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Sanjana MRCS > abdo > Flashcards

abdo Flashcards

1
Q

subtotal colectomy stoma?

A

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

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2
Q

purpose of loop ileostomy?

A

defunctioning of colon post rectal cancer surgery

does not decompress colon (if ileocaecal valves competent)

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3
Q

spigelian hernia?

A

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

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4
Q

Richter’s hernia?

A

anti mesenteric border of the small bowel goes into the hernia

therefore luminal patency maintianed–> can still strangulat e

usually at laparoscopic port sites

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5
Q

lumbar hernia?

A

iliac crest inf

latissimus medially

external oblique laterally

usually following renal surgery

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6
Q

littres hernia

A

hernia contianing meckels diverticulum

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7
Q

bochdalek hernia

A

left sided diaphragmatic hernia -

commoner in males and

associated hypoplasia,

contains stomach and

requires repair due to high mortality

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8
Q

Morgagni hernia

A

R sided (usually) herniation through foramen of morgagni.

direct anatomical repair

can contain transverese colon

less severe usually than bochdalek

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9
Q

umbilical hernia

A

herniation thorugh weak umbilicus

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

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10
Q

paraumbilical hernia

A

defect in linea alba

commoner in females

multiparity and obesity

repaired using Mayo’s technique

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11
Q

best abdominal access incision for kids?

A

transverse supra umbilical

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12
Q

mesenteric cyst?

A

kids

smooth and mobile

nil pain nless torsion etc

usually an incidental finding

–> USS and CT

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13
Q

when do you perform a loop colostomy?

A

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

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14
Q

loop ileostomy?

A

following a right hemi

-to protect the anastomosis

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

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15
Q

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

A

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

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16
Q

psoas abscess causes?

A

primary - immunocompromised, haematogenous spread

secondary -to ibd like Crohn’s.

back pain +/- mass in inguinal/femoral area

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17
Q

a burst abdomen is most common X days after surgery?

A

6

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18
Q

best incision for pancreas resection?

A

Rooftop

(NOT Kochers)

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19
Q

features of microscopic colitiis?

A

normal endoscopic appearance

inflammation (lymphocytes) in the subepithelial collagen layer

no granulomas

possibly a preceding bout of infective diarrhoea

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20
Q

spleic vein causes and treatement?

A

causes:pacreatitits, panc ca, trauma, hypecoaguability

–> gastric varices (oesophageal rare)

tx: splenectomy

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21
Q

causes of post op abdo compartment syndrome?

A

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

22
Q

treatments for abdo compartment syndrome?

A

gastric deocmpression

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

drain fluid collections

fluid restrict/diuretics

—-> lapartomoy and bogota bag/vac

23
Q

pancreas ca

A

usu - head

CT scan - panc protocol

metastatic disease–> no resection. palliation with stent

resectable disease –> adjuvent chemo

24
Q

Ivor lewis oesophagectomies are used for?

A

middle and lower third adenocarcinoma - NO mets.

local nodal involvement is okay

laparotomy plus thorax

25
Q

proximal oesophagela cancer requires?

A

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

26
Q

transhiatal approach to oesphagectomy can be used in ?

A

very distal tumours

27
Q

endsocopic mucosal resection can be used for ?

A

in situ disease

28
Q

oesophageal carcinoma plus met

A

ablative therapy and stents–> NO surgery

29
Q

staging process for oesophagela cancer?

A

CT CAP

then

staging lap

THEN

Pet for occult mets

30
Q

(RUQ) sepsis +jaundice =

A

cholangitis

-gallbladder empyema etc will not usu exhibit jaundice

tx fluid resus, broad spec abx, correct coagulopathy and ERCP

31
Q

acute cholecytitis picture?

A

sepsis, mildy deranged lfts, RUQ pain

USS+cholecytectomy within 48 hrs…

32
Q

swingin fever, RUQ pain, prodromal illness….

A

gallbladder abscess–>

USS or CT

sub total chole (if calots triangle is hostile)

percutaneous drainaige if unfit patient.

33
Q

acalculous cholcystitis?

A

other illness e.g. organ failure/diabetes +

high fever

cholecystitis without prescence of stones

tx - chole or perc drain

34
Q

stone stuck in CBD - cannot surgically remove?

A

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

35
Q

best feeding option post oesophageal perf?

A

TPN

36
Q

what does a roux en y look like?

A
37
Q

what are the side effects of roux en y?

A

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

38
Q

bile leaks/biliary damage

….leaking bile, jaundice

A

ERCP, then can decide if need stent or sphincterotomy.

39
Q

treatement for varices?

A

banding/sclerotherapy

sBS/minnesota tube

medical therapy and tipps to reduced portal pressures

40
Q

gall stone ileus

A

leave the gall bladder alone!!!

41
Q

difficulty intubating the oesophagus?

A

pharyngeal puch

42
Q

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

A

radical chemoradiotherapy

43
Q

mirrizzi syndrome +surgery

A

very inflamed Calot’s triangle —> opt for cholecystostomy

44
Q

hepatocellular carcinoma protocol?

A

serum AFP and liver USS 6-12 months

MRI if suspicious

45
Q

pancreatitis sequelae?

A

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

46
Q

pharnygeal puch is a contraindication to …

A

endoscopy

47
Q

obstructive picture LFTS +HIV patient

A

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

48
Q

difference between tx for obstructiong colonic lesion vs rectal lesion?

A

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

49
Q

anal cancer

A

HPV 16

biopsies with EUA

staging with CT

chemoradiotherapy orrrr radical APEAR

50
Q

chronic fissure

A

>6/52

sentinel pile, enlarged anal papillae and ulcer

51
Q

investigations for carcinoid?

A

5hiaa in 24 hr urine

somtostatin receptor scintopgrpahy

CT

blood chormogranin A

Sanjana MRCS (8 decks)

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