Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1B Gastroenterology > General surgery > Flashcards

General surgery Flashcards

1
Q

what diseases can occur in right upper quadrant pain?

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
2
Q

what diseases can occur with epgastrium pain?

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
3
Q

what diseases can occur with left upper quadrant pain?

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
4
Q

what diseases can occur with right lower quadrant pathology?

A
  • Acute Appendicitis
  • Colitis
  • IBD
  • 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
5
Q

what diseases can occur with suprapubic/central pathology?

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
6
Q

what diseases can occur with left lower quadrant pathology?

A
  • Diverticulitis
  • Colitis
  • IBD
  • 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
7
Q

what is the presentation of bowel ischemia?

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
8
Q

what is the presentation of acute mesenteric ischaemia?

A

small bowel

usually occlusive due to thromboemboli

sudden onset (presentation and severity varies)

abdominal pain out of proportion of clinical signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the presentation of ischaemic colitis?

A

large bowel

usually due to non-occlusive low flow states or atheroscelerosis

more mild and gradual

moderate pain and tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the 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
11
Q

what investigations can be done for suspected bowel ischaemia?

A

bloods

imaging

endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the bloods seen in bowel ischaemia?

A

FBC: neutrophilic leukocytosis

VBG: lactic acidosis

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

what imaging can be done in bowel ischaemia?

A
  • Imaging-CTAP/CT angiogram
    • Detects:
      • Disrupted flow
      • Vascular stenosis
      • ‘pneumatosis intestinalis’ (transmural ischaemia/ infarction)
      • Ischaemic colitis: Thumbprint sign (unspecific sign of colitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when is endoscopy done in bowel ischaemia?

A

for mild/moderate cases of ischaemic colititis (oedema, cyanosis, ulceration mucosa)

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

what conservative management can be used for bowel ischaemia?

A
  • Mild to moderate cases of ischaemic colitis (not suitable for Small Bowel/acute mesenteric ischaemia)
  • IV fluid resuscitation
  • Bowel rest (Nil by mouth)
  • Broat 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
16
Q

what are the indications for surgery in bowel ischaemia?

A
  • Small bowel ischaemia
  • Signs of peritonitis or sepsis
  • Haemodynamic instability
  • Massive bleeding
  • Fulminant colitis with toxic megacolon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what surgery can be done for bowel ischaemia?

A
  • Exploratory laparotomy
    • Resection of necrotic bowel +/- open surgical embolectomy
    • Or mesenteric arterial bypass
  • Endovascular revascularisation
    • Balloon angioplasty/ thrombectomy
    • In patients without signs of ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the presentation of acute appendicitis?

A
  • Initially periumbilical pain that migrates to RLQ (within 24 hrs)
  • Anorexia, nausea +/- vomiting, low grade fever, change in bowel habit
  • Important clinical signs
    • McBurney’s point:
      • Tenderness in RLQ (lateral 1/3 of a hypothetical line drawn from right ASIS to umbilicus)
    • Blumberg sign
      • Rebound tenderness especially in 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 and knee flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what blood results are present in acute appendicitis?

A
  • FBC: neutrophilic leukocytosis
  • ↑ed CRP
  • Urinalysis: possible mild pyuria/haematuria
  • Electrolyte imbalances in profound vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what imaging is used in acute appendicitis?

A
  • CT: gold standard in adults esp. if age > 50
  • USS: children/pregnancy/breastfeeding
  • MRI: in pregnancy if USS inconclusive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is done if suspected appendicitis with persistent pain and inconclusive imaging?

A

diagnostic laparoscopy

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

how is the likelihood of appendicitis calculated?

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

what is the conservative management for appendicitis?

A
  • IV fluids, analgesia, IV or PO antibiotics
  • In abscess, phlegmon or sealed perforation
    • Resuscitation + IV Abx +/- percutaneous drainage
    • CT guided drainage
  • Consider interval appendectomy- rate recurrence after conservative management of abscess/ perforation is 12-14%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the indications for conservative management?

A
  • After -ve imaging in selected patients with clinically uncomplicated appendicitis
  • In delayed presentation with abscess/ phlegmon formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what surgical management is used for appendicitis?

A
  • appendectomy
  • Usually laparoscopically
    • Less pain
    • Lower infection
    • Decreased hospital stay
    • Earlier return to work
    • Overall costs
    • Better quality of life scores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is a bowel obstruction?

A

intestinal obstruction- restriction of normal passage of intestinal contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the types of bowel obstruction?

A
  • Paralytic (adynamic) ileus
  • Mechanical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how is mechanical obstruction classified?

A

speed of onset

site

nature

aetiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the possible speed of onsets of mechanical obstruction?

A

acute

chronic

acute on chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the possible sites of mechanical obstruction

A

high or low

roughly synonymous with small or large bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the possible nature of mechanical obstruction

A
  • Simple vs strangulation
    • 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)
32
Q

what are the possible aetiologies of bowel obstruction?

A
  • Causes in lumen- faecal impaction, gallstone ‘ileus’
  • Causes in the wall- Crohn’s disease, tumours, diverticulitis of colon
  • Causes outside wall
    • Strangulated hernia (external or internal)
    • Volvulus
    • Obstruction due to adhesions or bands
33
Q

what are the possible causes of small bowel obstruction?

A

adhesions- history previous abdo surgry

neoplasia (primary, metastatic, extraintestinal)

incarcerated hernia(external- abdo wall, internal-mesenteric defect)

crohn’s disease (acute-oedma, chronic-strictures)

other ( intussusception, intraluminal (foreign body, bezoar)

34
Q

what are the causes of large bowel obstruction?

A

colorectal carcinoma

volvulus

diverticulitis

faecal impaction

Hirschsprung disease

35
Q

what is the presentation differences between small and large bowel obstruction?

A
36
Q

how is bowel obstruction diagnosed?

A
  • Diagnosed by presence of symptoms
  • Examination should always include search for hernias & abdominal scare, including laparoscopic port holes
  • Is it simple or strangulation?
37
Q

what are the features suggesting strangulation?

A
  • Change character pain from colicky to continuous
  • Tachycardia
  • Pyrexia
  • Peritonism
  • Bowel sounds absent or reduced
  • Leucocytosis
  • Increase CRP
38
Q

is a large or small hernia more dangerous?

A

large is less dangerous as less change obstruction and ischaemic bowel

39
Q

what are the common hernial sites?

A

epigastric

umbillical

incisional

inguinal

femoral

40
Q

how does a hernia cause obstruction?

A

neck of sack forms strangulated hernia -> richter’s hernia

41
Q

what are the blood results for hernia?

A
  • 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)
42
Q

what imaging is done for hernias?

A
  • 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
43
Q

what is seen in a Abdo XRay for small bowel obstruction?

A
  • 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
44
Q

what is seen on an Xray for large bowel obstruction?

A
  • Distended large bowel tends to lie peripherally
  • Show haustrations of taenia coli - do not extend across whole width of the bowel.
45
Q

what can a CT scan show about a bowel obstruction?

A
  • Can localise site of obstruction
  • Detect obstruction lesions & colonic tumours
  • May diagnose unusual hernias (e.g obturator hernias)
46
Q

when is conservative management used for bowel obstruction?

A
  • In patients with no signs of ischaemia/no signs of clinical deterioration
  • supportive management combined with conservative treatment
47
Q

what are the supportive managements for bowel obstruction?

A
  • NBM (nil by mouth), IV peripheral access with large bore cannula - IV Fluid resuscitation
  • IV analgesia, IV antiemetics, correction of electrolyte imbalances
  • NG tube for decompression (also stop aspiration pneumonia), urinary catheter for monitoring output
  • Introduce gradual food intake if abdominal pain and distention improve
48
Q

what are the options for conservative treatment for bowel obstruction?

A
  • 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
49
Q

what are the indications for surgical management in bowel obstruction?

A
  • Haemodynamic instability or signs of sepsis
  • Complete bowel obstruction with signs of ischaemia
  • Closed loop obstruction
  • Persistent bowel obstruction >2 days despite conservative management
50
Q

what operation is done for bowel obstruction?

A
  • Exploratory laparotomy/ laparoscopy
  • Restoration of intestinal transit (depending on intra-operational findings)
  • Bowel resection with primary anastomosis or temporary/ permanent stoma formation
  • Endoscopic stenting if obstruction is distal is always an option
51
Q

What is the presentation for GI perforation?

A
  • 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
52
Q

what are the signs of a perforated peptic ulcer?

A

sudden epigastric or defuse pain

referred shoulder pain

history of NSAIDs, steroids, recurrent epigastric pain

53
Q

what are the signs of perforated appendix?

A

migratory pain

anorexia

gradual worsening RLQ pain

54
Q

what are the signs of perforated diverticulum?

A

LLQ pain

constipation

insidious onset

55
Q

what are the signs of perforated malignancy?

A

change in bowel habit

weight loss

anorexia

PR bleeding

56
Q

what are the bloods in someone with GI perforation?

A
  • FBC: neutrophilic leucocytosis
  • Possible elevation of urea, creatinine
  • VBG: lactic acidosis
57
Q

what is seen in imaging in someone with GI perforation?

A
  • 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

58
Q

what are the differential diagnosis of GI perforation?

A
  • Acute cholecystitis, appendicitis
  • Myocardial infarction, acute pancreatitis (check analyse)
59
Q

what are the conservative managements for GI perforation?

A
  • NBM & NG tube
  • IV peripheral access with large bore cannula - IV Fluid resuscitation
  • Broad spectrum Abx
  • IV PPI
  • Parenteral analgesia & antiemetics
  • Urinary catheter
60
Q

what is the conservative management in localised peritonitis without signs of sepsis?

A
  • IR - guided drainage of intra-abdominal collection
  • Serial abdominal examination & abdominal imaging for assessment
61
Q

when is surgical management used in GI perforation?

A
  • In generalised peritonitis +/- signs of sepsis
62
Q

what surgery is done in GI perforation?

A
  • Exploratory laparotomy/laparascopy
  • 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
63
Q

what surgery is done for perforated appendix?

A

laparoscopic or open appendectomy

64
Q

what is done on GI perforation if malignancy?

A

intraoperative biopsies if possible

65
Q

what are the symptoms of biliary colic?

A
  • Postprandial RUQ pain with radiation to the shoulder.
  • Nausea
66
Q

what are the symptoms of acute cholecystitis?

A
  • Acute, severe RUQ pain
  • Fever
  • Murphy’s sign
67
Q

what are the symptoms of acute cholangitis?

A

Charcot’s triad: jaundice, RUQ pain, fever

68
Q

what are the symptoms for acute pancreatitis?

A
  • Severe epigastric pain radiating to the back
  • Nausea +/- vomiting
  • Hx of gallstones or EtOH use
69
Q

what are the investigation results for biliary colic?

A
  • Normal blood results
  • USS: cholelithiasis
70
Q

what is the management for biliary colic?

A
  • Analgesia, Antiemetics, Spasmolytics
  • Follow up for elective cholecystectomy
71
Q

what are the investigation results for acute cholecystitis?

A
  • Elevated WCC/CRP
  • USS: thickened gallbladder wall
72
Q

what is the management for acute cholecystitis?

A
  • Fluids, ABx, Analgesia, Blood cultures
  • Early (<72 hours) or elective cholecystectomy (4-6 weeks)
73
Q

what is the investigation results for acute cholangitis?

A
  • Elevated LFTs, WCC, CRP, Blood MCS (+ve)
  • USS: bilary dilatation
74
Q

what is the management for acute cholangitis?

A
  • Fluids, IV Abx, Analgesia
  • ERCP (within 72hrs) for clearance of bile duct or stenting
75
Q

what is the investigation results for acute pancreatitis?

A
  • Raised amylase/lipase
  • High WCC/Low Ca2+
  • CT and US to assess for complications/cause
76
Q

what is the management for acute pancreatitis?

A
  • Admission score (Glasgow-Imrie)
  • Aggressive fluid resuscitation, O2
  • Analgesia, Antiemetics
  • ITU/HDU involvement

1B Gastroenterology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions