ILOs Flashcards

Question

resisting cell death

Answer 1

removal of survival factors P53 supressed (increased expression of anti-apoptotic regulators, down-regulation of pro-apoptotic factors, short circuiting of extrinsic ligand-induced death pathway)

Answer 2

* overproduction of growth factors * faulty receptors- e.g., don't need signal, perpetually on, amplified receptors, increased response * CDK's dysregulated * cancer cells can produce growth factors for itself (EGDR and HER2 overexpresison) *

Answer 3

* G1 (gap 1) * S (DNA synthesis) * G2 (gap 2) * M (mitosis./ meiosis)

Answer 4

* normally telomeres shorten progressivley with successive cycles * prevents cells from dividing after a certain point * cancer cells ecpress high lvels of telomerase enzyme *

Answer 5

blood vessels derived from tumour-mediated signalling VEGF and PDGF

Answer 6

cadherin-1 expression decreased

Answer 7

cancer cells upregulate GLUT1 glucose transplrter favouring aerobic gyloclysis

Answer 8

vasodilation reults in increased blood flow increased permeability of vessels exudation of plasma proteins and fluid into tissues

Answer 9

1. Axillary lymph node status 2. Tumor size 3. Lymphatic/vascular invasion 4. Patient age 5. Histologic grade 6. Histologic subtypes (eg, tubular, mucinous [colloid], or papillary) 7. Response to neoadjuvant therapy 8. Estrogen receptor/progesterone receptor (ER/PR) status 9. *HER2* gene amplification or overexpression

Answer 10

hospital based assessment clinic that allows for early and rapid detectoion of breast cancer and other breast diseases. Women (and men) can be referred by a ‘one stop’ clinic by their GP if they have signs or symptoms that meet the breast cancer “2 week wait” referral criteria, or if they have early intervention in the treatment of breast cancer. 1. history and examination by breast surgeobn or associate specialist 2. imaging 3. histology

Answer 11

***_history and examination_*** * Presenting complaint * Potential risk factors (red flags: night sweats, cachexia, bloody discharge, change to eating habits) * Family history * Medication history * Social history ***_imaging_*** Based around either mammography (X-rays) or ultrasound investigations. Which one is used will be determined by patient factors. * _Mammography_- X rays- compression views of the breast across 2 views (oblique and craniocaudal), allowing for the detection of mass lesions or microcalcifications * _Ultrasound imaging_- more useful in women \<35 years and in men, due to density of the breast tissue in identifying anomalies. This form of imaging is also used to guide core biopsies * _MRI- n_ot used in the mainstay of triple assessment however can be useful in the assessment of lobular breast cancers (and in assessing response to neoadjuvant therapy); whilst it has high sensitivity, it has a low specificity. ***_histology_*** * A biopsy is required of any suspicious mass or lesion presenting to the clinic, most commonly obtained via core biopsy. * A core biopsy provides full histology (as opposed to fine needle aspiration (FNA) which only provides cytology), allowing differentiation between invasive and in-situ carcinoma. * The test can generate important information about tumour grading and staging, and has a higher sensitivity and specificity than FNA for detecting breast cancer.

Answer 12

***_Breast conserving surgery_*** * Only suitable for individuals with **localised operable disease** and **no evidence of metastatic disease**. * **Wide local excision** (WLE) is the most common breast conserving treatment and involves excision of the tumour, typically ensuring a **1cm margin** of macroscopically normal tissue is taken as well. * Suitable for **smaller focal cancers** but is also dependant on the location and relative size of the breast. * Better asthetics ***_Mastectomy_*** * multifocal disease * high tumour: breast tissue ratio * disease recurrence or patient choice * Removes all of the tissue of the affected breast, along with a significant amounts of superficial skin * Leaves muscle layer intact ***_Axillary surgery_*** * Commonly done alongside WLE and mastectomies in order to **assess nodal status** and r**emove any nodal disease** * **Sentinel node biopsy**- removing first lymph node into which tumour drains. They are identified by injecting blue ink and radioisotope. * **Axillary node clearance**- removing all nodes in the axilla, ensuring to not damage any associated important structures in the axilla, which are then sent

Answer 13

* Lymphatic fluid drains into lymph nodes, its contents including biomarkers and inflammatory markers. * Cancer cells can break off from the main tumour and circulate through the lymphatic system or through blood vessels. * Some of these cells can grow in the lymph nodes or drain to elsewhere in the body. * Breast is largely drained by the axillary (armpit) lymph nodes. * ***_Sentinel lymph node_***, the first lymph node through which a certain area of tissue drains into. If you can rule out sentinel lymph node involvement then you reduce the need for axillary lymph node dissection.

Answer 14

Many cancer cells get an overly strong, uncontrolled signal to proliferate. This often comes in the form of a mutated gene coding for cell receptors. * Most common are **oestrogen** (ER) or **progesterone** (PR) positive tumours. HER2. * **Hormonal therapy** aims to stop the growth of hormone sensitive tumours by blocking the body’s ability to produce hormones or by interfering w the effects that the hormones have of the cancerous cells. ***_1) Blocking ovarian function:_*** * Ovaries main source of oestrogen in premenopausal women. Blocking ovarian function = ovarian oblation. This is done surgically or radiologically. ***_2) Block oestrogen production_*** * Aromatase inhibitors block aromatase enzyme used to create oestrogen ***_3) Blocking oestrogen’s effect_*** * **Tamoxifen**- selective oestrogen receptor modulator used to treat oestrogen receptor positive breast cancer * Aromatase inhibitors- e.g., **letrozole**, anastrozole, exemestane * Goserelin (**Zoladex**) e.g., synthetic analogue of luteinizing hormone-releasing hormone, reducing secretion of gonadotropins from the pituitary. * Leuprorelin (**Prostap**)peptide-based GnRH receptor superagonist * Fulvestrant (**Faslodex**)- estrogen receptor antagonist used to treat HR+ breast cancer that may also be HER2-.

Answer 15

Anyone registered with a GP as female **every 3 years** between **50-71** * Trans man/ woman or a non-binary person you may be invited automatically. * Those over 71 aren’t automatically invited but can still get screened every 3 years.

Answer 16

***_benefits_*** 1. allows you to catch a cancer that is too small to find 2. catch cancers early- more succesful treatment and breast preservation ***_drawbacks_*** 1. can't always tell if a tumour is life-threatening or not, therefore you could undergo traumatic treatment for something that wouldn't have killed you 2. false negative- missing a cancer that is there 3. flase positive- undergo unneccessary treatment 4. exposure to xrays from mammogram

Answer 17

60-74 year olds get sent a FIT kit every 2 years some 56 year olds are starting to be sent them in england

Answer 18

Happens when a blood vessel becomes narrowed and there is subsequent reduced blood flow. Arms and legs (usually arms) don’t receive enough BF to meet demand often causing pain. Any vessels not supplying heart or brain, usually involves the artery usually a sign of atherosclerosis fonataine and rutherford classifications ![]()

Answer 19

* Muscle pain or cramping triggered by activity or at late stages at rest, eased with rest * Leg numbness * Leg weakness * Lack of peripheral pulse * Coldness in affected leg * Sores on toes, feet or legs that won’t heal * Change in colour to the legs (usually go pale) * Hair loss or slower growth * Shiny skin on legs * Erectile dysfunction in men Symptoms may be worse at night as patients lie down and lose the aid of gravity in perfusing their legs often asymptomatic at early stages

Answer 20

Functional- exaggerated dilation in response to sommething *_**Organic**- change in the structure of the blood vessels_* * Most often by atherosclerosis (build up of fatty deposits on your artery walls) so they reduce BF * Blood vessel inflammation * Injury to your limbs (compartment syndrome) * Unusual anatomy of ligaments/ muscles * Radiation exposure * smoking * high blood pressure * diabetes * high cholesterol

Answer 21

* Smoking * Diabetes * Obesity (a body mass index over 30) * High blood pressure * High cholesterol * Increasing age, especially after age 65 or after 50 if you have risk factors for atherosclerosis * A family history of peripheral artery disease, heart disease or stroke * High levels of homocysteine, an amino acid that helps your body make protein and to build and maintain tissue

Answer 22

* Critical limb ischaemia: condition begins as open sores that won’t heal. Infection or injury progresses and causes tissue death, sometimes requiring amputation of affected limb. * Stroke and heart attack: atherosclerotic plaque can rupture and form thromboembolism * tissue death, which can lead to limb amputation * impotence * pale skin * pain at rest and with movement * severe pain that restricts mobility * wounds that don’t heal * life-threatening infections of the bones and blood stream

Answer 23

![]()ankle brachial index first colour duplex ct/ mri angiography

Answer 24

***_Conservative management_*** * Supervised exercise programme- reduce symptoms by inrceasing collateral blood flow * vasoactive drugs- naftidofural oxylate * percutaneous transluminal angioplasty- for disease limited to one artery (balloon) * surgical reconstruction * amputation * future therapies

Answer 25

**1) Angioplasty**- blocked or narrowed section of artery is widened by inflating a balloon inside the vessel. Used for disease that is confined to one artery. **2) Artery bypass graft**- where blood vessels are taken from another part of your body and used to bypass the blockage in an artery. Most common arteries to use are the internal mammary arteries (IMA) **3) Stent with or without graft** **4) amputation-** try to preserve knee where possible. protects against gangrenous necrosis and sepsis

Answer 26

***_Lifestyle changes:_*** Lowering cholesterol- less fatty diet Control high blood pressure Lose weight Quit smoking Exercise regularly- increases collateral blood flow to area Sometimes prescribe blood thinners Watchful waiting

Answer 27

* ***_abdominal aortic aneursym_***- most common, characterized by chest and jaw pain, stabbing abdominal or back pain, fainting, difficulty breathing, and weakness on one side of the body. Often asymptomatic at first * ***_Arterial aneurysm-_*** develop in the portion of the aorta that passes through the chest. Also like abdominal aortic aneurysms, thoracic aortic aneurysms are largely asymptomatic – so you’re unlikely to know that it’s lurking. However, some symptoms to look out for are back pain, hoarseness, shortness of breath, or tenderness or pain in the chest prior to a thoracic aneurysm’s rupture. * ***_Cerebral-_*** ages 30-60

Answer 28

Popliteal aneurysms (70-80%) Femoral artery Visceral arteries- splenic, hepatic and renal

Answer 29

***_criteria for surgical intervention for AAA_*** 1. \>5.5cm in diameter 2. Expanding at \> 1cm per year 3. Symptomatic AAA in a patient who is otherwise fit ***_a) open repair-_*** involves a midline laparotomy or long transverse incision, exposing the aorta, and clamping the aorta proximally and the iliac arteries distally, before the segment is then removed and replaced with a prosthetic graft ***_b) Endovascular repair_***- introducing a graft via the femoral arteries and fixing the stent across the aneursysm shown below

Answer 30

***_monitor_*** -----\< 5.5cm monitor w duplex USS as surgery before this point offers no survival advantage 3. 0-4.4cm yearly ultrasound 4. 5- 5.4cm 3 monthly ultrasound ***_control risk factors:_*** * Smoking cessation (reduces rate of expansion and risk of rupture) * Improve blood pressure control * Commence statin and aspirin therapy * Weight loss and increased exercise ***_medication-_*** antihypertensives (beta blockers and ANG II R blockers) and antiplatelets

Answer 31

A s**udden onse**t of **severe abdominal pain** developing over a short time period. It has a **large number of possible causes** and so a structured approach is required ***_presentations requiring immediate surgical intervention:_*** 1. Bleeding 2. Perforated viscus 3. Ischaemic bowel ***_Less severe_*** 1. Colic 2. peritonism (perforation of ulcer, diverticulum, appendicitis, colecysticis) signs: prostration unable to bend, shock, +ve cough test, no bowel souds 3. Obstruction

Answer 32

***_Bleeding_*** * most serious is a ruptured AAA but also consider ruptured ectopic pregnancy, bleeding gastric ulcer, and trauma. * Hypovolaemia- Clinical features: tachycardia,pale and clammy on inspection, cool to touch ***_Perforated viscus (organ)_*** * peritonitis is caused by inflammation of the peritoneum, **generalised peritonitis is most commonly caused by perforated abdominal viscus**. * Causes- peptic ulceration, bowel obstruction small and large, diverticular disease, IBD * Clinical features: lie completely still to avoid pain, DDX renal colic would be writhing in pain. Tachycardia, rigid abdomen with percussion tenderness, involuntary guarding, reduced or absent bowel sounds ***_Ischaemic bowel_*** * Any patient who has **severe pain out of proportion to the clinical signs** has ischaemic bowel **until proven otherwise**. They are often **acidaemic** with a **raised lactate** and **physiologically compromised**. * Patients will often complain of a **diffuse and constant pain**, however the examination can often otherwise be unremarkable. Definitive diagnosis is via a **CT scan** with **IV contrast**, with early surgical involvement. ***_Colic pain_*** * A **pain that crescendos to become very severe and then disappears**. Happens as a tube contracts onto something blocking it. The forms are **biliary colic** (gall stones), **ureteric colic** (kidney stones) or **bowel obstruction** ***_Peritonism_*** * Localised inflammation of the peritoneum. Usually starts with viscus inflam-- visceral peritoneum and then parietal peritoneum. This pain migrates and becomes more well localised e.g. appendicitis.

Answer 33

***_labs for acute abdomen_*** 1. Urine dipstick- signs of infection and haematuria, preg test for wpmen of age 2. ABG- septic or bleeding patients 3. Routine bloods- FBCs, U&Es, LFTs,CRP and amylase, ,,, group and save for those who might need surgery 4. Blood cultures ***_Imaging_*** 1. Erect chest plain film radiography (eCXR)- for evidence of free abdominal air 2. Ultrasound- kidneys, ureters and bladder (KUB), biliary tree and liver, transvaginal 3. CT imaging ***_ECG_*** 1. rule out heart referred pain

Answer 34

1. Intravenous access 2. Nil by mouth status set 3. Analgesia +/- anti-emetics 4. Initial imaging 5. VTE prophylaxis 6. Urine dip 7. Bloods 8. Start IV fluids 9. Monitor Fluid balance ***_Consider_*** 1. urinary catheter 2. nasogastric tube

Answer 35

Acute appendicitis most common surgical abdominal emergency 1. **Abdominal pain**- peri-umbilical, dull and poorly localised (visceral peritoneum inflam) and then later well localised once it has migrated to the right iliac fossa (parietal peritoneum involvement) 2. **Vomiting** 3. **Anorexia** 4. **Nausea** 5. **Diarrhoea** 6. **Constipation** *_On examination:_* 1. Rebound tenderness 2. Percussion pain over mcBurney’s point (point 2) 3. Guarding 4. Features of sepsis when severe ![]() *_Specific signs of examination:_* **Rovsing’s sign**; RIF pain on palpation of the LIF **Psoas sign**; RIF pain with extension of the right hip, specifically suggest an inflamed appendix abutting psoas major muscle into a retrocaecal position

Answer 36

***_DDX appendicitis general_*** * *_Renal:_* ureteric stones, urinary tract infection, pyelonephriti * *_Gastrointestinal:_* inflammatory bowel disease, Meckel’s diverticulum, or diverticular disease * _Paediatrics-_ acute mesenteric adenitis, gastroenteritis, constipation, intussusception, or urinary tract infection. ***_DDX appendicitis males_*** 1. testicular torsion 2. epididymo-orchitis ***_DDX appendicitis females_*** 1. ovarian cyst rupture 2. ectopic pregnancy

Answer 37

* **B**owel obstruction * **A**ppendicitis/ adenitis * **D**iverticulitis (mesenteric), diabetic ketoacidosis * **G**astroenteritis/ gall stones * **U**rinary tract obstruction (stones)/ infection * **T**?

Answer 38

***_DDx for RIF pain_*** **Gastrointestinal** 1. appendicitis 2. Crohn’s disease 3. inflamed Meckel diverticulum 4. cholecystitis with low gall bladder 5. mesenteric adenitis 6. epiploic appendagitis 7. colon cancer 8. constipation 9. irritable bowel syndrome **Reproductive female** 1. ectopic pregnancy 2. acute ovarian event (cyst rupture, hemorrhage, torsion) 3. Mittelschmerz (ovulation pain mid-cycle) 4. Pelvic inflammatory disease 5. Endometriosis **Reproductive male** 1. seminal vesiculitis 2. undescended testicle pathology **Urinary** 1. renal colic 2. UTI **Nearby areas** 1. abdominal: RUQ, central, groin pain 2. hip pathology 3. psoas abscess 4. rectus sheath haematoma 5. right lower lobe pneumonia

Answer 39

***_Lab tests for appendicitis_*** * Urinalysis- exclude renal or urological cause. Pregnancy test in women * Routine bloods- FBC and CRP to check for inflame markers, pre-op assessment, serum B-hCG to exclude ectopic pregnancy ***_Imaging for appendicitis_*** * Ultrasound- helps exclude gynaecological findings * CT- helps exclude GI or urological causes

Answer 40

Definitive treatment is ***_laparoscopic appendicectomy_*** Some debate over ***_conservative antibiotic therapy_*** in uncomplicated appendicitis. Laparoscopic appendectomy - low morbidity - in females gives you better visualisation of the uterus and ovaries for assessment - appendix should be sent to histopathology for evidence of malignancy - entire abdomen should be inspected for evident pathology e.g., meckel’s diverticulum

Answer 41

* ***_Perforation_***- this will cause a peritoneal contamination- particularly bad in children with a delayed presentation * ***_Surgical site infection_*** – rates vary depending on simple or complicated appendicitis * ***_Appendix mass_***- where omentum and small bowel adhere to the appendix * ***_Pelvic abscess_***- presents as fever with a palpable RIF mass, can be confirmed via CT scan for confirmation, management is usually w antibiotics and percutaneous drainage.

Answer 42

inflammation of the pancreas can be distinguished from chronic pancreatitis by its limited damage to the secretpry function of the gland, with no gross structural damage developing ***_investigations_*** ***_lab tests_*** 1. serum amylase- if 3x above normal limit 2. LFTs 3. serum lipase ***_imaging_*** 1. abdominal ultrasound 2. AXR can show sentinal loop sign 3. contrast enhanced CT scan

Answer 43

**G**allstones **E**thanol **T**rauma **S**teroids **M**umps **A**utoimmune disease **S**corpion venom **H**ypercalcaemia **E**ndoscopic retrograde cholangio-pancreatopraphy **D**rugs

Answer 44

1. casues trigger a premature and exaggerated activation of the digestive enzymes within the pancreas 2. pancreatic inflammatory response 3. increase in vascular permeability 4. fluid shifting (third spascing) 5. enzymes released into the systemic circulation casuing autodigestion of fats (fat necrosis) and blood cessels

Answer 45

_***abdominal pain**-*_ **sudden onset** which **gradually intensifies** until reaching a steady dull and **boring ache.** Occurs in the epigastrium but may be felt on the flanks depending on which side of the pancreas is affected. May **radiate to back** * **bruisinng around umbilicus** * nausea * anorexia * vomiting * diarrhoea * discomfort lessens when leaning forwards

Answer 46

in order of frequency fever and tachycardia abdominal tenderness, mescular guarding, distension jaundice dyspnoea haemodynamic instability rarely

Answer 47

*_grading system for acute pancreatitis_* * **modified Glasgow criteria** assesses severity within the first 48 hours of admission * any patient with +/\>3 should be admitted to ICU with severe pancreatitis **P**O2 ,8kPa **A**ge \>55 years **N**eutrophils (/WCC)\> 15 x 109/L **C**alcium \<2mmol/L **R**enal function (urea) \> 16mmol/L **E**nzymes LDH\> 600 U/L or AST\>200U/L **A**lbumin \<32g/L **S**ugar (blood glucose) \>10 mmol/L

Answer 48

Mainly symptom control and not curative 1. admit to emergency ward 2. Resuscitation with intravenous fluids. 3. Supplemental oxygen. 4. Intravenous analgesia. 5. Intravenous antibiotics for treatment of infected pancreatic necrosis and/or associated cholangitis. 6. Early nutritional support which may involve initial parenteral feeding if the person is unable to tolerate oral intake.

Answer 49

* **Endoscopic retrograde cholangiopancreatography** (ERCP) to relieve the obstruction within 72 hours of the onset of pain, for those with gallstones and cholangitis, jaundice, or common bile duct obstruction. * **Percutaneous** or **endoscopic drainage of pancreatic collections**, and potential surgical management of other complications such as **debridement of necrotic tissue**.

Answer 50

***_systemic complication_*** 1. disseminated intravascular coagulation (DIC) 2. acute respiratory distress syndrome 3. hypocalcaemia 4. hyperglycaemia (secondary to destruction of Langerhans and subsequent disturbances to insulin metabolism ***_local complications_*** 1. Pancreatic necrosis- persisting inflame leads to ischaemic infarct of the pancreatic tissue. Confirm via CT. 2. Pancreatic pseudocyst- collection of fluid containing pancreatic enzymes, blood and necrotic tissue

Answer 51

Gallstones are **hardened deposits of digestive fluid** that can form in your **gallbladde**r. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. ***_2 types of gallstones:_*** 1) **cholesterol gallstones** * most common type * appears yellow in colour * mainly undissolved cholesterol 2) **pigment gallstones** * dark brown or black stones that form when bile has too much bilirubin

Answer 52

A- fundus of gall bladder B- body of gall bladder C- neck of gall bladder D- cystic duct E- hepatic duct F- common bile duct

Answer 53

1. **Cholecystitis**-inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder. Causes severe pain and fever. 2. **Blockage of the common bile duct**- blockage of the tubes through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result. 3. **Gallstone blockage in the pancreatic duct-** which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization. 4. **Gallbladder cancer**- People with a history of gallstones have an increased risk of gallbladder cancer.

Answer 54

Hospital stay for all ***_1) cholecystitis (inflam of gallbladder)_*** control symptoms: * fasting (nil by mouth) * fluid through a vein * antibiotics * analgesia * surgery- (endoscopic retrograde cholangiopancreatography) ERCP tube to remove stones ***_2) common bile duct obstruction_*** * ERCP * antibiotics * stent it up if caused by cancer ***_3) blockage of the pancreatic duct causing pancreatitis_*** * cholecystectomy with occasional lymph node removal ***_4) gall bladder cancer_*** * normal cancer stuff + add a stent in

Answer 55

***_Diverticula-_*** * The bulges (pockets) that stick out of the side of the large intestine. * Often associated with ageing. * The large intestine becomes weaker with age and the pressure of hard stool passing through the large intestine is thought to cause them. ***_Diverticular disease-_*** * 1/4 people woth diverticula experience symtpoms, this is having diverticular disease ***_Diverticulitis-_*** * Symptomatic inflammation of the diverticula * Major risk is the western diet (low fibre) ***_Diverticulosis_*** * Asymptomatic inflammation of the diverticula

Answer 56

1. **intermittent left lower abdominal pain** that is usally **colicky** and may be **relieved by defaecation** 2. **constipation** 3. **rectal bleeding** some many asymptomatic, no systemic features ***_presentation of diverticulitis_*** 1. **acute abdo pain** (sharp and localised in LIF, worsened by movement) 2. localised tenderness on examination 3. **systemic upset** (appeitie, fever, nausea)

Answer 57

recurrence of diverticulitis high 10-35%- elective segmental resection 1. ***_Abscess formation_*** managed with bowel rest, broad spec antibiotics, with or without CT guided drainage. Surgical management if medical fails. 2. ***_stricture_*** (narrowing of lumen)- most common, repeated episodes of inflam leave a fibrotic lump that narrows the lumen 3. ***_fistula formation_*** (abnormla connection of passsageway)- surgical intervention required always 4. Perforation

Answer 58

diverticulosis- no treatment needed diverticulitis- conservative management for majority of patients, symptoms clear within 3 days 1. broad spec antibiotics 2. IV fluid 3. analgesia 4. Increase dietary intake of fibre required for those with **perforation, faecal peritonitis or overwhelming sepsis** 1. **Hartmann's procedure** (major)- this is a sigmoid colectomy with formation of an end colostomy, an anastamosis with reversal colostomy may be available later Other interventions include resection with primary anastomosis and loop ileostomy or laparoscopic peritoneal lavage, however neither option have shown superior outcomes ![]()

Answer 59

1) **mechanical bowel obstruction**- structural pathology blocks lumen and passage of intestinal contents * 15% of acute abdomen= obstruction * Once bowel segment has been occluded, gross dilation of the proximal limb of bowel occurs resulting in increased peristalsis. Leads to large secretion of large volumes of electrolyte rich fluid into the bowel (often referred to as “third spacing”) * ***_Closed loop obstruction_***- when there is another obstruction distally ***_Causes of mechanical_*** * Twisted * Inflamed * Intussipation * Scar tissue or hernia * Tumour or other growth * Famaged blood vessels 2) ***_Functional obstruction_*** No physical blockage but bowel can't move food through lumen i.e. denervation ***_Futher categorisation of obstructions:_*** 1. partial- liquid and gas can pass 2. complete- nothing can pass

Answer 60

vomiting, nausea + anorexia, colic pain, constipation, abdo distension, tinkling bowel sounds small bowel- vomiting happens sooner, distension less, pain higher in abdomen large bowel- pain is more constant in ileus there is essentially paralysis so there will be no or minimal bowel sounds

Answer 61

***_Small intestine obstruction causes;_*** 1. adhesions 2. herniae 3. Intuscuception (children) 4. volvulus ***_Large intestinal obstruction causes;_*** 1. malignancy 2. diverticular disease 3. volvulus

Answer 62

1. nil by mouth 2. drip and suck- nasogastric tube to (suck) contents, start IV fluids and correct electrolyte distrubances (drip- fluid rescus) 3. urinary catheter and fluid balance 4. analgesia PRN + anti-emetics CT

Answer 63

* Suspicion of **intestinal ischaemia** or **closed loop bowel obstruction** * A cause that requires surgical correction (such as a **strangulated hernia** or **obstructing tumour**) * If patients **fail to improve with conservative measures** (typically after ≥48 hours)

Answer 64

Specifics alter the surgery but generally a lap 1. **Laparotomy** 2. If **resection of bowel** is required, the re-joining of obstructed bowel is often not possible and a **stoma** may be necessary. ***_large bowel obstruction_*** 1. fix hernia 2. stent 3. resection and colostomy

Answer 65

inflammation of the peritoneum **_types_** 1. **primary spontaneous peritonitis**, an infection that develops in the peritoneum 2. **secondary peritonitis**, which develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum ***_causes_*** 1. a burst stomach ulcer 2. a burst appendix 3. digestive problems, such as Crohn's disease or diverticulitis 4. pancreatitis 5. surgery 6. injury to the stomach 7. pelvic inflammatory disease 8. cirrhosis

Answer 66

***_The first symptoms of peritonitis are:_*** 1. typically poor appetite 2. nausea 3. d**ull abdominal ache** that quickly turns into **persistent severe abdominal pain, which is worsened by any movemen**t. ***_Other signs and symptoms related to peritonitis may include:_*** 1. Abdominal tenderness 2. Abdo distention 3. Chills

Answer 67

1. Antibiotics 2. stop peritoneal dialysis 3. supportive care: IV analgesia, oxygen, blood transfusion 4. nasogastric feeding?

Answer 68

1. Firstly, **physical abdo examination** and **review of medical history** to reveal underlying conditions or medical procedures that may have caused peritonitis. 2. **Blood test** for **WBC** and and **blood film** for presence of bacteria 3. **Peritoneal fluid analysis** can also be performed to determine if there is infection or inflammation 4. **X-rays or CT scans**, can show perforation or other trauma in the gastrointestinal tract.

Answer 69

1. IV antibiotics 2. Surgery * Used to remove infected tissue * treat underlying cause of infection and prevent infection spread * especially if peritonitis is due to a ruptured appendix, stomach or colon

Answer 70

***_Can the patient talk?_*** If yes then their airway is patent and you can move onto B. No: 1. Look for signs of airway compromise: 1. Cyanosis 2. See saw breathing 3. Use of accessory muscles 4. Diminished breath sounds + added sounds 2. Open the mouth and inspect look for obstructions: 1. Inhaled foreign body  SOB and stridor 2. Blood in the airway  from epistaxis, haematemesis or trauma 3. Vomit/ secretions in the airway 4. Soft tissue swelling anaphylaxis and infection 5. Local mass effect  lymphoma 6. Laryngospasm asthma, GORD and intubation ***_Interventions_*** 1. Seek immediate expert support 2. Head tilt chin lift manoeuvre 3. Jaw thrust 4. Insert oropharyngeal airway 5. Nasopharyngeal airway 6. CPR

Answer 71

***_Observations_*** RR between 12-20? Bradypnoea sedation, opioid toxicity, COPD exhaustion? Review SP02 94-98 in healthy 88-92 in COPD HYpoaxaemia seen in PE, spiration, COPD, asthma and pulmonary oedema Quick end of bed exam ***_Investigations_*** ABG CXR ***_Interventions_*** Oxygen CPR Oxygen and nebulisers in asthma

Answer 72

HR ***Tachycardia*** \>99  hypovolaemia, arrhythmia, infection, hypoglycaemia, thyrotoxicosis, anxiety, pain, drugs like salbutamol ***Bradycardia*** \<60  acute coronary syndrome, ischaemic heart disease, electrolyte abnormalities like hypokalaemia, drugs (B-blockers) BP 90/60  140/90 is normal Hypertension hypervolaemia, stroke, Conns syndrome, cushing’s syndrome, pre- eclampsia Hypotension  hypovolaemia, sepsis, adrenal crisis, drugs like hypotensive, diuretics and opiates Fluid balance assessment General inspection Palpation temperature of hands, cap refill, pulses and BP, JVP, auscultation, ankles and sacrum

Answer 73

Consciousness AVPU Pupils size, symmetry, light reflex Drug chart review ***_Investigations and procedures_*** Blood glucose and ketones Imaging e.g., CT head

Answer 74

Rashes Review any IV lines Assess calves for DVT Review surgical wounds Review output of drains and catheters Assess temperature

Answer 75

1. Neoplastic polyps 2. IBD 3. Altered bowel habit or obstruction 4. Diet (low fibre, high in red and processed meat) 5. Alcohol 6. Smoking 7. Previous cancer

Answer 76

Bleeding/ mucous Altered bowel habit Tenesmus Mass PR

Answer 77

decreased weight decreased Hb abdo pain obstruction less lilkey

Answer 78

abdo mass perforation haemorrhage fistula decreased weight

Answer 79

FBC--\> microcytic anaemia FOB sigmoioscopy/ endoscopy CEA blood marker

ILOs Flashcards

(106 cards)