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Flashcards in Week 8 Deck (92)
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1

What 5 things are important to consider in assessing the severity of liver cirrhosis?

Encephalopathy
Ascites
Bilirubin
Albumin
Prothrombin time

2

Loss of haustral markings in the distal part of the bowel suggests which disease?

Ulcerative Colitis

3

Which test is the single most important factor for considering suitability for a liver transplant?

Arterial pH

4

Behavioural changes, clumsiness and excess salivation could indicated which condition?

Wilson's Disease

5

What is Wilson's Disease treated with?

Penicillamine

6

How would achalasia present differently to oesophageal malignancy in terms of dysphagia?

Achalasia would present with dysphagia to both liquids and solids from the outset whereas oesophageal malignancy would involve progressive symptoms with dysphagia first to solids and then to liquids.

7

How are alcohol units calculated?

(Volume (ml) x ABV) Divided by 1000

8

What is the most likely cause of an elevated ALT and AST in the 10,000s?

Paracetamol overdose

9

Can pain be felt above or below the dentate line in the anal canal?

Anything below the dentate line will be very painful but anything above will not cause pain as there are no sensory fibres to this area

10

What are haemorrhoids?

Disrupted and enlarged vascular cushions in the lower rectum and the anal canal

11

What percentage of the population will have symptomatic haemorrhoids at some point in their life?

10%

12

What is the classical position of the haemorrhoids when the patient is in the lithotomy position and what does this correspond to?

The position corresponds to the branches of the superior haemorrhoids artery at 3, 7 and 11 o'clock

13

What can cause haemorrhoids?

***Constipation and prolonged straining
Congestion from a pelvic tumour
Pregnancy
Portal hypertension

14

How might haemorrhoids present?

Painless bleeding - bright red (on the paper/ in the pan)
Perianal itchiness
Anaemia

15

Describe the classification of haemorrhoids

1st degree - remain in the rectum
2nd degree - protrude through the rectum on defecation but then reduce
3rd degree - ^ &require reduction
4th degree - remain persistently prolapsed

16

What investigations might be done for haemorrhoids?

Abdominal exam (to rule out other causes)
PR exam
Proctoscopy (to visualise internal haemorrhoids)
Flexible sigmoidoscopy

17

How would haemorrhoids be managed/ treated?

Topical analgesics
Stool softeners
Topical steroids
Sclerotherapy
Rubber band ligation
Haemorrhoidectomy
HALO/ THD procedure

*For acutely thrombosis/ painful haemorrhoids
- ice compressions and topical GTN or diltiazem to reduce sphincter spasm

18

What is a rectal prolapse? What is the difference between a type 1 and type 2 prolapse?

A rectal prolapse is a protruding mass from the anus, especially during defecation
Type 1 - partial - just mucosal layers
Type 2 - complete - transmural / all layers

19

How would a rectal prolapse present?

Protruding mass
Bleeding and mucus per rectum
Poor anal tone on examination

20

How would a rectal prolapse be managed? consider management of both a complete and incomplete prolapse

Incomplete
- Dietary advice and treatment of constipation
Complete
- Bulking agent
- Delform's procedure
- Perineal rectopexy
- Abdominal rectopexy
- Anterior resection

21

What are some of the causes of rectal prolapse?

Lax sphincter
Prolonged straining
Chronic neurological and psychological disorders

22

What is an anal fissure? Where do these most commonly occur?

A tear in the anal margin due to the massage of a constipated stool
- Usually midline posteriorly but can be anterior

23

What is the typical presentation of an anal fissure? Which age group are they most common in?

*Sharp and severe pain on defecation after constipation
- pain may last for up to half an hour and becomes dull in character
*Bright red rectal bleeding
*Most common in young people - very rare in the elderly

24

How are anal fissure managed?

- Stool softeners and dietary advice
- Topical diltiazem or GTN ointment (pharmacological sphyncterotomy)
- Sphyncterotomy
- Botox injection

25

What is meant by 'Fistula in Ano' ?

An abnormal communication between two epithelial surfaces - the anal canal and the peri-anal skin

26

What is the most common cause of fistula-in-ano? State the other less common causes

Inadequate treatment of an anorectal abscess

Crohn's
Carcinoma
TB

27

How might Fistula-In-Ano present?

Pain
Bright red PR bleeding
Incontinence of flatus/ stool

28

How would fistula-in-ano be investigated?

EUA of anorectum
Rigid sigmoidoscopy and proctoscopy
Flexible sigmoidoscopy
MRI

29

How is fistula-in- and managed?

Laying it open (fistulotomy)
Insertion of Seton suture
LIFT procedure
Glue/ permacol
Defunctioning colostomy

30

List 3 perioperative complications of GI surgery

Ileus
Anastamotic Dehiscence
Adhesions