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MBBS - Year 3 > The Digestive System - Lower Gastrointestinal Tract > Flashcards

The Digestive System - Lower Gastrointestinal Tract Flashcards

1
Q

Diverticula

A

Sac like protrusion of the colonic mucosa through the muscular wall

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2
Q

Which part of the GIT does diverticula disease affect the most

A

Sigmoid colon

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3
Q

Diverticulosis

A

Presence of asymptomatic diverticula

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4
Q

Diverticular disease

A

Symptomatic diverticula (e.g. abdo pain) in the absence of infl (can be used as umbrella term)

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5
Q

Diverticulitis

A

Symptomatic a/c infl and infection of diverticula

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6
Q

Epidemiology of diverticulosis

A

Increases w/ age, affects up to 80% at 85
Lifetime risk of a/c diverticulitis 4-25%

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7
Q

Risk factors for diverticular disease

A

Diet - red meat, low fibre
obesity
Fhx
Smoking
Meds - NSAIDs, steroids

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8
Q

Pathophys of diverticular disease

A

Colonic mucosa protrudes through muscualris externa, only covered by serosa
Occurs in weak areas, related to increased intra-liminal pressure and abnormal colonic motility

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9
Q

Clinical features of diverticulitis

A

Abdo pain - LLQ/ LIF
Pyrexia
CIBH
Guarding/ peritonism
Tachycardia

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10
Q

Ix of diverticular disease

A

CT CAP - best for dx
Bloods

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11
Q

Classification of diverticulitis

A

Used to help guid need for surgical intervention
Ranges from confined pericolic infl to generalised faecal peritonitis

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12
Q

Out pt mx for a/c diverticulitis

A

For mild, uncomplicated disease
7-10 days of co-amoxiclav
Analgesia - avoid NSAIDs and opiates
Reassess after 2/7 and arrange colorectal clinic appt

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13
Q

What alternative abx can be used in diverticulitis

A

Cipro
Metronidazole

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14
Q

Why should NSAIDs and opiates be avoided in diverticular disease

A

Risk of perforation

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15
Q

In-pt mx of divertiuclitis

A

Admit pts who are elderly, co-morbid, unwell and peritonitis
If features of severe infection - sepsis 6
Commence IV abx and should be NBM

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16
Q

What should be advised for pts if diverticula disease

A

Start high-fibre diet

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17
Q

Complications of diverticula

A

Fistula
Colic stricture
Diverticular bleed

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18
Q

Imaging of SBO

A

Can see central stacked bowel loops >3.5cm but usually <6cm in diameter
Markings cross lumen diameter
Paucity of gas in large bowel

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19
Q

Pathologies causing SBO

A

Adhesions and bands
Hernia
Crohn’s disease
Infiltrating neoplasms
Intussecption

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20
Q

Intussusception

A

Piece of small bowel slides onto adjacent part of the Intestine
Typically, a paediatric dx, v concerning in adults (used by large polyps)

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21
Q

Imaging of large bowel obstruction

A

Peripheral air-filled loops >7cm in diameter
Haustra do not cross lumen diameter

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22
Q

Does dilated large bowel obstruction always cause SBO

A

Depends on competency of ileocoecal valve

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23
Q

Classification bowel obstruction

A

No fluid or gas is able to pass beyond the site of obstruction

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24
Q

Partial/ incomplete bowel obstruction

A

Some fluid or gas is able to pass beyond the site of obstruction

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25
Q

Mechanical bowel obstruction

A

Physical blockage to the flow of GI content

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26
Q

Non-mechanical bowel obstruction (ileus)

A

Obstruction to flow 2’ to neuromuscular dysfunction (e.g failure in peristaltic activity)

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27
Q

Closed loop bowel obstruction

A

The bowel is obstructed at two points, this prevents proximal or distal decompression os contents
High-risk of rapid necrosis and perforation

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28
Q

Causes of large bowel obstruction

A

Tumours
Volvulus
Diverticular strictures

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29
Q

Key positive finding in bowel obstruction

A

Raised lactate - indicator of ischaemia
Raised infl markers

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30
Q

3, 6, 9 rule in bowel obstruction

A

Dilatation of the small bowel >3cm, large bowel > 6cm or the caecum > 9cm is suggestive of abnormal dilatation

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31
Q

Supportive mx of bowel obstruction

A

Drip and suck - IV fluid and NGT insertion (aspiration)
Analgesia
Anti-emetic
Abx as needed
Correction of electrolytes

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32
Q

Surgery for bowel obstruction

A

Defunctioning stoma and resection - observe lesions
Adhesiolysis +/- bowel resections

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33
Q

Role of appendix in diarrhoea

A

May serves as bacterial reservoir to repopulate enteric bacteria following illness

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34
Q

Unique colonic anatomy

A

Taeniae coli
Haustra
Epiploic appendages

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35
Q

Taeniae colic

A

There bands of smooth muscle that make up longitudinal muscle layer of muscularis, except at terminal end

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36
Q

Haustrae

A

Contraction of taemia coli bunch up
Causes of wrinkled appearance of colon

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37
Q

Epiploic appendages

A

Small, fat-filled sacs of visceral peritoneum
Attached to taenia colic

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38
Q

Recta valves

A

3 lateral bends in rectum
Separate faeces from gas to prevent simultaneous passage of faeces and gas

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39
Q

Differences in internal and external anal sphincter

A

Internal - made of smooth muscle, involuntary contractions
External - skeletal muscle, voluntary contractions

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40
Q

Anal sinuses

A

Depression between anal columns that’s secrete mucous to facilitate defectaion

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41
Q

Dentate line

A

Horizontal, jagged line that runs below anal sinuses
Represents junction between hindgut and external skin

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42
Q

Why is the area below the dentate line more sensitive than the area above

A

Due to innervation by somatic sensory fibres vs visceral, sensory fibres

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43
Q

Role of goblet cells in anal mucosa

A

Ease movement of faeces
Protects intensive from the effects of the acids and gases produced by enteric bacteria

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44
Q

How does immune system in healthy gut work

A

Peptidoglycan activates release of cytokines by mucosal epithelial cells, drafting immune cells e.g. dendritic cells
Dendritic cells becomes APCs and travel to lymphoid follicles to trigger an IgA-mediated response

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45
Q

How does fibre optimise activities of the colon

A

Softens stool
Increases power of colonic contractions

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46
Q

Mechanical digestion of large intestine

A

When chyme moves from ileum into caecum (ileocecal sphincter)
When caecum is distended w/ chyme, contraction of sphincter strengthen
When a hausturm is distended w/ chyme, its muscle contracts, pushing residue into next haustrum

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47
Q

How does chemical digestion occur in the large intestine

A

No digestive enzymes so done by bacteria

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48
Q

What is flatulence

A

Excessive flatus

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49
Q

Composition of faeces

A

Undigested food residue
Unabsorbed digested substance
Millions of bacteria
Old epithelial cells
Inorganic slats
Water to let it pass smoothly out of the body

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50
Q

What is defecation

A

Mass movement forces faeces from the colon into the rectum, scratching rectal wall and provoking defecation reflex

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51
Q

Defecation reflex

A

Parasympathetic reflex
Contracts sigmoid colon , rectum and eternal anal sphincter, relaxes internal
Faeces in anal canal triggers signal, allowing you to choose to open external anal sphincter
If you delay defecation, takes a few secs to relax

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52
Q

What happens if defection is delayed an extended time

A

Addn water is absorbed, making faeces firmer —> constipation

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53
Q

Dysentery

A

Severe diarrhoea w. blood or mucous

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54
Q

Blood test findings for IBD

A

Anaemia
Thrombocytosis
Rased ESR and CRP
Hypoalbuminaemia
Raised fecal calprotectin

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55
Q

Infective ddx for IBD

A

Gastroenteritis/ dysentrey
C diff
Amoebiasis
TB
CMV
Histoplasmosis

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56
Q

Non-infective ddx for IBD

A

Appendicitis
Diverticulitis
Carcinoma
Ischaemic colitis
Endometriosis

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57
Q

Indications of aminosalicylates

A

Indication of remission in active UC (not CD)
Maintenance of remission in uC (not CD)

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58
Q

Post-op prophylaxis in CD

A

Smoking
Mesalazine
Thiopurines
Metronidasole 3/12
(Biologics)

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59
Q

Episcleritis in IBD

A

Asymptomatic to itching and barring
Treat IBD and use steroid drops

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60
Q

Uveitis and IBD

A

Px w/ eye pain, blurred vision, photophobia
Doesn’t correlate w/ IBD activity
Treat w/ topical/ systemic steroids

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61
Q

Erythema noduosum and IBD

A

Seen in 15% of IBD pts
Mirrors IBD activity
Treat IBD and use steroids

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62
Q

Lower GI motility symptoms

A

Diarrhoea
Constipation

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63
Q

Definition of diarrhoea

A

Passage of loose/ watery stool, typically 3x/ day
Reduced consistency/ increased freq

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64
Q

Time period for diarrhoea - definitions

A

A/c - 14 days or less
Persistent - 15-30 days
C/c - 30+ days

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65
Q

What causes increased water content of stool in diarrhoea

A

Impaired water absorption and/or
Active water secretion by the bowel

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66
Q

What is a/c diarrhoea usually due to

A

Infections - viral, bacterial, protozoal
Drugs

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67
Q

Osmotic diarrhoea - pathophys

A

Water is drawn into or retained in the bowel due to presence of solutes within the lumen due to indigestion of poorly absorbed solutes or malabsorption

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68
Q

What type of diarrhoea can be reduced by fasting

A

Osmotic

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69
Q

Causes of secretory diarrhoea

A

Bacterial endotoxin
Stimulant laxatives
Hormones
Bile acid malabsorption
Mucosal infl
Rectal villous adenoma

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70
Q

Secretory diarrhoea

A

Disruption of epithelial electrolyte transport so water build up

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71
Q

Treatment of diarrhoea

A

Treat underlying disorder
Opiates
Anti-secretory drugs - octreotide (SST analogue)

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72
Q

Opiates for diarrhoea

A

Decreases urgency, bowel freq and stool volume
Codeine phosphate, loperamide

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73
Q

U&E’s changes w/ diarrhoea

A

Low potassium
Urea increases, before creatinine

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74
Q

Definition of constipation

A

Slow colonic transit, impaired rectal emptying or both
3x/day - 3x/ week

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75
Q

Treatment of constipation

A

General measure
Bulk forming laxatives

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76
Q

General measure for constipation

A

Identify anatomical abnormalities
Identify biochem causes
Stop constipating drugs
Exercise
Increase fluid intake
Increase dietary fibre - (SE: bloating, flatulence)

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77
Q

What are bulk forming laxative used for

A

Mild constipation
Improves bowel freq rather than consistency / straining

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78
Q

Examples of bulk forming laxatives

A

Ispaghula
Sterculia

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79
Q

When are stimulant laxatives used

A

C/c constipation
Increases motility, freq and improves consistency

80
Q

Examples of stimulant laxatives

A

Biscadoyl
Senna
Sodium picosulphate

81
Q

Examples of stool softeners

A

Sodium docusate
Liquid paraffin
Arachis oil enema

82
Q

Examples of osmotic laxatives

A

Lactulose
Mg salts

83
Q

Lactulose as an osmotic laxative

A

Decreases colic pH by generation of fatty acids and fermentation products
SE - bloating, flatulence

84
Q

Novel therapies for constipation

A

Prucalopride
Lubiprostone
Linaclotide
Naloxegol

85
Q

Epidemiology of colorectal cancer

A

2nd commonest cause of cancer death
Age - 85-89
Sex distribution same as colon cancer
Highest Unicode in Europe and North America

86
Q

Prognosis of colorectal cancer

A

10 yrs survival 55%
>20% px w/ distant mets
Surgery in 80% but half have recurrence

87
Q

Risk factors for colorectal cancer

A

Genetic syndromes
Diet - fat and cholesterol, red meath
Obesity
Alcohol
DM
Smokers

88
Q

FAP

A

Familial Adenomatous Polyposis
Autosomal dominant
Characterised by hundreds of adenomatous polyps

89
Q

FAP and colorectal cancer

A

Risk of cancer exceeds 90% by 70, if no surgery
Prophylactoc surgery 16025 yrs

90
Q

Exctracolinc manifestations of FAP

A

DerMoid tumours/ duodenal adenomas
Congenital hypertrophy retinal pigment epithlioma (CHRPE)

91
Q

HNPCC

A

Hereditary Non-polyposis Colorectal cancer
Autosomal dominant

92
Q

HNPCC and CRC

A

Lifetime risk 85%
CRC < 45, R sided lesions
Colonoscopy screening every 2 yrs

93
Q

Geneses related to CRC

A

ACP
CTNB1
AXIN1

94
Q

Aetiology of CRC

A

Adenoma- carcinoma sequences
UBD
Acromegaly - related to serum growth hormones
Gastric surgery - changes to bile acid
Irradiation

95
Q

Where do most cancer in large bowel px

A

Caecum
Sigmoid colon
Rectum

96
Q

Diff routes of CRC px

A

Bowel screening
Symptomatic - 2 WW, emergency px

97
Q

Bowel screening for CRC

A

Faecal occult blood & colonoscopy [FIT] - Every 2 yrs for those 60-75
Flexi sig

98
Q

Clinical features of CRC

A

CIBH
Rectal bleeding
Anaemia
Abdo pain
Tenesmus
Wt loss

99
Q

Emergency px of CRC

A

Seen in 25%

Obstruction
Peritonitis
Bleeidng

100
Q

Evaluation of CRC pts

A

Hx and exam
Rectal exam
Sigmoidoscopy
Colonoscopy
Staging - CT/ US/ MRI
Bloods - CEA

101
Q

When is colonic stenting used

A

Pt w/ metastatic disease, who have large bowel obstruction
Occasionally in benign strictures

102
Q

Possible surgeries for CRC

A

R or L hemicolectomy
Resection w/ colostomy
Pan proctocolectomy and ileostomy
Sub-tital colectomy
Defunctiong stoma

103
Q

Complication from surgery for CRC

A

Anastomotic leak
Wound infections
DVT/ PE
Bleeding
Nerve injury
Stoma complications

104
Q

When to consider anastomotic leak following CRC surgery

A

Any deteriotatation in condn within 10 days
Elderly - cardiac/ reps sx
Raised CRP, metabolic acidosis

105
Q

How doe we excl anastomotic leak following CRC surgery

A

CT w/ contrast

106
Q

Methods of spread of CRC

A

Nodal
Vascular
Direct
Transcoelemic

107
Q

Histopathology of anal cancer

A

90% SCC

108
Q

Risk factors for anal cancer

A

HPV - type 16/18
Smoking/ lowered immunity - hIV
Hx cervical cancer/ large no. sexual partners

109
Q

Faecal incontinence

A

Inability to control bowel movements causing faeces to leak unexpectedly from rectum

110
Q

How can we classify causes of faecal incontnences

A

Trauma
Neuro
Colorectal causes

111
Q

Traumatic causes of faecal incontinence

A

Iatrogenic
Obstetric

112
Q

Neuro causes of faecal incontinence

A

Cauda equina
MS
Neuropathy

113
Q

Colorectal causes of faecal incontinence

A

Hx
Neuro problems
Rectal exam
QoL - Wexner score

114
Q

Obstructive defecation syndrome

A

Difficulty in evacuation which may or may not be associated w/ constipation

115
Q

Causes of ODS

A

Pain
Rectocele
Rectal invagination/ intussecpition
Internal anal sphincter
Anal stenosis
Faecal impaction
Rectal/ anal cancer

116
Q

Clinical features of ODS

A

Incomplete or unsuccessful of emptying
Rectal pain
Prolonged episodes of evacuation
Prolapse

117
Q

Diagnostic approach for ODS

A

Clinical assessment
Colonoscopy/ CTC - excl tumours
Colonic transit studies
Defecation proctogram

118
Q

Mx of ODS

A

Conservative
Stool consistency - fibre
Laxative/ loperamide/ codeine
Rectal enema
Biofeedback
Surgery

119
Q

Surgical mx of faecal incontinence

A

Sphincter repair
Artificial sphincter
Anal plugs
Sacral nerve stimulation
Stoma

120
Q

Sacral nerve stimulation for faecal incontinence

A

Low voltage of sacral nerves, S3
Significant improvement (50%)
70-80% success rate

121
Q

Surgical mx of ODS

A

Anterior rectocele repairs
Rectopexy

122
Q

How can rectal prolapse be classified

A

Complete - full thickness
Partial - only mucosa (circumferential, only portion of mucosa)

123
Q

Clinical features of rectal prolapse

A

Prolapse during straining, coughing, lifting weights
Constipation (60%)
Faecal incontinence
Mucous discharge
Bleeding
Pain

124
Q

Ix for rectal prolapse

A

Assess general health of pt
Flex sig/ colonoscopy
Proctogram, if prolapse not obvious

125
Q

Mx of rectal prolapse

A

Reduce oedema - ice wrapped in cloth or sugar
Usually surgical - abdo vs perineal approach
Delormes procedure (perineal)
Rectopexy (abdo)

126
Q

Referral for CRC

A

40+ w/ unexplained wt loss and abdo pain
50+ w/ unexplained rectal bleed
60+ w/ IDA and CIBH
Occult blood in faeces

127
Q

Sx of diverticular disease

A

Abdo pian in LLQ
Constipation, diarrhoea or rectal bleed
Tenderness in LLQ

128
Q

Which pts are most likely to have recurrence in diverticular

A

Higher in young pts
Pts w/ abscess formation

129
Q

Px of IBS

A

Abdo pain - relived by defecation
Altered bowel habit
Abdo distension
Rectal mucous
No nocturnal sx

130
Q

Classification of IBS

A

Constipation predominant - IBS-C
Diarrhoea predominant - IBS-D
Mixed bowel habits - IBS-M
Neither predominant - IBS-U

131
Q

Mx of IBS-D

A

Avoid legumes and dietary fibre
Anti-diarrhoea drugs: loperamide, codeine, cholestyramine
If sx persist, amitriptyline in night

132
Q

Mx of IBS-C

A

High fibre diet
Laxatives: lactulose, ispaghula

133
Q

Epidemiology of iBS

A

10-20% of general pop.
More common in young women
Stress associated w/ episodes of IBS

134
Q

Ix for IBS

A

Bloods - FBC, U&Es, CRP, TSH, tTG/ IgA
Faecal calprotectin
-ve findings on endoscopy, X-ray, blood tests

135
Q

Dx criteria for IBS

A

Recurrent bro pain for at least 1/7 in the last 3/12
Related to defecation
Associated w/ change in form/ freq of stool

136
Q

Px of ascariasis infection

A

Depends on parasite burden, can be asymptomatic
Malabsorption
Rare, obstruction
Biliary sepsis/ obstruction

137
Q

Ix for ascariasis

A

Stol microscopy
Ultrasound
ERCP

138
Q

Mx of ascaris

A

Antiparasitic agents - albendazole, ivermectin, melbendazole

139
Q

MOA of bendmidiazoles

A

Degeneration of parasites cytoplasmic microtubules
Blocking of glucose uptake –> depleted energy stores –> reduced ATP formation

140
Q

MOA of ivermectin

A

Similar to macrolide button antibacterial effect
Increased cell membrane permeability to Cl- –> cellular hyper polarisation –> paralysis and death

141
Q

Where do adult hookworms live

A

Lumen of small intestine, where they attach to intestinal wall

142
Q

Px of hookworms

A

Transient pneumonitis
Epigastric pain, diarrhoea, anorexia, eosinophilia (small bowel)
C/c abdo pain
IDA
Malnutrition in children

143
Q

Ix for hookworms

A

Stool microscopy
Expelled adult worms
PCR

144
Q

Mx for hookworms

A

Iron replacement
Anti-helminthic therapy - albendazole, mebendazole, pyrantel pamoate

145
Q

Prevention strategies for hookworms

A

Annual deworming - targeting children and pregnant women
Vaccine development

146
Q

Immune reaction to eggs and larvae seen in schistosomiasis

A

Skin rash (cellular infiltration of skin) - ‘swimmers itch’
Katyama syndrome (circulating immune complexes)
Granuloma formation in tissues
Hepatomegaly

147
Q

Ix for schistosomiasis

A

Microscopy
Serology

148
Q

Mx for schistosomiasis

A

Praziquantel - adults worms only, may work w/ artemisinin
Oxamniquine

149
Q

Prevention of schistosomiasis

A

No swimming in fresh water
Vaccine in development

150
Q

Non-spp px of tapeworms

A

Reduced nutrient absorption
Altered gut motility

151
Q

What blood finding may be seen in c/c tapeworm infection

A

Megaloblastic anaemia

152
Q

Ix for tapeworms

A

Microscopy:
Stool - eggs
Tissue bx

153
Q

Mx of tapeworms

A

Praziquantel
Niclosamide

154
Q

Prevention of tapeworm infection

A

Met inspection
Good animal husbandry
Adequate cooking

155
Q

Relevant protozoa in GIT

A

Entamoeba histiolytica
Giardia intestinalis
Cryptospporidium hominis

156
Q

Features of intestinal protozoa - amoebiasis

A

Entamoeba histolytic can attach to intestinal walls with the aim to perforate and enter blood vessels (liver, lungs, brain 15-20cm)

157
Q

Px of amoebiasis

A

Abdo pain, NO fever
Later at abscess disease (2-3/12) - fever, v raised ESR

158
Q

Dx of amoebiasis

A

Surgery
CT

159
Q

Mx of amoebiasis

A

Metronidozale
Paromomycin

160
Q

Px of Giardia

A

Asymptomatic
A/c self limiting diarrhoea w/ abdo cramps, bloating and flatulence
C/c diarrhoea, malasbsorption and wt loss

161
Q

Ix for giardia

A

Microscopy
Antigen detection (EIA)

162
Q

Treatment for giardiasis infections

A

Metronidazole

163
Q

CEA

A

Carcinoembryonic antigen
Detected in blood and elevated in CRC

164
Q

Prevention of giardiasis

A

Water quality

165
Q

Features of crytosporidium infection

A

Seen in <5s and immunocompromised
Source is contaminated water
Diarrhoea - a/c and self-limiting
No effective drug mx

166
Q

Px of enteriobiasis

A

Asymptomatic
Pruritus ani
Vaginal discharge
Dysuria and enuresis
Non-spp: anorexia, irritability, abdo pain

167
Q

Ix for enterobiasis

A

Sellotape slide - adult worm
Stool microscopy - eggs

168
Q

Mx for enterobiasis

A

Albendazole
Mebendazole
Ivermectin
Piperazine

Monitor household contacts and take good hygiene measures

169
Q

Bacterial perinanal infections

A

Perianal abscesses
Perianal fistulae
Pilonidal abscesses

170
Q

LGV

A

Lymphogranuloma venereum
STD caused by chlamydia
Seen in MSM

171
Q

Px of LGV

A

Ulcerative proctitis
1st stage - single skin lesion
2nd stage - painful, enlarged inguinal lymphadenopathy

172
Q

Px of rectal gonorrhoea

A

Usually asymptomatic, but some pts have a/c proctitis
Sx are anal pruritus, tenesmus, purulent discharge or rectal bleeding

173
Q

Viral perianal infections

A

HSV
HZV
Warts - HPV

174
Q

Features of SIRS

A

HR 90+
RR 20+
Temp <36 OR >38
WCC >12,000 OR <4,000

Sepsis = 2 of above w/ suspected source of infection

175
Q

Sepsis 3qSOFA

A

RR 22+
Change in mental state
SBP <100mmHg

Score of 2 or above w/ suspected infection

176
Q

NEWS and sepsis

A

Score of 5 or more in the presence of known infection, signs and sx of infection

177
Q

Acute abdomen

A

Abdo pain of less than 7/7 duration needing hosp admission

178
Q

Where is pain experienced in appendicitis

A

Visceral peritoneum around umbilicus then RIF, parietal peritoneum

179
Q

Why might pts w/ cholecystitis have pain in R shoulder

A

Phrenic nerve

180
Q

Features of peritoneal infl

A

Diffuse tenderness (widespread) or localised
Rebound tenderness
Guarding - spasms of muscles

181
Q

Ix for a/c abdo

A

Bloods
Urine
XR - erect CXR, AXR
ECG (inferior MI?)
Cultures
CT/ US

182
Q

Bloods for a/c abdomen

A

FBC
U&Es
Amylase
CRP
LFT
Clotting
Blood gases

183
Q

Urine ic for a/c abdomen

A

Disptick
Pregnancy tests

184
Q

Sepsis 6

A

Blood cultures
Urine Output
Iv fluids
Abx
Lactate
Oxygen

185
Q

Condns giving rise to intra-ab sepsis

A

Biliary
A/c appendicitis
A/c diverticulitis
Perforations - DU, diverticula, appendix
Post-op leak
Ischaemic bowel

186
Q

When is early operation indicated in a/c abdomen

A

A/c appendicitis
Perforations
Ischaemic bowel

Theatre after limited resus/ ix

187
Q

Which factors are considered in decision making process for a/c abdomen

A

Haemodynamic status
Rigid/ non-rigid - abdomen
Poorly/ well localised
Pt comorbidities / fitness for operation

188
Q

General measures for pts admitted w/ a/c abdomen

A

Analgesia
IV fluids
Oxygen
Abx
Catheter insertion
VTE prophylaxis
FluId balance
NG pan
Decide if NBM

189
Q

Imaging for appendicitis

A

US scan pelvis - first line in children and pregnant women
Contrast enhanced CT

190
Q

What is the peritoneal cavity lined with

A

Serous membrane that serves as conduit for fluids

191
Q

Peritoneal cavity in M vs F

A

Cavity closed in males and open in females

192
Q

Intra peritoneal organs

A

Organs completely or almost completely enclosed by peritoneum

193
Q

Examples of intraperitoneal organs

A

Stomach
Liver
GB
Transverse colon
Jejunum
Ileum
Caecum/ sigmoid colon
Duodenum (1st part)

194
Q

Examples of retro-peritoneal organs

A

Duodenum (2nd, 3rd, 4th)
Ascending colon
Descending
Pancreas
Kidneys

195
Q

Retro-peritoneal organs

A

Organs that are located mostly or completely behind the posterior parietal peritoneum

196
Q

Role of normal flora in abdomen

A

Competition for nutrients and mucosal binding sites
Gut motility
Local pH
Bile flow
Production of antimicrobial substances

197
Q

When should rectal prolapse be referred for surgery

A

Irreducible or recurrent
Substantial incontinence
Obstructed defectaion

MBBS - Year 3 (9 decks)

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