Gastroenterology

Question 1

What extra vaccines do you need for coeliac?

Answer 1

Pneumococcal
Hib
Flu
- same as splenectomy

Question 2

Risks of coeliac

Answer 2

Osteoporosis
Vit D deficiency
Cancer - lymphoma
Anaemia

Question 3

Where does the inguinal ligament run?

Answer 3

ASIS to pubic tubercule

Question 4

Where does the inguinal canal run?

Answer 4

ASIS to pubis symphisis

Question 5

What are the contents of the inguinal canal?

Answer 5

Spermatic cord/Round ligament

Ilioinguinal nerve

Question 6

What are the borders of the inguinal canal?

MALT

Answer 6

Muscle - internal oblique
Aponeurosis (ext oblique)
Ligament (inguinal ligament)
Tendon (transversalis tendon)

Question 7

Where is the midinguinal point?

Answer 7

Halfway between ASIS to pubic symphisis

Question 8

Where is the midpoint of the inguinal ligament?

Answer 8

Midpoint between origins of inguinal ligament (ASIS to pubic tubercle) = deep inguinal ring

Question 9

Direct inguinal hernia

Answer 9

through external inguinal ring

if reduced, can’t be controlled by pressing over deep inguinal ring

Question 10

Indirect inguinal hernia

Answer 10

herniated contents run in inguinal canal
can run right down into scrotum - inguino-scrotal hernia
due to failure of proc

Question 11

Inguinal vs femoral hernia

Answer 11

femoral - below and lateral to pubic tubercule
direct inguinal - above and medial
indirect - anywhere between deep inguinal and scrotum

Question 12

Differentials for hernias

Answer 12

Psoas abcess
Femoral neurofibroma (hard, painful, lateral to femoral artery)

Question 13

Features of a colostomy

Answer 13

LIF
solid faeces
flush with skin

Question 14

Features of an ileostomy

Answer 14

RIF
liquid faeces
spouted (to protect skin from enzymes)

Question 15

Features of a urostomy

Answer 15

RIF
urine
flush with skin

Question 16

What is a end colostomy ad what is it for?

Answer 16

all of distal bowel removed w/ proximal end brought to surface
e.g for resection of low rectal tumours, Hartmann

Question 17

What a loop colostomy and what is it for?

Answer 17

two made in central part of large bowel and brought to surface
e.g to protect distal anastamosis while bowel structures heal
reversed after 6w

Question 18

What is a barrel colostomy and what is it for?

Answer 18

segment of bowel removed and both ends brought to surface

e.g for sigmoid volvulus

Question 19

What is an end ileostomy and what is it for?

Answer 19

who colon removed

e.g UC, FAP Hirschsprungs

Question 20

What is an ileal conduit and what is it for?

Answer 20

urostomy when short segment of ileum removed to act as bladder
e.g after cystectomy

Question 21

What are the early complications of a stoma?

Answer 21

high output (dehydration, hypokalaemia), retraction, bowel obstruction, ischaemia of stoma

Question 22

What are the late complications of a stoma?

Answer 22

parastomal hernia, prolapse, fistulae, psychological, dermatits

Question 23

Stoma care

Answer 23

stoma nurse
empty via tap when 2/3 full, irrigated with water, change 2-4 days/whenever full
diet: lots of full, low fibre to begin with
avoid foods that cause blockage or flatulence
can wear in shower

Question 24

Cuases of hepatosplenomegaly

Answer 24

Viral hepatits
Mono
CMV
Haematology; leukaemia, sickle cell, lymphoma

Question 25

Risk factors for Dupetryns

Answer 25

``` Trauma/ occupational Genetics Smoking/alcohol hypercholesterolaemia anticonvulsants ```

Question 26

Questions to ask in Dupetryns

Answer 26

How it affects life? What job they did? Can you put your hand flat on table? Feet or Willy?

Question 27

Crohns Barium Enema features

Answer 27

``` Cobblestone Transverse stripes Kantors string sign Ulcers Patrial obstruction ```

Question 28

Inducing remission in UC

Answer 28

rectal aminosalicylates or steroids if distal oral salicyates if no response __> oral pred IV steroids (1st line if severe)

Question 29

Causes of ascites

Answer 29

``` Cirrhosis Hypoalbuminaemia Peritoneal mets Hepatic vein thrombosis TB Ovarian Ca ```

Question 30

Acute Pancreatitis Managemet

Answer 30

IV fluids NBM (enteral fluids) Analgesia ABx

Question 31

Causes of Bowel Obstruction

Answer 31

Adhesions Hernias Tumours (Gallstones, Crohns, diverticulitis)

Question 32

Symptoms of bowel obstruction

Answer 32

Pain Vomiting DIstention Absolute Constipation

Question 33

Volvulus

Answer 33

``` Loop of bowel twisted on mesentery Idiopathic/due to faecal loading Sudden severe abdo pain w/ distention Unrelieved by opiates Obstruction then ileus then peritonitis ```

Question 34

Coffee Bean Sign

Answer 34

sigmoid volvulus

Question 35

Acute Pancreatitis Management

Answer 35

``` FBC, LFTs, U+Es, bHCG amylase, lipase BM ABG ECG - rule out MI CXR - pneumoperitoneum USS - pancreas CT - pancreas later ```