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Surgery > Abdo > Flashcards

Abdo Flashcards

1
Q

Anatomy of the inguinal canal

A

Anterior: external oblique and internal oblique for the lateral third
Posterior: transversalis fascia and conjoint tendon for medial third
Floor: inguinal ligament
Roof: arching fibre of transversus and internal oblique

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2
Q

Contents of inguinal canal

A

M: spermatic cord and illoinguinal nerve
F: round ligament, illoinguinal nerve , gen branch of gen fem nerve

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3
Q

Hesselbach’s triangle

A

Medial: rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament

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4
Q

Classification of inguinal hernia

A

Indirect - 80% - patent processus vaginalis - arise lateral to inferior epigastric artery
Direct -20% - emerge through hesselbach’s triangle - due to acquired weak wall of canal

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5
Q

Laparoscopic techniques for inguinal hernia

A

TEP: totally extra peritoneal

TAPP: transabdominal pre- peritoneal

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6
Q

Complications of inguinal hernia repair

A 
Early
 - urinary retention
 - haematoma/ seroma formation
 - infection
 - intrabdominal Injury 
Late - reoccurrence
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7
Q

Borders of the femoral canal

A

Medial: lacunar ligament
Lateral: femoral vein
Anterior: inguinal ligament
Posterior: pectineal ligament of cooper

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8
Q

Operative management of a femoral hernia

A

Elective: Lockwood low approach
Emergency: McEvedy high approach

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9
Q

Definition of an inguinal hernia

A

Extrusion of peritoneum and abdominal contents through a previously acquired defect

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10
Q

Risk factors for incscional hernias

A

Pre-op: increased age, co-mobrdities ( malignancy and obesity ) Intra - op: surgical technique ( width of suture bites, suture material, midline, placing drain through wounds ) Post op: incensed IAP, infection, heamatoma

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11
Q

Cause of a paraumbilcal hernia

A

Acquired defect in linea Alba just above or below the umbilicus

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12
Q

Definition of a hernia

A

Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity

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13
Q

Risk factor for umbilical hernias

A

Afro-Caribbean
Trisomy 21
Congenital hypothyroidism

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14
Q

Definition of a hydroele

A

Accumulation of fluid within the tunica vaginalis

Tunica vaginalis is a rememant of the processus vaginalis

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15
Q

Cause of hydroceles

A

Primary: patent processus vaginalis
Secondary: testicular tumours, epidymo-orchitis, trauma, torsion

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16
Q

Surgical treatment of hydrocele

A

Lords repair: plication of the tunica vaignalisJaboulay’s repair: eversion of the sac

17
Q

Definition of a varicocele

A

Dilated viens of the pampinifrom plexus

18
Q

Operation for varicocele

A

Palomo operation

19
Q

Risk factor for testicular cancer

A

Undescended testis Infant hernia Infertility

20
Q

Royal marsden classification of testicualr cancer

A
  1. Disease only in testis
  2. Sub diaphragmatic para-aortic node involvement
  3. Supra and infra diaphragmatic lymph nodes involved
  4. Extra lymphatic spread - lungs liver
21
Q

No scars and stoma =

A

Colonoscopy assisted trephine colostomy

22
Q

Definition of a stoma

A

Artificial union between conduits or between a conduit and the outside

23
Q

Fistula definition

A

Abnormal connection between two hollow epithelial surface

24
Q

Indication for a stoma

A

Exteriorisation - perforated or contaminated bowel - permenant Diversion- protection of distal anastomosis- acute chrons - urinary diversion following cystectomy Decompression: bypass of distal obstructing lesion Feeding: gastrostomy/ jejunostomy Laveage: appendecictomy

25
Q

How to site a stoma

A

Avoid: bony prominences, skin folds/creases, waistline, old wounds, umbilicus Chose - a site that is easily accessible to the patient - ideally below the belt line for concealment - within the rectus: decreased risk of hernia or prolapse

26
Q

Complication of a stoma

A

Early - haemorrhage - ischemia - hight out put leading to electrolyte disturbances - parastomal abscess - stoma retraction Delayed - parastomal hernia - more common on the lateral side -obstruction: adhesion or herniation through lateral space around stoma - dermatitis - stoma prolapse - stenosis or stricture - fistula - psychosexual dysfunction

27
Q

Layers of tissues around abdomen

A

Skin Campers fascia Scarpas fascia Linea Alba Transversalis fascia Pre-peritoneal fat Preitoneum Some catholic sluts like to practise phallactio

28
Q

Jenkins rule

A

Length of suture should be 4 times the length of the incscion

29
Q

Indication for midline Laparotomy

A

Trauma Vascular: AAA, Vascualr bypass Gastro: perforated Dueodenal ulcer, Hartmann, colectomy

30
Q

Indications for a roof top incscion

A

Hepatobillary: - liver transplant - whipples - liver resection Gastric surgery

31
Q

Lateral layers of the abdominal wall

A

Skin Campers fascia Scarpas fascia External oblique Internal oblique Transversus Transversalis fascia Pre-peritoneal fat Preitoneum

32
Q

Nerves at risk in appendicetomy

A

Ilioinguinal Iliohypogastric

33
Q

Cause of post op jaundice

A

Pre-hepatic: heamolysis after a transfusion Hepatic: halogenated anaesthetic, sepsis, intra-post operative hypotensionPost hepatic: billary injury in lap Chloe

34
Q

Cause of gynecomastia

A

Drugs
- recreational: marijuana, diazepam, anabolic steroid
- prescription: spirolactone, digoxin, catopril, verapamil, ranitidine
Physiological
- puberty resolve by adulthood
Pathological
- decreased androgen production: hypogoandism: hyperprolactinemia, renal failure, testicualr atrophy, post-orchitis, bilateral torsion, klienfelter XXY
- increased oestrogen
- increased production: sex-cord stromal tumours, lung ca
- increased peripheral aromatisation: CLD, thyrotoxicosis

35
Q

Risk factors for oesophageal cancer

A 
GORD
EtOH 
Smoking 
Achalasia 
Plummer Vinson syndrome
36
Q

What’s is a pharyngeal pouch

A

Outpouching between crico and thyro pharyngeal components of the inferior pharyngeal constrictiors Pulsion diverticulum Area of weakness is called killians dehiscnse

37
Q

Riglers triad

A

Small bowel obstruction Pneumobillia Gallstone in right iliac fossa

Surgery (10 decks)

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