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 (Hepatocellular carcinoma)
Cirrhosis
PBC (Primary Biliary Cholangitis)
PSC (Primary Sclerosing Cholangitis)
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 - Suggests:
Pancreatitis
Ectopic Pregnancy
Trauma to abdomen
Aortic Rupture
Flank bruising in pancreatitis
Grey Turners sign:
Suggests bleeding into the retroperitoneum: ie around the kidneys and pancreas.
Causes of retroperitoneal haemorrhage
Pancreatitis
Ectopic pregnancy
Aortic rupture
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Grey Turners Sign or Cullens Sign
Grey Turners (LaTeral)
Cullens sign (Central, on umbilicus)
Causes of dysphagia (At least 3)
Motility: Achalasia,
Oesophageal spasm,
Bulbar/suprabulbar palsy
-From CVA or MND.
Myasthenia Gravis
Structural:
Plummer Vinson
Oesophagitis
Malignancy, Oesophageal cancer
Rolling hiatus hernia,
lung ca,
Retrosternal goitre
mediastinal LNs (extramural)
Management of BPH
Conservative:
- Reduce EtOH + caffeine
- Bladder training
Medical:
- Alpha blockers, (For urinary retention, Eg Tamsulosin)
- 5a-reductase inhibitors (Eg Finasteride)
Surgical:
- TURP (transurethral resection of the prostate)
- Laser prostatectomy
Management of prostate cancer
Conservative:
Watchful waiting.
Prostate biopsy: for grading (Gleason classification, grade 1-5)
Pelcvic CT: for staging
Medical:
Symptomatic:
TURP (Transurethral Resection of the Prostate)
Analgesia (WHO pain ladder)
Radiotherapy, for bone pain
LHRH analogs (Eg Goserelin)
Antiandrogens (Eg Flutamide)
Radical:
Radical prostatectomy
Brachytherapy (Basically a radioactive catheter)
Ix in man with lower urinary tract symptoms
Examination:
DRE
Bedside:
Urine dip
Urine Microscopy Culture and Sensitivity
Bloods:
U+Es,
PSA
Imaging:
Transrectal USS +/- biopsy
Specialist:
Urodynamics
Other:
Voiding diary
Consider:
- 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 Intra Abdomenal Pressure:
- Cough
- Obesity
- Constipation
- Heavy lifting
- Ascites
Direct inguinal hernia - describe its main features
- Emerge through Hesselbach’s triangle
- More commoner elderly
- Rarely strangulate
Hesselbach’s triangle: borders? significance?
Borders:
- Inferior epigastric vessels
- Inguinal ligament
- Rectus abdominis: lateral border
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Direct inguinal hernia location!
Borders of the inguinal canal
MALT
Roof: Transversus abdominis MUSCLE and Internal oblique MUSCLE
Anterior: Aponeurosis of External oblique
Floor: Inguinal Ligament
Posterior: Transversalis fascia (+ Conjoint Tendon)
Contents of the inguinal canal
Male:
- Spermatic cord
- Ilioingiunal nerve
Female:
- lioinguinal nerve,
- Round ligament,
- gen branch of the genitofemoral nerve