Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Aneesha Flashcards BRS 2 > General GI surgery > Flashcards

General GI surgery Flashcards

(57 cards)

Start Studying
1
Q

What do we look for in the history of a patient with GI complaint?

A

-History of presenting complaint- SOCRATES, associated symptoms
- PMHx (past medical history)
- DHX (drug history)
- SHx (social history)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What range of investigations are there?

A
  • Bloods
  • Urinalysis + urine MC&S → check for UTI
  • Imaging
  • Endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What bloods can be done?

A
  • VBG
  • FBC
  • CRP
  • U&Es (renal profile)
  • LFTs + amylase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What imaging is performed?

A
  • Erect CXR
  • AXR
  • CTAP (CT of abdomen and pelvis)
  • CT angiogram- when you suspect bleeding or infarction or large intraabdominal blood vessel
  • USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 approaches to management?

A
  • ABCDE approach
    • Airways
    • Breathing
    • Circulation
    • Disability
    • Exposure
  • Conservative management
  • Surgical management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What diseases are associated with RUQ?

A
  • Bilary Colic
  • Cholecystitis/Cholangitis
  • Duodenal Ulcer
  • Liver abscess
  • Portal vein thrombosis
  • Acute hepatitis
  • Nephrolithiasis
  • RLL pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What diseases are associated with epigastrium?

A
  • Acute gastritis/GORD
  • Gastroparesis
  • Peptic ulcer disease/perforation
  • Acute pancreatitis
  • Mesenteric ischaemia
  • AAA (Abdominal Aortic Aneurysm) Aortic dissection
  • Myocardial infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What diseases are associated with LUQ?

A
  • Peptic ulcer
  • Acute pancreatitis
  • Splenic abscess
  • Splenic infarction
  • Nephrolithiasis
  • LLL Pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What diseases are associated with RLQ?

A
  • Acute Appendicitis
  • IBD
  • Colitis
  • Infectious colitis
  • Ureteric stone/Pyelonephritis
  • PID/Ovarian torsion
  • Ectopic pregnancy
  • Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What diseases are associated with suprapubic/ central?

A
  • Early appendicitis
  • Mesenteric ischaemia
  • Bowel obstruction
  • Bowel perforation
  • Constipation
  • Gastroenteritis
  • UTI/Urinary retention
  • PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What diseases are associated with LLQ?

A
  • Diverticulitis
  • IBD (Inflammatory Bowel Disease)
  • Colitis
  • Infectious colitis
  • Ureteric stone/Pyelonephritis
  • PID/Ovarian torsion
  • Ectopic pregnancy
  • Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of bowel ischaemia

A

Sudden onset crampy abdominal pain
Severity of pain depends on the length and thickness of colon affected
Bloody, loose stool (currant jelly stools)
Fever, signs of septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for bowel ischaemia

A

Age >65 yr
Cardiac arrythmias (mainly AF), atherosclerosis
Hypercoagulation/thrombophilia
Vasculitis
Sickle cell disease
Profound shock causing hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 2 types of ischaemic bowel?

A

Acute mesenteric ischaemia and ischaemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Differences between acute mesenteric ischaemia and ischaemic colitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bowel ischaemia investigations

A

Bloods
FBC: neutrophilic leukocytosis
VBG: Lactic acidosis

Imaging -CTAP/CTAngiogram
Detects
Disrupted flow
Vascular stenosis
‘Pneumatosis intestinalis’ (transmural ischaemia/infarction)
Ischaemic colitis: Thumbprint sign (unspecific sign of colitis)

Endoscopy
For mild or moderate cases of ischaemic colitis (oedema, cyanosis, ulceration of mucosa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is bowel ischaemia managed conservatively?

A

Mild to moderate cases of ischaemic colitis (not suitable for SB ischaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Conservative management for bowel ischaemia?

A

Bowel rest
Broad-spectrum ABx - colonic ischaemia can result in bacterial translocation & sepsis
NG tube for decompression - in concurrent ileus
Anticoagulation
Treat/manage underlying cause
Serial abdominal examination and repeat imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Indications for surgical management of bowel ischaemia

A

Small bowel ischaemia
Signs of peritonitis orsepsis
Haemodynamic instability
Massive bleeding
Fulminant colitis with toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Surgical management of bowel ischaemia

A

Exploratory laparotomy:
-Resection of necrotic bowel +/-open surgicalembolectomy
or mesenteric arterial bypass

Endovascular revascularisation:
-Another technique to try prior to surgery
-Balloon angioplasty/thrombectomy
-In patients without signs of ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of acute appendicitis

A

Initially periumbilical pain that migrates to RLQ (within 24hours)
Anorexia, nausea +/- vomiting, low grade fever, change in bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Important clinical signs of acute appendicitis

A

McBurney’s point: tenderness in the RLQ (lateral 1/3 of a hypothetical line drawn from the right ASIS to the umbilicus)
Blumberg sign: rebound tenderness especially in the RIF
Rovsing sign: RLQ pain elicited on deep palpation of the LLQ
Psoas sign: RLQ pain elicited on flexion of right hip against resistance
Obturator sign: RLQ pain on passive internal rotation of the hip with hip & knee flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Acute Appendicitis – Investigations

Study These Flashcards
A

Bloods
FBC: neutrophilic leukocytosis
↑ed CRP
Urinalysis: possible mild pyuria/haematuria
Electrolyte imbalances in profound vomiting

Imaging
CT: gold standard in adults esp. if age > 50
USS: children/pregnancy/breastfeeding
MRI: in pregnancy if USS inconclusive

Diagnostic Laparoscopy
In persistent pain & inconclusive imaging

24
Q

What is the Alvarado score?

Study These Flashcards
A

clinical scoring system for appendicitis

  • RLQ tenderness- 2 points
  • Rebound tenderness- 1 point
  • Fever >37.3°C- 1 point
  • Pain migration- 1 point
  • Anorexia- 1 point
  • Nausea +/- vomiting- 1 point
  • WCC >10.000- 2 points
  • Neutrophilia (left shift 75%)- 1 point

≤4 unlikely

5-6 possible

≥7 likely

25
Conservative management for acute appendicitis
IV Fluids, Analgesia, IV or PO Antibiotics In abscess, phlegmon or sealed perforation Resuscitation + IV ABx +/- percutaneous drainage
26
Indications for conservative management for acute appendicitis
After negative imaging in selected patients with clinically uncomplicated appendicitis  In delayed presentation with abscess/phlegmon formation CT-guided drainage 
27
What do we consider after conservative management?
interval appendicectomy - rate of recurrence after conservative management of abscess/perforation is 12-24%
28
Laparoscopic vs Open appendicectomy benefits
Less pain Lower incidence of surgical site infection ↓ed length of hospital stay Earlier return to work Overall costs  Better quality of life scores
29
Steps of Laparoscopic Appendicectomy
Trocar placement (usually 3) Exploration of RIF & identification of appendix Elevation of appendix + division of mesoappendix (containing artery) Base secured with endoloops and appendix is divided Retrieval of appendix with a plastic retrieval bag Careful inspection of the rest of the pelvic organs/intestines Pelvic irrigation (wash out) + Haemostasis Removal of trocars + wound closure
30
What is intestinal obstruction? What are the 2 types?
Intestinal obstruction - restriction of normal passage of intestinal contents. Two main groups: Paralytic (Adynamic) ileus Mechanical.
31
How is mechanical intestinal obstruction classified?
Speed of onset: acute, chronic, acute-on-chronic Site: high or low roughly synonymous with small or large bowel obstruction Nature: simple vs strangulating Simple: bowel is occluded without damage to blood supply. Strangulating: blood supply of involved segment of intestine is cut off (e.g. in strangulated hernia, volvulus, intussusception) Aetiology: Causes in the lumen - faecal impaction, gallstone ‘ileus’ Causes in the wall - Crohn’s disease, tumours, diverticulitis of colon Causes outside the wall – Strangulated hernia (external or internal) Volvulus Obstruction due to adhesions or bands.
32
What are the causes of small bowel obstruction?
- Adhesions (60%)- Hx of previous abdominal surgery - Neoplasia (20%)- primary (rare), metastatic, extraintestinal- can happen in ovarian peritoneal disease - Incarcerated hernia (10%)- external (abdominal wall), internal (mesenteric defect) - Crohn’s Disease (5%)- acute (oedema), chronic (strictures) - Other (5%)- intussusception, intraluminal (foreign body, bezoar)
33
What are the causes of large bowel obstruction?
- Colorectal cancer- commonest cause- usually obstructs on left hand side because on right the bowel can expand and compensate - Volvulus- sigmoid, caecal - Diverticulitis- inflammation, strictures - Faecal impaction - Hirschsprung disease- commonly found in infants/children (lack of nerve ganglions means bowels can’t do peristalsis)
34
Presentation of bowel obstruction
35
What are the 3 important things to remember about diagnosing bowel obstruction?
- Diagnosed by the presence of symptoms - Examination should always include a search for hernias and abdominal scars, including laparoscopic portholes - Is it simple or strangulating?
36
Features suggesting strangulation
Change in character of pain from colicky to continuous Tachycardia Pyrexia Peritonism Bowel sounds absent or reduced Leucocytosis ↑ed C-reactive protein
37
Types of hernias
38
Bowel Obstruction  - Investigations
Bloods WCC/CRP usually normal (if raised suspicion of strangulation/perforation) U&E: electrolyte imbalance VBG if vomiting: HypoCl-,HypoK+ metabolic alkalosis VBG if strangulation: Metabolic Acidosis (lactate) Imaging Erect CXR/AXR  SBO: Dilated small bowel loops >3cm proximal to the obstruction (central) LBO: Dilated large bowel >6cm (if caecum >9cm) predominantly peripheral CT abdo/pelvis → Transition point, dilatation of proximal loops – IV +/- oral contrast if possible
39
What does SBO abdominal Xray show?
Ladder pattern of dilated loops & their central position Striations that pass completely across the width of the distended loop produced by the circular mucosal folds
40
What does LBO abdominal Xray show?
Distended large bowel tends to lie peripherally Show haustrations of taenia coli - do not extend across whole width of the bowel.
41
What can CT show in bowel obstruction?
Can localize site of obstruction Detect obstructing lesions & colonic tumours May diagnose unusual hernias (e.g. obturator hernias).
42
When are patients with bowel obstruction conservatively managed?
In patients with no signs of ischaemia/no signs of clinical deterioration
43
Supportive management for bowel obstruction
NBM, IV peripheral access with large bore cannula - IV Fluid resuscitation IV analgesia, IV antiemetics, correction of electrolyte imbalances NG tube for decompression, urinary catheter for monitoring output Introduce gradual food intake if abdominal pain and distention improve
44
Conservative management for bowel obstruction
Faecal impaction: stool evacuation (manual, enemas, endoscopic) Sigmoid volvulus: rigid sigmoidoscopic decompression SBO: oral gastrograffin (highly osmolar iodinated contrast agent) can be used to resolve adhesional small bowel obstruction
45
Indications for surgical management of bowel obstruction
Haemodynamic instability or signs of sepsis Complete bowel obstruction with signs of ischaemia Closed loop obstruction Persistent bowel obstruction >2 days despite conservative management 
46
Surgical management of bowel obstruction
Exploratory Laparotomy/Laparoscopy  Restoration of intestinal transit (depending on intra-operational findings) Bowel resection with primary anastomosis or temporary/permanent stoma formation (Endoscopic stenting)
47
GI Perforation – Presentation 
Sudden onset severe abdominal pain associated with distention Diffuse abdominal guarding, rigidity, rebound tenderness Pain aggravated by movement Nausea, vomiting, absolute constipation Fever, Tachycardia, Tachypnoea, Hypotension Decreased or absent bowel sounds
48
What are 4 causes of GI perforation and how do they present?
49
GI Perforation – Investigations 
Bloods FBC: neutrophilic leukocytosis Possible elevation of Urea, Creatinine VBG: Lactic acidosis Imaging Erect CXR → subdiaphragmatic free air (pneumoperitoneum)   CT abdo/pelvis → Pneumoperitoneum, free GI content, localised mesenteric fat stranding can exclude common differential diagnoses such as pancreatitis
50
GI Perforation – Conservative Management
Supportive management on presentation NBM & NG tube IV peripheral access with large bore cannula - IV Fluid resuscitation Broad spectrum Abx IV PPI Parenteral analgesia & antiemetics Urinary catheter  Conservative management in localised peritonitis without signs of sepsis Very rare IR - guided drainage of intra-abdominal collection Serial abdominal examination & abdominal imaging for assessment
51
When would a GI perforation be surgically managed
Generalised peritonitis +/- signs of sepsis
52
GI Perforation – Surgical management
Exploratory laparotomy/laparoscopy Primary closure of perforation with or without omental patch (most common in perforated peptic ulcer) Resection of the perforated segment of the bowel with primary anastomosis or temporary stoma  Obtain intra-abdominal fluid for MC&S, peritoneal lavage ++++ If perforated appendix: Lap or open appendicectomy If malignancy: intraoperative biopsies if possible
53
Biliary & Pancreatic Causes of Acute Abdomen
Biliary Colic Acute Cholecystitis Acute Cholangitis Acute Pancreatitis
54
Symptoms, investigations and management for biliary colic
55
Symptoms, investigations and management for Acute Cholecystitis
56
Symptoms, investigations and management for Acute Cholangitis
57
Symptoms, investigations and management for Acute Pancreatitis

Aneesha Flashcards BRS 2 (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions