abnormal enhancement of bowel wall presence of embolus or infarction of other organs
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surgical management for AMI?
emergency exploratory laparotomy | restore SMA blood flow (embolectomy or arterial bypass) , resect nonviable bowel
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risk factors for SMV thrombosis?
portal htypertension portal pyaemia SCD
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what is portal pyaemia?
septic thrombophlebitis of portal venous system | can be complication of appendicitis / diverticulitis
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how can portal pyaemia present on CT?
air in SMV and intrahepatic portal venous system

BRS 2 (12 decks)

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