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Flashcards in GI / Gen Surg Deck (47)
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1
Q

When are pseudocysts unlikely to be present after an attack of acute pancreatitis?

A

< 4 weeks

2
Q

Local complications of AP

A
Peripancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Pancreatic abscess
Haemorrhage
3
Q

What % of AP get peripancreatic fluid collections?

A

25%

4
Q

Describe peripancreatic fluid collections

A

Located in or near the pancreas and a lack of granulation or fibrous tissue

5
Q

What may happen to peripancreatic fluid collections?

A

May resolve
May turn into abscess
May turn into pseudocysts

6
Q

Describe pseudocysts

A

In AP result from organisation of peripancreatic fluid collection
The collection is walled by fibrous or granulation tissue and typically occurs > 4 weeks after an attack of AP

7
Q

Where are most pseudocysts due to AP found?

A

Retrogastric

8
Q

What are 75% of pseudocysts associated with?

A

Elevation of amylase

9
Q

Investigation of pseudocysts due to AP

A

CT
ERCP
MRI
Endoscopic USS

10
Q

Management of pseudocysts due to AP

A

Symptomatic cases may be observed for 12 weeks as up to 50% resolve
Endoscopic or surgical cystogastrostomy or aspiration

11
Q

Describe pancreatic necrosis

A

May involve both the pancreatic parenchyma and the surrounding fat

12
Q

What are complications of pancreatic necrosis linked to?

A

Extent of parenchymal necrosis

Extent of necrosis overall

13
Q

Treatment of pancreatic necrosis

A
If sterile necrosis - manage conservatively 
Early necrosectomy (although high mortality rate so try to avoid)
14
Q

What is a pancreatic abscess?

A

Intraabdominal collection of pus associated with the pancreas in the abscess of necrosis

15
Q

What do pancreatic abscesses generally occur due to?

A

As a result of an infected pseudocyst

16
Q

Treatment of a pancreatic abscess

A

Antibiotics
Transgastric drainage
Endoscopic drainage

17
Q

How may haemorrhage occur in terms of AP?

A

Infected necrosis may involve vascular structures which result in haemorrhage may occur de novo or as a result of surgical necrosectomy

18
Q

What sign may be present if retroperitoneal haemorrhage may occur?

A

Grey turners sign

19
Q

Preferred diagnostic test for chronic pancreatitis - what are you looking for?

A

CT pancreas with intravenous contrast

Looking for pancreatic calcification

20
Q

3 criteria for aneurysm surgery

A

An asymptomatic aneurysm > 5.5cm in diameter
An asymptomatic aneurysm which is enlarging more than 1cm per year
A symptomatic aneurysm

21
Q

Criteria for emergency repair of aneurysm

A

Symptomatic aneurysm

Rupture

22
Q

Most common causes of ascending cholangitis

A
  1. E coli

2. Klebsiella

23
Q

Another name for hartmans procedure

A

Proctosigmoidectomy

24
Q

What is hartmans procedure?

A

The surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

25
Q

What reduces the risk of intra abdominal adhesions?

A

Use of laparoscopic approach over open approach

26
Q

What is used to monitor the response to treatment of colon cancer?

A

CEA

27
Q

Is there a screening programmme for aortic aneurysm? If so for who?

A

Yes
Men aged 65 y/o
Single AUSS

28
Q

Indications for surgical treatment of a sigmoid volvulus

A

Repeated failed attempts at decompression
Necrotic bowel noted on endoscopy
Suspected or proven perforation
Peritonitis

29
Q

1st line investigation for SBO

A

CT abdo

30
Q

Two most common causes of SBO

A

Intraabdominal adhesions

Hernias

31
Q

What is a defunctioning stoma?

A

The name given to any stoma which prevents the passage of bowel contents in the distal segment of the bowel

32
Q

Are end stomas reversible?

A

No

33
Q

What are intramural calcifications of the gallbladder a strong risk factor for?

A

Gallbladder cancer

34
Q

What is Reynolds pentad?

A

Charcots triad + Hypotension + Confusion

35
Q

Associations of sigmoid volvulus

A
Older patients
Chronic constipation 
Chagas disease
Neurological conditions e.g. PD, Duchennes
Psych conditions e.g. schizophrenia
36
Q

Assosiations of caecal volvulus

A

All ages
Adhesions
Pregnancy

37
Q

What is used to assess the severity of an upper GI bleed?

A

Blatchford score

38
Q

What may an enterovesical fistula cause?

A

Frothy urine

39
Q

What is a common cause of enterovesical fistula?

A

Colorectal malignancy

40
Q

Features of post op ileus

A

Occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting become apparent

41
Q

What is the rule for eating and drinking before general anaesthesias?

A

No eating for 6 hours before operation

No clear fluids for 2 hours before operation

42
Q

Definition of upper GI bleed

A

GI haemorrhage with an origin proximal to the ligament of Treitz

43
Q

What is the ligament of Trietz?

A

Suspensory muscle of the duodenum

44
Q

Describe richters hernia

A

Can present with strangulation without obstruction

Bowel lumen is patent whilst bowel wall is compromised

45
Q

Is an anal fissure is present anteriorly what is it usually due to? And posteriorly?

A

Anteriorly - Underlying organic disorder (merit endoscopy)

Posteriorly - Passage of hard stool

46
Q

What does the modified Glasgow criteria for severe pancreatitis involve?

A
P - PaO2 < 8
A - Age > 55
N - Neutrophilia
C - calcium < 2
R - renal function - urea > 16
E - enzymes - LDH > 400, AST > 200
A - Albumin < 32 (serum)
S - Sugar - BG > 10
47
Q

What is an (odd) risk factor for acute limb ischaemia?

A

AF