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Gastrointestinal System > Lecture 11.2: Main GI Conditions > Flashcards

Lecture 11.2: Main GI Conditions Flashcards

1
Q

What is Appendicitis?

A

Inflammation of the Appendix

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2
Q

Risk Factors for Appendicitis (4)

A
  • Family History
  • Ethnicity (Caucasians)
  • Environmental (summer months)
  • Diet
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3
Q

Causes of Appendicitis (4)

A
  • Luminal Obstruction
  • Acute Inflammation
  • Ischaemia
  • Necrosis +/-perforation
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4
Q

Pathophysiology of Appendicitis: Luminal Obstruction (4)

A
  • Faecolith
  • Lymphoid Hyperplasia
  • Impacted Stool
  • Appendiceal/Caecal Tumour
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5
Q

Pathophysiology of Appendicitis: Acute Inflammation

A

Multiplication of commensal bacteria

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6
Q

Symptoms of Appendicitis (7)

A
  • Abdominal Pain (migrates from umbilicus to right iliac)
  • Vomiting
  • Fever
  • Anorexia
  • Nausea
  • Diarrhoea
  • Constipation
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7
Q

Signs of Appendicitis (4)

A
  • Rebound tenderness and percussion pain over
    McBurney’s point
  • Guarding
  • Mass in RIF
  • Haemodynamic Changes
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8
Q

What is Rovsing’s Sign?

A

RIF pain on palpation in the LIF

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9
Q

What is Psoas Sign?

A

RIF pain with extension of the right hip

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10
Q

What is Obturator Sign?

A

Internal rotation of the flexed right hip causes pain

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11
Q

What is the Hop Test?

A

Hopping or jumping causes pain

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12
Q

What is the Murphy’s Triad? (3)

A
  • N+V
  • Low-Grade Fever
  • RIF Pain
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13
Q

What Laboratory Tests to do for Appendicitis? (4)

A
  • Urinalysis
  • FBC
  • CRP (elevated suggests inflammation)
  • Urea and Electrolytes
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14
Q

How will Appendicitis appear on an Ultrasound? (5)

A
  • Non-compressible appendix (>6mm)
  • Apendicolith
  • Wall thickening (>3mm) with hyeraemia
  • Free fluid in RIF
  • Echogenicity of the mesenteric fat
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15
Q

Management of Appendicitis (3)

A
  • Appendectomy
  • Antibiotics
  • FLuid Therapy
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16
Q

Complications of Appendicitis (6)

A
  • Delay in presentation
  • Perforation
  • Abscess formation
  • Complications of surgery
  • Bleeding
  • Wound infection
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17
Q

What is Acute Pancreatitis?

A
  • Acute inflammation of the pancreas
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18
Q

Causes of Acute Pancreatitis: GET SMASHED

A
  • Gallstone
  • Ethanol
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune Diseases
  • Scorpion Venom
  • Hypercalcaemia
  • Endoscopic Retrograde CholangioPancreatography
    (ERCP)
  • Drug
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19
Q

Symptoms of Acute Pancreatitis

A
  • Severe upper abdominal pain (Epigastric/LUQ)
  • Pain radiates through to the back
  • Nausea and Vomiting
  • Bloating
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20
Q

Signs of Acute Pancreatitis (7)

A
  • Epigastric tenderness +/- guarding
  • Haemodynamic `instability
  • Cullen’s sign
  • Grey-Turner’s Sign
  • Tetany
  • Jaundice
  • Respiratory signs
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21
Q

What is Cullen’s Sign?

A

Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region

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22
Q

What is Grey-Turner’s Sign?

A

Ecchymosis or discoloration of the flanks

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23
Q

Investigations for Acute Pancreatitis: Lab Tests (7)

A
  • Serum amylase (3x normal)
  • FBC
  • U+E
  • Glucose
  • CRP
  • Bilirubin and LFT
  • Calcium Levels
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24
Q

What Imaging is done for Acute Pancreatitis? (2)

A
  • Contrast Enhanced CT scan
  • Ultrasound
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25
Risk Scoring via The Modified Glasgow Criteria
* PaO2 <8kPa * Age >55yrs * Neutrophilia: WCC>15×109/L * Calcium <2mmol/L (normal: 2.12mmol-2.65mmol/L) * Renal function: urea>16mmol/L (normal: 2.5- 6.7mmol/L) * Enzymes: LDH >600iU/L (normal: 70-250iU/L) * Albumin <32g/L * Sugar: blood glucose >10mmol/L
26
Treatment of Acute Pancreatitis (5)
* NBM * IV fluid resuscitation * Catheterisation * Analgesia * Treat underlying cause
27
Local Complications of Acute Pancreatitis (5)
* Pancreatic Necrosis * Infected Necrosis * Fluid Collections/Pseudo-Cysts * Pancreatic Abscess * Acute Cholecystitis
28
Systemic Complications of Acute Pancreatitis: Respiratory (4)
* Acute Respiratory Distress Syndrome * Pleural Effusions * Consolidation * Pulmonary Oedema
29
Systemic Complications of Acute Pancreatitis: GI (2)
* Haemorrhage * Ileus
30
What is Ileus?
A temporary lack of the normal muscle contractions of the intestines
31
Systemic Complications of Acute Pancreatitis: Metabolic (2)
* Hypocalcaemia * Hyperglycaemia
32
What is Weber-Christian Disease?
Skin condition that features recurring inflammation in the subcutaneous fat layer of the skin
33
What are the 3 methods by which a tube can get blocked?
* Blockage within the tube * Blockage due to problem with wall of tube * Blockage due to external pressure
34
What can cause blockage within a tube? (3)
* Gallstone ileus * Foreign body * Faecal impaction
35
What can cause blockage due to problem with the wall of a tube? (3)
* Cancer * Strictures (inflammatory/diverticular) * Meckel’s diverticulum * Lymphoma * Intussusception
36
What can cause blockage due to external pressure in a tube? (4)
* Hernias * Adhesions * Volvulus * Peritoneal metastases
37
What are the most common causes of Small Bowel Obstructions? (2)
* Hernias * Adhesions
38
What are the most common causes of Large Bowel Obstructions? (3)
* Cancer * Strictures (inflammatory/diverticular) * Volvulus
39
Symptoms of a Bowel Obstruction (5)
* Abdominal pain (colicky/cramping) * Nausea & Vomiting * Maybe Faecalent * Absolute Constipation * Abdominal Distension
40
Signs of a Bowel Obstruction (6)
* Abdominal Distension * Abdominal Tenderness * Tympanic percussion and tinkling bowel sounds * Succusion Splash * Haemodynamic Instability * Empty Rectum
41
Investigations for Bowel Obstruction: Lab Tests (6)
* FBC * U+E * CRP * LFTs * G+S * Venous blood gas
42
Investigations for Bowel Obstruction: Imaging (2)
* CT scan with IV contrast * AXR
43
Management of Bowel Obstruction (6)
* NBM * NG tube * IV fluids * Urinary catheter * Analgesia * Laparotomy +/- resection +/- stoma formation
44
Complications of Bowel Obstruction (3)
* Bowel Perforation * Bowel Ischaemia * Renal Impairment
45
What are the 3 Main Types of Gallstones?
* Pigmented * Cholesterol * Mixed
46
What Conditions can Gallstones cause? (4)
* Biliary colic * Cholecystitis * Cholangitis * Pancreatitis
47
What are the 5 F's of Gallstones
Fat Fair Fertile Female Fourty
48
Risk Factors for Gallstones (5)
* 5 F's * Pregnancy * Oral Contraceptive * Haemolytic Anaemia * Malabsorption
49
Symptoms of Gallstones/Cholecystitis (4)
* Constant pain RUQ/epigastrium * Fever * Lethargy * Jaundice
50
Signs of Gallstones/Cholecystitis (2)
* Tender RUQ * Positive Murphy’s sign
51
What is a Positive Murphy’s Sign?
* Apply pressure to RUQ * Ask patient to inspire * Positive sign when inspiration is halted due to pain
52
Investigations for Gallstones/Cholecystitis: Lab Tests (5)
* FBC * CRP (inflammatory response) * LFTs (raised ALP) * Amylase (to exclude pancreatitis) * Urinalysis (to exclude UTI and pregnancy)
53
What can be seen on U/S of patient with Gallstones/ Cholecystitis? (3)
* Presence of Gallstones * Gallbladder Wall Thickness * Bile Duct Dilatation
54
Management of Gallstones (4)
* IV antibiotics * Analgesia * Antiemetic * Surgery (laparoscopic cholecystectomy)
55
Complications of Gallstones (6)
* Mirizzi Syndrome * Gallbladder Empyema (pus in gallbladder) * Chronic Cholecystitis * Cholecystoduodenal Fistula * Bouveret’s Syndrome * Gallstone Ileus
56
What is Mirizzi Syndrome?
* Obstructive jaundice caused by a stone located in Hartmann's pouch or in the cystic duct * Compresses the adjacent CHD
57
What is Diverticulum?
Outpouching of the bowel wall
58
What is Diverticulosis?
Presence of diverticula, asymptomatic
59
What is Diverticulitis?
Inflammation of the diverticula
60
What is Diverticular Bleed?
Erosion into a vessel causes large volume painless bleeding
61
Pathophysiology of Diverticultis
* Bowel weakened with aging * Movement of stool causes increased luminal pressure * Causes out-pouching at weak area * Bacterial overgrowth leads to inflammation and complications
62
Risk Factors for Diverticultis (6)
* Age * Low Dietary Fibre Intake * Obesity * Smoking * Family History * NSAID Use
63
Symptoms of Diverticultis (6)
* Acute Abdominal Pain * Anorexia * Fever * Sudden change in bowel habit * PR bleeding * Dysuria
64
How does Pain due to Diverticultis Present?
* Acute abdominal pain * Starts hypogastrium before localising * Sharp, localising to the LIF * Worse with movement
65
Signs of Diverticultis (4)
* Localised Tenderness * Abdominal Distension * Haemodynamic Instability * Evidence of Perforation
66
Investigations for Diverticultis: Lab Tests (5)
* FBC * CRP * U+Es * Consider Faecal Calprotectin * CT Abdomen-Pelvis
67
Management of Diverticultis (5)
* Analgesia * Antibiotics * IV Fluids * Surgery * Hartmann’s Procedure
68
Complications of Diverticultis (7)
* Perforation * Bleeding * Abscess Formation * Recurrence * Stricture * Obstruction * Fistula
69
What is Testicular Torsion?
* Spermatic cord and contents twist, this compromises blood supply to the testicles * This is a surgical emergency
70
Risk Factors for Testicular Torsion
* Age * Previous Torsion * FHx * Undescended Testes * Bell-Clapper Deformity
71
What is a Bell-Clapper Deformity?
Testis lacks a normal attachment to tunica vaginalis and hangs freely
72
Symptoms of Testicular Torsion (3)
* Unilateral Testicular Pain * Referred Abdominal Pain * Nausea and Vomiting
73
Signs of Testicular Torsion (3)
* High Swollen/Tender Testis * Absent Cremasteric Reflex * Prehn’s Sign Negative
74
What is Prehn’s Sign?
Alleviation of scrotal pain by lifting of the testicle and is suggestive of the diagnosis of acute epididymitis
75
What is the Cremasteric Reflex?
* This reflex is elicited by stroking or pinching the medial thigh, causing contraction of the cremaster muscle, which elevates the testis * The cremasteric reflex is considered positive if the testicle moves at least 0.5 cm
76
Investigations for Testicular Torsion
* USS * Urinalysis
77
Management of Testicular Torsion
Surgery
78
Renal Colic
A severe form of sudden flank pain that typically originates over the costovertebral angle and extends anteriorly and inferiorly towards the groin or testicle
79
Renal Colic is often caused by obstructions in the urinary tract, what are the 3 most common locations of obstructions?
* The ureteropelvic junction (UPJ) * The crossing of the ureter over the area of the pelvic brim (the iliac vessels) * The ureterovesical junction (UVJ)
80
Symptoms and Signs of Renal Colic (4)
* Severe pain, flank to pelvis * Nausea & Vomiting * Haematuria * Tenderness
81
Investigations for Renal Colic (7)
* Urine Dip * FBC * CRP * U+E * Urate and Calcium Levels * CT KUB * USS
82
Management of Renal Colic (6)
* Rehydration * Spontaneously pass majority of cases if <5mm * Analgesia * IV abx if infection * Nephrostomy if signs of obstruction * ESWL, PCNL, URS if stones cannot pass
83
Symptoms of Ectopic Pregnancy (4)
* Missed Period/Signs of Pregnancy * Abdominal Pain * Vaginal Bleeding/Discharge * Shoulder Tip Pain
84
Signs of Ectopic Pregnancy (3)
* Abdominal Tenderness * Signs of Peritonitis * Haemodynamically Unstable
85
Investigations for Ectopic Pregnancy (3)
* Urinary pregnancy test * USS * If not able to visualise will need serum BHCG
86
Management of Ectopic Pregnancy (3)
* Medical * Surgical * Conservative

Gastrointestinal System (22 decks)

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