Gastroenterology Flashcards
(190 cards)
1
Q
Anatomical boundaries and blood supply of the GI tract?
A
Foregut = oesophagus to proximal half of 2nd part of duodenum (coeliac artery)
Midgut = distal half of 2nd part of duodenum to proximal 2/3rd transverse colon (SMA)
Hindgut = distal 1/3rd transverse colon to rectum (IMA)
2
Q
Segments of the small vs large bowel?
A
Small = duodenum → jejunum → ileum
Large = caecum → ascending → transverse → descending → sigmoid → rectum → anus
3
Q
Fat-soluble vitamins?
A
A, D, E and K
4
Q
Deficiency signs of vitamin A, B1, B3, B12, C, D and K?
A
A = night blindness
B1 (thiamine) = wernicke-korsakoff, dry beri beri, wet beri beri
B3 (niacin) = pellagra (dermatitis, diarrhoea, depression)
B12 = macrocytic anaemia, atrophic glossitis
C = scurvy (gum disease, poor wound healing)
D= rickets, osteomalacia
K = coagulopathy
5
Q
Gastroenteritis bacteria with short incubation time?
A
Staphylococcus aureus
Bacillus cereus
Clostridium perfringens
6
Q
Gastroenteritis pathogens which cause bloody diarrhoea?
A
E. Coli O157 (shiga toxin-producing)
Shigella
Salmonella
Campylobacter
Amoebiasis
7
Q
Gastroenteritis pathogens linked to severe dehydration & rice water diarrhoea, flu-like prodrome, long incubation, most common in UK, most common viral, most common in kids?
A
Severe dehydration/rice water diarrhoea = cholera
Flu-like prodrome = campylobacter
Long incubation = amoebiasis, giardiasis
Most common in UK = campylobacter
Most common viral = norovirus
Most common in kids = rotavirus
8
Q
Most common cause of Traveller’s diarrhoea and complication?
A
E. Coli O157
Haemolytic uraemic syndrome (AKI, microangiopathic haemaolysis and thrombocytopaenia)
9
Q
WHO definition of diarrhoea and timescale?
A
≥ 4 loose/watery stools a day
< 14 days = acute
> 14 days = chronic
10
Q
Common antidiarrhoeal drug and mechanism of action?
A
Loperamide
Opioid agonist
11
Q
What conditions does IBD cover?
A
Crohn’s disease
Ulcerative colitis (UC)
12
Q
Extra-intestinal features of IBD?
A
Arthritis
Osteoporosis
Episcleritis, uveitis
Erythema nodosum
Pyoderma gangrenosum
13
Q
Blood test features of IBD?
A
Anaemia
Vitamin deficiencies
Raised inflammatory markers e.g. CRP/ESR
Raised faecal calprotectin
14
Q
Bowel section most affected in Crohn’s vs UC?
A
Crohn’s = terminal ileum
UC = rectum (proctitis)
15
Q
Clinical and histological features of Crohn’s disease?
A
Diarrhoea (non-bloody)
Weight loss
Abdominal pain
Perianal disease
Histology = transmural inflammation, skip lesions, non-caseating granulomas, cobblestoning, lots of goblet cells
16
Q
Investigations for Crohn’s disease?
A
Colonoscopy + biopsy
Small bowel enema
MRI for small bowel disease
17
Q
Findings of small bowel enema in Crohn’s disease?
A
“Kantor’s string” sign
“Rose thorn” ulcers
18
Q
Drug options for inducing remission in Crohn’s disease?
A
1st line = steroid (adults), enteral nutrition (kids)
2nd line = azathioprine or mercaptopurine
3rd line = infliximab
19
Q
Drugs options for maintaining Crohn’s remission and screening test?
A
Azathioprine or mercaptopurine
→ thiopurine methyltransferase (TPMT)
20
Q
Drug for isolated perianal vs ileocaecal Crohn’s disease?
A
Perianal = metronidazole
Ileocaecal = budesonide
21
Q
Investigation and management of perianal fistulae?
A
Investigation = MRI
Management = draining seton (high) or fistulotomy (low)
22
Q
Management of perianal abscess?
A
Incision and drainage + antibiotics
23
Q
Management of anal fissures?
A
Acute = soften stool (fluids/laxatives), topical treatment
Chronic = topical GTN (1st line) or sphincterotomy (2nd line)
24
Q
Classic position of haemorrhoids?
A
3, 7 and 11 o’clock position
25
Management of haemorrhoids?
1st line = soften stool (fluids/laxatives), topical treatment
2nd line = surgery e.g. rubber band ligation, haemorrhoidectomy, stapling
26
Types of UC and where they affect?
Proctitis (rectum)
Left sided colitis (rectum + left colon)
Pancolitis (rectum + whole colon)
27
Clinical and histological features of UC?
Diarrhoea (bloody)
Tenesmus
Weight loss
Abdominal pain
Histology = mucosal/submucosal inflammation, continuous, crypt abscesses, loss of goblet cells
28
Investigations for UC?
Sigmoidoscopy/colonoscopy + biopsy
Barium enema
29
Findings of barium enema in UC?
Loss of haustra
Pseudopolyps
"Drainpipe" colon
30
Drug options for inducing remission in UC?
1st line = topical aminosalicylate
2nd line = oral aminosalicylate
3rd line = steroid
31
Drug options for maintaining remission in UC?
1st line = topical aminosalicylate
2nd line = topical + oral aminosalicylate
3rd line = azathioprine or mercaptopurine
32
Aminosalicylate examples, mechanism of action and side effects?
Examples = mesalazine, sulfasalazine
Mechanism of action = inhibits prostaglandin synthesis
Side effects = GI upset, headache, agranulocytosis, pancreatitis (mesalazine), lung fibrosis
33
Truelove and Witt's criteria for UC flare?
Mild = < 4 stools/day + little blood
Moderate = 4-6 stools/day + varying blood
Severe = > 6 stools/day + systemic upset
34
Management of severe UC flare?
1st line = IV steroids
2nd line = IV ciclosporin
3rd line = surgery
35
Surgical techniques commonly used for rectosigmoid pathology?
Hartmann's procedure + end colostomy
36
Cancer linked to IBD and which condition is it more common in?
Colorectal cancer
More common in UC
37
Classification of C. difficile infection by WCC?
Normal = mild
< 15 = moderate
> 15 = severe
N.B. life-threatening characterised by hypotension, shock, toxic megacolon etc.
38
Investigation and management of C. difficile infection?
Investigation = stool toxin
First episode = oral vancomycin (1st line) or oral fidoxamin (2nd line)
Recurrent episode = oral fidoxamin (< 12 weeks) or oral vancomycin OR fidoxamin (> 12 weeks)
Life threatening = oral vancomycin + IV metronidazole
N.B. faecal transplant an option if ≥ 2 episodes
39
Investigation and feature of toxic megacolon?
AXR
Transverse colon dilatation > 6cm
40
Clinical and histological features of coeliac disease?
Diarrhoea (non-bloody)
Steatorrhoea
Weight loss
Abdominal pain
Histology = villous atrophy, crypt hyperplasia, intra-epithelial lymphocytes
41
Conditions associated with coeliac disease?
Dermatitis herpetiformis
Hyposplenism
Type 1 diabetes mellitus
Autoimmune thyroid disease e.g. Grave's
42
Investigations and management of coeliac disease?
Anti TTG IgA antibodies + total IgA
OGD + jejunal biopsy (gold-standard)
Management = gluten-free diet
43
Vaccination advice for coeliac disease?
Pneumococcal booster every 5 years
44
Cancer linked to coeliac disease?
Enteropathy-associated T-cell lymphoma
45
Features of irritable bowel syndrome?
Abdominal pain (relieved by defecation)
Bloating
Change in bowel habit
46
Management of irritable bowel syndrome?
Pain = antispasmodic
Diarrhoea = loperamide
Constipation = bulk-forming laxative
47
Diverticulosis vs diverticular disease vs diverticulitis?
Diverticulosis = diverticula present
Diverticular disease = symptomatic diverticulosis
Diverticulitis = infected diverticulum
48
Most common site affected by diverticulosis?
Sigmoid colon
49
Feature and management of diverticular disease?
Colicky left sided abdominal pain
Management = high-fibre diet
50
Features and management of diverticulitis?
Generally unwell e.g. fever, N&V
Diarrhoea (bloody or non-bloody)
Left iliac fossa pain
Management = oral antibiotic (mild) or IV antibiotics + IV fluids (severe)
51
Hinchey classification of diverticulitis?
I = para-colic abscess
II = pelvic abscess
III = purulent peritonitis
IV = faecal peritonitis
52
Investigations and management of SBBOS?
Hydrogen breath test
Trial of antibiotics
Management = rifaxamin
53
Jejunal biopsy showing macrophages with Periodic acid-Schiff (PAS) granules and management?
Whipple's disease
Management = co-trimoxazole
54
Cause of achalasia?
Damage to myenteric plexus reducing LOS relaxation
55
Investigation, feature and management of achalasia?
Investigations = barium swallow (bird beak appearance)
Management = balloon dilatation, Heller's cardiomyotomy
56
Investigations for GORD?
Standard dose PPI trial
Upper GI endoscopy if concerned
Oesophageal pH monitoring
57
Short-term management of GORD?
1st line = high-dose PPI for 1-2 months
2nd line = H. pylori test if still symptomatic
58
Long-term management of GORD?
Ideally an antacid e.g. Gavison
Low-dose PPI if symptoms persist
59
Histology of Barrett's oesophagus?
Metaplasia of squamous to columnar epithelium
60
Management of metaplastic vs dysplastic Barrett's oesophagus?
Metaplastic = high-dose PPI + endoscopic surveillance every 3-5 years
Dysplasia = radiofrequency ablation or endoscopic mucosal resection
61
PPI examples, mechanism of action and side effects?
Examples = omeprazole, lanzoprazole
Mechanism of action = blocks H+/K+ ATPase of gastric parietal cells
Side effects = hyponatraemia, hypomagnesia, osteoporosis, increased risk of C. diff
62
Preferred PPI for patients taking clopidogrel?
Lansoprazole
63
ALARMS features of upper GI malignancy?
Anaemia/age > 55
Loss of weight
Anorexia
Recent onset
Masses/malaena/haematemesis
Swallowing issues
64
Types of oesophageal cancer, where they affect and key risk factor?
Adenocarcinoma (lower 1/3rd) = Barrett's oesophagus
Squamous cell carcinoma (upper 2/3rds) = smoking
65
Investigation for H. Pylori and rules?
Urea breath test
→ not within 4 weeks of antibiotic treatment
→ not within 2 weeks of PPI
66
H. pylori eradication?
No penicillin allergy = PPI + amoxicillin + clarithromycin or metronidazole
Penicillin allergy = PPI + clairithromycin + metronidazole
67
Complications of H. pylori infection?
Duodenal ulcers (95% responsible)
Gastric ulcers (75% responsible)
MALT lymphoma
Atrophic gastritis
68
Main feature of duodenal vs gastric ulcers?
Epigastric pain
Duodenal = worse at night, relieved by eating
Gastric = worse when eating
69
Drugs associated with peptic ulcer disease?
NSAIDs
SSRIs
Corticosteroids
Bisphosphonates
70
Investigation and management of peptic ulcer disease?
Investigation = endoscopy + rapid urease test
Management = PPI (H. pylori -ve) or H. pylori eradication (H. pylori +ve)
71
Main bleeding source in ruptured peptic ulcer?
Gastroduodenal artery
72
Investigation, feature and management of a ruptured peptic ulcer?
Investigation = erect CXR (pneumoperitoneum)
Management = endoscopic intervention + IV PPI
73
Most common causes of acute upper GI bleed and scoring systems?
Peptic ulcer disease and oesophageal varices
Glasgow-Blatchford score (pre-endoscopy)
Rockall score (post-endoscopy)
74
Blood test feature indicating an upper rather than lower GI bleed and why?
High urea
Blood proteins are dissolved in stomach
75
Outline the pathology of pernicious anaemia?
- Anti-intrinsic factor antibodies bind to intrinsic factor blocking vitamin B12
- Gastric parietal cell antibodies cause atrophic gastritis
- Decreased intrinsic factor production → low vitamin B12 absorption
76
Investigation and management of pernicious anaemia?
Investigation = anti-intrinsic factor antibodies
Management = IM vitamin B12
77
Features of Zollinger-Ellison syndrome and association?
Duodenal/pancreatic/gastric tumour
Excessive gastrin secretion
Association = MEN 1
78
Most common type of gastric cancer, sub-types and associations?
Adenocarcinoma
Intestinal = H. pylori, smoking, chronic gastritis
Diffuse = non-H. pylori
79
Histological feature of diffuse gastric carcinoma?
Signet ring cells
80
LFT cholestatic pattern?
Raised ALP
Raised GGT
Raised bilirubin
81
LFT hepatitic pattern?
Very raised ALT/AST
Raised ALP
Raised bilirubin
82
LFT deranged synthetic function pattern?
Raised bilirubin
Raised PT/INR
Low platelets
Low albumin
Low glucose
83
Stool/urine in pre-hepatic, hepatic and post-hepatic jaundice?
Pre = both normal
Hepatic = dark urine, normal stool
Post = dark urine, pale stool
84
Explain the stool/urine pattern of post-hepatic jaundice?
Blockage forces bile back into liver where it moves into systemic circulation
Stool = less bilirubin absorbed in GI tract to be excreted in faeces
Urine = more bilirubin in blood and filtered by kidneys
85
Features of acute appendicitis?
Genrally unwell e.g. fever, N&V
Abdominal pain (central → RIF)
Anorexia, weight loss
Rovsing's sign (LLQ pressure = RLQ pain)
McBurney's sign
86
Blood test feature of appendicitis?
Neutrophil-dominant leukocytosis
87
Investigation and management of appendicitis?
Investigation = clinical diagnosis, abdo USS or CT if unsure
Management = IV prophylactic antibiotics + laparoscopic appendicetomy
88
Causes of acute pancreatitis?
GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Mumps (and other viruses)
Autoimmune
Scorpion venom
Hypercalcaemia
ERCP
Drugs (e.g. mesalazine)
89
Most common causes of acute pancreatitis in the UK?
Gallstones
Alcohol
90
Features of acute pancreatitis?
General unwell e.g. fever, N&V
Abdominal pain (epigastric → back)
Pain relieved sitting forward
Periumbilical (Cullen's) and flank (Grey-Turner's) discolouration are rare
91
Blood test features of acute pancreatitis?
Amylase > 3x normal
Hypocalcaemia
High LDH
Deranged LFTs
92
Scoring system used for acute pancreatitis?
Modified Glasgow criteria
93
Investigations and management of acute pancreatitis?
Investigations = abdo US, CT, MRCP
Management = IV fluids + IV analgesia + surgery dependent on cause e.g. ERCP
94
Persistent elevated amylase following acute pancreatitis?
Pseudocyst
95
Most common cause of chronic pancreatitis?
Alcohol excess
96
Features of chronic pancreatitis and tests used to assess them?
Exocrine dysfunction = faecal elastase
Endocrine dysfunction = fasting glucose/OGTT
97
Investigations and management of chronic pancreatitis?
Investigations = AXR, CT
Management = treat complications, pancreatic supplements e.g. creon
98
Courvoisier's law?
Patients with painless jaundice + RUQ mass are unlikely to have simple gallstones
Treat as a pancreatic or biliary neoplasm until proven otherwise
99
Features of pancreatic cancer?
Painless jaundice
Weight loss
Palpable mass
Atypical back pain
Trousseau syndrome (migratory thrombophlebitis)
Steatorrhoea/diabetes
100
Investigation and feature of pancreatic cancer?
Abdo US, CT abdo/pelvis, endoscopic US
"Double-duct" sign (dilated CBD + pancreatic duct)
101
Management options for pancreatic cancer?
Surgery e.g. Whipple's resection
Chemotherapy
ERCP with stenting
102
Tumour marker for pancreatic cancer?
CA 19-9
103
Outline the production of bile salts?
- Liver makes the primary bile acids (cholic acid and chenodeoxycholic acid)
- Excreted into bowel where gut flora coverts them into secondary bile acids (deoxycholic acid and lithocholic acid)
- Primary/secondary acids return to liver and are conjugated with taurine or glycine to form the 8 principal bile salts
104
Risk factors for gallstones?
Fat/female/fertile/forty
Crohn's disease
Diabetes mellitus
Drugs e.g. COCP
105
Blood test features of biliary colic vs acute cholecystitis vs ascending cholangitis?
Biliary colic = normal
Acute cholecystitis = raised inflammatory markers, normal/slightly raised LFTs
Ascending cholangitis = raised inflammatory markers and deranged LFTs
106
Features, investigation and management of biliary colic?
Colicky abdominal pain (RUQ → shoulder)
Investigation = abdo US, MRCP
Management = avoid triggers, elective lap chol
107
Most common pathogens associated with biliary infection?
E.Coli
Klebsiella
108
Areas affected by cholecystitis vs cholangitis?
Cholecystitis = inflammation of the gallbladder and cystic duct
Cholangitis = inflammation of the biliary tree
109
Features, investigation and management of acute cholecystitis?
Generally unwell e.g. fever, N&V
Abdominal pain (RUQ → shoulder)
NO JAUNDICE
Investigation = abdo US, MRCP/ERCP
Management = IV antibiotics + lap chol
110
Small bowel obstruction following acute cholecystitis. AXR shows air in the biliary tree?
Gallstone ileus
111
Features of ascending cholangitis?
Charcot's triad:
→ RUQ pain, fever, jaundice
Reynold's pentad:
→ above, hypotension, confusion
112
Investigations and management of ascending cholangitis?
Investigation = abdo US, MRCP
Management = IV antibiotics + ERCP
113
Complications of ERCP?
Bleeding
Duodenal perforation
Pancreatitis
Cholangitis
114
Features of primary sclerosing cholangitis (PSC)?
Abdominal pain (RUQ)
Jaundice, pruritis
PMH of ulcerative colitis
115
Blood test feature of primary sclerosing cholangitis (PSC)?
p-ANCA +ve
116
Investigation, finding and management of primary sclerosing cholangitis (PSC)?
Investigation = MRCP (multiple biliary strictures)
Management = ERCP, cholestyramine
117
Cancer linked to PSC vs PBC?
PSC = cholangiocarcinoma
PBC = hepatocellular carcinoma
118
Tumour marker for cholangiocarcinoma?
CA 19-9
119
Stages of liver disease?
Steatosis (NAFLD or alcoholic)
Steatohepatitis
Cirrhosis
120
Investigations for liver cirrhosis?
ELF blood test
FibroScan (liver USS)
Biopsy
121
Monitoring of cirrhosis?
Liver USS every 6 months +/- AFP
122
LFT features indicative of alcoholic hepatitis?
AST:ALT > 2
Raised GGT
123
Alcohol intake guidelines?
No more than 14 units/week
If around 14 units, spread over 3 days
124
Management of acute alcoholic hepatitis?
High dose steroid
125
Management of alcoholic ketoacidosis?
IV saline + IV thiamine
126
Features and complications of liver failure?
Low albumin → ascites → SBP
High ammonia → hepatic encephalopathy → cerebral oedema
High oestrogen → palmar erythema, gynaecomastia, spider naevi etc.
Low clotting factors → coagulopathy → bleed
Shunts → varices → bleed
Release of vasodilators → hepatorenal syndrome
127
Outline the pathophysiology of hepatic encephalopathy?
- Liver failure leads to ammonia build-up
- Ammonia crosses BBB and converted into glutamine
- Glutamine disturbs osmotic pressure and causes astrocyte swelling
128
Management and prophylaxis of hepatic encephalopathy?
Management = lactulose + IV mannitol
Prophylaxis = rifaxamin
129
Outline the pathophysiology of hepatorenal syndrome?
- Portal hypertension causes release of vasodilators
- Splanchnic vasodilation and decreased SVR
- Kidneys activate RAAS in response to hypovolaemia leading to vasoconstriction and decreased eGFR
130
Management of hepatorenal syndrome?
Terlipressin + IV albumin
131
Serum-ascites albumin gradient (SAAG) categories and causes?
> 11g/L = portal hypertension
< 11g/L = malignancy, infection e.g. TB
132
Management options for ascites?
Low sodium intake
Fluid restriction
Aldosterone antagonist
Therapeutic paracentesis
133
NICE spontaneous bacterial peritonitis (SBP) prophylaxis guidelines?
Offer oral ciprofloxacin or norfloxacin to those with cirrhosis and ascites with a SAAG < 15g/L
134
Blood test feature, most common pathogen and management of SBP?
Neutrophil count > 250 + ≥ 90% polymorphs
E.Coli
Management = IV tazocin
135
Management of acute variceal haemorrhage?
ABCDE
Terlipressin + IV antibiotics
Band ligation (1st line), sclerotherapy (2nd line)
Sengstaken-Blakemore tube if uncontrolled
TIPS procedure if all above fails
136
Drug prophylaxis of variceal bleeding?
Propanolol
137
What is TIPS procedure, indications and key side effect?
Transjugular intrahepatic portosystemic shunt (channel between hepatic vein and portal vein)
Severe portal hypertension, refractory ascites, hepatorenal syndrome, secondary prophylaxis of variceal bleed
Can worsen or cause hepatic encephalopathy
138
Features of hepatitis?
Abdominal pain (RUQ)
Hepatomegaly
Jaundice
Fatigue
139
Hepatitis most associated with chronic infection, IVDUs, co-infection, mum to baby, tropical travel and acute/flu-like disease?
Chronic = hepatitis C
IVDUs = hepatitis C
Co-infection = hepatitis B & D
Mum to baby = hepatitis B
Tropical travel = hepatitis E
Acute/flu-like disease = hepatitis A
140
First serum marker to appear after hepatitis B infection?
HBsAg (surface antigen)
141
Hepatitis B significance of HBsAg, anti-HBs, anti-HBc (IgM/IgG), HbeAg and anti-HBeAg?
HBsAg = current infection
Anti-HBs = immunity
Anti-HBc = IgM (acute infection) and IgG (chronic infection)
HbeAg = high infectivity
Anti-HBeAg = low infectivity
N.B. those immune via vaccine only WILL NOT be positive for anti-HBc
142
Anti-HBs level criteria following immunisation programme?
> 100 = good response, booster every 5 years
10-100 = suboptimal response, give 1 more dose then re-check levels
< 10 = no response, test for current/past infection, give 3 more doses then re-check levels
143
Drug used to treat hepatitis B and indications?
Peginterferon alfa-2a
→ liver disease, pregnant, kids
144
Most common group affected by autoimmune hepatitis vs primary biliary cirrhosis?
AH = young women
PBC = middle-aged women
145
Blood test features of autoimmune hepatitis?
ANA, SMA
Raised IgG
146
Blood test features of primary biliary cholangitis (PBC)?
AMA, ANA
Raised IgM
147
Main drugs for primary biliary cholangitis (PBC)?
Ursodeoxycholic acid
Cholestyramine
148
What is Budd-Chiari syndrome and causes?
Hepatic vein thrombosis
→ blood disease e.g. polycythaemia, thrombophilia
→ pregnancy
→ COCP
149
Investigation for Budd-Chiari syndrome?
Liver US with doppler flow studies
150
Outline the pathophysiology of bilirubin metabolism?
- Heme is broken down into biliverdin and iron
- Biliverdin is oxidised to UCB and released into blood
- UCB taken into hepatocytes and conjugated
- CB moved into bile then digestive tract
- Most removed in faeces, some in urine
151
Bilirubin level at which jaundice becomes noticeable?
35umol/l
152
Gilbert's syndrome deficiency and blood test feature?
UDP glucuronosyltransferase
Unconjugated hyperbilirubinaemia
153
Features of Wilson's disease?
Liver disease
Neurological deficit
Psychiatric changes
Kayser-Fleischer rings
154
Most common place of copper deposition in the brain?
Basal ganglia (especially putamen and globus pallidus)
155
Blood test features of Wilson's disease?
Low/normal serum caeruloplasmin
Low/normal serum copper
Raised free and urinary copper
156
Management of Wilson's disease?
1st line = D-penicillamine
2nd line = trientine
157
Features of haemochromatosis?
Fatigue
Bronze skin
Liver disease
Arthritis/arthralgia (hands)
Erectile dysfunction
Dilated cardiomyopathy
158
Iron study features of haemochromatosis?
Raised transferrin saturation
Raised ferritin
Raised iron
Low TIBC
159
Management of haemochromatosis?
1st line = venesection
2nd line = desferrioxamine
160
Monitoring of haemachromatosis and target values?
Transferrin saturation < 50%
Serum ferritin < 50ug/l
161
Most common liver tumours?
Metastatic (95%)
Hepatocellular carcinoma
Chlolangiocarcinoma
162
Most common cause of hepatocellular carcinoma?
Chronic hepatitis B or C
163
Location of inguinal vs femoral hernias, which is more common and which has a higher risk of strangulation?
Inguinal = superomedial to pubic tubercle
Femoral = inferolateral to pubic tubercle
Inguinal are more common
Femoral have a higher risk of strangulation
164
Cough test for inguinal hernia?
Press over deep inguinal ring and ask to cough
Direct hernias will reappear
Indirect hernias will not
165
Surgical management of femoral vs inguinal hernia?
Femoral = laparoscopic or laparotomy
Inguinal = open (unilateral) or laparoscopic (bilateral/recurrent)
166
Incarcerated vs strangulated hernia?
Incarcerated = can't be reduced
Strangulated = ischaemic hernia
167
Types of hiatus hernia, anatomy and which is more common?
Sliding = GOJ moves above diaphragm
Rolling = GOJ stays below diaphragm but another section of stomach herniates through oesophageal hiatus
Sliding are 95% of all hiatus hernias
168
Investigations and management of hiatus hernia?
Investigations = barium swallow, endoscopy
Management = weight loss, PPI, surgery
169
Big 3 of bowel obstructions?
Adhesions (small bowel)
Hernias (small bowel)
Tumours (large bowel)
170
Features of bowel obstruction?
Abdominal pain (central)
Bilious vomiting
No stools or flatulence
Abdominal distension
Tinkling bowel sounds
171
Investigations and findings of bowel obstruction?
AXR, CT (dilated bowel, pneumoperitoneum)
172
Management of bowel obstruction?
1st line = nasogastric tube + IV fluids ("drip and suck")
2nd line = surgery
173
Investigations, finding and management of sigmoid volvulus?
Investigation = AXR, CT (coffee bean sign)
1st line = therapeutic sigmoidoscopy
2nd line = laparotomy (1st line if necrosis/perforation/peritonitis)
174
Diffuse abdominal pain following an URTI?
Mesenteric adenitis
175
Hamartomatous polyps and pigmented lesions on lips, face, palms and soles?
Peutz-Jeghers syndrome
176
Most common cause of inherited colon cancer?
HNPCC (Lynch syndrome)
177
Affected genes in HNPCC vs FAP?
HNPCC = mismatch repair e.g. MSH2
FAP = APC
178
Most common site of colorectal cancer?
Rectum
179
Outline colorectal cancer screening?
- FIT test every 2 years between 60-74 (England) and 50-74 (Scotland)
- If result abnormal, offered a colonoscopy
180
Duke's staging for colorectal cancer?
A = limited to bowel wall
B = extends beyond bowel wall
C = local lymph node involvement
D = distant metasases
181
Tumour marker used to monitor colorectal cancer?
Carcinoembryonic antigen (CEA)
182
What is removed in a hemicolectomy, subtotal colectomy, proctocolectomy, panproctocolectomy, anterior resection, AP resection and Hartmann's procedure?
Hemicolectomy = right or left side of colon
Subtotal colectomy = whole colon but rectum and anus remain
Proctocolectomy = whole colon + rectum
Panproctocolectomy = whole colon + rectum + anus
Anterior resection = sigmoid + part or all of rectum
Abdomino-perineal resection = sigmoid + rectum + anus
Hartmann's = sigmoid
183
Ileostomy vs colostomy?
Ileostomy = spouted, discharges small bowel liquid
Colostomy = level with skin, discharges formed stools
184
Bowel surgery technique used alongside proctocolectomy?
Ileo-anal pouch (J pouch)
185
Acute management of abdominal wound dehiscence?
Cover with saline-soaked gauze
IV broad-spectrum antibiotics
Analgesia
Return to theatre
186
List some classes and examples of anti-emetics?
H1 antagonists = cyclizine
D2 antagonists = domperidone, metoclopramide
5HT3 antagonists = ondansetron
Anti-muscarinics = hyoscine butylbromide
187
Preferred route of total parenteral nutrition (TPN) and why?
Via a central vein e.g. PICC line
Peripheral veins are at risk of thrombophlebitis
188
Bilious vomit and absent bowel sounds post-abdominal surgery?
Ileus (small bowel paralysis)
189
Central colicky pain after eating and abdominal bruit on examination?
Chronic mesenteric ischaemia
190
Mallory-Weiss vs Boerhaave syndrome?
Mallory-Weiss = GOJ lacerations
Boerhaave = oesophageal rupture
