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Gen Med and Surg - C.U > Gastroenterology / General surgery > Flashcards

Gastroenterology / General surgery Flashcards

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1
Q

Definition of colic

A

Pain in a hollow organ, contraction causes the pain to come in waves

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2
Q

Presentation of acute abdomen

A 
Acute tenderness over the abdomen 
Guarding 
Rigidity of the abdomen 
ABSENCE OF BOWEL SOUNDS 
Septic - sweating, pale, weak pulse, shallow breath
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3
Q

Associated symptoms in an abdo pain hx

A 
Vomiting 
Haematemasis 
Eating / drinking 
Swallowing 
Stools - loose / blood 
Urine - frequency, urgency, blood 
Vaginal discharge 
Menstruation 
FEVER 
Weight loss 
Night sweats
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4
Q

Abdo pain investigations

1) Bloods
2) Bedside
3) Imaging

A

FBC, U&E, LFT, glucose, CRP, amylase

Urine dip - glucose, infection, pregnancy

CXR - perforation
USS abdo
CT

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5
Q

5 Fs of abdo distension

A

Fluid, foetus, flatus, fat and faeces

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6
Q

To complete an abdominal examination

A 
Hernial orifices 
External genitalia 
PR 
Urine dip 
Stool sample if feel appropriate
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7
Q

Where is McBurneys point

A

2/3 of the way between umbilicus and AIDS

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8
Q

Rovsings sign

A

Press on RIF and pain in the LIF

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9
Q

What needs to be ruled out in females with suspected appendicitis ?

A

Ectopic preg

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10
Q

Bed side tests in appendicitis

A

Urine dip
BM
Preg test
BP

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11
Q

Blood tests in suspected appendicitis

A

FBC
U&Es
CRP

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12
Q

Imagining in suspected appendicitis?

A

USS

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13
Q

AB used in appendicitis

A

Metronidazole and cefuroxime

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14
Q

What should be considered with any change in bowel habit?

A

malignancy

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15
Q

GI causes of diarrhoea

A 
Infection 
Malignancy 
IBD
IBS 
Malabsorption
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16
Q

Systemic causes of diarrhoea

A

Endocrine
Anxiety
Bacterial overgrowth

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17
Q

Drugs causing diarrhoea

A

Laxatives
AB
SSRIs
Metformin

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18
Q

Infections leading to blood in stool (4)

A

E.coli
Shigella
Salmonella
Campylobacter

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19
Q

Social hx in diarrhoea hx

A

Travel hx

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20
Q

Bed side test with diarrhoea

A

PR (overflow due to constipation)
Urine dip and culture
Stool sample - viral / bacterial / occult blood

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21
Q

Blood tests in diarrhoea

A 
FBC
UandEs 
LFTs 
CRP 
TFTs
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22
Q

Non bedside tests in diarrhoea

A

GI endoscopy

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23
Q

Imaging in diarrhoea

A

Abdo x-ray

Abdo US

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24
Q

Treatment of diarrhoea

A

Treat the cause
Rehydrate
Slow bowel movements (?) - opioids / stop medication

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25
GI causes of N and V
Infection - pancreatitis, pyelonephritis, gastroenteritis, cholecystitis Obstruction Inflammatiom
26
Metabolic causes of N and V
``` Diabetic ketoacidosis Raised calcium Low sodium Addisions Pregnancy ```
27
Neurological causes of N and V
Head trauma Tumour Motion sickness Menieres
28
Cardiac cause of N and V
Heart attack
29
Drugs commonly causing N and V
Opioid AB Chemo Alcohol
30
NICE guideline for referral for suspected bowel cancer
They are aged 40 and over with unexplained weight loss and abdominal pain or They are aged 50 and over with unexplained rectal bleeding or They are aged 60 and over with: Iron-deficiency anaemia or Changes in their bowel habit Tests show occult blood in their faeces (new NICE recommendation for 2015).
31
Presentation of bowel cancer in RHS
``` Diarrhoea Weight loss Anaemia RIF mass Abdo pain ``` OFTEN LATE PRESENTING
32
Presentation of bowel cancer in LHS
Constipation Bleeding Mucus Tenesmus
33
Signs on exam of bowel cancer
``` Abdominal mass Enlarged liver (mets) Rectal mass Signs of iron deficiency anaemia ```
34
Blood tests in suspected bowel cancer
FBC - look for iron deficiency anaemia LFT UandE CEA - monitor progress
35
Investigation options in suspected bowel cancer
Colonoscopy Barium swallow Imagining - MR / endorectal US
36
Caecum and right colon affected - surgery ->
Right hemicolectomy
37
Transverse segment affected - surgery ->
Extended Right hemicolectomy
38
Descending colon affected - surgery ->
Left hemicolectomy
39
Sigmoid colon affected surgery ->
sigmoid colectomy
40
Rectum affected surgery ->
Anterior resection
41
Low rectum affected surgery ->
abdo-perineal resection with PERMANENT COLOSTOMY
42
When should radiotherapy be done in bowel cancer?
preoperatively
43
Screening for bowel cancer in the UK
Flex sigmoidoscopy - age 55+ | FOB 70 -74 (male and female)
44
90% of oesophageal malignancies are?
squamous cell carcinoma
45
which type of cancer is associated with barretts oesophagus?
adenocarcinoma
46
Risk factors for oesophageal cancer
``` Smoking Alcohol Barrets Diet Coeliac disease ```
47
Which virus is squamous cell carcinomas associated with?
HPV
48
Symptoms of oesophageal cancer
``` Fatigue Increasing dysphagia Odynophagia Hoarseness Vomiting Haematemisis Cough ```
49
Signs of oesophageal cancer
``` Weight loss Anaemia Lymphadenopathy Hepatomegaly Ascites ```
50
Where does oesophageal cancer often metastasise to?
Liver
51
Tests in oesophageal cancer
Blood - FBC, LFTs Upper GI endoscopy Barium swallow Further imaging for staging
52
Treatment of oesophageal cancer if no mets / not v advanced
oesophageal resection
53
Treatment of oesophageal cancer if mets / advanced
palliative
54
Most gastric carcinomas are?
adenocarcinomas
55
Risk factors for gastric cancer
``` h.pylori smoking poor diet blood group A chronic gastritis ```
56
Symptoms of gastric cancer
``` B symptoms vomiting abdo pain dyspepsia dysphagia (oesophageal obstruction) may be an upper GI bleed ```
57
Signs of gastric cancer
Palpable epigastric mass | Virchows node - CHECK LYMPH NODES
58
Blood tests in gastric cacner
FBC | LFTs - mets
59
Gold standard investigations for gastric cancer
Upper GI endoscopy | Barium swallow
60
Management in localised gastric cancer
Resection / gastrectomy
61
Management in metastatic gastric cancer
Palliative Stents if obstructions etc
62
Risk factors for pancreatic cancer
Smoking Diabetes Pancreatitis
63
Usual type of cancer in the pancreas?
Ductal adenocarcinoma
64
Symptoms of pancreatic cancer
Usually painless Abdo mass Weight loss May be non specific back pain
65
Signs of pancreatic cancer
painless progressive jaundice
66
Bloods in pancreatic cancer
FBC | LFTs
67
Investigations in pancreatic cancer
USS CT ERCP
68
Management options in pancreatic cancer
Surgical - whipples Palliative - stenting and pain relief
69
Oesophageal cancer referal pathway URGENT DIRECT ACCESS (2ww) NON URGENT DIRECR ACCESS
UPPER GI ENDOSCOPY 1) Dysphagia or 55+ and weight loss + one of upper abdo pain, reflux or dyspepsia 2) Haematemesis 55+ other upper GI symptoms
70
Causes of constipation - medical
``` Diverticulitis IBD IBS Coeliac Immobility Dehydration Raised calcium / phosphate Parkinsons disease Pregnancy HypoT ```
71
Surgical causes of constipation
Appendicitis Malignancy Ischaemic bowel obstruction
72
Drugs causing constipation
Anti cholinergics Opiates Iron Calcium channel blockers
73
Important questions with constipation
Normal bowel habit - how many stools per day (? <3 per week) and for how long Over flow diarrohea Maelena Pain Diet New medications Red flags - fever/ weight loss / nightsweats FOREIGN TRAVEL
74
Examination in constipation
Abdo and PR
75
Blood tests in constipation
FBC - haematinics U&Es TFTs LFTs
76
Imaging in constipation
US Abdo X-ray CT - extreme
77
Conservative management in constipation
Exercise and fibre
78
Types of laxatives - BOSS
Bulking - e.g. methylcellulose Osmotic - Lactulose Softer - Docusate Stimulants - Senna
79
Causes of acute pancreatitis G E T ``` S M A S H E D ```
Gall stones Ethanol Trauma ``` Steroids MUMPS Autoimmune Scorpion venum Hyperlilipidaemia / hypercalacaemia / hyperparathyroidism ERCP Drugs ```
80
Define acute pancreatitis
acute inflammation of the pancreas by autodigestion
81
Grey turners sign =
haemorrage in the flanks
82
Cullens sign =
bruising at the umbilicus
83
Presentation of acute pancreatitis
abdo pain radiating to the back - relieved by sitting forward NandV
84
Criteria for clinical outcome for pancreatitis
Glasgow score
85
Blood tests to do in acute pancreatitis
``` FBC - increased WBC UandE LFTs Glucose - increased Albumin - reduced Calcium - reduced Urea - raised CRP - increased Amylase - raised Serum lipase - raised ```
86
Increased ALT in acute pancreatitis suggests?
gall stone aetiology
87
Imaging in acute pancreatitis
CXR - check for perforation
88
Glasgow score to send to intensive care?
>3
89
Supportive care in acute pancreatitis
``` O2 Fluids Analgesics Anti emetics Insulin Antibiotics 5-7 days PPI Regular monitoring ```
90
Causes of chronic pancreatitis
``` Alcohol Hypercalacaemia Hyperparathyrodism Hyperlipidaemia Biliary disease Cystic fibrosis ```
91
Clinical feature of chronic pancreatitis
``` Jaundice Abdo pain - radiates to the back, improves on sitting forward Bloating Steatorhhoea Weight loss ```
92
Imaging in chronic pancreatitis
CXR CT USS
93
Dyspepsia =
indigestion
94
Local causes of dyspepsia
``` GORD H.pylori Gastritis Ulcer - gastric / duodenal Hiatus hernia ```
95
Systemic causes of dyspepsia
Infection Alcohol Smoking
96
Drugs causing dyspepsia
NSAIDS Steroids Bisphosphinates
97
Conservative management for dyspepsia
Weight loss stop smoking reduce alcohol intake less hot drinks
98
Intraluminal causes of dysphagia
Inflammation - oesophagitits | Malignancy
99
Extraluminal causes of dysphagia
``` Stricture Malignancy Acalasia Goite Vascular obstruction ```
100
Systemic causes of dysphagia
``` Parkinsons Myasthenia Gravis Scleroderma Bulbar palsy MND ```
101
Important questions in dysphagia
Solids / liquids B symptoms
102
1st line investigation in dysphagia
endoscopy
103
Imaging in dysphagia
barium swallow ct
104
gall stones made of?
cholestrol, calcium and bile salts
105
choleithiasis is?
gallstones in the gallbladder
106
choledocholithiasis is?
gallstones passed into the biliary tree
107
cholecystitis is?
inflammation of the gallbladder
108
what percentage of gall stones are radio opaque?
10% seen on x-ray
109
What increases the incidence of gall stones?
Over weight Pregnancy Diuretics ?smoking
110
main precipitant for mixed stones?
infection
111
Courvoisiers law?
Pt presents with painless obstructive jaundice with an enlarged gallbladder NOT gallstones
112
size of gall bladder in 1) gall stone disease? 2) obstruction of biliary tree?
smaller enlarged
113
5 Fs of gall stone disease
fat, female, fertile, forty and fair
114
presentation of gall stones most commonly?
80% asymptomatic
115
cause of obstructive jaundice due to gall stones?
choledocholithiasis
116
Imaging option in gall stones?
X-ray US MRCP ERCP
117
Management of asymptomatic stones found incidentally?
conservative treatment
118
Medical therapy for gall stones?
pain relief anti emetics antibiotics if infection
119
Surgical treatment used when in gall stones?
symptomatic / complications
120
What is the surgical treatment for gall stones?
either laproscopic or open cholecystectomy
121
When inoperable what at the options for symptomatic gall stones?
Could have ERCP or lithotripsy (US shock waves)
122
Main cause of cholecystitis?
gallstones
123
Presentation of cholecystitis?
feverish and unwell URQ pain previously told had gallstones
124
Symptoms of cholecystitis
``` Pain in RUQ which can refer to right shoulder Fever Pt has to take shallow breaths Can have N&V Indigestion ```
125
Signs of cholecystitis
fever tachycardia increased RR MURPHY'S sign - pain when two fingers put on RUQ and pt asked to breath in (gallbladder moves up to the costal margin on inspiration)
126
Blood tests in cholecystitis?
``` FBC U&E LFT CRP Amylase ?blood cultures ```
127
Medical management of cholecystitis?
Nil by mouth Fluids Antibiotics - cover gram -ve and +ve anti emetic and analgesia
128
surgical management of cholecystitis?
cholecystectomy - if severe / complications within 72hrs
129
what is cholangitis?
inflammation of bile duct
130
Causes of cholangitis
Infection Iatrogenic - past stent Obstruction
131
Charcots triad (only in 25% of those with cholangitis) but what is it?
Jaundice Fever RUQ pain
132
Common presentation of cholangitis?
SEPSIS
133
Treatment of cholangitis
EMERGENCY - ABCDE....
134
Gallbladder cancer usually?
adenocarcinoma
135
RF for gallbladder cancer?
Chronic gallstones | congenital malformation
136
Presentation of gallbladder cancer
late presentation weight loss jaundice RUQ mass
137
Organisms that cause vomiting in gastroenteritis
Staph aureus | Bacillus cereus
138
Organisms causing watery diarrhoea gastroenteritis
Cholera E.coli (enterotoxigenic)
139
organisms causing dysentry
Shigella Campylobacter E.coli (enterohaemorrhagic) Salmonella
140
those at risk of gastroenteritis?
young / old immunosuppressed travellers
141
If symptoms of gastroenteritis emerge within 4 hours - indicates which type of infection? 12-48hrs - indicates which type of infection?
food poisoning toxin producing / cell invaders
142
Treatment of gastroenteritis
most resolve on their own fluids anti emetics rehydrate AB - if systemically unwell / immunocompromised
143
three types of bacteria causing gastroenteritis
food poisoning toxin producing cell invaders
144
viruses causing gastroenteritis
norovirus | rotovirus
145
group most common to contract viral gastroenteritis
children
146
Classification of an upper GI bleed
mouth to second part of duodenum
147
Classification of a lower GI bleed
2nd part of duodenum to rectum
148
Oesophageal causes of bleeding
oesophagitis mallory- weiz tear malignancy
149
Gastric causes of bleeding
gastritis ulcer cancer
150
Small and large bowel causes of bleeding
``` Cancer Gastritis Inflammatory bowel disease Diverticulitis Ulcer Polyps ```
151
Rectal causes of bleeding
Malignancy
152
Anal causes of bleeding
Fissure Haemorrhoid Fistula
153
Associated symptoms and signs of GI bleeding
Weight loss Vomiting Signs of chronic liver disease Signs of anaemia ?
154
PMH q. in GI bleed
Binge drinking - MWT | Liver decompensation
155
Medications leading to GI bleeds
``` Warfarin Antiplatlets Anticoagulants Steroids NSAIDs Alcohol ```
156
Bedside tests in GI bleed
BP (lying and standing) PR Monitor urine output
157
Blood tests in GI bleed
``` FBC Haematimics LFTs U&Es Clotting screen Group and save ``` ABG
158
Imaging in GI bleed
CXR ( look for perforation) could do barium swallow / endoscopy
159
Score used to determine prognosis of acute GI bleeds
Rockall
160
Management of an acute GI bleed
ABCDE IV access and transfuse if necessary Manage clotting problems Endoscopy when they are stable Interventional radiology - identify bleeding point and stop Medical management - AB, PPI and H.pylori eradication Surgery - if failure to stop bleeding
161
Lifestyle advice post bleeding
Avoid NSAIS and reduce alcohol intake
162
Treatment if high risk of re bleeding post GI bleed
PPI infusion
163
Risk factors for hernia
Obesity Previous surgery Coughing Straining due to chronic constipation
164
Incarcerated hernia =
Hernial contents fixed due to adhesions, surgical emergency
165
Strangulated hernia
Ischaemia of the bowel contents of the hernia, surgical emergency
166
Surgical treatment of hernias
Mesh or suture to secure
167
Where does a femoral hernia sit in relation to pubic tubercle
Below and lateral
168
Where does an inguinal hernia sit in relation to the pubic tubercle
Above and medial
169
Strangulation more likely in an inguinal or femoral hernia? Why?
femoral because the lacunar ligament is sharp
170
How do femoral hernias present?
Tender swelling in upper medical thigh | Often irreducible
171
Treatment of femoral hernias
Surgical treatment quickly as likely to strangulate
172
Indirect hernia passes through? Direct passes though?
Deep and superficial ring Just superficial ring
173
Inidrect or direct hernia has higher chance of strangulation?
Indirect
174
How to ascertain if an inguinal hernia is direct or indirect
direct reduces on lying down ``` But also - get the patient to lie down - put finger over the mid point of inguinal ligament (over deep ring) get the patient to stand and cough - direct - no restrained (protrudes) - indirect - restrained ```
175
Periumbilical hernia presentation
umbilicus is a semicircle
176
Umbilical hernia presentation
mass bulges directly from the umbilicus
177
How to distinguish small bowel from large on x-ray
Valvulae conniventes - span the whole lumen, found in small bowel Large bowel have haustra - don't cross the whole lumen
178
Causes of small bowel obstruction In the lumen In the wall Outside the bowel
1) Polyp Interssuception Gallstone Faeces 2) Tumour Crohns Infarction Stricture 3) Interssusception Adhesions Vovulus
179
Typical presentation of small bowel obstruction
Crampy / colicky central abdominal pain Bilious vomiting Can be some distension increased bowel sounds - tickling
180
Examinations in bowel obstruction
Abdo exam Hernial orifices PR exam
181
Blood tests in bowel obstruction
FBC UandEs ABG Amylase
182
Imaging small bowel obstruction
CXR | Abdo x-ray
183
Main treatment of small bowel obstruction
Conservative in adults Put in a drip to rehydrate Insert a nasogastric tube to remove bowel contents
184
When is surgery needed to treat small bowel obstruction
Ischaemic bowel | Incarcerated hernia
185
Cause of large bowel obstruction Inside the lumen In the wall Outside the bowel
1) Polyp Mass ``` 2) Diverticulitis Crohns Mass Impacted faeces ``` 3)Outside Volvulus Adhesions
186
Small bowel obstruction Early symptom Late symptom Vs Large bowel obstruction
Vomiting Constipation Constipation Vomiting
187
Large bowel obstruction presentation
Colicky pain Distended abdomen (more than in small) Constipation
188
Imaging in large bowel obstruction
CXR AXR consider sigmoidoscopy, barium enema and CT
189
Treatment of large bowel obstruction
Medical - drip and suck - water soluble enema Surgical - emergency surgery is ischaemic bowel - stenting - laparotomy
190
Volvulus =
twisting of bowel around its mesenteric attachement
191
Where does volvulus usually occur?
Sigmoid
192
Presentation of volvulus
Colicky abdo pain Distension Constipation
193
Types of lesions in UC Crohns
Continuous Skip
194
The extent of inflammation in at a cellular level UC Crohns
Muscosal inflam Transmural
195
Which of UC and Crohns commonly has bleeding
UC
196
Extraintestinal manifestations in IBD
``` Eyes - Uveitis Joint arthritis Erythema nodosum Pyoderma gangrenosum Clubbing Sclerosing cholangitis -> cirrhosis ```
197
Imaging investigations in IBD
Endoscopy Barium swallow CT / MR
198
Colonic surveillance in IBD
10 years after first diagnosis, repeat depending on risk stratification
199
Prognosis in IBD
life long remitting and relapsing
200
"cure" in UC
Colectomy
201
What can precipitate UC
Infection / stress
202
Gene UC is linked with
HLA-B27
203
Type of mediated response in UC
T helper - type 2
204
Severe colitis presenation
fever weight loss haemodynamic compromise
205
Liver condition linked with UC
Sclerosing cholangitis
206
Blood tests in IBD
FBC UandE CRP/ESR LFTs
207
Bedside tests in IBD
Stool sample | Faecal calprotectin
208
Presentation of severe UC in AXR
Loss of colonic markings - lead pipe picture
209
How to introduce remission in UC Mild / mod Severe
Pred, aminosalicylate, steroid enema IV hydrocortisone with hydration
210
Maintaining remission in UC
5-Aminosalicylate Mesalazine Immunosuppressants
211
Surgical management of UC
20% Colectomy / ileostomy
212
Indications for surgery in UC
Carcinoma Haemorrhage Obstruction Perforation
213
Complications of UC
Peroration Bleeding Toxic mega colon Colonic cancer risk
214
Disease associated with Crohns
Ank Spond
215
Presenation of Crohns
Diarrhoae (non bloody) Abdo pain - RIF / suprapubic Weight loss / fever/ malaise Mouth ulcers
216
Mild to mod crohns intor remission treatment
Prednisolone / aminosalicylates
217
Severe crohns intro remission treatment
IV hydrocortisone | IV fluids
218
Maintaining remission in crohns
Immunosuppresants - azathioprine Biologics
219
Indications for surgery in Crohns
Failure of medical therapy Intestinal obstruction Perforation
220
H.pylori eradication treatment
Amoxicillin and clarithromycin + PPI (for a month)
221
Important q to ask in H.pylori
Had eradication before?
222
Classification of IBS
Diarrhoea and Constipation
223
What are bowel changes usually related to in IBS?
Stressful events
224
Symptoms of IBS
``` Bloating Pain Feeling of not emptying bowel Nausea Anxiety / depression ```
225
Blood tests to exclude other causes when IBS suspected
``` FBC UandE CRP Haematimics TFTs Coeliac serology Ca-125 ```
226
Other tests to exclude other causes when IBS suspected
Stool culture Faecal calprotectin Urinalysis ?US
227
Medical treatment for diarrhoea IBS
Imodium
228
Medical treatment for constipation IBS
Gentle laxative | Antispasmodics
229
Causes of malabsorption
``` Failure of digestive enzymes Inflammation Structural abnormalities - resections . diverticulae Pancreas disease CF Coeliac Malignancy ```
230
Clinical features of malabsorption
``` Diarrhoea Weight loss Failure to thrive Letheragy Flatus Ascites and oedema Abdo pain Distension May be vitamin deficiences ```
231
Blood tests in suspected malabsorption
``` FBC Iron studies LFTs Clotting Coeliac serology ```
232
Other tests in suspected malabsorption
faecal calprotectin Faecal appearance and fat collection over 3 days Faecal elastase
233
Imaging in malabsorption
endoscopy
234
+ 55y/o + dyspepsia should have what?
OGD and h.pylori test
235
<55 with dyspepsia and no red flags
urea breath test
236
Causes of bleeding from the rectum
Vascular - haemorroids Trauma - anal fissure Inflammatory - Crohns / UC Malingancy
237
Inital investigations for patients with rectal bleeding
PR Procto-sigmoidoscopy
238
If patient with rectal bleeding has change in bowel habit / evidence of IBD what investigations should be done?
colonoscopy
239
Causes of massive splenomegaly?
CML Malaria Myelofibrosis
240
Causes of splenomegaly
``` Sickle-cell thalassaemia Rheumatoid arthritis Haemolytic anaemia CLL Infectious mononucleosis ``` CML Malaria Myelofibrosis

Gen Med and Surg - C.U (16 decks)

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