Abdo- surgery Flashcards

1
Q

3 main causes of hepatomegaly

A

3 Cs
Cirrhosis (fatty liver)
Cancer
Congestion (R heart failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 main causes of splenomegaly

A

3 Ms
Malaria
Myelofibrosis
Chronic myeloid leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications for splenectomy

A

Rupture: post trauma, iatrogenic, EBV

Haem: sickle cell, ITP, lymphoma, leukaemia,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Work up for a splenectomy patient - 3 things?

A

Vaccination against encapsulated bacteria (pneumococcal, Meningitis, Hib, influenza)

Prophylactic penicillin V

Medic alert bracelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Early complications of stoma

A

Haemorrhage
Skin inflammation
High output
Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Late complications of stoma

A

Parastomal hernia
Prolapse
Obstruction
Stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 indications for liver transplant

A
Acute liver failure
Liver cancer
Cirrhosis
PSC
PBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name of the kidney transplant scar

A

Rutherford Morrison

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Complications of immunosuppression used in renal transplant patients

A

Gum hypertrophy - ciclosporin
Fine tremor - tacrolimus
Skin cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of hernias

A

Conservative:
Wt loss, treat cough, belts, watchful waiting

Surgical: open mesh/suture repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

WTF is hepatorenal syndrome

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Umbilical bruising in pancreatitis

A

Cullens sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Flank bruising in pancreatitis

A

Grey Turners sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of retroperitoneal haemorrhage

A

Pancreatitis
Ectopic pregnancy
Aortic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of dysphagia

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of BPH

A

Conservative: reduce EtOH + caffeine, bladder training

Medical: alpha blockers, 5a-reductase inhibitors

Surgical: TURP, laser prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of prostate cancer

A

Watchful waiting
Symptomatic: TURP, analgesia, radiotherapy for bone pain

Radical: Radical prostatectomy, Brachytherapy
Medical: LHRH analogs, Antiandrogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ix in man with lower urinary tract symptoms

A
DRE
Urine dip + MCS
U+Es, PSA
Transrectal USS +/- biopsy
Urodynamics
Voiding diary
  • If ?ca –> MRI prostate + Bone scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define a hernia

A

Protrusion of a viscus through the walls of its containing cavity into an abnormal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aetiology of an inguinal hernia

A

Congenital: patent processus vaginalis –> indirect hernia

Acquired: anything which increases IAP: cough, obesity, constipation, heavy lifting, ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Direct inguinal hernia - describe its main features

A

Emerge through Hesselbach’s triangle
commoner in elderly
rarely strangulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hesselbach’s triangle: borders? significance?

A

Borders: Inf epigastric vessels + inguinal ligament + rectus’ lateral border

Direct inguinal hernia location!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Borders of the inguinal canal

A

MALT

Roof: Transversus MUSCLE and Int oblique MUSCLE
Anterior: Aponeurosis of ext + int oblique
Floor: inguinal Ligament
Posterior: Transversalis fascia + Conjoint Tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contents of the inguinal canal

A

Male: spermatic cord + ilioingiunal nerve
Female: ilioinguinal nerve, round ligament, gen branch of the genitofemoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Anatomical location of inguinal vs femoral hernia

A

Inguinal hernia: above inguinal ligament

Femoral hernia: below inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Location of the deep ring

A

mid point of the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

O/E, how can u differentiate between direct + indirect inguinal hernia

A

place fingers over the deep ring = mid pt of the inguinal ligament

If hernia is controlled = indirect hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where is the femoral canal

A

Medial to the femoral vein, behind the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where is the femoral pulse

A

Mid inguinal point (btw ASIS + pubic symphysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

4 distinguishing features O/E of an inguinal hernia

A

cough impulse
reducible
above the pubic tubercle
bowel sounds heard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

SURGICAL management of inguinal hernias

A

Open or lap (lap if recurrent/bilateral)

Open = LICHTENSTEIN TENSION FREE MESH

Lap = TEP (enters the peritoneal cavity) vs TAPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Complications of hernia repair (specific)

A

Early:
Haematoma/seroma (10%)
Infection (1%)
Urinary retention

Late:
Chronic groin pain (5%)
Ischemic orchitis (thrombosis in pampiniform plexus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What complication must you mention to a patient undergoing inguinal hernia repair

A

Risk of testicular damage

Ischemic orchitis from thrombosis in pampniform plexus (this is in the spermatic cord)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Femoral hernia - risk of strangulation? Mx?

A

50% risk of strangulation in 1 month!

Lockwood(elective) or McEvedy (urgent = high approach to allow visualtion and resection of non-viable bowel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Hydrocele - definition?causes? Ix?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

which side is varicocele more common? why?

A

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!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Key Qs in the examination of a scrotal lump

A
  1. Get above it? (no = inguinal hernia)
  2. Feels separate from testis? (yes = varicocele, epididymal cyst. no = tumour, hydrocele)
  3. Transilluminable? (hydrocele, epididymal cyst)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Oesophageal cancer: types

A

Squamous cell or Adenocarcinoma

Lower 1/3: ADENOcarcinoma (GORD)

Upper 2/3: SqCC (smoking, EtOH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Sx of oesophageal cancer***

A

Dysphagia (liquids –> solids)
Weight loss
Retrosternal chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Ix for ?oesophageal cancer

A

FBC (anaemia)
Ferritin
2 week wait for OGD + biopsy

Staging: CT
Thoracoscopy + laparoscopy (mets)

41
Q

Mx

A

only 1/3 are suitable for oesophagectomy

  • 2 stage (ivor lewis): abdo + R thoracotomy
  • 3 stage (mackeown): abdo + R thoracotomy + L neck incision
  • transhiatal

USUALLY palliative: laser coagulation, analgesia, stenting, chemoradiotherapy

42
Q

Oesophageal cancer: staging

A
T1: submucosa
T2: muscular
T3: adventitia
T4: adjacent structures (eg R laryngeal nerve, lymphatics)
N1: LNs
M1: distant mets
43
Q

Vomiting, retrosternal chest pain, subcut emphysema

A

Oesophageal rupture

44
Q

Complications of splenectomy

A

Haemorrhage
Pancreatic fistula
Infection w encapsulated organisms
Thrombocytosis

45
Q

Mx of sigmoid volvulus

A

Rigid sigmoidoscopy + rectal tube insertion

46
Q

Mx of caecal volvulus

A

SURGICAL - usually, R hemicolectomy

47
Q

Main parts of presenting a Stoma examination

A
LTTBS
Location
Type
Tissue
Bag
Systemic
48
Q

Indications for an end ileostomy

A

End ileostomy = may be permanent (panproctocolectomy) or temporary (subtotal w future IPAA)

49
Q

Pt has an end ileostomy - why would a patient have a subtotal colectomy and not a panproctocolectomy

A

Future potential of an ileal pouch anal anastamosis

50
Q

Indications for loop ileostomy?

A

CRC –> excision of ca + anastomosis formed –> Loop ileo diverts from healing anastomosis

Crohns –> loop ileostomy provides temporary diversion from disease

51
Q

End ileostomy - what must you check and why?

A

Is there an anus?

No anus –> panproctocolectomy therefore permanent ileostomy

52
Q

2 diseases which are indications for formation of end colostomy? which procedures?

A

CRC + diverticulitis

Either following:
AP resection (no anus)
or Hartmann’s

53
Q

Complications of a stoma

A
Early:
(- Bleeding
- Infection
- Pain)
- High output --> K
- Ischemia + necrosis
- Perforation
Late:
Parastomal hernia
Prolapse
Retraction
Stenosis
Psych
Dermatitis
54
Q

AP resection vs anterior resection of a rectal tumour

A

anterior resection = can be performed if cancer is >4cm from anal verge

55
Q

Why is there no way an end colostomy would be formed after an anterior resection

A

Anterior resection = removal of upper rectum + sigmoid. lower rectum and desc colon are anastomosed.

The anastomosis would need to be rested via a loop ileostomy

56
Q

Diverticular disease vs diverticulosis vs diverticulitis

A

Diverticulosis = presence of diverticula

Diverticular disease = recurrent abdo pain

Diverticulitis = acute inflammation

57
Q

Mx of diverticular disease

A

Conservative: high fibre diet
Medical: Abx
Surgical: Hartmanns + loop ileostomy

58
Q

Midline laparotomy - what layers are cut through?

A
Skin
Campers fascia
Scarpa's fascia
Linea alba
Transversalis fascia
Pre-Peritoneal fat
Peritoneum
59
Q

Midline laparotomy - uses?

A

Emergency:
Hartmann’s procedure, perforated DU (GI)
Ruptured AAA, trauma

Elective:
AAA
Vascular bypass…

60
Q

+ves and -ves of midline laparotomy

A

+ves:
No arteries
Minimal nerve + muscle injury

-ve: bare pain

61
Q

Name of a R sided oblique subcostal scar

A

Kocher’s

62
Q

Indications for Kocher’s scar

A

R sided = open cholecystectomy

L sided = splenectomy

63
Q

Indications for a rooftop scar

A

Liver + biliary tree

  • Whipple’s procedure
  • Liver transplant
  • Liver resection
64
Q

Name of a horizontal, suprapubic scar?

Uses?

A

Pfannensteil

Gynae surgery
Lower urinary tract

65
Q

Layers of abdo wall in a McBurneys/Lanz incision

A
Skin
Campers fascia
Scrapas fascia
External oblique
Internal Oblique
Transversus
Transversalis fascia
Pre-peritoneal fat
Peritoneum
66
Q

2 types of appendicectomy scar - names? Which one is favoured?

A
Oblique = McBurneys
Transverse = Lanz

Lanz favoured = hidden in skin crease

67
Q

Half a Pfannensteil scar (i.e. v groiny + transverse) - what is the use?

A

Emergency femoral hernia repair

68
Q

Scar following a R hemicolectomy?

A

Transverse muscle splitting

69
Q

Subtotal colectomy

  • what is excised?
  • Indication?
  • stomas formed?
A

Whole colon except the distal sigmoid + rectum

Acute + severe UC

Initially, end ileo formed. This is followed by IPAA or completion proctectomy

70
Q

Indication for R hemicolectomy? L hemicolectomy?

A
R = tumour
L = tumour
71
Q

Indication for AP resection?

Indication for anterior resection

A

AP resection = tumour<4cm from anal verge

anterior resection = tumour >4cm from anal verge (the colorectal anstamosis is covered by loop ileo)

72
Q

What is excised in panproctocolectomy?

Give 2 indications

A

Whole colon + rectum + anus

UC or FAP

73
Q

Complications of UC

A

Toxic megacolon
Haemorrhage
CRC, cholangiocarcionma

74
Q

complications of Crohns

A

Fistulae
Abscess (^both perianal)
Strictures
Malabsorption

75
Q

Indications for surgery in IBD?

A

Acutely:
Toxic megacolon (UC)
Perforation
Severe bleed

Chronic:
Failed medical Mx
Malignancy

76
Q

Commonly affected area for Crohns

A

Terminal ileum

77
Q

Definition of a severe IBD exacerbation

A

Symptoms: BM >6x/day
Large PR bleed

Systemic: HR>90, Pyrexial

Bloods: Anemia, raised ESR

78
Q

Extra intestinal features of IBD

A
Episcleritis/anterior uveitis
Erythema nodosum
Arthritis
Gallstones
PSC (UC)
79
Q

Contrast studies performed in UC?

A

Gastrograffin or barium enema

80
Q

Surgical mx of pharyngeal pouch

A

Dohlman’s procedure

Endoscopic stapling of pouch

81
Q

Surgical mx of achalasia

A

Heller’s cardiomyotomy

- incision through muscular propria at lower oesophageal sphincter

82
Q

Surgical mx of umbilical hernia

A

Mayo repair

83
Q

2 approaches to femoral hernia repair

  • in which context is one favoured over another?
A

Lockwood or mcevedy

Lockwood = lower approach, elective

McEvedy = high approach from inguinal region, emergency

84
Q

2 approaches to inguinal hernia repair

A

TEP (totally extraperitoneal)

TAPP (transabdo pre peritoneal)

85
Q

Surgical mx of anal fissure

A

Lateral sphincterotomy = division of internal anal sphincter

86
Q

Ddx of RIF mass

A

Caecal cancer
Crohns disease
Appendix abscess
Hepatmegaly

87
Q

Imaging for palpable RIF mass

A

Abdo USS
Barium enema
Colonoscopy
CT

88
Q

Pt with ?perforated bowel needs investigation. what kind of enema should be used?

A

Water soluble enema

89
Q

In whom would barium enema be unsuitable

A

Requires ouptaitnet bowel prep + giving loads of fluid

Frail pts (can’t make it to toilet)
Severe arthritis
HF + dialysis pts (can’t tolerate fluids)
?Colonic perforation

90
Q

3 Ix for old man with dysphagia + FLAWs (apart from bloods)

A

OGD
Barium swallow
CXR - to look for dysphagia due to lung ca

91
Q

Pancreatitis - amylase level is over???

A

1000

92
Q

Pancreatic pseudocyst - how is it formed? what would the next step be?

A

Blockage of pancreatic ducts from pancreatitis

Therefore ERCP - a blockage can then be stunted

or Percutaneous drainage

93
Q

Mx of sigmoid volvulus

A

Sigmoidoscopy + flatus tube insertion

–> may require sigmoid colectomy

94
Q

AXR - coffee been sign

A

Sigmoid volvlus

95
Q

Caecal vs sigmoid volvulus on AXR?

A

Sigmoid volvulus: no haustra seen on bowel loop
Large bowel dilatation

Caecal volvulus: bowel loop has haustra
Small bowel dilatation

96
Q

Management of rectal cancer

A

Adjuvant radiotherapy

Surgical excision:
>4cm from anal verge –> anterior resection + defunctioning loop ileostomy

<4cm from anal verge –> AP resection + end colostomy + total mesolectal excision

97
Q

Mx of diverticular idsease

A

High fibre diet
Mebeverin

Elective resection for chronic pain

98
Q

Mx of acute diverticulitis?

Indications for surgery?

A

Admit if unwell/pain uncontrolled:

  • NBM (may need surgery)
  • Analgesia
  • IV fluids
  • Abx

Indications for surgery(Hartmann’s): perforation, massive bleed, stricture –> obstruction

99
Q

mx of abscess from diverticulitis

A

abx + Ct/US guided drainage