Chapter 1 - Principles of Surgery Flashcards
What’s the items for taking hx of presenting complaint?
SR.COPD.SARAH
Site
Radiation
-
Character
Onset
Periodicity
Duration
-
Severity
Associated symptoms
Relieving factors
Aggravating factors
History of this symptoms
Components of Upper GI symptoms?
Dyspepsia
Dysphagia
GORD/Heartburn
Haematemesis
Altered bowel habit
Rectal bleeding
Tenesmus
Components of Hepatobiliary symptoms?
Jaundice
- Yellowish discoloration of sclera and skin due to hyperbilirubinemia
Components of Peripheral Arterial Disease symptoms?
Claudications
- Pain calf, thigh, buttock precipitated by exercise and relieved by rest due to inadequate blood flow
Rest pain
- Severe, burning pain in limb affected by inadequate arterial flow. present at rest.
Ddx of RUQ pain?
- Biliary colic
- Cholecystitis /Cholangitis
- Hepatitis
- Pneumonia RLL
Ddx of epigastric pain?
- PUD/ Gastritis
- Pancreatitis
- GORD
- Cardiac: inferior MI/ Pericarditis
- Ruptured AAA
Ddx of LUQ pain?
- Pneumonia LLL
- Splenic abcess/ infarct
- Gastric ulcer
- Gastritis
- Herpes zoster
Ddx of Right lumbar pain?
- Renal colic
- Pyelonephritis
- MSK: sciatica, lumbar disc, bone mets
Ddx of umbilical pain?
- UTI
- Appendicitis
- Small bowel obstruction (SBO)
Ddx of Left lumbar pain?
- Renal colic
- Pyelonephritis
- MSK: sciatica/ lumbar disc/ bony mets
Ddx of RIF pain?
- Appendicitis
- Ectopic pregnancy
- Ovarian cyst rupture/ torsion
- PID
- Renal colic
- Inguinal hernia
- IBD
- Psoas abscess
Ddx of suprapubic pain?
- Urine retention
- UTI
- Proctitis
- PID
- IBD
- Osteitis pubis
Ddx of left iliac fossa pain?
- Diverticulits
- Ectopic pregnancy
- Ovarian cyst rupture/ torsion
- PID
- Renal colic
- Inguinal hernia
- IBD
- Psoas abscess
In case of cholangitis, what are the Charcot’s triad and Reynold’s pentad?
Charcot’s triad: pain, fever/chills, jaudice.
Reynold’s pentad: Above + shock/hypotension, confusion.
Ddx of diffuse abdominal pain?
- Gastroenteritis
- Acute mesentric ischemia
- Chronic mesentric ischemia
- Bowel obstruction
Difference between SBO and LBO?
SBO (high): First, billous vomit; later constipation.
LBO (low): First constipation; later faeculant vomiting. O/e: distension, tympanic abdomen, high pitched bowel sounds.
Define Rovsing sign?
LIF palpation increases RIF pain
How to illicit obturator sign?
Lie supine, flex hip and knee 90 degrees. Passively internally rotate the hip, causing pain. Retrocaecal appendicitis can inflame obturator internus, which stretches in this maneuver.
What are the 3 types of drains and its function?
- Open passive drains: Provide a conduit for drainage of secretions
- Closed passive drains: Siphon effect of gravity and capillary action
- Closed active drains: Generate active suction
Poor nutrition leads to?
- Impaired albumin production
- Impaired wound healing and collagen deposition
- Skeletal muscle weakness (icu myopathy)
- Reduced neutrophil and lymphocyte function
What are the types of nutritional supports?
- Oral
- Nasogastric or nasojejunal
- Feeding gastrotomy or jejunostomy
- TPN
- Central TPN
What are the risk of inserting CVC?
- Haematoma/haemorrhage
- Line superinfection
- Line obstruction/kinking/malplacement
What are the TPN-assiociated complications?
- Hyperosmolarity
- Lack of glycemic control
- Nutrient deficiency
- Liver dysfunction, cholestasis and pancreatic atrophy
- Fluid overload
What lab ix thats need to be monitor in patient with TPN?
- Daily U&E and glucose until stabilised on TPN
- LFT twice weekly
- Magnesium, copper, manganese, zink and phosphate weekly
