upper GIT disorders tutorial

Question 1

POSSIBLE non surgical causes of upper gastro pain

Answer 1

cardiac
gastroenterological
muscleoskeletal
diabetes
dermatological

Question 2

possible surgical causes of upper gastro pain

Answer 2

PUD (peptic ulcer disease) / GORD
pancreatitis
billiary pahtology
abdo pain
vascular
small bowel/ LB

Question 3

WHAT is the first investigation to do in upper abdo pain presentation?

Answer 3

CXR and AXR (chest and abdo)

Question 4

pain improves with fluids and paracetamol and is discharged. then he represents 2 days later, fevers and infection signs, vomiting, pain now constant rather than itnemrmittent. what are you suspecting?

Answer 4

perforated viscus

Question 5

most likely site of perforated viscus?

Answer 5

duodenum

Question 6

sign expected in CXR AND AXR in perforated viscus?

Answer 6

Rigler’s sign: free intraperitoneal air (in AXR - some clack in there)

and free subdiaphragmatic air (black inder diaphragm- normally no black just liver- white) in CXR

Question 7

abdo CT sign in perforated intestine

Answer 7

you see black in intestine, normal but also black OUTSIDE intestine between intestine and belly

Question 8

pre-operative management of acute peritonitis

Answer 8

NGT (nasal gut tube)
NBM (nil by mouth)
and IV fluids
ABx

Question 9

operative management of acute peritonitis

Answer 9

identification of aetiology of peritonits

eradication of the source ofperitoneal contamination

lavage and drainage of peritoneum

Question 10

possible treatments for perforated ulcers - conservative and radical

Answer 10

conservatives treatment- taylors approach
surgery: laparoscopic omental patch ( patch over ulcer with the peritoneum )
radical surgery- vagotomy anf gastrectomy

Question 11

where are perforations specifically more and less likely?

Answer 11

more on anterior/ superior surface of duodenum

less on posterior surface of duodenum, pre- pyloric antrum, stomach .

Question 12

how many times mor eliely is duodenal perforation compared to gastric?

Answer 12

10x

Question 13

how often do acute ulcers show up in patients with nO history of ulceraiton

Answer 13

25-30%

Question 14

post op the patient is fine initially but 3rd day after he has SOB, O2 sats drop, HIGH TEMP, SINUS TACHY, BIBASAL CREPS ON AUSCULTATION R>L low pO2. what is it prob?

Answer 14

pneumonia

Question 15

then hes fine but returns 2 days after with abdo pain and vomit
low bp hr 110 febrile 38
abdomen soft but tender and guarding epigastrium
high wcc
ecg sinus tachy and cxr axr unremarkkable

likely diagnosis

Answer 15

intra abdo collection

Question 16

what to do for intra abdo collection

Answer 16

drainage and IV antibiotics

Question 17

how do we asses severity for acute pancreatitis

Answer 17

modified glasgow criteria

Question 18

what are the glasgow criteria for acute pancr

Answer 18

ACRONYM: P A N C R E A S
PO2
AGE OVER 75
N- WCC >15
C CALCIUM<2
RENAL : UREA > 26 MMOL/L
E: ENZYMES
A: ALBUMIN
S: SUGAR

Question 19

hoe much do you need to score for acute pancr on glasgow criteria

Answer 19

score of 3> within 48h of onset suggetss evere

Question 20

CRP what des it tell us for acute pancreatitis diagnosis

Answer 20

its and independent predictor of severity >200 suggests severe

Question 21

what is the first step to acute pancreatitis management?

Answer 21

ABC if needed

Question 22

4 principles of acute pancreatitis

Answer 22

1) fluid resuscitation (IV Fluids, Urinary catheter, strict fluid balance monitoring)
2) analgesia
3) pancreatic rest (+/- nutritional support if prolonged recovery)
4) determine underlying cause

Question 23

what percentage of people with pancreatitis settle with conservative treatment? what are approaches for more severe cases?

Answer 23

95% settle

HDU (high dependancy unit) if severe pancreatitis score

surgery very rare

Question 24

when do we give antibiotics for severe pancreatitis?

Answer 24

NOT ROUTINE (THOUGH its a common mistake) bc its inflammation and nOT infection. only give if necrotic pancreatitis or infective necrosis.

Question 25

next investigation done on patient with pancreatitis

Answer 25

USS (ultra sound scan) abdomen

Question 26

when do you do MRCP in pnacreatitis

Answer 26

if LFTS remain derranged after days in acute pancreatitis

Question 27

WHY MRC over ERCP

Answer 27

bc ERCP is very dangerous procedure, cn CAUSE pancreatitis in itself, only do it if absolutely necessary.

Question 28

what to do if patien tin HDU in pain abnormal urine output and HR and low BP and glasgow 3

Answer 28

CT abdo/ pelvis

Question 29

what do you do if someone comes with presentation of cholecystectomy (RUQ pain) over 3 days?

Answer 29

NOT acute lap cholecystectomy bc of duration of symptoms
instead treat conservatively with fluids and IV antibiotics - should get better and schedule cholecystectomy for a specific day

Question 30

which 2 structures need to be identified and divided during laparoscopic cholecystectomy?

Answer 30

cystic duct and cystic artery

Question 31

what do you do if uppon removal of a drain post surgery the drain snaps and the drain tip cant be found?

Answer 31

re-laparoscoped drain removed pt home next day

Question 32

MRCP abnormality seen for stones

Answer 32

it should all be white with fluid but it has black- = stone in common bile duct.

Question 33

what is something that varries amonsts patients u need to be aware anatomically for cholecystectomies?

Answer 33

biliary or vascular anomalies: slight differences in bile duct or vessel relations you need to know bc this can lead to vascular or billiary complicaitons if you clip wrong ect.