abdo Flashcards by Sanjana Shetty

subtotal colectomy stoma?

removal of whole colon and part of sigmoid–> end ileostomy and rectal stump closed up

How well did you know this?

Not at all

Perfectly

purpose of loop ileostomy?

defunctioning of colon post rectal cancer surgery

does not decompress colon (if ileocaecal valves competent)

How well did you know this?

Not at all

Perfectly

spigelian hernia?

intra parietal - rare. between the muscles of the abdo wall–>usually between the internal and external oblique

lateral to the rectus abdominis

open repair IF strangulated

How well did you know this?

Not at all

Perfectly

Richter’s hernia?

anti mesenteric border of the small bowel goes into the hernia

therefore luminal patency maintianed–> can still strangulat e

usually at laparoscopic port sites

How well did you know this?

Not at all

Perfectly

lumbar hernia?

iliac crest inf

latissimus medially

external oblique laterally

usually following renal surgery

How well did you know this?

Not at all

Perfectly

littres hernia

hernia contianing meckels diverticulum

How well did you know this?

Not at all

Perfectly

bochdalek hernia

left sided diaphragmatic hernia -

commoner in males and

associated hypoplasia,

contains stomach and

requires repair due to high mortality

How well did you know this?

Not at all

Perfectly

Morgagni hernia

R sided (usually) herniation through foramen of morgagni.

direct anatomical repair

can contain transverese colon

less severe usually than bochdalek

How well did you know this?

Not at all

Perfectly

umbilical hernia

herniation thorugh weak umbilicus

repair after 3rd birthday as usually will resolve by 2 years old

How well did you know this?

Not at all

Perfectly

paraumbilical hernia

defect in linea alba

commoner in females

multiparity and obesity

repaired using Mayo’s technique

How well did you know this?

Not at all

Perfectly

best abdominal access incision for kids?

transverse supra umbilical

How well did you know this?

Not at all

Perfectly

mesenteric cyst?

kids

smooth and mobile

nil pain nless torsion etc

usually an incidental finding

–> USS and CT

How well did you know this?

Not at all

Perfectly

when do you perform a loop colostomy?

obstructing rectal cancer below the peritneal refelction (ie likley going to be a lower anterior resection)

How well did you know this?

Not at all

Perfectly

loop ileostomy?

following a right hemi

-to protect the anastomosis

in in the context of rectal cancer…to protect a primary anastomosis

How well did you know this?

Not at all

Perfectly

recurrent RIF abdo pain and iron deficiiency anaemia. negative gastroscopy and colonoscopy?

Meckels’s - ectopic gastric mucousa is secreting acid and causing ulceration

How well did you know this?

Not at all

Perfectly

psoas abscess causes?

primary - immunocompromised, haematogenous spread

secondary -to ibd like Crohn’s.

back pain +/- mass in inguinal/femoral area

How well did you know this?

Not at all

Perfectly

a burst abdomen is most common X days after surgery?

How well did you know this?

Not at all

Perfectly

best incision for pancreas resection?

Rooftop

(NOT Kochers)

How well did you know this?

Not at all

Perfectly

features of microscopic colitiis?

normal endoscopic appearance

inflammation (lymphocytes) in the subepithelial collagen layer

no granulomas

possibly a preceding bout of infective diarrhoea

How well did you know this?

Not at all

Perfectly

spleic vein causes and treatement?

causes:pacreatitits, panc ca, trauma, hypecoaguability

–> gastric varices (oesophageal rare)

tx: splenectomy

How well did you know this?

Not at all

Perfectly

causes of post op abdo compartment syndrome?

obese

use of mesh

–> increased NG aspirates, met acidosis, reduced urine output

defined as: sustain IAP > 20 mmhg +new organ dysfunction

normal range 12-25. low in crit ill patiens 5-7

treatments for abdo compartment syndrome?

gastric deocmpression

meds to relax gastric wall e.g. sedative/relaxants

drain fluid collections

fluid restrict/diuretics

—-> lapartomoy and bogota bag/vac

pancreas ca

usu - head

CT scan - panc protocol

metastatic disease–> no resection. palliation with stent

resectable disease –> adjuvent chemo

Ivor lewis oesophagectomies are used for?

middle and lower third adenocarcinoma - NO mets.

local nodal involvement is okay

laparotomy plus thorax

proximal oesophagela cancer requires?

McEowan resection - ie total oesophagectomy with anastomosis to the cervical oeshopagus

transhiatal approach to oesphagectomy can be used in ?

very distal tumours

endsocopic mucosal resection can be used for ?

in situ disease

oesophageal carcinoma plus met

ablative therapy and stents--\> NO surgery

staging process for oesophagela cancer?

CT CAP then staging lap THEN Pet for occult mets

(RUQ) sepsis +jaundice =

cholangitis -gallbladder empyema etc will not usu exhibit jaundice tx fluid resus, broad spec abx, correct coagulopathy and ERCP

acute cholecytitis picture?

sepsis, mildy deranged lfts, RUQ pain USS+cholecytectomy within 48 hrs...

swingin fever, RUQ pain, prodromal illness....

gallbladder abscess--\> USS or CT sub total chole (if calots triangle is hostile) percutaneous drainaige if unfit patient.

acalculous cholcystitis?

other illness e.g. organ failure/diabetes + high fever cholecystitis without prescence of stones tx - chole or perc drain

stone stuck in CBD - cannot surgically remove?

choledochoduedonostomy --\> make an opening from the cbd to the duodenum and anastomose can get an unused bit of bile duct that causes SUMP where all the debirs and stones collect

best feeding option post oesophageal perf?

TPN

what does a roux en y look like?

![]()

what are the side effects of roux en y?

dumping syndrome -\>sugary food moves into intestine, distention, insuline release cramy abdo pain diarrhoea and hypogylcaemia ensue -afferent and efferent limb syndrome bile gastritis metabolic bone disease b12 deficiceny

bile leaks/biliary damage ....leaking bile, jaundice

ERCP, then can decide if need stent or sphincterotomy.

treatement for varices?

banding/sclerotherapy sBS/minnesota tube medical therapy and tipps to reduced portal pressures

gall stone ileus

leave the gall bladder alone!!!

difficulty intubating the oesophagus?

pharyngeal puch

SCC of upper 1/3 od oesophagus can be treated with ?

radical chemoradiotherapy

mirrizzi syndrome +surgery

very inflamed Calot's triangle ---\> opt for cholecystostomy

hepatocellular carcinoma protocol?

serum AFP and liver USS 6-12 months MRI if suspicious

pancreatitis sequelae?

peripancreatic fluic 4 weeks \> walled off grnaulmoa/fibrous wall--\> pseudocyst. pesistent mildly raised amylase and likely retrogastric.even symptomatic cases can be observed for 12 weeks as 50%resolve. if not tx cystgastrostomy pancreatic necrosis--\>FNA then decidec if necrosectomy abscess--\> usually following psudocyst--\> drains

pharnygeal puch is a contraindication to ...

endoscopy

obstructive picture LFTS +HIV patient

scleorinsing choangitis secindary to infection e.g. CMV, cryptosporidium etc

difference between tx for obstructiong colonic lesion vs rectal lesion?

colonic -stent or resect. can use chemo as adjunct rectal - do NOT resect without staging. includes mri defunction using loop colostomy. irradiation as extraperiotneal -if present in nodes then resect either AR or APER. meso rectum dissected out

anal cancer

HPV 16 biopsies with EUA staging with CT chemoradiotherapy orrrr radical APEAR

chronic fissure

\>6/52 sentinel pile, enlarged anal papillae and ulcer

investigations for carcinoid?

5hiaa in 24 hr urine somtostatin receptor scintopgrpahy CT blood chormogranin A