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Year 1 - Gastrointestinal (DP) > Surgical Presentations of Abdominal Disease > Flashcards

Surgical Presentations of Abdominal Disease Flashcards

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0
Q

Where does gall bladder pain tend to radiate?

A

Through to the back and right

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1
Q

What structures cause pain in the upper three zones?

A

Gall bladder
Stomach and duodenum
Pancreas

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2
Q

Where does gastric and duodenal pain radiate?

A

Straight through to the back

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3
Q

Where does pancreatic pain radiate to?

A

Through to the back and left

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4
Q

What causes throbbing pain?

A

Inflammation

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5
Q

What sort of pain does obstruction cause?

A

Colic

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6
Q

How does a patient suffering colic pain tend to act?

A

They move around

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7
Q

If the patient is lying still, what sort of pathology may be occurring?

A

Inflammation

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8
Q

If the abdomen is moving with respiration, there is general peritonitis. True or false?

A

False.

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9
Q

If there is tenderness to percussion, what term is used?

A

Peritonitis

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10
Q

What are the diagnostic conditions for anorexia nervosa?

A
  1. Significant weight loss (BMI < 17.5)
  2. Weight loss is self induced (Avoiding fatty food, calorie counting)
  3. Core psychopathology (Body image distortion)
  4. Widespread endocrine abnormality
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11
Q

What endocrine abnormalities can result due to anorexia?

A

Amenorrhoea
Loss of sexual interest
Elevated GH/cortisol
Abnormalities of insulin secretion

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12
Q

What are the two types of anorexia?

A

Restricting type

Binge eating/Purging type

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13
Q

What is the aetiology of anorexia and bulimia?

A

Socio-cultural pressures (family dysfunction)
Personal vulnerability
Sexual maturity

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14
Q

What is factitious disorder?

A

Intentional feigning
Either physical or psychiatric
Munchausen Syndrome

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15
Q

What is malingering?

A

Deliberate exaggeration of symptoms

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16
Q

What are the types of antidepressants and what do they do?

A

Tricyclics - enhance mono amine activity in the brain

Selective Serotonin Reuptake Inhibitors - Stimulate 5HT3 receptors

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17
Q

What bowel sounds are present in obese patients?

A

None

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18
Q

When is the plain AXR useful?

A

In obstruction
In colitis
In perforation

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19
Q

What is the gold standard of radiological imaging of the abdomen?

A

CT

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20
Q

How is a sigmoid Volvulus managed?

A

Decompressed with a rigid sigmoidscope

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21
Q

What is the classification of Diverticulitis?

A

Hinchey Classification

  1. Para colic abscess
  2. Pelvic abscess
  3. Purulent abscess
  4. Faecal peritonitis
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22
Q

What is Hartmann’s procedure?

A

Remove sigmoid
Leave rectum
Bring out colostomy

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23
Q

How do haemorrhoids present?

A

Painless bleeding
Fresh, bright red blood, not in stool, on toilet paper
Perianal itchiness
No other symptoms

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24
What investigations can be done in a patient with haemorrhoids?
PR exam Rigid sigmoidoscopy Proctoscopy Flexible sigmoidoscopy (Age above 50)
25
Treatment of haemorrhoids?
``` Slcerosation therapy (5% phenol in almond oil) Rubber band ligation Open haemorrhoidectomy Stapled haemorrhoidectomy HALO/THD procedure ```
26
What part of the rectum prolapses in a partial prolapse?
Anterior mucosa
27
How does a rectal prolapse present?
Protruding mass (especially during defaecation) PR bleeding and mucus Poor anal tone
28
Management of complete rectal prolapse?
``` Bulking agent and education on manual reduction Delormes procedure Perineal rectopexy Abdominal rectopexy Anterior resection ```
29
Where are anal fissures typically located?
In the midline posteriorly
30
What is the presentation of an anal fissure?
Severe acute anal pain (often following constipation) Pain lasts for 30 mins after defaecation Bright rectal bleeding
31
What is the treatment of anal fissures?
``` Dietary advice Stool softeners Pharmacological sphyncterotomy Lateral sphyncterotomy Botox ```
32
Where does the bowel dilate in obstruction: Proximally or Distally?
Proximally
33
What is the typical presentation of an upper small bowel obstruction?
``` Acute Hours of onset Large volume of vomit - Gastric secretions - Pancreatic secretions - Biliary secretions ```
34
What is the presentation of a distal small bowel of large bowel obstruction?
Colicky abdo pain Distension (Faeculent vomiting)
35
What are the general symptoms of bowel obstruction?
Vomiting Pain Constipation Distension
36
If vomit contains semi-digested food with no bile, where is the obstruction?
Gastric outlet
37
If there is copious bile in the vomitus, where is the obstruction?
Upper small bowel
38
What is the character of vomitus in a distal obstruction?
Thicker Brown Foul-smelling
39
When is back flow of accumulated colonic contents prevented?
If the ileocaecal valve remains competent
40
What is a 'closed loop obstruction'?
A caecum that progressively dis tends with swallowed air | Eventually may rupture
41
What happens to the muscle of the bowel wall if obstruction is chronic?
It hypertrophies
42
What are the signs of dehydration?
Dry mouth | Loss of skin turgor and elasticity
43
What is the appearance of dilated bowel in an AXR?
Lie in a central position | Have valvulae coniventes
44
What is the AXR appearance of a distended large bowel?
Lies in anatomical position | Has haustra coli
45
Management of intestinal obstruction?
NG tube (decompress stomach) Nil by mouth Blood sample IV fluids
46
Examples of mechanical obstruction?
``` ADHESIONS or BANDS Incarnated hernia Volvulus Tumour Strictures Bolus Intussusception ```
47
What type of obstruction do inflammatory strictures tend to cause?
Incomplete
48
What may cause a bolus obstruction?
Food Impacted faeces Impacted gallstone Trichobezoar
49
What is Intussusception?
Segment of bowel wall becomes 'telescoped' into the segment distal to it
50
When is cholecystitis or biliary colic pain often exacerbated?
By eating
51
What is the first line investigation in cholecystitis or biliary colic?
Ultrasound
52
How do we further clarify cholecystitis or biliary colic?
MRCP and/or ERCP
53
What is the ideal method of imaging in suspected pancreatitis and when is it best performed?
CT (to evaluate complications) | 1 week following symptom onset
54
What is the investigation of choice in perforation?
ERECT CXR
55
How do we investigate appendicitis?
Ultrasound
56
What investigation is used in diverticulitis?
CT
57
What symptoms may prompt the idea of a urological cause of abdominal pain?
Associated urinary symptoms | Haematuria
58
What might prompt you to consider vascular causes of abdominal pain?
Sudden onset Back pain Hypotension
59
If a patient has a distended abdomen and a bowel source if suspected, what is the first line investigation?
AXR
60
If a patient has a distended abdomen and a fluid cause is suspected what is the first line investigation?
Ultrasound
61
How is haematemesis investigated?
Endoscopy | Allows intervention or biopsy
62
What method of contrast may be given in a patient who is suffering from haematemesis?
IV (for CT scan)
63
What radiological investigations are done in a patient with a change in bowel habit?
Barium enema | CT virtual colonography
64
When is a small bowel MRI used?
In small bowel Crohn's | In large bowel Crohn's with suspected small bowel involvement
65
What scan can be used to localise active inflammation in known IBD?
Radio-labelled White cell scan
66
How does cirrhosis appear on ultrasound?
Small volume of ascites | Nodular contour and course echotexture
67
How do liver metastases appear on an ultrasound?
Hypoechoic Solid Varying size 'Target' appearance
68
How does ischaemic colitis appear histologically?
Crypt withering Pink smudgy lamina propria Fewer chronic inflammatory cells
69
Explosive fibrinopurulent exudate on surface
Pseudomembranous colitis
70
Thickened basal membrane with a patchy appearance and intrepithelial inflammatory cells
Collagenous colitis
71
Telangectasia | Bizarre stromal cells
Radiation colitis

Year 1 - Gastrointestinal (DP) (8 decks)

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