GI

Question 1

features of appendicitis

Answer 1

vomiting
anorexia
fever
constipation
diarrhoea

Question 2

DDx for appendicitis

Answer 2

renal stone
testicular / ovarian torsion
ectopic
GI obstruction
constipation
strangulation hernia
mesenteric adenitis
intussusception
meckel diveriticulitis

Question 3

what is mesenteric adenitis

Answer 3

self-limitting inflammation of the mesenteric lymph nodes

RIF pain
- common DDx for appendicitis

Question 4

what results would increase suspicion towards appendicitis

Answer 4

raised neutrophil
raised WCC
raised CRP

Question 5

what should always be performed in a women with abdo pain

Answer 5

pregnancy test

Question 6

define diverticulitis

Answer 6

inflammation of the diverticular

Question 7

define diverticulosis

Answer 7

presence of diverticula in the GI tract

Question 8

define diverticular disease

Answer 8

symptomatic diverticula

Question 9

what is the main stay of conservative Mx in diverticular disease

Answer 9

analgesia
abx
adequate hydration

Question 10

complications of diverticular disease

Answer 10

perforation
bleeding
abscess 
fistula 
strictures

Question 11

how do you determine betwen inguinal and femoral hernias

Answer 11

inguinal - more medial + superior to pubic tubercle

femoral - inferior + lateral

Question 12

most common type of hernia

Answer 12

inguinal (80%)

direct (20%)

Question 13

how to determine the difference between indirect and direct hernia - in relation to the inferior epigastric vessels

Answer 13

indirect - laternal to the inferior epigastric vessels

direct - medial to the inferior epigastri cvessels

Question 14

which hernia is high risk of strangulation

Answer 14

femoral

Question 15

obstructed inguinal hernia

Answer 15

implies that the contents of the GI tract cannot pass

Question 16

how do inferior hernias occur

Answer 16

1. testes descend from the posterior abdominal wall into the scrotum following the processus vaginalis

–> passing through the inguinal ring into the scrotum

Question 17

RF for developing inguinal hernia

Answer 17

chronic cough
obese
prematurity
male
heavy lifting

Question 18

what are haemorrhoids?

Answer 18

vascular rich connective tissue cushions within the anal canal

internal - proximal to dentate line

external - distal to the dentate line

Question 19

Mx for haemorrhoids

Answer 19

increase dietary fibre

band ligation

Question 20

bloody supply to foregut / mid / hide

Answer 20

fore - celiac artery (up to 1/2 duodenum)

mid - superior mesenteric artery

hide - inferior mesenteric artery

Question 21

metabolic electrolyte balance of acute mesenteric ischaemia

other bloods

Answer 21

metabolic acidosis

lactate
raised WCC

Question 22

gold standard for mesentaric ischaemia

Answer 22

angiography

Question 23

indications for splenectomy

Answer 23

• spontanous rupture / EBV
• trauma
• hyperspenism (hereditary sphereocytosis)
• malignancy

Question 24

what do howell jolly bodies signify?

Answer 24

occur where there is no spleen or a non-functing spleen = asplenia

they are RBC with the nuclear remanent

Question 25

most common pathogen of meningitis in asplenia

Answer 25

meningingitis pneumonia

Question 26

long term Mx following splenectomy

Answer 26

1. life long prophylatic abx (pen V) | 2. pneumonccal vaccine

Question 27

Acute pancreatis causes

Answer 27

``` gallstones alcohol trauma steroids mumps autoimmune scorp HYPER - lipidaemia / calcium / PTH ERCP drugs (azathopurine, tetracycline, mesalaine ) ```

Question 28

acute / chronic complications of acute pan

Answer 28

acute: - ARDS - shock - DIC - sepsis Chronic: - chronic panc - pancreatic pseudocyst (fibrosis/gransulation tissue) - pancreatic necrosis

Question 29

acute panc Mx

Answer 29

use glasgow-imrie criteria - determines severity of pancreatitis (48hrs after hosp admission) 1. NG tube - helps prevent bacterial translocation from the gut (prevents panc necrosis) 2. fluid managament 3. abx therapy 3. if due to gallstones --> cholecystectomy

Question 30

acute panc Ix

Answer 30

serum lipase - more sensitive + specific than amylase serum amylase do not correlate with disease severity

Question 31

how to detemine between small / large bowel obstruction

Answer 31

normal (3/6/9 rule) small bowel - valvulae conniventes (width of the bowel) - central in the abdomen - diameter is around 2.5cm - greater than 3cm - adhesions, from previous surgery (75%) large bowel - haustra (arrow head) Most common: - colorectal carcinoma - diverticular strictures

Question 32

causes of bowel obstruction

Answer 32

``` adhesions hernias strictures tumour diverticultis ```

Question 33

common origin tumours going to the liver

Answer 33

GI tract breast lung

Question 34

Mx for bowel obstruction

Answer 34

bowel rest 'drip + suck' - NG - give the bowel a rest from secreting gastric contents

Question 35

what does TNF-a inhibitors do?

Answer 35

antibody directed against tumour-necrosis factor - important in establishing inflammation + granuloma formation

Question 36

site of porta-systemic anatosomes

Answer 36

superior rectal vein shunts - haemorrhoids paraumbilical vein shunts - caput madusae