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surgery Flashcards

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1
Q

Define Appendicitis

A

inflammation of appendix

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2
Q

Cause of appendicitis

A

lumen obstruction => distended appendix => increased mucus production + bacterial overgrowth => impaired lymphatic/venous drainage => leading to oedema, ischaemic necrosis and perforation.

Lumen obstruction caused by:

  • faecolith (hard fecal mass matter)
  • lymphoid hyperplasia after infection
  • impacted stool
  • foreign body
  • FHx
  • worms
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3
Q

Presenting symptoms of appendicitis

A
  • periumbilical pain that moves to right iliac fossa
  • pain worsened by movement (cough)
  • anorexia - loss of appetite
  • nausea + vomiting
  • constipation +/- diarrhoea
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4
Q

Atypical presentations of appendicitis

A
  • children- non-specific abdominal pain/ withdrawn/ not eating fave food
  • older - minimal pain/ fever + acute confusion
  • pregnant women (displaced appendix) later stages can be RUQ pain, nausea/vomiting mistaken for pregnancy problems
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5
Q

Examination findings of appendicitis

A
  • facial flushing, halitosis, dry tongue
  • Right iliac fossa tenderness (max over Mcburney’s point- 2/3 from umbilicus => ASIS)
  • palpable abdominal mass (appendix mass/ abscess)
  • Rovsing’s sign (palpation of LLQ => pain in RLQ)
  • Psoas sign (right hip extension in left lateral position => pain in RLQ)
  • Obturator sign (internal rotation of flexed right thigh => pain in RLQ)
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6
Q

Why does appendicitis initially present with periumbilical pain?

A

initial pain is visceral peritoneum inflammation => is poorly localised but as pain spreads to parietal peritoneum somatic more localised (RLQ)

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7
Q

Investigations + findings for appendicitis

A

*usually only to exclude other causes

  • Bloods:
    1. FBC- neutrophil leucocytosis (high WCC)
    2. raised C-reactive protein (inflammatory marker)
  • Urine dipstick (exclude UTI)
  • Pregnancy test (exclude ectopic pregnancy)
  • US/ CT (less common- as delay is fatal rules out ovarian torsion
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8
Q

Management for appendicitis

A
  1. Laparoscopic Appendicectomy (SURGERY)
  2. Conservative Antibiotics (cefuroxime, metronidazole)
  3. Exploratory Laparoscopy (diagnostic/ therapeutic for progressive/ persistant pain)

Immediate (pre surgery)

  • pain relief
  • fluids + NBM (surgery)
  • prophylaxis ABs => for peritonitic signs (as could be perforated appendix)
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9
Q

Differentials for appendicitis (RIF pain)

A
  • ovarian pathology (torsion/ cysts)
  • ectopic pregnancy
  • UTI
  • STI (pelvic inflammatory disease)
  • IBD flare up
  • Meckel’s diverticulitis (elderly- terminal ileum)
  • renal colic
  • mesenteric adenitis (children)
  • testicular torsion
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10
Q

Complications of appendicitis

A
  • appendix perforation => peritonitis signs (rigid, tender abdomen + rebound tenderness)
  • gangrenous appendix
  • appendix mass (inflamed appendix covered in omentum)
  • appendix abscess (pus around appendix)
  • surgical complications (small bowel obstruction, wound infection, abscess, stump leakage)
  • sepsis
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11
Q

prognosis of appendicitis

A
  • uncomplicated => most recover with no long-term problems
  • ruptured appendix => more complications/ death
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12
Q

Define acute pancreatitis

A

inflammation of pancreas due to uncontrolled enzyme release => autodigestion +/- local tissue or organ involvement

mild: minimal organ dysfunction, uneventful recovery
severe: organ failure (necrosis, abscesses)

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13
Q

Pathophysiology of acute pancreatitis

A
  • obstruction in pancreas => increases ductal pressures
  • build up of enzyme rich juice => acinar cell damage
  • lysozymes convert trypsinogen => trypsin which activates enzymes
  • => auto-digestion of pancreas => necrosis
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14
Q

causes of acute pancreatitis (I GET SMASHED)

A
  • Idiopathic
  • Gallstones - obstruction of pancreatic duct => activates pancreatic enzymes => auto-digestion of pancreas => inflammation
  • Ethanol misuse - alcohol toxic to pancreatic cells causing inflammation/ cell destruction + increased protein deposition => increased ductal pressure => intra-pancreatic enzyme activation.
  • Trauma
  • Steroids
  • Mumps/ HIV/ Coxsackie/ Malignancy
  • Autoimmune
  • Scorpion venom
  • Hypertriglyceridaemia/ hypercalcaemia
  • ERCP
  • Drugs (sodium valproate, steroids, thiazides, azathioprine)
  • pregnant, neoplasia
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15
Q

presenting symptoms of acute pancreatitis

A
  • sudden epigastric/ central abdominal pain
  • pain radiating to back
  • pain relieved by sitting forward
  • anorexia
  • nausea
  • vomiting
  • Hx of high alcohol intake/ gallstones
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16
Q

Examination signs of acute pancreatitis

A
  • epigastric pain
  • fever
    -shock (tachycardia, tachypnoea)
  • jaundice
  • decreased bowel sounds (ileus)
    In severe haemorrhagic pancreatitis
  • Cullen’s sign (periumbilical bruising)
  • Grey-Turner (flank bruising)
  • Fox’s sign (ecchymosis over inguinal ligament area)

hypocalcemia

=> Chvostek (touch facial nerve=> ipsilateral face contracts as low Ca2+)

=> trousseau’s (hand contraction when bp cuff)

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17
Q

Investigations + findings for acute pancreatitis

A

Bedside:

  • ECG- rule out cardiac causes (MI)
  • Urinalysis- infection
  • pregnancy test

Bloods:

  • VERY HIGH serum amylase
  • High Serum lipase (more sensitive)
  • FBC - Hb, High WCC
  • U&Es
  • high glucose
  • high CRP
  • low Ca2+ (lipase => FFA => chelate calcium => SOAPIFICATION => Ca2+ complex deposits)
  • LFTs (abnormal if gallstone/alcohol pancreatitis)
  • ABG (metabolic acidosis => to determine severity)
  • *USS** - check for gallstones
  • *CXR**- exclude pleural effusion (due to ARDS)
  • *CT abdomen pelvis** with contrast - exclude pseudocyst, abscess, necrosis

MRCP

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18
Q

Management of acute pancreatitis

A

MEDICAL:

  • fluid + electrolyte resuscitation (3L)- Ca2+/Mg
  • NG tube for vomiting
  • analgesia (WHO pain ladder) / anti-emetics
  • blood sugar control
  • prophylactic antibiotics to reduce mortality
  • enteral feeding

For gallstone pancreatitis => SURGERY: ERCP + early cholecystectomy

If signs of sepsis => image guided fine needle aspiration

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19
Q

complications of pancreatitis

A
  • early: VASODILATION + HYPOTENSION, shock, renal failure, ARDS (pleural effusion) (cytokine mediated), sepsis, DIC

Late:

  • pancreatic necrosis
  • pseudocyst (>4 weeks, painful)- drain with endoscopic US
  • peripancreatic collection
  • pancreatic haemorrhage / bleeding (shock + blood loss)
  • abscess (pain + fever/septic signs)

Long term problems:

  • diabetes
  • chronic pancreatitis (longer pain Hx worse after alcohol/meals, weight loss)
  • enteropancreatic fistula (pancreas => gut)
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20
Q

How to calculate Prognosis of acute pancreatitis (PANCREAS)

A

Modified Glasgow score

PaO2 <7.9

Age >55

Neutrophils (WCC>15)

Calcium (<2mmol/L)

uRea (>16mmol/L)

Enzymes

Albumin

Sugar (>10mmol/L)

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21
Q

Define intestinal obstruction

A

blocked movement of intestinal contents typically common in elderly

  • small/ large bowel
  • partial/ complete obstruction
  • strangulated (blood supply cut) /simple

*closed loop (obstructed both ways -no movement)

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22
Q

causes of bowel obstruction

A

Small

  • adhesions (post-op WESTERN)
  • hernias
  • strictures (CROHN’S)
  • neoplasms

Large

  • colorectal carcinoma
  • volvulus
  • diverticulitis
  • Hirschsprung’s disease- genetic in babies -poor neuron development in colon so poor peristalsis
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23
Q

presenting symptoms of bowel obstruction (Hx)

A
  • abdominal distension
  • colicky abdominal pain
  • absolute constipation - early large bowel sign, late small bowel sign
  • vomiting- early small bowel sign (billious large amounts), late large bowel sign (faecal vomiting)
  • Previous surgery
  • previous hernias
  • cancer symptoms- anaemia? weight loss? anorexia?lethargy?
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24
Q

examination findings of bowel obstruction

A

inspection

  • signs of dehydrations- dry mucous membranes, low bp, high HR
  • distended abdomen
  • scars from previous surgery ADHESIONS
  • check for hernias
  • Jaundice

Paplation

  • peritonitis signs (rebound tenderness, guarding, absent bowel sounds Auscultations
  • tinkling bowel sounds (early), absent bowel sounds (late)
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25
investigations for bowel obstruction
1. Bedside: urine dip (haematuria-kidney stones) 2. **_Bloods_**- FBC- Hb (anaemia), WCC (infection), amylase (pancreatitis), CRP, U&Es- urea&creatinine (AKI), lactate (if strangulation =\> ISCHAEMIA) 3. Venous blood gas - check for low K+ (vomiting) 4. Imaging: **_Abdominal X-ray (small bowel dilated \>3mm)_**, water soluble contrast enema (X-ray with contrast), barium follow through, CT abdomen (shows ischaemia + site of obstruction)
26
Differences in X-ray of small bowel and large bowel
small- central dilation, valvulae conniventes (across whole width), large- peripheral dilation, haustra (pouches)
27
Management of bowel obstruction
* conservative: 1. **NBM** 2. **NG tube for decompression + IV fluids** 3. analgesia, urinary catheter, electrolyte replacement (monitor urinary output) * surgical- *depends on cause* * fecal evacuation * rigid sigmoidoscope decompression -to untwist volvolus * gastrograffin- resolve adhesions * exploratory laparotomy + sigmoid colectomy (resect dead bowel) + **end colostomy/ ileostomy** (Hartmann's procedure- bowel connected to skin=\> stoma)
28
Complications of bowel obstruction
* peritonitis * bowel perforation * dehydration =\> ACUTE KIDEY INJURY * toxaemia * gangrene of ischaemic bowel wall *
29
Define bowel ischaemia
blockage of mesenteric vessels =\> bowel ischaemia (lack of oxygen) + necrosis 1. acute mesenteric ischameia- *affects small bowel + SMA* 2. chronic mesenteric ischaemia- small bowel 3. ischaemic colitis - *large bowel inflammation + IMA =\> ischaemia*
30
risk factors for bowel ischaemia
* \>65 * AF/ cardiac arrythmias * endocarditis * CVD risk factors: hypertension, hypercholesteremia, diabetes, smoking * thrombophillia (hypercoagulable) * vasculitis * shock =\> sepsis
31
causes of acute mesenteric ischaemia
arterial (SMA occlusion) * emboli * thrombosis * non-occlusive (hypotension, septic shock, hypoperfusion after cardiac surgery) Venous (SMV occlusion) * portal hypertension * sickle cell * portal pyaemia - pus in portal vein =\> inflammation
32
presenting symptoms of bowel ischaemia
* **sudden crampy** CENTRAL/RIF abdominal pain * signs of shock (hypotension, tachycardia, dehydration) * fever * loose bloody stools * nausea/ vomiting * Hx of CVD/ liver disease AMI- sudden severe abdominal pain, shock Chronic mesenteric ischaemia - central colicky abdominal pain, worse on eating, +/- PR bleeding, weight loss Ischaemic colitis - LIF pain +/- bloody diarrhoea
33
examination findings of bowel ischaemia
* diffuse abdominal tenderness * signs of shock (tachycardia, hypotension, dehydration) * absent bowel sounds * abdominal distension * palpable mass
34
Investigations for bowel ischaemia
1. bedside: ECG (AF) 2. Bloods: FBC- Hb, WCC- infection, CRP-inflammation, **_serum lactate_** (ISCHAEMIC), LFTs, U&Es, clotting screen, 3. ABG- lactic acidosis 4. Imaging - AXR-bowel obstruction, mesenteric angiography (if stable), CT/MRI angiography (narrowed vessels)
35
Gold standard investigation for ischaemic colitis
Colonoscopy + biopsy
36
Management for bowel ischaemia
* conservative: NBM, NG tube for decompression, IV fluids, broad spectrum ABs, treat cause * surgical: 1. Emergency exploratory laparotomy + resect non-viable bowel 2. restore SMA blood supply (embolectomy, SMA arterial bypass)
37
Indications for surgery in bowel ischaemia
* haemodynamically unstable * massive bleeding * toxic megacolon * peritonitis/ sepsis
38
Define diverticular disease
1. diverticulosis- presence of diverticulum * true = outpouching contains all layer * false = oupouches of only mucosa/submucosa 1. diverticular disease- diverticulosis + complications (infection/fistulae/ haemorrhage) VERY COMMON 2. diverticulitis - acute inflammation + infection of diverticulum
39
What is diverticulum?
diverticulum are outpouches of GI wall mucosa/submucosa through muscle layers at points of weakness (entry of arteries)
40
How to classify acute diverticulitis
Hinchley classification * I- with pus * Ia/II- abscess * III- perforation + peritonitis * IV- fecal peritonitis (due to large bowel perforation)
41
Causes of diverticular disease
* **_low fibre diet_** causes increased intraluminal pressures in large bowel =\> increased force of muscle contraction =\> herniation of gut mucosa/submucosa through gut muscle layers. * older age * decreased physical activity * smoking * alcohol * obesity * NSAIDs * Genetics (connective tissue disorder-more stretched, marfan's)
42
Presenting symptoms of 1. diverticular disease 2. diverticulitis + complications
1. MAINLY asymptomatic 2. diverticulitis =\> * LIF pain * fever * +/- PR bleeding * constipation, diarrhoea, abdominal mass * peritonitis (rigidity/ guarding) 1. diverticular fistualation =\> pneumaturia (gas in urine), faecaluria, recurrent UTIs
43
Examination findings of diverticulitis
1. LIF tenderness 2. signs of peritonitis (rigid, guarding, rebound tenderness)
44
Investigations for diverticular disease/ diverticulitis
Bedside: * stool culture (infection) + faecal calprotectin (bowel inflammation) * urinalysis (UTI) * DRE - rule out Bloods * **FBC** - Hb (anaemia), WCC (infection) * **raised CRP** * clotting/ cross match if bleeding * U&Es- exclude UTI/renal colic * amylase - exclude pancreatitis * LFTs- exclude cholecystitis Imaging * **barium enema** with contrast (like X-ray) * **Flexible sigmoidoscopy/ colonoscopy** (see diverticulae + exclude polyps/tumours) * CT abdo + pelvis (ACUTE) * CXR - rule out perforatation (air under diaphragm)
45
Management of diverticular disease
If asymptomatic =\> high-fibre diet (fruit, veg), stop smoking, weight loss laxatives (osmotic- more fluid in bowel, **_bulk-forming_** - more fluid in stools, stimulant- peristalsis) GI bleeding (*PR bleeding*)=\> IV fluids, transfusion, antibiotics acute diverticulitis: =\> IV fluids, **_antibiotics_**, bowel reset (NBM), drainage of abscess, analgesia (avoid opioids =\> constipation) SURGERY for perforation/ peritonitis * Hartmann's (end colostomy + leave rectum stump) * Sigmoid resection + anastomosis * Laprascopic drainage
46
Complications of diverticular disease
1. acute diverticulitis (abscess =\> Abx + drainage, perforation, peritonitis, fecal peritonitis) 2. colonic obstruction 3. haemorrhage 4. fistulae (vagina, bladder, small bowel)
47
Define volvulus
loop of bowel rotates around it's mesentery =\> closed loop bowel obstruction + ischaemia * mainly sigmoid colon + cecum
48
Causes/ risk factors of volvulus
adult * long sigmoid colon + long mesentery * **adhesions** (previous abdo surgery) * **chronic constipation** * **neuropsychiatric disorders** (parkinsons, MS, spinal chord injury) * **elderly** * parasite infection + chagas disease (kissing bugs spread parasite)
49
Presenting symptoms of volvulus
* sudden colicky abdominal pain (early sign) * absolute constipation (early sign) * vomiting (late sign)
50
examination findings of volvulus
* **abdominal distension** * dehydration (dry mucous membranes, tachycardia) * fever * tinkling/ absent bowel sounds (bowel obstruction)
51
investigations for volvulus
* Bloods: FBC, Ca2+/ TFT (exclude pseudo-perforation) * **_AXR_-** see bowel obstruction (**coffee bean sign**) * CXR- check for perforation * water soluble contrast enema (X-ray with contrast =\> show structure) * **_CTAP_** - site + cause of bowel obstruction (**whirl sign**)
52
Management for volvulus
Immediate * analgesia * IV fluids (for dehydration) conservative: * **_decompression by sigmoidoscope_** - tube to locate obstruction and once in correct position =\> relieve obstructed contents + gas * **_insertion of flatus tube_** =\> allows normal passage of bowel contents Surgical (perforation/ ischaemia /necrotic signs) * laparotomy (incision)=\> **_Hartmann's procedure_** (resect dead bowel + colostomy)
53
Complications of volvulus
* bowel obstruction * bowel perforation * bowel ischaemia * complications from stoma
54
Define acute cholangitis
infection of the bile duct
55
presenting symptoms of acute cholangitis
* Charcot's triad (fever, RUQ pain=\> spread to right shoulder, jaundice) * Reynold's pentad (charcot's + mental confusion + septic shock/hypotension) * pruritus (itching)
56
investigations for acute cholangitis
Bloods * FBC- high WCC * high CRP * LFTs - obstructive picture (raised GGT + ALP) * U&Es- check for renal dysfunction * slightly elevated amylase if stone in lower CBD * blood culture- check for sepsis Imaging * US KUB- check for stones * Abdominal ultrasound - check for gallstones/ biliary tree dilation/obstruction * CXR- exclude perforation * contrast CT/MRI - check for cholangitis * MRCP- check for non-calcified stones
57
Causes of acute cholangitis
* gallbladder/ bile duct obstruction by stones * ERCP * tumours (pancreatic, cholangiosarcoma) * parasites (ascariasis) * bile duct stricture/ stenosis * cholecystectomy =\> dilate common bile duct
58
Management of acute cholangitis
Immediate * ABC * analgesia, IV fluid, antibiotics * endoscopic billiary drainage Surgical * ERCP (Endoscopic retrograde cholangiopancreatography) + sphincterectomy * Open bile duct exploration is a last resort due to a high mortality risk
59
complications of ERCP
* infection * pancreatitis * aspiration pneumonia * duodenal perforation * haemorrhage * ascending cholangitis
60
presenting symptoms of acute cholangitis
* Charcot's triad (fever, RUQ pain=\> spread to right shoulder, jaundice) * Reynold's pentad (charcot's + mental confusion + septic shock/hypotension) * pruritus (itching)
61
Complications of acute cholangitis
* liver abscess * liver failure * AKI * septic shock =\> organ dysfunction endoscopic drainage can lead to=\> Intra-abdominal or percutaneous bleeding, sepsis, fistulae and bile leakage
62
Examination signs of acute cholangitis
* fever * RUQ pain * jaundice * mental confusion * sepsis * hypotension * tachycardia * mild hepatomegaly * Murphy's sign +ve
63
Causes of acute cholangitis
* gallbladder/ bile duct obstruction by stones * ERCP * tumours (pancreatic, cholangiosarcoma) * parasites (ascariasis) * bile duct stricture/ stenosis * cholecystectomy =\> dilate common bile duct
64
Define acute cholangitis
infection of the bile duct
65
Examination signs of acute cholangitis
* fever * RUQ pain * jaundice * mental confusion * sepsis * hypotension * tachycardia * mild hepatomegaly * Murphy's sign +ve
66
investigations for acute cholangitis
Bloods * FBC- high WCC * high CRP * LFTs - obstructive picture (raised GGT + ALP) * U&Es- check for renal dysfunction * slightly elevated amylase if stone in lower CBD * blood culture- check for sepsis Imaging * US KUB- check for stones * Abdominal ultrasound - check for gallstones/ biliary tree dilation/obstruction * CXR- exclude perforation * contrast CT/MRI - check for cholangitis * MRCP- check for non-calcified stones
67
Management of acute cholangitis
Immediate * ABC * analgesia, IV fluid, antibiotics * endoscopic billiary drainage Surgical * ERCP (Endoscopic retrograde cholangiopancreatography) + sphincterectomy * Open bile duct exploration is a last resort due to a high mortality risk
68
complications of ERCP
* infection * pancreatitis * aspiration pneumonia * duodenal perforation * haemorrhage * ascending cholangitis
69
Complications of acute cholangitis
* liver abscess * liver failure * AKI * septic shock =\> organ dysfunction endoscopic drainage can lead to=\> Intra-abdominal or percutaneous bleeding, sepsis, fistulae and bile leakage
70
Define anal fissures
tear in the squamous lining of the lower anal canal * 90% posterior to anus * some anterior (usually after childbirth)
71
Causes of anal fissures
* hard faeces * anal sphincter spasm =\> constricts infeior rectal artery =\> ischaemia + impaired healing * syphillis * HIV * Crohn's
72
Presenting symptoms of anal fissures
* tearing pain on defecation * PR bleeding/ blood on wiping
73
Examination findings of anal fissures
* PR exam - tear on squamous lining
74
Management of anal fissures
1. Conservative (high fibre diet, laxatives to soften stool, hydration) 2. Medical * lidocaine (local anaesthtic) * GTN + diltiazem (sphincter relaxants + improves healing) * botulinum toxin 1. Surgical (last resort) * internal sphincterectomy (relaxes sphincter but has complications= anal incontinence)
75
complications of anal fissures
chronic anal fissures
76
Define hernias
internal body part pushes through weakness in muscle or surrounding tissue wall
77
types of hernias
* indirect (stangulates easily -if ischaemia occurs, blood supply is compromised) * direct- usually reducable (pushed back in) * epigastric * paraumbilical * incisional -from muscle breakdown after surgery * spigelian - arcuate line and transverse abdominus) * lumbar * richters hernia- bowel wall only * inguinal * femoral * sciatic * sliding * hiatus
78
causes of femoral hernias
* enlarged prostate * pregnancy * frequent cough * chronic constipation * intense workouts * elderly * obesity
79
causes of inguinal hernias
* chronic cough * constipation * urinary obstruction * heavy lifting * ascites * past abdominal surgery * infants: prematurity, male sex
80
presenting symptoms of hernias
femoral * mass in upper medial thigh * lower abdomen pain inguinal * swelling palpable on coughing
81
examinations signs of hernias
femoral * cough impulse * hernia appears on cough/straining * hernia reduces on relaxation/ laying flat inguinal * look for previous scars * ask patient to cough if no lump is visible =\> hernia above pubic tubercle * no lump visible feel for impulse
82
How to differentiate between direct/ indirect inguinal hernias?
1. reduce hernia 2. press on the mipoint of the inguinal ring (deep ring) and ask patient to cough 3. direct hernia will re-emerge
83
How to repair hernias?
* stop smoking * watch diet Surgical: 1. laproscopic repair (bilateral/ recurrent hernias) 2. open repair \*mesh repair (fix to posterior abdo wall but risk of infection)
84
Define hiatus hernia
* upper part of the stomach comes up through the diaphragmatic oesophageal hiatus
85
Types of hiatus hernias
* sliding - hernia moves up and down in the chest =\> less competent LOS =\> acid reflux * rolling - hernia goes through an adjacent part of the diaphragm * mixed
86
risk factors for hiatus hernias
* obesity * oesophagitis * pregnancy * ascites * low-fibre diet *
87
Presenting symptoms of hiatus hernia
* can be asymptomatic * GORD symptoms (heartburn, waterbrash) + painless regurgitation = hiatus hernia
88
Investigations for hiatus hernia
* Bloods - FBC (anaemia) * Imaging- CXR (see gastric air bubble) * Imaging- Barium swallow * Endoscopy - exclude oesophagitis
89
Management for hiatus hernia
* Lifestyle- lose weight * PPIs- reduce acid production * reduce gastric motility Surgical (for minority + rolling hernias as can get strangulated) * Nissen fundoplication - wrap upper part of stomach around oesophagus to reduce herniation * Hill repair - cardia attached to posterior abdominal wall * Belsley IV fundoplication - 270 wrap
90
complications of hiatus hernia
* Barrett's oesophagus * oesophagitis * oesophageal strictures * intermittent bleeding * Incarceration of hiatus hernia =\> strangulation
91
define mesenteric adenitits
self-limiting inflammatory process causing swollen mesenteric lymph nodes \*MIMICS APPENDICITIS \*more common in teens/ adolescents
92
presenting symptoms of mesenteric adenitis
* abdominal pain (central/RIF) * abdominal tenderness * fever * mesenteric lymph node enlargement * +/- diarrhoea * +/- nausea/vomiting * more common in **children/teens**
93
Causes of mesenteric adenitis
* gastroenteritis * bacterial infection (Yersinia enterocolitica, helicobacter, campylobacter jejuni, shigella, salmonella, mycobacterium tuberculosis) * lymphoma * IBD
94
Differentials for mesenteric adenitis
* **_appendicitis_** * interssusseption * Meckel's diverticulitis (of the terminal ileum)
95
Investigations for mesenteric adenitis
Bloods * FBC * ESR/CRP * LFTs * U&Es Imaging * **Ultrasound** (as mainly children) - see enlarged lymph nodes, bowel wall thickening, normal appendix * CT (for older patients)
96
Management of mesenteric adenitis
* usually self-limiting * getting it during childhood, reduces risk of getting UC in adulthood
97
Complications of mesenteric adenitis
* ischaemic colitis
98
define varicose veins
dilation of superficial veins
99
Risk factors for varicose veins
* Female * obesity * elderly * Family Hx * caucasian
100
Causes of varicose veins
1. Primary (idiopathic)- 90% 2. Secondary * venous outflow obstruction (pregnancy, ascites, ovarian cysts, pelvic malignancy) * DVT * AV malformations
101
symptoms + signs of varicose veins
symptoms: * dilated veins * aching/swelling * itching * bleeding signs: * hard/painful veins * tap test- finger over SFJ and press on varicose vein if a thrill is felt = valve incompetance * auscultation for bruits * trendelenberg test
102
describe trendelenburg test
1. Patient flat + Lift the patient’s leg up to empty the superficial veins by milking the leg towards the groin (SFJ). 2. Place a tourniquet over the saphenofemoral junction (SFJ) – this is found approximately 2-3cm below and lateral to the pubic tubercle. 3. Ask the patient to stand and observe for filling of the veins Results: * If the veins have not filled and remain collapsed incompetent valve was at the level of the SFJ. * If the veins have filled up again, it indicates the incompetent valve are inferior to the SFJ * Repeat the test
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Investigations for varicose veins
* Doppler US (location of valve incompetence)
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Management for varicose veins
Conservative: * compression stockings * lifestyle (lose weight) Endovascular * radiofrequency ablation * endovenous laser ablation * sclerotherapy Surgery (rarely)
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complications of varicose veins (venous insufficiency)
* venous ulcers * lipodermatosclerosis (champagne bottle) * haemociderin deposits * stasis eczema
Year 3
flashcards
Decks in class (27)
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