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Flashcards in Hepto / Gastro Deck (42)
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1
Q

Describe the ligaments of the liver

A

Flaciform ligament attaches the anterior liver to anterior abdo wall. Contains the ligamentum teres (remnant of the umbilical vein)

Coronary + Triangular Ligaments (L. + R.) attach superior liver to diaphragm

Hepatoduodenal + Hepatogastric ligament make up lesser omentum

Posterior surfrace of the liver attached to IVC by hepatic veins

2
Q

Describe the hepatic recesses

A

Subphrenic recess (L. + R.) between diaphragm and liver divided by falciform ligament

Subhepatic recess between liver and transverse colon

Morison’s pouch: part of R. subhepatic space near the kidney. Deepest aspect of the peritoneal cavity. Where fluid collection occurs when supine

3
Q

Glisson’s Capsule?

A

Fibrous layer surrounding the liver

4
Q

Lobes of the liver

A

L. + R. lobe divided by falciform ligament

Caudate lobe: upper aspect of posterior liver between IVC and ligamentum venosum (fetal ductus venosus)

Quadrate lobe: lower aspect of posterior liver between gallbladder and ligamentum teres (fetal umbilical vein)

5
Q

Porta Hepatis

A

Fissure between caudate and quadrate lobe transmitting all vessels, nerves and ducts to the liver

6
Q

Describe microscopic structure of the liver

A

Hepatocytes arranged into lobules, hexagonal shapes with central vein at the centre. At each corner of the lobules lie 3 vessels called portal triad (Artery, Vein and Duct). Portal traid also carries lymp vessels and vagus nerve

7
Q

Arterial and Venous Supply to the liver

A

Arteries: Common hepatic A. (from coeliac trunk)

Hepatic Portal Vein Veins: 3 hepatic veins into IVC

8
Q

Nerve supply to liver.

A

Hepatic plexus containing

Sympathetic fibres from coeliac plexus

Parasympathetic fibres from vagus nerve

9
Q

When would you perform a percutaneous liver biopsy

A

Abnormal LFTs with unknown cause

Hep C. Autoimmune or Herdiatary liver conditions

Following liver transplant

10
Q

What things are important during when taking a GI history

A

Abdo Pain (SOCRATES)

Swallowing – difficulty swallowing or painful swallow

Indigestion – do they get reflux following a meal or when lying down

Nausea and vomiting (all the time or when eating, drinking, taking pills)?

Haematemesis – blood in vomit

Bowel habits – change in bowel habit is the most important thing (Frequency, Constipation, diarrhoea)

Stools Consistency and colour (Blood, melaena or mucus present, Difficulty flushing (steatorrhea), Incontinence/Urgency)

Tenesmus – the feeling of incomplete emptying

Ask about recent travel – GI infection is a likely differential after foreign travel

11
Q

What should you look for in a GI exam upon general examination

A

Items around bedside (sickbowl/drip/feed)

General wellbeing (obvious jaundice)

12
Q

What should you look for in a GI exam upon hand examination

A

* Koilonychia (hypochromic anaemia, iron deficiency especially) * Leuconychia (hypoalbuminaemia) Clubbing * Malabsorption / Crohn’s and Ulcerative Colitis / Cirrhosis * Also think about lung disease and heart disease such as chronic hypoxia, interstitial lung disease, lung cancer, endocarditis Palmar erythema * Portal hypertension, chronic liver disease (hepatitis, cirrhosis), polycythaemia * Also think about thyrotoxicosis, rheumatoid arthritis, eczema, psoriasis Dupuytren’s contracture * Excessive alcoholism and liver disease Asterixis (hepatic flap) * sign of encephalopathy caused by cirrhosis

13
Q

What should you look for in a GI exam upon arm inspection

A

Petechiae (small red bruised patches) * may be present in liver cirrhosis Look for signs of IV drug abuse * Hepatitis * Signs of scratching (from pruritis which is common in jaundice)

14
Q

What should you look for in a GI exam upon face inspection

A

Eyes * Sclerae for jaundice * Conjunctivae for anaemia Mouth * Angular stomatitis (indicative of iron deficiency) Glossitis (shiny, smooth tongue) * Iron deficiency or pernicious anaemia (B12 deficiency) Ulceration * Crohn’s disease * Candidiasis Neck * JVP * Lymphadenopathy (especially in Virchow’s node)

15
Q

What should you look for in a GI exam upon abdo inspection

A

* Spider Naevi (cirrhosis) * Caput medusae (portal hypertension) * Stoma Bag

16
Q

What should you look for when palpating the abdo?

A

* Distended + Tense (suggests ascites) * Tenderness + Rigidity (suggests peritonitis) * Masses * Size of spleen/liver * Ballot kidneys (tumour/PCKD/hydronephrosis) * Aorta (should be pulsatile + non expansile)

17
Q

What should you look for in a GI exam upon percussion and asculatation of Abdo

A

* Dullness (mass) * Size of bladder (fluid retention) * Shifting dullness/Fluid thrill (ascities) Bowel sounds * Absent/Tinkling suggest BO * Frequent bowel sounds may be present prior to blockage

18
Q

How should you finish a GI exam

A

* Periperal oedema (ankles + sacrum) * Examination of hernial orifices + DRE + external genitalia * ECG in patients with abdo pain (MI reffered pain) Check Obs chart * Temp * Weight * Stools * Fluid/Food intake

19
Q

Causes of RUQ pain?

A

* Gallstones * Cholangitis * Hepatitis * Liver abscess * Cardiac/Lung causes

20
Q

Causes of LUQ pain?

A

* Splenic Abscess * Acute Splenomegaly * Splenic Rupture

21
Q

Causes of Epigastric Pain?

A

* Esophagitis * Peptic Ulcer * Perforated Ulcer * Pancreatitis

22
Q

Causes of L. / R. Flank Pain?

A

* Ureteric Colic * Pyelonephritis

23
Q

Causes of Umbilical Pain?

A

* Early appedicitis * Mesenteric adenitis * Meckel’s diverticulitis * Lymphoma

24
Q

Causes of RIF pain?

A

* Late appendicitis * Crohn’s disease * Caecum obstruction * Ovarian Cyst * Ectopic Preg * Hernias

25
Q

Cause of LIF pain?

A

* Diverticulitis * UC * Constipation * Ovarian Cyst * Hernias

26
Q

Causes of Suprapubic Pain?

A

* Testicular torsion * Urinary Retention * Cystitis * Placental Abruption

27
Q

Cause + RF for GORD

A

Cause * Lax osophageal sphincter * reduced osophaheal motility * reduced stomach emptying RFs * Smoking * Alcohol * Pregnancy * NSAIDS * Hiatus Hernia

28
Q

Signs of GORD?

A

Epigastric Buring Pain * Relieved by eating * Worse lying down * Dysphagia + Odynophagia

29
Q

Complications of GORD

A

Barrett’s osophagus * Treated with osophageal resection/ablation Osophageal Ulceration * Bleeding + Anemia * Hemoptasis Osophageal Stricture * Obstruction causing dysphagia * Osophagitis * Aspiration

30
Q

What grading systems are used to asses GORD?

A

* Savary Miller (1-5) * LA grading (A-D)

31
Q

Differential’s for GORD

A

OsophagitisInfectionPeptic UlcerGI malignancyMIGallstonesNon-ulcer dyspepsia

32
Q

Investigations of GORD

A

Can start treatment imediatly if simple case Endoscopy * Assess degree of dysplasia in Barrett’s * Differentiate between gastric ulceration Barium swallow * Hiatus hernia Oesophageal pH * Acid reflux Urea breath test * H. pylori infection

33
Q

Treatment for GORD?

A

Lifestyle Modifications * Smoking cessation * Reduce Weight * Reduce alcohol * Sleep with pillows under head * More frequent smaller meals * Avoid Food/Drink 3 hours prior to sleep * Stop Precipitating Drugs Medications * PPIs (Lansoprazole/Omeprazole) H2 receptor antagonists (Ranitidine)

34
Q

Causes of post-op ileus

A

* Bowel obstruction * Intestinal atrophy * Paralysis

35
Q

Different types of enteral feeding

A

* NG tube * Nasojejunal tube * Percutaneous endogastric gastrostomy (PEG) * Jejunostomy tube

36
Q

In colorectal cancer are men or women more likely to get the cancer in a) colon b) rectum

A

Men = rectumWomen = colon

37
Q

Is colorectal cancer more common on the left or right side of the colon?

A

Left

38
Q

Which gene is most important and specific to colorectal cancer

A

APC Adenomatous polyposis coli

39
Q

What is an ulcer

A

Persistant breach of the epithelial linning

40
Q

Classification for colorectal cancer and describe it.

A

Dukes’ classification:A: confined to wall of bowelB: through the wall of bowelC: involved lymph nodesD: distant metastases

41
Q

Most common organ for colorectal metastasis

A

Liver via venous portal system and lungs.

42
Q

3 most common cause of small bowel obstruction

A

HerniaAdhesions TumourForeign body