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Yr 6 PACES knowledge > Abdo- surgery > Flashcards

Abdo- surgery Flashcards

1
Q

3 main causes of hepatomegaly

A

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

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2
Q

3 main causes of splenomegaly

A

3 Ms
Malaria
Myelofibrosis
Chronic myeloid leukaemia

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3
Q

Indications for splenectomy

A

Rupture: post trauma, iatrogenic, EBV

Haem: sickle cell, ITP, lymphoma, leukaemia,

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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

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5
Q

Early complications of stoma

A

Haemorrhage
Skin inflammation
High output
Necrosis

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6
Q

Late complications of stoma

A

Parastomal hernia
Prolapse
Obstruction
Stenosis

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7
Q

5 indications for liver transplant

A 
Acute liver failure
Liver cancer
Cirrhosis
PSC
PBC
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8
Q

Name of the kidney transplant scar

A

Rutherford Morrison

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9
Q

Complications of immunosuppression used in renal transplant patients

A

Gum hypertrophy - ciclosporin
Fine tremor - tacrolimus
Skin cancer

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10
Q

Management of hernias

A

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

Surgical: open mesh/suture repair

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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

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12
Q

Umbilical bruising in pancreatitis

A

Cullens sign

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13
Q

Flank bruising in pancreatitis

A

Grey Turners sign

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14
Q

Causes of retroperitoneal haemorrhage

A

Pancreatitis
Ectopic pregnancy
Aortic rupture

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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)

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16
Q

Management of BPH

A

Conservative: reduce EtOH + caffeine, bladder training

Medical: alpha blockers, 5a-reductase inhibitors

Surgical: TURP, laser prostatectomy

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17
Q

Management of prostate cancer

A

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

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

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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
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19
Q

Define a hernia

A

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

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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

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21
Q

Direct inguinal hernia - describe its main features

A

Emerge through Hesselbach’s triangle
commoner in elderly
rarely strangulate

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22
Q

Hesselbach’s triangle: borders? significance?

A

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

Direct inguinal hernia location!

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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

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24
Q

Contents of the inguinal canal

A

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

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25
Anatomical location of inguinal vs femoral hernia
Inguinal hernia: above inguinal ligament Femoral hernia: below inguinal ligament
26
Location of the deep ring
mid point of the inguinal ligament
27
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
28
Where is the femoral canal
Medial to the femoral vein, behind the inguinal ligament
29
Where is the femoral pulse
Mid inguinal point (btw ASIS + pubic symphysis)
30
4 distinguishing features O/E of an inguinal hernia
cough impulse reducible above the pubic tubercle bowel sounds heard
31
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
32
Complications of hernia repair (specific)
Early: Haematoma/seroma (10%) Infection (1%) Urinary retention Late: Chronic groin pain (5%) Ischemic orchitis (thrombosis in pampiniform plexus)
33
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)
34
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)
35
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
36
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!!!
37
Key Qs in the examination of a scrotal lump
1. Get above it? (no = inguinal hernia) 2. Feels separate from testis? (yes = varicocele, epididymal cyst. no = tumour, hydrocele) 3. Transilluminable? (hydrocele, epididymal cyst)
38
Oesophageal cancer: types
Squamous cell or Adenocarcinoma Lower 1/3: ADENOcarcinoma (GORD) Upper 2/3: SqCC (smoking, EtOH)
39
Sx of oesophageal cancer***
Dysphagia (liquids --> solids) Weight loss Retrosternal chest pain
40
Ix for ?oesophageal cancer
FBC (anaemia) Ferritin 2 week wait for OGD + biopsy Staging: CT Thoracoscopy + laparoscopy (mets)
41
Mx
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
Oesophageal cancer: staging
``` T1: submucosa T2: muscular T3: adventitia T4: adjacent structures (eg R laryngeal nerve, lymphatics) N1: LNs M1: distant mets ```
43
Vomiting, retrosternal chest pain, subcut emphysema
Oesophageal rupture
44
Complications of splenectomy
Haemorrhage Pancreatic fistula Infection w encapsulated organisms Thrombocytosis
45
Mx of sigmoid volvulus
Rigid sigmoidoscopy + rectal tube insertion
46
Mx of caecal volvulus
SURGICAL - usually, R hemicolectomy
47
Main parts of presenting a Stoma examination
``` LTTBS Location Type Tissue Bag Systemic ```
48
Indications for an end ileostomy
End ileostomy = may be permanent (panproctocolectomy) or temporary (subtotal w future IPAA)
49
Pt has an end ileostomy - why would a patient have a subtotal colectomy and not a panproctocolectomy
Future potential of an ileal pouch anal anastamosis
50
Indications for loop ileostomy?
CRC --> excision of ca + anastomosis formed --> Loop ileo diverts from healing anastomosis Crohns --> loop ileostomy provides temporary diversion from disease
51
End ileostomy - what must you check and why?
Is there an anus? No anus --> panproctocolectomy therefore permanent ileostomy
52
2 diseases which are indications for formation of end colostomy? which procedures?
CRC + diverticulitis Either following: AP resection (no anus) or Hartmann's
53
Complications of a stoma
``` Early: (- Bleeding - Infection - Pain) - High output --> K - Ischemia + necrosis - Perforation ``` ``` Late: Parastomal hernia Prolapse Retraction Stenosis Psych Dermatitis ```
54
AP resection vs anterior resection of a rectal tumour
anterior resection = can be performed if cancer is >4cm from anal verge
55
Why is there no way an end colostomy would be formed after an anterior resection
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
Diverticular disease vs diverticulosis vs diverticulitis
Diverticulosis = presence of diverticula Diverticular disease = recurrent abdo pain Diverticulitis = acute inflammation
57
Mx of diverticular disease
Conservative: high fibre diet Medical: Abx Surgical: Hartmanns + loop ileostomy
58
Midline laparotomy - what layers are cut through?
``` Skin Campers fascia Scarpa's fascia Linea alba Transversalis fascia Pre-Peritoneal fat Peritoneum ```
59
Midline laparotomy - uses?
Emergency: Hartmann's procedure, perforated DU (GI) Ruptured AAA, trauma Elective: AAA Vascular bypass...
60
+ves and -ves of midline laparotomy
+ves: No arteries Minimal nerve + muscle injury -ve: bare pain
61
Name of a R sided oblique subcostal scar
Kocher's
62
Indications for Kocher's scar
R sided = open cholecystectomy L sided = splenectomy
63
Indications for a rooftop scar
Liver + biliary tree - Whipple's procedure - Liver transplant - Liver resection
64
Name of a horizontal, suprapubic scar? Uses?
Pfannensteil Gynae surgery Lower urinary tract
65
Layers of abdo wall in a McBurneys/Lanz incision
``` Skin Campers fascia Scrapas fascia External oblique Internal Oblique Transversus Transversalis fascia Pre-peritoneal fat Peritoneum ```
66
2 types of appendicectomy scar - names? Which one is favoured?
``` Oblique = McBurneys Transverse = Lanz ``` Lanz favoured = hidden in skin crease
67
Half a Pfannensteil scar (i.e. v groiny + transverse) - what is the use?
Emergency femoral hernia repair
68
Scar following a R hemicolectomy?
Transverse muscle splitting
69
Subtotal colectomy - what is excised? - Indication? - stomas formed?
Whole colon except the distal sigmoid + rectum Acute + severe UC Initially, end ileo formed. This is followed by IPAA or completion proctectomy
70
Indication for R hemicolectomy? L hemicolectomy?
``` R = tumour L = tumour ```
71
Indication for AP resection? | Indication for anterior resection
AP resection = tumour<4cm from anal verge anterior resection = tumour >4cm from anal verge (the colorectal anstamosis is covered by loop ileo)
72
What is excised in panproctocolectomy? | Give 2 indications
Whole colon + rectum + anus UC or FAP
73
Complications of UC
Toxic megacolon Haemorrhage CRC, cholangiocarcionma
74
complications of Crohns
Fistulae Abscess (^both perianal) Strictures Malabsorption
75
Indications for surgery in IBD?
Acutely: Toxic megacolon (UC) Perforation Severe bleed Chronic: Failed medical Mx Malignancy
76
Commonly affected area for Crohns
Terminal ileum
77
Definition of a severe IBD exacerbation
Symptoms: BM >6x/day Large PR bleed Systemic: HR>90, Pyrexial Bloods: Anemia, raised ESR
78
Extra intestinal features of IBD
``` Episcleritis/anterior uveitis Erythema nodosum Arthritis Gallstones PSC (UC) ```
79
Contrast studies performed in UC?
Gastrograffin or barium enema
80
Surgical mx of pharyngeal pouch
Dohlman's procedure Endoscopic stapling of pouch
81
Surgical mx of achalasia
Heller's cardiomyotomy | - incision through muscular propria at lower oesophageal sphincter
82
Surgical mx of umbilical hernia
Mayo repair
83
2 approaches to femoral hernia repair - in which context is one favoured over another?
Lockwood or mcevedy Lockwood = lower approach, elective McEvedy = high approach from inguinal region, emergency
84
2 approaches to inguinal hernia repair
TEP (totally extraperitoneal) TAPP (transabdo pre peritoneal)
85
Surgical mx of anal fissure
Lateral sphincterotomy = division of internal anal sphincter
86
Ddx of RIF mass
Caecal cancer Crohns disease Appendix abscess Hepatmegaly
87
Imaging for palpable RIF mass
Abdo USS Barium enema Colonoscopy CT
88
Pt with ?perforated bowel needs investigation. what kind of enema should be used?
Water soluble enema
89
In whom would barium enema be unsuitable
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
3 Ix for old man with dysphagia + FLAWs (apart from bloods)
OGD Barium swallow CXR - to look for dysphagia due to lung ca
91
Pancreatitis - amylase level is over???
1000
92
Pancreatic pseudocyst - how is it formed? what would the next step be?
Blockage of pancreatic ducts from pancreatitis Therefore ERCP - a blockage can then be stunted or Percutaneous drainage
93
Mx of sigmoid volvulus
Sigmoidoscopy + flatus tube insertion --> may require sigmoid colectomy
94
AXR - coffee been sign
Sigmoid volvlus
95
Caecal vs sigmoid volvulus on AXR?
Sigmoid volvulus: no haustra seen on bowel loop Large bowel dilatation Caecal volvulus: bowel loop has haustra Small bowel dilatation
96
Management of rectal cancer
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
Mx of diverticular idsease
High fibre diet Mebeverin Elective resection for chronic pain
98
Mx of acute diverticulitis? Indications for surgery?
Admit if unwell/pain uncontrolled: - NBM (may need surgery) - Analgesia - IV fluids - Abx - Indications for surgery(Hartmann's): perforation, massive bleed, stricture --> obstruction
99
mx of abscess from diverticulitis
abx + Ct/US guided drainage

Yr 6 PACES knowledge (14 decks)

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