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GI surgery Flashcards

(104 cards)

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1
Q

Which volvulus is more common

A

Sigmoid > Cecal

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2
Q

Risk factors for sigmoid volvulus

A

Old, constipation, chagas disease, Neurological disease and mental health condition

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3
Q

Risks for cecal volvulus

A

Adhesion and pregnancy

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4
Q

Sigmoid volvulus leads to

A

Large bowel obstruction; coffee bean sign aka bent inner tube sign on AXR

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5
Q

Caecal volvulus leads to

A

Small bowel obstruction

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6
Q

Management of sigmoid volvulus

A

Colonoscopy decompression aka Rigid sigmoidoscopy

laparoscopic or open sigmoid colectomy

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7
Q

Management of Cecal volvulus

A

laparoscopic or right hemicolectomy
no colonoscopy as can perforate cecum
Caecostomy

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8
Q

Hemorrhage in post-Op

A

Primary: during surgery
Reactive: At the end or early post op
Secondary: >24 hours due to infection

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9
Q

Post-op urinary retention

A

Drugs: opioids, epidural, antiACHM; pain- SNS

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10
Q

Pulmonary Atelectasis post op

A

General anaesthesia relayed, mucus plugging, absorption of distal air and collapse of lung;
Risks: smoking pre-op, Anaesthetic concentration, pain inhibits cough and respiratory excursion

Presents within first 48 hours, mild fever, dyspnea and dull bases with decreased air entry

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11
Q

Wound infections post-op

A

Typically occur 5 to 7 days post-op

S. Aureus and Coliforms

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12
Q

Wound dehiscence

A

10 days post op, preceded by serosanguinous discharge from the wound

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13
Q

Colonic surgery post op

A

Ileus, anastomosis leak, enterocutaneous fistula and abscess

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14
Q

Small bowel surgery Post op

A

Short gut syndrome

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15
Q

Post op pyrexia

A

early: Blood transfusion, physiological (SIRS), atelectasis (24-48h)
Delayed: pneumonia, VTE, wound infection, Anastomotic leak at 7 d

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16
Q

What is the most common cause of secondary peritonitis

A

Acute perforated appendicitis in under 45s

Elderly - Diverticultitis perforated

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17
Q

Investigation of choice in peritonitis

A

Abdominal CT scan

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18
Q

treatment of choice for peritonitis

A

IV metronidazole + Cefuxime

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19
Q

What is a fistula in Ano

A

Abnormal connection between ano-rectal canal and the skin
Presents with anal discharge and pain
May be purulent

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20
Q

Perianal fistula pathogenesis

A

occurs secondary to perianal sepsis and blocked intramuscular gland forming abscess, abscess forms a fistula

Associated to Crohns, Diverticular disease, rectal cancer

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21
Q

High and low Anal fistula

A

High: cross sphincter muscles above the dentate line
Low: below the dentate line

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22
Q

Goodsall’s Rule

A

Fistula anterior to anus track in a straight line

Fistula posterior to anus - has internal opening at 6 oclock position

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23
Q

Investigation in Anal fistula

A

MRI and endoanal USS

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24
Q

Treatment of anal fistula

A

examination under anaesthesia
Fistulotomy and excision - low fistula
High fistula: suture passed through fistula and gradually tightened over months

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25
Treatment of perianal abscess
EUA and Incision and drainage 2 intention healing complication is fistula
26
Which ulcer pain gets relieved by eating
Duodenal ulcer
27
Which ulcer pain gets worse on eating
Gastric; relieved by antacids
28
What are curling's ulcers related to
Burns
29
Investigation of Peptic ulcers
Breath test, OGD - gold standard (stop PPI 2 weeks) | Gastrin levels for Zollinger-Ellison
30
Surgical management of peptic ulcers
Vagus nerve stimulates acid secretion and also by gastrin (from antral G cells) 1. Vagotomy: truncal: prevents pyloric sphincter relaxation, combined with pyloroplasty or gastroenterostomy Selective- nerves of laterhet left intact 2. Antrectomy with vagotomy: distal stomach removed Subtotal gastrctomy with Roux-en-Y: Zollinger-Ellison
31
Dumpling syndrome
Abdo distention, flushing, n/v | hypoglycemia and hypovolemia
32
H pylori increases the risk of
Lymphoma and gastric primary adenocarcinoma
33
Triple and quadruple therapy - H pylori
Bismuth + metronidazole + Tetracycline + PPI or Clarithromycin + AMoxicillin + PPI
34
Gastrinoma located in pancreas, MEN1, hypersecretion of gastrin from tumor in pancreas or duodenum, diarrhea
Zollinger-Ellison syndrome
35
Cushing ulcer triad
Hypertension + widening pulse pressure and bradycardia due to ICP
36
Type A gastritis vs Type B gastritis
Type a: autoimmune gastritis, Pernicious anemia, anti-pariteal antibodies Type b: pylorus and antrum, H, pylori, increased risk of gastric and duodenal adenocarcinoma
37
painless Jaundice, Dark urine and light stools, Nausea, pain after eating, unintended weight loss, upper abdominal pain, back pain, cachexia, virchow's nodes, Courvoisers sign and trousseau's syndrome - Migratory thrombophlebitis
Pancreatic cancer
38
Risks for pancreatic cancer
Smoking, inflammation (chronic), high fat diet, Etoh and DM
39
Signs of pancreatic cancer
palpable GB + jaundice + Trousseau + splenomegaly + Ascites
40
Investigation of pancreatic cancer
Cholestatic LFTs + Ca19-9 USS: pancreatic mass, dilated ducts and hepatic metastasis Endoscopic USS > CT/MRI for staging CXR: metastasis ERCP: shows anatomy, allows stent and biopsy
41
Surgical treatment of pancreatic cancer
Whipple's Pancreaticoduodenectomy Palliation - P/C or endoscopic stenting pain relied coeliac plexus block
42
Lower 3rd oesophagus, GORD related and barretts - cancer
Adenocarcinoma
43
upper and middle third, Associated with alcohol and smoking
SCC
44
Progressive dysphagia from solids to liquids, weight loss, retrosternal chest pain, lymphadenopathy and upper third hoarseness - recurrent laryngeal nerve and cough and aspiration pneumonia
Oesophageal cancer
45
Diagnosis of oesophageal cancer
Upper GI endoscopy- biopsy BA swallow: apple core stricture Staging: CT/ EUS
46
Surgical treatment of oesophageal cancer
Oesophagectomy Ivor-lewis, McKeown and trans-hiatal Palliative: laser coagulation, stenting, radiotherapy
47
Following a viral infection, enlargement of LNs causing pain, tenderness and fever Causes: high temp, tenderness is generalised, lymphocytosis, Post URTI and photophobia
Mesenteric adenitis
48
Ileal remnant of vitellointestinal duct that joins the yolk sac to the mid gut
Meckel's diverticulum
49
PC of meckel's
Rectal bleeding, diverticulitis, intussuception, volvulis, malignant change into adenocarcinoma, raspberry tumor Investigation: Pertechenecate scan Surgical resection is required
50
Triad of mesenteric ischemia
Acute abdominal pain + PR bleeding + shock + No abdominal signs AF can be seen
51
Imaging in mesenteric ischemia
AXR: gas less bowel | Arteriography, CT angi, MRI angio
52
management in ischemic bowel
Resection of the necrotic bowel
53
Imaging in bowel onstruction
AXR- fluid levels and CT | gastrograffin - mechanical obstruction
54
AXR findings in Obstruction
>3 cm, central, many loops and many short fluid level- SBO | >6cm or >9 cecum, peripheral, haustra, gas present, few loops - LBO
55
Management of Bowel Obstruction
NBM, IV fluids, NGT and cathetrise Surgery: closed loop, neoplasm, strangulation or perforation with peritonitis, failed conservative LBO: hartmann's, colectomy, bypass, loop ileostomy or colostomy, caecostomy
56
Strictures, transmural, cobblestone mucosa, granuloma, fistula, aphthous ulcers
Crohn's
57
Mucosal, pseudopolyps, bloody stools, tenesmus, urgency , CRC
UC
58
Associations of IBD with systemic diseases
Erythema nodusum, pyoderma gang, iritis, arthritis, PSC + cholangiocarcinoma
59
induce Remission in mild to moderate UC
5ASA and prednisolone
60
Maintaining remission in UC
5ASA Po, azathioprine or Mercaptopurine | Infliximab 3rd line
61
Surgical treatment in UC
Emergency: Total or subtotal colectomy with end ileostomy + mucus fistula panprotocolectomy + end ileostomy Elective: pan proctocolectomy with end ileostomy
62
Types of hiatus hernia
Sliding common - GOJ slides up into chest, associated with GORD Rolling: Stomach into the chest with oesophagus; stangulation risk
63
Investigation and treatment of hiatus hernia
CXR- gas bubble and fluid level Ba swallow: diagnostic choixe OGD: oesophagitis Repair of rolling hernia
64
Surgical repair of inguinal hernia
``` Lichtenstein repair open approach laproscopic: bilateral repair and recurrent hernia primary unilateral - Open Children- sac excision - hernitomy ```
65
symptoms of Haemorrhoids
Fresh PR bleeding, pruritus ani, lump in perianal area and thrombosis
66
Investigation of hemorrhoids
proctoscopy and DRE
67
management of hemorrhoids
rubber bind ligation, injection sclerotherapy, excision for acutely thrombosed within 72 hours
68
Metaplasia of squamous epithelium
Barretts
69
Metaplasia to dysplasia to adenocarcinoma
Cancer
70
Surgical management of GORD
nissen fundoplication: severe sxs, refarctory to medical therapy and confirmed reflux on pH monitoring
71
GORD investigation
High risk OGD | 24 hour manometry and pH
72
Risk factors for gastric cancer
Atrophic gastritis, pernicious anemia, nitrates, smoking, BG-A, partial gastrectomy
73
Pathology of gastric cancer
adenocarcinoma + H pylori- MALToma | SXS: late pC, weight lost, anorexia, dyspepsia, dysphagia and n/v, acanthosis nigricans
74
Surgical management of gastric cancer
Pyloric stenting and bypass procedures resection endoscopically total gastrectomy
75
Choice of investigation for biliary colic
USS uncertain- HIDA dilated ducts seen MRCP
76
Murphy sign
pain and breath catch on GB and absent on left
77
Boas's sign
hyperaesthesia below right scapula
78
empyema
High fever, RUQ mass and P/C drainage
79
Riger's triad for gallstone ileus
pneumobilia + sbo + RLQ Gallstone
80
Ascending cholangitis
1st line USS 1st ERCP PTC
81
Reynolds pentad
fever + RUQ + Jaundice + confusion + hypotension
82
Hypovolemia + retroperitoneal hemorrhage + pancreatic necrosis
Acute pancreatitis
83
Causes of acute pancreatitis
mostly gallstones alcohol others- ethanol, idiopathic, trauma, steroids, mumps, ERCP
84
Modified glasgow scale
paO2, age, neutrophils, Calcium low, renal function, LDH, albumin and sugar
85
Imaging in acute pancreatitis
US, Contrast CT**
86
treatment in pancreatitis
ERCP if gallstones | ERCP + sphincterotomy
87
Surgical treatment in acute pancreatitis
Pancreatic necrosis, abscess laparotomy + necrosectomy peritoneal lavage
88
Complications of acute pancreatitis
ARDS, pleural effusion, shock, DIC late: necrosis, infection, abscess, pseudocyst, bleeding, thrombosis, fistula
89
pseudocyst of pancreas
lesser sac, 4-6 weeks after acute attack, pain and early satiety, infection can occur persistent raised amylase PC drainage under US/Ct
90
Chronic pancreatitis causes
alcohol is most common
91
Pain into back, steatorrhea, weight loss, polyuria and polydipsia, pseudocyst, elastase and exocrine function
CT calcification
92
Surgical treatment of chronic pancreatitis
Distal pancreatectomy whipples drainage and stenting
93
Hellers cardiomyotomy
Achalasia
94
ANal fissure treatment
EUA | medical: laxative, lignocaine, GTN, diazepam, and botulinum injection
95
Surgical treatment of anal fissures
lateral partial sphincterotomy
96
Hinchey grading
``` diverticultis small confined pericolic abscesses large abscess Generalized peritonitis faecal peritonitis ```
97
Surgical therapy in diverticulitis
Hartmann's
98
Colon cancer treatment
Caecal, ascending, or proximal transverse colon: right hemicolectomy Distal transverse descending colon: left hemicolectomy Sigmoid colon: High anterior resection Upper rectum: anterior resection with TME low rectum: anterior resection with low TME anal verge APER
99
Familal adenomatous polyposis
Autosomal dominant, APC gene, 100-1000s adenomas by 16 years of age Variants Attenuated- <100 >50 CRC Gardners: TODE- thyroid, osteoma, dental problem, epidermal cysts treat using prophylactic colectomy before 20
100
Hereditary non-polyposis colorectal cancer
Autosomal dominant, commonest CRC Lynch 1: right sided CRC lynch 2: CRC + gastric, prostate and breast
101
Peutz-Jeghers
Autosomal dominant | increased cancer risk, hyperpigmentations
102
appendicitis pain veretbrae
t10-11
103
McBurney's point
Guarding and tenderness
104
psoas sign
retrocecal appendix

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