MED I CAL ST UDENT L OWE R G I
S URG ERY
KNOWLEDGE FOR FINALS
, Final Year Notes
Lower GI surgery
Smooth hepatomegaly causes:
Hepatitis, CCF, sarcoidosis, early alcoholic liver (small liver is typically later
on in cirrhosis), tricuspid regurgitation
Craggy hepatomegaly causes:
Secondary metastasis
Primary hepatoma
Pelvic masses:
Fibroids
ovarian cysts
bladder
malignancies – If the mass is truly pelvic then you won’t be able to get below
it.
Diverticulitis
A diverticulum is an outpouching of the GI tract wall usually at the site of the
perforating arteries.
They usually occur in the sigmoid colon (95%) due to increased intraluminal
pressure due to low dietary fibre
Usually out-pouches between the layers of taeniae coli where perforating
arteries enter – for this reason the rectum is often spared as it does not have
any taeniae coli.
30% of westerners will have them by the age of 60
Symptoms
CIBH
Left sided colic relieved by defaecation
Flatulence and nausea
DIVERTICULITIS includes all the above symptoms with pyrexia, generalised
abdominal tenderness, inflammatory blood changes and peritonism
Investigations
Bloods (FBC, WCC, CRP, amylase etc.)
Imaging (AXR and CXR, contrast CT)
Endoscopy (flexi sig but more often a full colonoscopy)
S URG ERY
KNOWLEDGE FOR FINALS
, Final Year Notes
Lower GI surgery
Smooth hepatomegaly causes:
Hepatitis, CCF, sarcoidosis, early alcoholic liver (small liver is typically later
on in cirrhosis), tricuspid regurgitation
Craggy hepatomegaly causes:
Secondary metastasis
Primary hepatoma
Pelvic masses:
Fibroids
ovarian cysts
bladder
malignancies – If the mass is truly pelvic then you won’t be able to get below
it.
Diverticulitis
A diverticulum is an outpouching of the GI tract wall usually at the site of the
perforating arteries.
They usually occur in the sigmoid colon (95%) due to increased intraluminal
pressure due to low dietary fibre
Usually out-pouches between the layers of taeniae coli where perforating
arteries enter – for this reason the rectum is often spared as it does not have
any taeniae coli.
30% of westerners will have them by the age of 60
Symptoms
CIBH
Left sided colic relieved by defaecation
Flatulence and nausea
DIVERTICULITIS includes all the above symptoms with pyrexia, generalised
abdominal tenderness, inflammatory blood changes and peritonism
Investigations
Bloods (FBC, WCC, CRP, amylase etc.)
Imaging (AXR and CXR, contrast CT)
Endoscopy (flexi sig but more often a full colonoscopy)
