Block 1 - vascular surgery + (general surgery) Flashcards
What is ankle brachial pressure index (ABPI)?
Posterior tibial BP / brachial BP - patient lying down - using ultrasound and cuff inferior to patella
What ABPI indicates critical leg ischaemia?
<0.5
What ABPI is normal?
0.8-1.2
When may a ABPI be false?
Diabetics with calcification in arteries leading to them being less easily occluded
What are the red flag symptoms for critical leg ischeamia?
- pain at rest - pian at night (think gravity and leg dangling out of bed) - necrosis
What are the indicators of acute limb ischaemia?
The 6 Ps: - Pain - Pulseless - Pallor - Perishing in cold - Powerless - Paratheasia
What is claudication distance?
- distance walking until patient has to stop due to pain
Thrombus acute limb ischaemia:
- hour to days of onset - collateral make less severe ischaemia - history of claudication
Embolism of acute limb ischaemia
- s/ mins of onset - pulsless - no history of claudication
Treat AAA:
- greater than 5.5cm - rapidly growing
What are the features of a venous ulcer?
History of venous insufficency (varicous, DVT)
Medial gaiter area
Superficial
Irregular edges
Extrudating fluid
Some pain
What are the features of a arterial ulcer?
History of peripheral vascular disease
Moderate/severe pain
Deep
Puncted out
Necrotic
lateral malleaolus and metatarsal heads
What are the features of diabetic ulcer?
Due to diabetic neuropathy
At pressure points
No pain
Surronding callus
What are the two types of gal stones?
Pigmented ( formed from bilirubin)
cholesteol
What are the risk factors for gal stones?
Fat
- *F**emale
- *F**orty
- *F**ertile
What is Murphys sign?
RUQ pain during inspiration that is not present in the LUQ
This indicates cholecystitis
How are gal stones clinical represented?
Asymptomatic (most common)
Biliary colic
Cholecystitis
Cholangitits
What is Biliary colic?
> 6 hours of RUQ pain
+/- nausea and vomiting
Gals stones are present in the body and fundus
What is cholecystitis?
> 6 hours of RUQ pain
+/- nausea and vomiting
Gal stone present in the neck occluding the gal bladder, this leads to more violeent contraction and pain.
What is cholangitis?
> 6 hours of RUQ pain
+/- nausea and vomiting
Fever
jaundice
MEDICAL EMERGENCY - ERCP in 24 horus
Gal stones occulding common bile duct
What is Charcots triad?
RUQ pain
Fever
Jaundice
What are the risk factors for pancreatitis
Idiopathic
Gal stones
Ethenol
Trauma
Steroids
Mumps vaccine
Autoimune
Scorpion venom
Hyper -lipideamia -calceamia -parathyroid
ERCP
Drugs
I GET SMASHED
What is Crohns?
An idiopathic, chronic transmural inflammation of the GI tract
What is ulcerative collitis?
Conitneous
only mucosa/ submucosa
mosty in terminal rectum, sigmoid colon and desceding colon
What is Lanz scar?
Scar over Mc Burney’s point
Transverse inscision
Not diagnoal (Langer’s lines)
For appendectomy
What is a midline abdominal scar?
Through the midline however circumnavigates the umbilicus.
Used for laparotomy, AAA etc.
Superior portion alone for foreforgut etc.
What is a Kochers incision?
Below the right costal margin
Used for cholesystitis
What is a chevron/ Roof top incision?
Follows left and right costal margin towards the xiphisternum
For Wipples procedure
What is a Mercedez benze incision?
Chervron and a midline sternotomy
For diapramatic hernias and esophagealectomy
What would a C shaped scar in the RLQ indicate?
Kidney transplant
Match the numbers to the type of incision:
1 - midline
2 - para midline
3 - Kochers incision
4 - Chevron incision
5 - mercedez benz incision
What is a medial stenotomy?
Midline incision throught the sternunu
Open heart surgery: CAGAB, valve replacement
What is a pacemaker incision?
Incision at the left upper oprtion of the chest
What is the posterior lateral incision?
Thoroctomy as described inferior to the scapular
This is the Gold standard in order to access the pleural cavity
