GI Surgery Flashcards
(42 cards)
On x-ray, what is the rule for judging abnormalities in the small and large bowel?
3/6/9
- small bowel is dilated is >3cm
- large bowel is dilated if >6cm
- sigmoid and caecum shouldn’t be >9cm
What is a sigmoid volvulus?
A twisting of the mesentery around the sigmoid colon resulting in ischaemia and infarction risk?
What is your management of a sigmoid volvulus?
- emergency rigid sigmoidoscopy - insert a rectal tube to decompress the volvulus
What is the typical abdominal x-ray sign associated with a sigmoid volvulus?
- coffee bean sign
- may occur chronically, located near acetabulum
How do you recognise a caecal volvulus? What is your management of it?
- occurs in the upper abdomen (sigmoid occurs near the acetabulum of the femur), coffee-bean sign
- treat with a laparotomy and a right hemicolectomy
What is your acute management of free air under the diaphragm and what is it called? Why is it so bad?
- pneumoperitoneum - indicates a bowel perforation
- A-E and resuscitation, immediate surgical involvement and antibiotics
What is a porcelain gallbladder?
Calcification of the gallbladder, often pre-malignant condition and requires a cholecystectomy
A patient post-op presents with a distended abdomen and is complaining of a ‘lump in their groin’. The most likely cause is…?
- an incarcerated hernia
What would you see on x-ray for inflammatory bowel disease?
- thumbprinting, inflamed colon, looks wooly and fluffy
- can present with diarrhoea, bloody stools, increased frequency, thickened walls
- bloody stools more likely to be UC, but not differentiatable on XR
Gallstones present on XR not in the gallbladder indicates…?
- Gallstone ileus
- they’ve passed through to the bowel and are causing a small bowel obstruction
- there is usually pneumobilia
What are some potential causes of calcification in the kidneys on abdominal x-ray?
- ureter stone
- staghorn calculus
- renal calculus
Air present throughout the large bowel indicates…?
Pseudo-obstruction
A chest x-ray shows a different projection of texture over the heart - what is the most likely cause?
Hiatus hernia
Murphy’s sign is indicative of what…?
It is tenderness of gallbladder palpation - it usually indicates cholecystitis
What are the risk factors for gallstones?
Fat, Female, Fertile, FOrty
What is your investigation of choice for gallstones/biliary colic?
Abdominal USS
MRCP
(bile stones won’t show on CT)
What are the usual defining features of gallstones?
Severe RUQ pain radiating to the back, occurs 2hrs after eating food
What are your primary management options for gallstones?
- Laparotomy cholecystectomy
- Analgesia and discharge, arrange for return for above
What are gallstones made from?
- Bile pigments (broken down Hb)
- phospholipids
Can be PIGMENT stones, CHOLESTEROL stones or MIXED stones
What are some complications of gallstones?
- biliary colic
- cholecystitis
- obstructive jaundice
- cholangitis
- gallstone ileus
What is acute cholecystitis?
Impaction in the bile duct resulting in inflammation of the gallbladder
How do you differentiate between… biliary colic, acute cholecystitis and cholangitis?
- biliary colic is just RUQ pain
- acute cholecystitis is pain and inflammation, might be fever
- cholangitis is pain, fever and jaundice
What is the most common presentation of ascending cholangitis?
- acute illness, jaundice
- RUQ pain
- fevers
What is your best investigation to visualise the biliary tree?
NOT CT
- Abdo USS
- MRCP
