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CP3 SURGERY > UGI/CR - Gastric pathology + Acute Abdomen > Flashcards

UGI/CR - Gastric pathology + Acute Abdomen Flashcards

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1
Q

What is a peptic ulcer caused by?

A

Imbalance between luminal acid and mucosal defences

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2
Q

Causes peptic ulcer (6)

A 
H pylori 
NSAIDs 
Zollinger-Ellison syndrome 
RF e.g. smoking, coffee, hepatic/renal failure 
Steroid use
Stress
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3
Q

What is Zollinger-Ellison syndrome

A

Excessive acid secretion due to non-insulin secreting Islet cell tumour of pancreas secreting a gastrin like hormone –> XS ulceration

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4
Q

Sx peptic ulcer

A

Epigastric pain (related to eating)
Nausea
Anorexia /W loss
Haematemesis/melaena

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5
Q

Ix peptic ulcer

A

Urgent OGD if ALARMS 55

If resolves w/ Antacids + no ALARMS 55 - No Ix needed

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6
Q

H pylori Ix (2)

A

C13 urea breath test

Gastric biopsy + phenol red

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7
Q

What can give false -ves C13 urea breath test (2)

A

Abx within 4 weeks of test

PPIs within 2 weeks of test

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8
Q

Complications of peptic ulcer

A

Bleeding (anaemia)
Perforation
Stricture

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9
Q

Gastric VS Duodenal ulcer: acid secretion

A

G: Normal
D: Increased

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10
Q

Gastric VS Duodenal ulcer: age

A

G: Elderly
D: <40 y/o

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11
Q

Gastric VS Duodenal ulcer: M:F

A

G: 2:1
D: 4:1

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12
Q

Gastric VS Duodenal ulcer: location

A

G: mainly < curvature
D: 90% within 2cm pylorus

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13
Q

Gastric VS Duodenal ulcer: epigastric pain

A

G: After eating
D: nocturnal/hunger pain

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14
Q

Gastric VS Duodenal ulcer: vom

A

G: Not uncommon
D: Rare

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15
Q

Gastric VS Duodenal ulcer: other Sx

A

G: W loss, loss appetite
D: Nil

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16
Q

Gastric VS Duodenal ulcer: biopsy

A

G: Edge ulcer - excl malignancy
D: Antral biopsy - H pylori

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17
Q

Gastric VS Duodenal ulcer: relieved by

A

Antacids

Eating/drinking milk

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18
Q

Gastric VS Duodenal ulcer: Tx

A

G: H.pylori eradication if present
+ 4 weeks PPI
D: Hpylori eradication only

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19
Q

Where does H pylori mainly occur

A

In the antrum

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20
Q

If H pylori occurs in the body of the stomach, what can occur

A

Atrophic gastritis –> metaplasia

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21
Q

Why is smoking bad for peptic ulcer (2)

A

Impairs gastric mucosal healing

Nicotine increases acid secretion

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22
Q

XR appearance of peptic ulceration that is an emergency

A

Pneumoperitoneum
HENCE
Perforation

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23
Q

Mx peptic ulcer disease if no ALARMS 55 present (3)

A

Lifestyle nod
Meds - PPI/H2RA
Stop NSAIDs

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24
Q

Mx peptic ulcer disease (ALARMS Sx/H pylori)

A

Triple therapy

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25
Triple therapy - Non Penicillin allergy
``` PPI + Amoxicillin + Clarithromycin/metronidazole 7 days ```
26
Triple therapy - Penicillin allergy
PPI + Clarithro + metronidazole 7 days
27
Mx of triple therapy resistant cases peptic ulcer disease
Bismuth chelate + 2 Abx for 14 days
28
Who gets peptic ulcer surgery?
COmplications
29
3 types of peptic ulcer surgery
Highly selective vagotomy | Vagotomy + pyloroplasty Gastrectomy
30
Causes UGI bleed (6)
``` Peptic ulcer Gastroduodenal erosions Oesophagitis Mallory-Weiss syndrome Varices UGI Malignancy ```
31
What is Mallory-Weiss syndrome
Tear in G-O junction | Due to violent vomiting
32
Sx UGI Bleed (4)
Haematemesis Melaena Haematochezia (rare) Abdo pain
33
Assessment GI bleed using
Glasgow Blatchford score
34
What does a score of >6 in the Glasgow Blatchford score indicate
Mortality >50%
35
Mx acute GI haemorrhage (6)
``` Mx as per haemorrhagic shock Calculate Blatchford score Inset NGT + early UGI endoscopy Then Rockall score IV omeprazole 80mg stat Definitive surgery/embolization if endoscopy doesn't work ```
36
RF - Gastric cancer (8)
``` H.pylori High salt/NO3 Smoking Alcohol Genetic factors Pernicious anaemia Adenomatous polyps Low SE status ```
37
Sx gastric cancer (6)
``` Often non-specific Epigastric pain N V Dysphagia (if near fundus) Anorexia/W loss ```
38
Signs gastric cancer (4)
Palpable epigastric mass large L supraclavicular LN (Virchows) Hepatomegaly/jaundice/ascites Acanthosis nigricans
39
Ix gastric cancer (3)
OGD + multiple rolled ulcer edge biopsy Endoscopic uSS/CT (staging) Staging laparoscopy
40
Who gets gastric cancer
50-70y/o
41
Which population especially is susceptible to gastric cancer
Japanese population
42
M:F gastric cancer
3:1
43
What type of cancer is the majority of gastric cancer
adenocarcinoma
44
When does Leather Bottle stomach occur
When submucosal infiltration of tumour w/ marked fibrous reaction --> small but thickened + contracted stomach
45
Mets - gastric cancer (4)
Direct invasion abdominal viscera Lymphatics Liver - portal dissemination Transcoelomic --> bilat ovarian tumours
46
What are the bilateral ovarian tumours called caused by 2' mets of gastric cancer
Krukenberg tumours
47
What cells do stromal castric tumours arise from
Interstitial cells of Cajal (GIST)
48
5 year survival rate gastric cancer w/ surgery
20%
49
5 y survival rate gastric cancer w/o radical surgery
<10%
50
Mx gastric cancer
Gastrectomy = extensive lymphatic clearance | + adjunct chemo if T2-4
51
Palliative Mx of gastric cancer
Stenting of pylorus
52
Mx of stromal gastric tumours
Wide local excision
53
Complications of gastrectomy (5)
``` Chronic D+V Dumping syndrome Bacterial obergrowth w/ malabsorption Anaemia (B12/Fe) Osteomalacia ```
54
Acute abdomen - clinical picture: Inflammatory cause
Constant pain Raised Temp, pulse, leucocytosis Assoc w/ guarding and rigidity
55
Acute abdomen - clinical picture: Obstructive cause
Colicky pain Pt agitated May become constant b/c superimposed inflammation
56
Rx visceral pain: foregut
Upper abdomen
57
Rx visceral pain: midgut
Middle abdomen
58
Rx visceral pain: hind gut
Lower abdo
59
What is the foregut
Oesophagus to D2
60
What is the midgut
D2 to the transverse colon
61
DDx Acute abdomen - Adominal visceral causes (9)
``` Acute appendictis Merkel's diverticulitis Intestinal obstruction Perforation Acute pancreatitis Acute cholecystitis/cholangitis Renal calculi Acute scrotum IBD ```
62
DDx acute abdomen - vascualr causes (2)
AAA | Mesenteric thrombosis
63
DDx acute abdomen - medical causes
GORD Rx pain from pneumonia/MI UTI/pylelonehritis
64
DDx acute abdomen - gynae causes
Ruptured ectopic Torsion/ruptured ovarian cyst Salpingitis etc
65
Acute abdomen - sudden onset of pain suggests: (4)
Perforation Rupture (aneurysm) TOrsion Acute oancreatitis
66
Acute abdomen - back pain suggests (3)
pancreatitis AAA Renal tract disease
67
Ix acute abdomen (10)
``` FBC U+E LFT CRP AMYLASE ABG Pregnancy test Urinalysis Exert CXR/AXR USS/CT ```
68
What % of pop will have acute appendicitis?
1/6
69
Cause of appendicitis (2)
Appendix = obstructed by faecolith/FB | Lymphoid enlargement in wall
70
Sx appendicitis (4)
Abdo pain Constipation/diarrhoea Anorexia N+V
71
Abdominal pain progression in appendicitis
Starts dull + central | Becomes more sharp + localised in RIF at Mc Burney's point
72
Where is McBurney's point
1/3 between ASIS + umbilicus (RHS)
73
Signs of appendicitis (8)
``` Rebound tenderness RIF Percussion tenderness Guarding +ve Rosving's sign TachyC Mild fever, flush, fetor oris Psoas sign Obturator sign ```
74
What is Rosving's sign
> painful in RIF than LIF when LIF pressed
75
What is Psoas sign
Pain on R hip extension
76
What is obturator sign
Pain on internal rotation of R hip
77
Ix acute appendicitis
``` PR Pelvic exam (F) Pregnancy test Bloods - FBC, U+E, CRP/ESR Urinalysis USS/CT if uncertain ```
78
CRP significance acute appendicitis
40 if uncomplicated | 95 if ruptured
79
Mx acute appendicitis
Resus IV metronidazole/cephalosporin Laparoscopic appendectomy
80
Early complications - laparoscopic appendectomy (2)
Haematoma | WOund infection
81
Late complications - laparoscopic appendectomy (2)
SB obstruction/adhesions | Incisional hernia
82
Complications - perforated appendix
``` Peritonitis + sepsis Appendix mass Appendix abscess Adhesions Infertility ```
83
What is an appendix mass
Inflamed appendix becomes covered w/ omentum
84
What is an appendix abscess
Develops if appendix mass fails to resolve
85
Why can appendicitis cause infertility?
Tubal obstruction
86
DDx - mass in RIF
``` Inflamm cause (mass/abscess) Lymphoma Chrons Tumour mass Pelvic kidney ```
87
Mx - mass in RIF
USS/CT - confirm diag IV cefuroxime + metronidazole pct drainage if doesn't resolve
88
What is a Carcinoid tumour?
Tumour of argentaffin cells which produce active substances e.g. 5HTP Hence = neuroendocrine tumour
89
Where can a carcinoid tumour occur in the abdomen
Appendix
90
What syndrome are carcinoid tumours assoc w/
MEN-1 syndrome
91
What substance do carcinoid tumours take up readily
Silver stains
92
PS carcinoid syndrome
flushing of face | diarrhoea
93
Prgnosis carcinoid tumours
Good

CP3 SURGERY (19 decks)

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