Other Diseases

Question 1

What is peritonitis?

Answer 1

Inflammation of the peritoneum

Question 2

Causes of peritonitis?

Answer 2

• Underlying GI condition
• Perforated organ
• Peritoneal dialysis
• Ascites
• TB (rarely)

Question 3

What is the difference between localised and generalised peitonitis?

Answer 3

Localised due to acute inflam of an organ - hits against body wall

Generalised - irritation of peritoneum due to infection (perforation) or chemical irritation (perforated ulcer)

Question 4

Signs and symptoms of peritonitis

Answer 4

• Rigid abdo
• Rebound tenderness (when you lift hand quickly - causes more pain - rarely done in practice)
• Distended abdo (if related to ascietes)
• Fever

Question 5

Invx of peritonitis?

Answer 5

Erect CXR

Abdo paracentesis

Question 6

Management of peritonitis

Answer 6

Resuscitate (NG tube, IV fluids, antibiotics)

Surgery

Question 7

What is Peutz-Jeghers Syndrome?

Answer 7

Autosomal dominant condition characterised by hamartomatous (bengin?) GI polyps and mucocutaneous hyperpigementation - look at pics - wont be nice and symmetrical - will be blotchy (in BAME patients may have racial mucocutaneous hyperpigementation naturally)

Question 8

Why is Peutz-Jeghers syndrome bad?

Answer 8

93% will devlop cancer

Question 9

What is EBV and how is EBV spread?

Answer 9

Epstein-Barr virus Saliva

Question 10

EBV is normally asymptomatic - if it becomes symptomatic what does it become known as?

Answer 10

Infectious mononucleosis

Question 11

Orally how may EBV present?

Answer 11

Leukoplakia
Pharyngitis
Tonsilitis

Question 12

How is EBV treated?

Answer 12

Almost always self-limiting
Rest
Fluids
Analgesias

Question 13

If EBV is misdiagnosed and a course of antibiotics given, what may appear?

Answer 13

Widespread rash which will disappear on withdrawal of antibiotics

Question 14

How is EBV diagnosed?

Answer 14

Monospot - a test for antibodies

Question 15

How may EBV present in GI system?

Answer 15

Hepatomegaly

Splenomegaly

Question 16

What is necrotising enterocolitis?

Answer 16

GI wall invaded by bacteria in premature babies

bacteria invades wall -> wall necrosis -> bowel contents leak into peritoneum -> peritonitis

Question 17

Symptoms of necrotising entercoloitis?

Answer 17

Poor feeding
Abdo distension
Bile stained vomit
Sepsis

Question 18

What are anal fissures?

Answer 18

Small tear in anal??

Question 19

Who is most likely to get anal fissures?

Answer 19

Very young and old

Question 20

What are two types of anal fissure causes and give 3 examples of each

Answer 20

Traumatic

• Childbirth
• Anal intercourse
• Hard stool and straining

Non-traumatic

• IBD
• Anal cancers
• HIV

Question 21

Symptoms of anal fissures? (2)

Answer 21

Bright red blood on paper after wiping

Visible small crack on skin

Question 22

When does a fissure become chronic?

Answer 22

After 8 weeks

Question 23

Management of anal fissure?

Answer 23

Acute -
Topical nitroglycerin or lidocaine - to relax

Surgery - for chronic/recurrent

Question 24

Symptoms of appendictis?

Answer 24

Abdo pain - move from umblical to RIF

Signs of infection (fever, tachycardia, nasuea)

Question 25

Signs of appendicits?

Answer 25

- Rovsing (pressing on LIF causes pain on the RIF) | - Psoas (patient keeps right hip flexed)

Question 26

What is McBurneys point and what is it associated with?

Answer 26

1/3 of way between ASIS and ... ADD | Appendicitis

Question 27

What are 4A's of appendicular treatment?

Answer 27

- Analgesia (NSAIDS) - Antipyretcis (NSAIDS) - Antibiotics (normal surgical prophylaxis) - Appendectomy

Question 28

What is bowel obstruction?

Answer 28

Blockage of bowel leading to - accumulation of fluid/gas - ischaemia - perforation

Question 29

What are the 3 types of bowel obstruction

Answer 29

Intraluminal Luminal Extraluminal

Question 30

Symptoms of bowel obstruction?

Answer 30

``` Colicky central abdo pain Absolute constipation Vomiting (more proximal obstrcution - quicker vomiting) Borborygmus (stomach sounds) Abdo distension ```

Question 31

Invx of bowel obstruction (3)

Answer 31

Tinkling bowel sounds - big one AXR followed by contrast CT ABGs/bloods

Question 32

How to treat bowel obstruction?

Answer 32

Drip and suck - IV fluids (drip) - NG tube (suck) Analgesia for pain

Question 33

What is ischaemic colitis? | What causes it and where does it most commonly take place?

Answer 33

Commonest problem of bowel ischaemia (abdo angina) ADD Most commonly due to atherosclerosis Splenic flexture

Question 34

Who gets ischaemic colitis?

Answer 34

More common in elderly ADD fat folk - increased pressure by increased fat in abdo

Question 35

Management of ischemic colitis?

Answer 35

``` Mild cases - self resolve Major cases (or suspected to pass to true ischemia of bowel) - embolectomy (bypass of afflicted artery) - colectomy assorted if area of bowel damaged ```

Question 36

What is bowel ischemia/infarction? What causes it?

Answer 36

Death of colonic tissue due to lack of blood supply | Obstruction or severe narrowing of artery

Question 37

Difference in presentation of acute small bowel ischaemia and ischaemic colitits?

Answer 37

Both present with acute abdo pain Ischaemic colitis will have bloody stool unlike acute small bowel ischaemia