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Yr 6 PACES knowledge COPY RJ Challenger > 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 (Hepatocellular carcinoma)

Cirrhosis

PBC (Primary Biliary Cholangitis)

PSC (Primary Sclerosing Cholangitis)

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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 - Suggests:

Pancreatitis

Ectopic Pregnancy

Trauma to abdomen

Aortic Rupture

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13
Q

Flank bruising in pancreatitis

A

Grey Turners sign:

Suggests bleeding into the retroperitoneum: ie around the kidneys and pancreas.

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14
Q

Causes of retroperitoneal haemorrhage

A

Pancreatitis

Ectopic pregnancy

Aortic rupture

//////////////////////////

Grey Turners Sign or Cullens Sign

Grey Turners (LaTeral)

Cullens sign (Central, on umbilicus)

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15
Q

Causes of dysphagia (At least 3)

A

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)

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16
Q

Management of BPH

A

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
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17
Q

Management of prostate cancer

A

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)

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18
Q

Ix in man with lower urinary tract symptoms

A

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
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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 Intra Abdomenal Pressure:

  • 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
  • More commoner elderly
  • Rarely strangulate
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22
Q

Hesselbach’s triangle: borders? significance?

A

Borders:

  • Inferior epigastric vessels
  • Inguinal ligament
  • Rectus abdominis: lateral border

////////////////////////////////////

Direct inguinal hernia location!

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23
Q

Borders of the inguinal canal

A

MALT

Roof: Transversus abdominis MUSCLE and Internal oblique MUSCLE

Anterior: Aponeurosis of External 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:

  • lioinguinal nerve,
  • Round ligament,
  • gen branch of the genitofemoral nerve
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25
Q

Anatomical location of inguinal vs femoral hernia

A

Inguinal hernia: above inguinal ligament

Femoral hernia: below inguinal ligament

///////////////////////////////

In, Above

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26
Q

Location of the deep inguinal ring

A

mid point of the inguinal ligament

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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

If not = Direct

/////////////////////////

Indirect goes through Deep ring.

Direct Doesn’t go Through Deep Ring

(Deep ring is a Detour. Not done by Direct inguinal hernia)

Direct doesn’t do the Deep ring.

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28
Q

Where is the femoral canal

A

Medial to the femoral vein, behind the inguinal ligament

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29
Q

Where is the femoral pulse

A

Mid inguinal point (btw ASIS + pubic symphysis)

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30
Q

4 distinguishing features O/E of an inguinal hernia

A

cough impulse reducible above the pubic tubercle bowel sounds heard

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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

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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)

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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)

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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)

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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

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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!!!

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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)
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38
Q

Oesophageal cancer: types

A

Squamous cell or Adenocarcinoma Lower 1/3: ADENOcarcinoma (GORD) Upper 2/3: SqCC (smoking, EtOH)

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39
Q

Sx of oesophageal cancer***

A

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

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40
Q

Ix for ?oesophageal cancer

A

FBC (anaemia) Ferritin 2 week wait for OGD + biopsy Staging: CT Thoracoscopy + laparoscopy (mets)

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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

100
Q

Causes of small bowel obstruction?

A

Adhesions (Ia)

Hernias, obstructive (Ab)

Caecal Carcinoma (Ma)

Strictures, due to UC/ Crohns (Au)

Any cause of large bowel obstruction (Ab)

/////////////////////////////

IAMAA

101
Q

Sigmoid Volvulus management?

A
  • Supportive, analgesia and fluids
  • Sigmoidoscopy and decompression with a flatus tube
  • If recurring, consider sigmoid colectomy

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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