Term
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Definition
| embryonic reminant of the vitelline duct, located in antimesenteric border. contains ectopic gastric, pancreatic, duodenal or colonic tissue rule of 2 - 2% of pop, present age 2, 2 feet from ilocaecal valce, 2 inches long. usually asymptomatic. complications - peptic ulceration, intussuception, volvulus, inflammation |
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Term
| Celiac dissease etiology and epidemiology |
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Definition
| 1:100/200 common in europeans, strong family history. Aetiology - Autoimmune disease that results in loss of tolerance to gliaden peptide - T-cell mediated v giaden and transglutimase |
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Term
| celiac disease - pathology |
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Definition
| major affect proximal small bowell - crypt hyperplasia, villous atrophy, loss of brush border, vucuolisation, loss of gobletcell, infiltrate in the lamina proprial |
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Term
| clinical features of celiac |
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Definition
| weight loss, diarrhoea (bulky,frothy, smelly), FTT, anaemia, mouth ulcers, infertility,dermitits herpetiforms, osteoporosis. Diagnosis - documentation of malabsorption, biopsy showing loss of villi, restoration on gluten free diet, also presence of anti-gliaden antibiodies, anti- TTG antibodies. Treatment - gluten free diet and replacement antibodies. Complications - Cancer (enteropathic associated T cell lymphom, adenocarcinoma, oesphageal SCC, |
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Term
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Definition
| malabsorbtion disease presumably of infectious origin in people visiting tropics. features - diarroea, malabsorption, anorexia, weight loss, folate and B12 defeciency. Dx by exclusion, antibiotic treatment |
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Term
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Definition
| rare disease caused by tropheryma whipperlii gram positive actinmycetes in macrophage, shag pile villi - Dx visualisation. features - steatorrhea, feve, wt loss, also arthralgia, cardiac, neurological, and hyperpigmentation |
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Term
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Definition
| commonly caused by dog hook worm infection that mounts severe allergic responce. abdominal pain, obstruction, diarrheoa, bleeding - tx antihelmetics |
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Term
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Definition
| upto50% without problems - ileum (bile salt, B12, diarrhoea, electrolyte, steatorrhea) Jejunum (ileum can take over, gastric hypersecretion), Short bowel syndrome (crohns disease) - end in stoma (fluid/electrolyte depleting) colon (reduced fluid and elecrolyte loss, low fat diet) |
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Term
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Definition
| protrusion of hernia sac and content through a defectit in wall of peritoneal cavity. location - femoral, inguinal, umbilical, surgical, retroperitoneal. complications - incarceration, obstruction, strangulation |
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Term
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Definition
| fibrous bridge formaion commonly from surgery, lead to internal herniation and obstruction |
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Term
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Definition
| twisting of loop of bowel and mesentary. leads to obstruction, infarction. commonly - sigmoid, caecum, small bowel, stomach |
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Term
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Definition
| hernia, adhesion, intussusception, volvulus, tumor, strictures, stones, foreighn body, pseudoobstruction |
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Term
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Definition
| segment of intestine is telescoped into the immediate distal segment. cause - children, hypertropic lymphoid tissue, mass or tumour. complication obstructin and infarction. Tx barium meal, resection |
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Term
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Definition
| elderly, RF for emboli/atherosclerosis present with pain, centra/constant, increased WCC, fever. Cause - arterial occlusion (emboli, atherosclerosis) End artery occlusion (small focal ischemia), Venous occlusion (compression, thrombosis - heamorrhagic necrosis) No-occlusive (CHF, shock, dehydraction, vasoconstrictors-broad,spotty ischaemia) - massive oedema (thumbprints on mucosa, commonly affects watershed area) |
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Term
| benign tumors of small intestine |
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Definition
| Adenomas, hemangiomas (obstruct), connective tissue (stroma tumors - more aggressive c.f stomach) |
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Term
| malignant tumors of small intestine |
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Definition
| metastasis (most common) Adenomas (penetrate to serosal surface) Carcinoids - 50% of tumors, most common appendix, ielum, rectum, stomach, colon least common. multicentric, carcinoid syndrome. metasticis - lymph node, liver. Appendix usually benign. Morphology - rounded, well circumscribed, intact mucosa, yellow in colour. Lympoma (95%B-cell) plaques, diffue mural thickening, polyps, ulcerations - present obstruction, haemorrhage, perforation |
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Term
| Acute appendicites pathology |
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Definition
| 20-30yrs, obstruction of lumen via faecolith leading to bacterial proliferation. Macro - swollen, purulent, faecal matter. Histo - infiltrate of neutraphils, gangrenous. Presentation - anorexia, nausea, vomiting, diarrhoea, Abd pain central ->mcburney point. systemic signs of inflammation. Complications - perforation and peritonitits, abscess formation |
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Term
| other pathologies of appendix |
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Definition
| infection (enterobius vermicularis, eosinophilic rxns), tumour (adenocariconoma, carcinoid, adenoma). Mucoceloesle (obstruction and fills with mucus, may rupture and spread to peritoneaum) |
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Term
| Defence mechanisms of the GIT |
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Definition
| peristalsis, saliva, low pH, free flow of fluid, shedding of epithelia, secretary IgA, mucus, normal flora, macrophages, digestive enzymes, reticuloendothelial system |
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Term
| pathophysiology of peritonisits |
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Definition
| Lack of containment(organisms, inflammatory break down prods,leak of cytokines, increase ADH and aldosterone) Triggers inflammatory cascade (neutraphil, platelet, macrophage, release of cytokines, perpertuating cascade) Effects of mediatiors (fever, tachycardia, peripheral vasodilation, capillary permiability, massive exudate of inflammatory fluid) Generalisation (non containment of inflammatory mediator ->SIRS) |
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Term
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Definition
| Circulatory (hypovolemia, renal impairment, increased permeability, decreased peripheral resistance). Ventilatory (impaired gas exchange - VQ mismatchy or shunt, impaired diffusion, hypoventilation) GIT (impaired cell metabolism- open of tight junction, passige of organism, products into circulation. Absosption failure - decreased absorption of water and elecrtrolytes, worseinging of vol depletion, increased secretion. bacterial overgrowth in stasis) |
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Term
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Definition
| Bacteria (direct-trauma, local extension, blood borne) Bile/acid (chemical burn-secondary infection) Urine, Blood (breakdown activates inflammatory cascade) |
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Term
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Definition
| primary (rare-prepubertal girls strep infection from genital tract, liver disease) Secondary - Localised (sepsis at certain area, body is capable of containing,local pain, guaring) Generalised (continuation of localised, peritoneal adheasion and omentum contain, pain generalised, marked guarding and rigidity, inflammatory changes - temp tachy, inc BMR |
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Term
| organs causes of peritonitis |
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Definition
| appendix (most common), gall bladder (chemical, secondary bacterial), Colon (diverticulitis, colitis, trauma, ischemia) small bowel (trauma, ischemia, emboli, herniation) Stomach (ulcers, tumors) duodenum, Gynae (PID, post terminatio) Bladder and UTI (bladder rupture, trauma) |
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Term
| hernia epidemiology and terminology |
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Definition
| 10-20/1000 births (premature), 3% of adults, M>F inguinal, F>M femoral. Indirect inguinal most comm. Reducible (contents return spontaneously of manually) Irreducible (contents cannot be returned) Obstructed (bowel is obstructed) Strangulated (compromised blood supple) |
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Term
| Pathophysiology of hernias |
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Definition
| embryological inherint weakness in abdominal wall (exit of extraperitoneal structures, devoid of multilayer support) surgical incision. hernial sac - peritoneum and contents within. RF - prematurity, family history, undescended testes, increased intraabdominal pressure (ascites, peritoneal dialysis, copd, pregnancy) |
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Term
| Anatomy of the inguinal canal |
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Definition
| deep ring (transversalis fascia) M (transverse abdominus, internal oblique) A (aponeurosis of internal(lateral) external oblique) L (inguinal ligament) T (transverse fascia, conjoint tendon (medialy) |
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Term
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Definition
| 75% of hernias, 25x more commen in men. Indirect - congenital (persistant process vaginalis), follows path of descending testes,lateral to epigastic vessels, frequently incarcerate. Direct - passage thru transversalis fascia via inguinal triangle, acquired defect, rarely extend to scrotum, rarely incarcerate |
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Term
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Definition
| protrustion thru the femoral canal (femoral sheath) medial to femoral vein and lateral to the lacunar ligament. bulge below inguinal crease, roughly midline, more common in females, frequently stangulate |
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Term
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Definition
| incomplete development of the muscular umbilical ring allows herniation of abd contents. congenital - disapear by age of 2. adult hernia - frequently incarcerate |
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Term
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Definition
| epigastric (linea alba) Incisional (post surgical) Spigelian (semilunaris, arcurate line) Pelvic (sciatic, perineal, obturator) Lumbar |
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Term
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Definition
| symptomatic lump. Incarceration - hernia does not reduce on lying, sudden onset of pain, irritability in children, bowel obstruction) Strangulation (toxic, perforation, peritonitis, shock) |
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Term
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Definition
| inspection (full exposure, standing, lumps, scars, cough, examine in relation to pubic tubucle) Palpation (hand over tubucle ask to cough, check two testis, inversion of scrotum in inquinal canal cough - tapping relfex) Incarceration - tender, dont transluminate, bowel sounds, visable peristalsis |
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Term
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Definition
| inguinal hernia (above ing ligament), femoral hernia, lymph node (tender, multiple), Hydrocoele (transilluminate, nont tender) testicular torsion, tumor, undescended testis, epididmymitis, goin cellulitis, femoral thrombophlebitits, feroral artery aneurysm. |
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Term
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Definition
| resent duration place in trendelemburg position, administer analgesic, relaxants, warm compress, gentle compression. ->surgical resection of those that cannot be reduced. painless or reducible (elective, no heavy lifting, laxatives,return if pain) strangulation - broad spectrum antibiotics, fluid resusitaion |
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Term
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Definition
| stretching, ischemia, inflammtion. steady ache or colicky. follows segmental distribution (foregut, midgut, hind gut) felt in midline. patients wryth in agony |
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Term
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Definition
| irritaions of fibers in parietal peritoneam, localised to specific ares, tenderness, guarding, rigidity and rebound tenderness. patient lie still to avoid pain |
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Term
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Definition
| pain - nildocalfiaat, time frame (sudden- perforation, rupture. gradual - inflammatory) Associate symptoms - GI (nausea, vomiting, diarrhoea, constipation, flatus) Genitourinary (dysuria, frequency, urgency, hematuria) Gynaecological histor, Vascular. PMH - medications, surgery, hospitalisation,chronic disease. |
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Term
| Examination of the acute abdomen |
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Definition
| General - facial expression, diaphoresis, pallor, agitation, mobile/still. Vitals - pulse and bp standing (>30 bpm or >15/10) Abdomen - inspection (distension, peristalisis, scars, masses) Palpation (guarding, tenderness, rigidity, organomegaly, bladder, hernias) Auscultation (bowel sound, succession splash) pelvic exam, rectal exam |
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Term
| investigation of acute abdomen |
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Definition
| FBC (WCC), amylase, electrolyes (status) pregnancy test, CXR, ABD X-ray, Ultrasound, CT |
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Term
| acute appendicites presentation |
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Definition
| fever, central abdominal pain->localised to RIF, nausea, anorexia, vomiting occasional diarrhoea. tenderness at mcburneys point, Rosvings sign, Inv - Raised WCC, ultrasound, CT. DDx msenteric lymphdenitis, acute salpingitits, meckels diverticulum, functional, ileitis |
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Term
| presentation of peritonisits |
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Definition
| sudden onset (perforation,rupture) or gradual (inflammation) guarding, rigidity, rebound tenderness. Investigations - amylase, CXR, ultrasound, CT. Tx resusitation, |
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Term
| Bowel obstruction - causes |
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Definition
| adhesion, hernias, strictures, neoplasm, volvulus, intussesception, radiotion, foreighn body, diverticulu, congential |
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Term
| Pathophysiology of bowel obstruction |
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Definition
| dilation of bowel above the block, increased secretion of fluid in distended bowel, bacterial contamination, venous stangulation, ischemia and necrosis -> perforation, peritonitis |
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Term
| bowel obstruction - presentation |
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Definition
| symptoms - colicky abd pain, nausea vomiting (early small bowel) constipation, no passage of flatus. Signs abdominal distension, peristalsis, tenderness, rigidity, Auscultation - hyperactive bowel sound. Strangulation - tachycardia, abdominal tenderness, fever, leucocytosis, acidosis |
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Term
| Intestinal psuedo obstructionq |
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Definition
| no mechanical cuase. causes - post trauma, surgery, sepsis, pneumonia, metabolic, drugs. presentation - as per obstruction. management - withdrawel of drugs, treat offending cause, iv neostigmane |
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