General Surgery - Intestines

Question 1

what is a paralytic ileus?

Answer 1

adynamic bowel due to no peristaltic contractions

no mechanical obstruction

Question 2

risk factors for paralytic ileus?

Answer 2

abdo surgery

electrolyte imblances

Question 3

Tx for paralytic ileus?

Answer 3

NG tube decompression

Fluids

Question 4

what happens in pseudo obstruction? how to manage?

Answer 4

mechanical GI obstruction with no cause found

AXR and decompress

Question 5

features of bowel obstruction?

Answer 5

pain
vomiting
abdo distension
tinkling bowel sounds

Question 6

what is a volvulus?

Answer 6

mobile loop of bowel that has rotated on its mesentery

Question 7

common sites of volvulus?

Answer 7

sigmoid colon

Question 8

Ix for volvulus? what is the sign?

Answer 8

AXR

coffee bean appearance

Question 9

Tx for volvulus?

Answer 9

sigmoidoscopy + flatus tube

Question 10

risk factors for mesenteric ischaemia?

Answer 10

AF

Question 11

what 3 types of mesenteric ischaemia exist?

Answer 11

acute mesenteric
chronic
chronic colonic

Question 12

what causes chronic ischaemia?

Answer 12

low flow state and atheroma

Question 13

Ix for mesenteric ischaemia?

Answer 13

FBC
ABG (metabolic acidosis)
AXR (gassless abdo)
CT/MRI angio
colonoscopy + biopsy (for chronic colonic)

Question 14

what causes chronic colonic mesenteric ischaemia?

Answer 14

low flow in IMA
ischaemic colitis results
e.g bloody diarrhoea

Question 15

Tx for mesenteric ischaemia?

Answer 15

fluids
Abx
heparin
surgery (revascularise/resect)

Question 16

features of appendicitis?

Answer 16

fever
diarrhoea
umbilical abdo pain localising to RIF
mcburney's point 
rosving's sign

Question 17

most common position of the appendix?

Answer 17

retrocaecal

Question 18

what anatomical landmark helps distinguish the appendix during surgery?

Answer 18

taenia coli (smooth muscle) converge at the base

Question 19

what is the appendixes blood supply and why is it high risk?

Answer 19

appendicular artery

sole mesentery so high risk of gangrene if interrupted

Question 20

Ix for appendicitis?

Answer 20

FBC
U+Es
CRP
IV fluids
CT/US

Question 21

Tx for appendicitis?

Answer 21

appendicectomy

Abx if perforated - gent + met

Question 22

what are colonic polyps?

Answer 22

adenomas arising from the colonic mucosa

can become neoplastic

Question 23

features of polyps?

Answer 23

bleeding 
mucus
tenesmus 
anaemia
asymptomatic

Question 24

what genetic conditons are at risk of polyps?

Answer 24

FAP

peutz jegher syndrome

Question 25

Ix and Tx for polyps?

Answer 25

colonoscopy | biopsy/removal

Question 26

what is the screening regime after polyp removal?

Answer 26

``` low = 5 medium = 3 high = 1 ```

Question 27

what type is most common for colorectal cancer?

Answer 27

adenocarcinoma

Question 28

risk factors for colon cancer?

Answer 28

``` polyps meat low fibre diet smoking alcohol Hx of cancer FHx ```

Question 29

left side symptoms for colorectal cancer?

Answer 29

``` bleeding mucus altered habit tenesmus mass ```

Question 30

right side symptoms for colorectal cancer?

Answer 30

weight loss anaemia abdo pain

Question 31

what type of anaemia results from blood loss?

Answer 31

iron deficiency | microcytic (low MCV)

Question 32

Ix for colorectal cancer?

Answer 32

FBC FIT colonoscopy CT

Question 33

what is CAE used for?

Answer 33

confirms presence of disease in colorectal cancer | NOT a screening test

Question 34

what are the Dukes stages?

Answer 34

A - muscularis mucosae B - extension throughout C - LNs D - metastases

Question 35

Tx for colorectal cancer?

Answer 35

``` hemicolectomy anterior resection (rectum + diseased bowel) ```

Question 36

at what Dukes stage can chemo be added?

Answer 36

C - LNs involved

Question 37

who gets bowel screening?

Answer 37

50-74yrs | every 2 years

Question 38

what is diverticular disease?

Answer 38

herniations of mucosa and submucosa through the colonic wall (outpouchings)

Question 39

what is meckel's diverticulum? where is it found?

Answer 39

outpouching due to incomplete regression of the viteline duct above ileocaecal valve

Question 40

Ix for diverticular disease?

Answer 40

colonoscopy | CT

Question 41

features of diverticular disease?

Answer 41

abdo pain worse after eating bleeding bloating

Question 42

Tx for diverticular disease?

Answer 42

high fibre diet | hartmann's

Question 43

what happens in hartmann's procedure?

Answer 43

rectosigmoid colon resected anorectal stump closed end colostomy out tummy

Question 44

what is a complication of diverticular disease? Tx?

Answer 44

diverticulitis fluids, Abx may need CT guided abscess drainage

Question 45

features of peritonitis?

Answer 45

shock guarding rebound tenderness no bowel sounds