Tennis gastro tut

Question 1

What is a less likely cause of hypotension and why?

Answer 1

Blood loss- you have to loose 30% of your blood vol to become hypotensive

Question 2

What is the onset of ruptured AAA?

Answer 2

It can be a few days as it might leak at first then rupture

Usually onset is sudden in exam qs

Question 3

What are RF for ruptured AAA?

Answer 3

smoking hx

connective tissue disorders (marfans)

Question 4

What signs of shock do you get in ruptured AAA?

Answer 4

Hypotension
Sweaty
Pale
No fever!!!!

Question 5

What is the screening programme for AAA?

Answer 5

One USS at age 65 offered to all men

Question 6

What size is AAA for surgery?

Answer 6

> 5.5cm

Question 7

What is absolute constipation?

Answer 7

No flatus or faeces passed in the past 12-24 hrs

Question 8

How is small bowel obstruction managed?

Answer 8

drip and suck: iv fluids and NG tube w drainage
surgery if peritonitis or perforated
can be conservative for 72 hrs but most usually need surgery

Question 9

What are some reasons small vs large bowel are obstrcuted?

Answer 9

Large= volvulus, malignancy 
Small= adhesions, strictures (past surgery)

Question 10

What is SBP? How is it diagnosed?

Answer 10

Bacterial peritonitis

Tap the ascites and it has high neutrophils

Question 11

What are signs and symptoms of peritonitis?

Answer 11

rebound tenderness
guarding
rigidity

Question 12

What is a major RF for mesenteric ischaemia?

Answer 12

AF

Question 13

What happens in mesenteric ischaemia?

Answer 13

Blood clots cut off blood supply to mesentery

Question 14

What is the character of pain in mesenteric ischaemia?

Answer 14

Severe pain generalised out of proportion to findings

Question 15

How does mesenteric ischaemia present?

Answer 15

Severe abdo pain put of proportion to findings
May have distention
May have blood in stool
May have some NV

Question 16

What are RF for mesenteric ischaemia

Answer 16

smoking 
AF
MI
heart defects 
vasculitis
age

Question 17

What ix are done in mesenteric ischaemia and what is seen?

Answer 17

CT w contrast angiogram
Colonoscopy
Lactate will be high

Question 18

What acid base imbalance does metformin cause?

Answer 18

Metabolic acidosis

Question 19

How is mesenteric ischaemia managed?

Answer 19

Laparotomy

Question 20

What imaging done for bowel perforation?

Answer 20

ERECT cxr

Question 21

What sign is seen in erect cxr in bowel perforation? What is this?

Answer 21

Pneumoperitoneum- free air under the diaphragm

Question 22

how do you differentiate betwen sigmoid and caecal volvulus on imaging?

Answer 22

Sigmoids volv= coffee bean

Caecal volv= embryo sign

Question 23

What sign is seen on imaging in sigmoid volvulus?

Answer 23

Coffee bean sign

Question 24

What is the most common cause of pancreatitis in a men vs women?

Answer 24

Man= alcohol
Women= gallstones

Question 25

What severity scores are used in pacreatitis?

Answer 25

Modified glasgow score | RANSON criteria

Question 26

What is a marker of chronic pancreatitis?

Answer 26

Faecal elastase

Question 27

What is a common electrolyte abnormality in pancreatitis? When else is it seen

Answer 27

Hypocalcaemia | Usually not seen in much else

Question 28

Amylase above what level is diagnostic of pancreatitis?

Answer 28

above 1000

Question 29

How high is the glasgow score for pancreatitis?

Answer 29

more than 3

Question 30

What are the 2 main RF for pancreatitis?

Answer 30

gallstones | alcohol

Question 31

How does onset of pain differ between gastric and duodenal ulcers?

Answer 31

``` Duodenal= pain better after eating (sphicter closes) Gastric= pain worse right after eating ```

Question 32

What are some rf for duodenal ulcers?

Answer 32

antidepressants h pylori corticosteroids bisphosphonates

Question 33

What medications might cause duodenal ulcers?

Answer 33

Antidepressants corticosteroids bisphosphonates

Question 34

How do you test for h pylori?

Answer 34

carbon urea 13 breath test | CLO stool antigen test

Question 35

What is GS ix for peptic ulcer disease?

Answer 35

Endoscopy

Question 36

what are indications for endoscopy in peptic ulcer disease?

Answer 36

If you think its bleeding | You dont need to do it if the ulcer seems really stable

Question 37

What type of ulcer is more common in peptic ulcer disease?

Answer 37

Duodenal

Question 38

What abx are given alongside PPI to manage peptic ulcer disease as h pylori eradication?

Answer 38

Clarithromycin | amoxicillin

Question 39

Why does low fibre cause diverticulitis?

Answer 39

low fibre= low stool bulk= more intraluminal pressure= herniation of mucosa

Question 40

What is seen on barium enema in diverticulitis?

Answer 40

Saw tooth pattern

Question 41

How is diverticulitis managed?

Answer 41

abx, fluids, bowel rest