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Gill revision Flashcards

(48 cards)

1
Q

Inflammation pain vs obstruction pain in tummy?

A

Inflammation –> throbbing
Obstruction –> colic

Patient moving around –> colic
Patient lying still –> inflammation

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2
Q

Tenderness to percussion

A

Peritonism

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3
Q

Appendicitis march of events

A

1st Pain, usually epigastric or umbilical
2nd Anorexia, nausea, or vomiting
3rd Tenderness – somewhere in the abdomen or pelvis
4th Fever
5th Leucocytosis

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4
Q

McBurneys

A

1/3rd of way between ASIS and tummy button

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5
Q

Perforated appendice

A

Generalised pain and guarding with peritonism

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6
Q

Iliopsoas test for appendicitis?

A

Stretching the iliopsoas can elicit pain

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7
Q

Retrocaecal or pelvic appendix may require what?

A

May require rectal examination –> this may be the only way to elicit pain and point of tenderness
Remember that the appendix can be in loads of really weird places
RECTAL EXAMINATION ESSENTIAL IN ANY APPENDICITIS

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8
Q

Cell origin of oesophagus cancers?

A

Squamous cell
Adenocarcinomas in the lower third of the oesophagus are usually gastric in origin or have developed in Barrett’s oesophagus

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9
Q

Where do oesophageal carcinomas spread to?

A

Liver, lungs, bone and lymph glands

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10
Q

Dysphagia without weight loss?

A

Achalasia

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11
Q

Degeneration of the ganglion cells of Auerbach’s mesenteric plexus?

A

Achalasia

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12
Q

Confirming diagnosis of oesophageal carcinoma?

A

Endoscopy with biopsy

barium swallow will demonstrate irregular stricture

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13
Q

Primary investigation for achalasia?

A

Barium swallow
-proximal oesophagus is dilated and tortuous and merges into a smooth cone shaped narrowed segment above the gastro-oesophageal junction

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14
Q

Treatment for achalasia

A

Surgery –> Heller’s cardiomyotomy

Balloon dilatation

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15
Q

A low grade fever with tenderness and guarding over McBurneys point?

A

Acute appendicitis

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16
Q

Complications of appendicitis?

A

Perforation

Appendix mass

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17
Q

Gallstones risk factors

A
Age > 40
Female
High fat diet
Obesity
Pregnancy
Hyperlipidaemia
Five “Fs”
Bile salt loss (Crohn’s)
Diabetes
Dysmotility of GB
Prolonged fasting 
TPN
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18
Q

Biliary colic

A
Stone impacts in cystic duct
Gradual build-up pain in RUQ
Radiates to back / shoulder 
May last 2-6 hours
Associated with indigestion / nausea
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19
Q

Severe acute epigastric pain differentials

A
Biliary colic
Peptic ulcer disease
Oesophageal spasm
Myocardial infarction
Acute pancreatitis
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20
Q

Treatment for acute cholecystitis

A

IV antibiotics and IV fluids
Nil by mouth
US to confirm diagnosis

Urgent cholecystectomy** (asap)

Interval cholecystectomy (drainage of fluid then removal of gallbladder)

21
Q

Cholecystitis

A

Inflammation of the gallbladder

22
Q

Cholangitis

A

Infection of the common bile duct

23
Q

Complications of gallstones

A

Stone may migrate into CBD:

Jaundice
Cholangitis
Acute Pancreatitis

Gallstone Ileus

24
Q

Diagnosis of common bile duct pathology (e.g. if gallstones have passed into common bile duct)

A

Itch, nausea, anorexia
Jaundice
Abnormal LFTs

ERCP:
ES + stone removal

Surgical Exploration: CBD (Open vs Lap)

25
Gallstone ileus
Small bowel obstruction – gallstone impacted in distal ileum . Fistula gallbladder + duodenum - Large gallstone passes into small intestine. Moves down SB causing intermittent colic Present with distal SB obstruction.
26
Acute pancreatitis
Alcohol / gallstones 10% mortality AP Autodigestion of peri-pancreatic tissues by activated enzymes Cholecystectomy during INDEX admission ERCP / ES if frail
27
Treatment for gallstone ileus
Treatment: Urgent Laparotomy – SB enterotomy to remove stone Interval cholecystectomy in 3 months.
28
Clinical presentation of cholangiocarcinoma?
Clinical Presentation: Usually late ! - Jaundice; Weight loss; anorexia; lethargy - 50% lymph node metastases - 20-30% peritoneal metastases at diagnosis
29
Staging of cholangiocarcinoma?
Staging / Assessment: Duplex Ultrasound (Spiral CT / ERCP / PTC) MRI / MRCP/ MRA
30
Treatment for cholangiocarcinoma?
Surgical resection: Bile duct and liver resection | Palliation: insertion of biliary stent
31
Cholangiocarcinoma
Cancer of the bile ducts
32
Cholangiocarcinoma grading
``` I) confined to confluence II) below the confluence IIIa) extended into right hepatic duct IIIb) extended into left hepatic duct IV) extension into left and right hepatic duct ```
33
Bilirubin
Obstructive jaundice | -Urobiligen is not present in obstructive jaundice
34
What should you perform in all women presenting with acute abdomen?
Always perform urinary bHCG to exclude pregnancy in ALL women of childbearing age, however unlikely this is!
35
What do urea and creatinine show?
Hydration and renal status
36
What does prothrombin time show?
Synthetic function of liver e.g. CBD stone
37
Hydronephrosis
When one or both kidneys become stretched and swollen as a result of build up of urine in kidneys
38
Investigation for AAA
Ultrasound
39
Investigation for perforation or pancreatitis?
CT
40
Investigation for pancreatitis?
CT
41
Investigation for obstructive jaundice?
ERCP
42
What would you use a water soluble contrast swallow to investigate?
Oesophageal rupture | -it will show contrast in mediastinum
43
Grey-turners sign
Bruising in the flanks (last rib --> top of hip) | Acute pancreatitis
44
Cullen's sign
Cullen's sign is yellow blue discolouration of the skin around the umbilicus. It was first reported in ruptured ectopic pregnancy but is more commonly associated with severe, acute pancreatitis. (looks like a bug bruise around the tummy button)
45
Causes for immediate surgery (<1hour)
Bleeding, perforation, incarceration, ectopic pregnancy
46
Causes for urgen surgery (<24 hours)
Appendicitis, uncomplicated bowel obstruction
47
Scheduled surgery >24 hours
Cholecystitis, adhesive SBO
48
Tests you should definitely do in acute abdomen?
urinalysis, bHCG, and PR