GI surgery Flashcards
(34 cards)
Presentation of gastric ulcer
burning epigastric pain. Presents with nausea, vomiting, belching and heartburn. Made worse by eating and relieved by vomiting. Often worse during the day.
Always biopsy
Presentation of duodenal ulcers
burning epigastric pain 2-3hrs after eating. Radiates to the back often worst at night with bloating and heart burn. Precipitated by missing a meal- biopsies not needed
first line management of peptic ulcers
H. Pylori eradication
- PPIs
Define:
- Kocher’s sign
- Rovsing’s sign
- Psoas sign
- Dunphey’s sign
- Sitkovsky’s sign
- periumbilical pain moved to RIF
- pain RIF > LIF when LIF is pressed
- pain in RLQ on coughing
- Pain in RLQ lying on left side
cardinal features of bowel obstruction
absolute constipation
vomiting
colicky pain
distension
Management of
a) sigmoid volv
b) caecal volv
a) sigmoidoscopy and flatus tube decompression
b) usually requires right hemicolectomy
emergency procedures in diverticulitis
Hartmann’s procedure
Presentation of acute mesenteric ischaemia
acute abdominal pain PR bleed rapid hypovolaemia normal abdo exam Pts usually have AF
investigation of choice in mesenteric ischaemia
CT scan
what is ischaemic colitis
acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in ‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.
management of ischaemic colitis
usually supportive
Boas’ sign
RUQ/ epigastric pain that radiates to right shoulder
Mirizzi syndrome
common hepatic duct obstruction due to impacted stone in cystic duct causing obstructive jaundice
Risk factors for gallstone disease
female fat fair fertile >40s crohn's disease
Charcot’s triad
- jaundice
- fever
- RUQ pain
Glasgow score
Pa02 <8kPa Age >55yrs Neutrophilia (WCC >15) Calcium <2 Renal failure (urea >16) Enzymes (LDH >600) Albumin <32 Sugar >10
Causes of acute pancreatitis
idiopathic gallstones ethanol trauma steroids mumps autoimmune scorpion bites Hypercalcaemia/hypothermia/hyprlipidamia ERCP drugs (lithium, azathioprine)
Presentation of chronic pancreatitis
- management
- surgical options
severe, constant pain radiates to back with loss of exocrine and endocrine dysfunction
- oral pancreatic enzymes, ADEK vitamins
- Whipples
Presentation of pancreatic carcinoma
painless obstructive jaundice with epigastric pain that radiates to the back
- sudden onset DM in the elderly
what is trousseau sign of malignancy
migratory thrombophlebitis presents in pancreatic ca
sister mary joseph nodule?
umbilical mets from gastric ca
features of the gastric blatchford bleeding score
urea Hb systolic BP pulse melaena syncope hepatic disease cardiac failure
Definitive diagnosis of coeliac disease
OGD & biopsy- subtotal villous atrophy, crypt hyperplasia
surgical management of:
a) rectal ca
b) sigmoid ca
3) descending colon ca
4) ascending colon ca
a) anterior resection wih temp loop ileostomy
- if <4cm from anal verge use AP resection with end colostomy
b) high anterior resection
c) left hemicolectomy
d) right hemicolectomy
