Abdo- surgery Flashcards
3 main causes of hepatomegaly
3 Cs
Cirrhosis (fatty liver)
Cancer
Congestion (R heart failure)
3 main causes of splenomegaly
3 Ms
Malaria
Myelofibrosis
Chronic myeloid leukaemia
Indications for splenectomy
Rupture: post trauma, iatrogenic, EBV
Haem: sickle cell, ITP, lymphoma, leukaemia,
Work up for a splenectomy patient - 3 things?
Vaccination against encapsulated bacteria (pneumococcal, Meningitis, Hib, influenza)
Prophylactic penicillin V
Medic alert bracelet
Early complications of stoma
Haemorrhage
Skin inflammation
High output
Necrosis
Late complications of stoma
Parastomal hernia
Prolapse
Obstruction
Stenosis
5 indications for liver transplant
Acute liver failure Liver cancer Cirrhosis PSC PBC
Name of the kidney transplant scar
Rutherford Morrison
Complications of immunosuppression used in renal transplant patients
Gum hypertrophy - ciclosporin
Fine tremor - tacrolimus
Skin cancer
Management of hernias
Conservative:
Wt loss, treat cough, belts, watchful waiting
Surgical: open mesh/suture repair
WTF is hepatorenal syndrome
Portal HTN causing renal failure
Portal hypertension —> increased shear stress in splanchnics –> vasodilators released –> reduced renal perfusion –> RAAS system activation –> this isn’t enough to overcome the splanchnic vasodilation + persistent underiflling of these vessels –> renal failure
Umbilical bruising in pancreatitis
Cullens sign
Flank bruising in pancreatitis
Grey Turners sign
Causes of retroperitoneal haemorrhage
Pancreatitis
Ectopic pregnancy
Aortic rupture
Causes of dysphagia
Motility:
Achalasia, Oesophageal spasm, bulbar/suprabulbar palsy from CVA/MND, Myasthenia Gravis
Structural:
Plummer Vinson, Oesophagitis
Malignancy
Rolling hiatus hernia, lung ca, retrosternal goitre, mediastinal LNs (extramural)
Management of BPH
Conservative: reduce EtOH + caffeine, bladder training
Medical: alpha blockers, 5a-reductase inhibitors
Surgical: TURP, laser prostatectomy
Management of prostate cancer
Watchful waiting
Symptomatic: TURP, analgesia, radiotherapy for bone pain
Radical: Radical prostatectomy, Brachytherapy
Medical: LHRH analogs, Antiandrogens
Ix in man with lower urinary tract symptoms
DRE Urine dip + MCS U+Es, PSA Transrectal USS +/- biopsy Urodynamics Voiding diary
- If ?ca –> MRI prostate + Bone scan
Define a hernia
Protrusion of a viscus through the walls of its containing cavity into an abnormal position
Aetiology of an inguinal hernia
Congenital: patent processus vaginalis –> indirect hernia
Acquired: anything which increases IAP: cough, obesity, constipation, heavy lifting, ascites
Direct inguinal hernia - describe its main features
Emerge through Hesselbach’s triangle
commoner in elderly
rarely strangulate
Hesselbach’s triangle: borders? significance?
Borders: Inf epigastric vessels + inguinal ligament + rectus’ lateral border
Direct inguinal hernia location!
Borders of the inguinal canal
MALT
Roof: Transversus MUSCLE and Int oblique MUSCLE
Anterior: Aponeurosis of ext + int oblique
Floor: inguinal Ligament
Posterior: Transversalis fascia + Conjoint Tendon
Contents of the inguinal canal
Male: spermatic cord + ilioingiunal nerve
Female: ilioinguinal nerve, round ligament, gen branch of the genitofemoral nerve
Anatomical location of inguinal vs femoral hernia
Inguinal hernia: above inguinal ligament
Femoral hernia: below inguinal ligament
Location of the deep ring
mid point of the inguinal ligament
O/E, how can u differentiate between direct + indirect inguinal hernia
place fingers over the deep ring = mid pt of the inguinal ligament
If hernia is controlled = indirect hernia
Where is the femoral canal
Medial to the femoral vein, behind the inguinal ligament
Where is the femoral pulse
Mid inguinal point (btw ASIS + pubic symphysis)
4 distinguishing features O/E of an inguinal hernia
cough impulse
reducible
above the pubic tubercle
bowel sounds heard
SURGICAL management of inguinal hernias
Open or lap (lap if recurrent/bilateral)
Open = LICHTENSTEIN TENSION FREE MESH
Lap = TEP (enters the peritoneal cavity) vs TAPP
Complications of hernia repair (specific)
Early:
Haematoma/seroma (10%)
Infection (1%)
Urinary retention
Late:
Chronic groin pain (5%)
Ischemic orchitis (thrombosis in pampiniform plexus)
What complication must you mention to a patient undergoing inguinal hernia repair
Risk of testicular damage
Ischemic orchitis from thrombosis in pampniform plexus (this is in the spermatic cord)
Femoral hernia - risk of strangulation? Mx?
50% risk of strangulation in 1 month!
Lockwood(elective) or McEvedy (urgent = high approach to allow visualtion and resection of non-viable bowel)
Hydrocele - definition?causes? Ix?
Accumulation of fluid within the tunica vaginalis
Causes: primary (patent proc vaginalis)
secondary = tumour, epididymo-orchitis, trauma
Ix: MUST do an USS to exclude malignancy
which side is varicocele more common? why?
LEFT is more common
Left testicular vein is more vertical than right
Left testicular vein is LONGER
- more likely compressed by colon
- sudden onset –> think L renal cell carcinoma!!!
Key Qs in the examination of a scrotal lump
- Get above it? (no = inguinal hernia)
- Feels separate from testis? (yes = varicocele, epididymal cyst. no = tumour, hydrocele)
- Transilluminable? (hydrocele, epididymal cyst)
Oesophageal cancer: types
Squamous cell or Adenocarcinoma
Lower 1/3: ADENOcarcinoma (GORD)
Upper 2/3: SqCC (smoking, EtOH)
Sx of oesophageal cancer***
Dysphagia (liquids –> solids)
Weight loss
Retrosternal chest pain