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Year 3 - Junior Surgery > Common General Surgical Emergencies > Flashcards

Common General Surgical Emergencies Flashcards

1
Q

What are the broad categories of general surgical emergencies?

A
  • Acute abdomen (some presentations)
  • Perforation
  • Obstruction
  • GI bleeds
  • Incarcerated Hernias
  • HPB emergencies
  • Abscesses
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2
Q

Where can a GI perforation occur?

A

Essentially anywhere along the GI tract

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3
Q

What is the most common cause of upper GI perforation?

A

Gastric ulcer

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4
Q

What are the symptoms of gastric ulcer?

A

Dyspepsia (after eating suggests duodenal)

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5
Q

What is the surgical management for an upper GI perforation?

A

Closure

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6
Q

What is the surgical management of a lower GI perforation?

A

Resection

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7
Q

How may a bowel obstruction present?

A

Colicky pain Abdominal distension Vomiting Lack of bowel movements

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8
Q

What parts of the bowel can become obstructed?

A

Small and Large

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9
Q

What are the common causes of small bowel obstruction?

A
  • Adhesions
  • Hernias
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10
Q

What can cause a large bowel obstruction?

A
  • Colorectal cancer
  • Diverticular disease
  • Sigmoid volvulus
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11
Q

What can sigmoid volvulus cause?

A

Ischaemia of the bowel

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12
Q

What can be seen on examination of a patient with an obstruction?

A
  • Distension
  • Visible scars/hernias?
  • Dehydrated
  • Tachycardia
  • Hypotensive
  • Bloating pain
  • (Any focal tenderness suggests bowel ischaemia)
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13
Q

What will an AXR show if there is a bowel obstruction?

A
  • Dilated bowel loops
  • Visible valvulae conniventes in small bowel
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14
Q

How are valvulae conniventes distinguishable from haustra?

A

Haustra are incomplete lines crossing the bowel lumen

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15
Q

How should an obstruction be managed?

A
  • NBM
  • IV fluids
  • Catheter
  • Analgesia and antiemetics
  • Surgery (except in adhesions of SB or volvulus)
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16
Q

When are hernias an emergency?

A

When they are strangulated

17
Q

How do strangulated hernias appear?

A
  • Erythematous
  • Tender
  • Irreducible
18
Q

How are strangulated hernias managed?

A

Surgical repair

19
Q

What systemic symptoms can a strangulated hernia cause?

A
  • Abdominal distension
  • Vomiting
20
Q

What imaging modality can be used to diagnose a femoral hernia?

A

USS

21
Q

Of all abdominal wall hernias, which is the most concerning?

A

Femoral

22
Q

Why are femoral hernias most concerning?

A

Most likely to become incarcerated and thus strangulated

23
Q

Why are femoral hernias most likely to become incarcerated?

A

They are bound by solid ligamentous and bony structures

24
Q

How does a perianal abscess present ?

A

Area of painful inflammation around the anus

25
Q

When are perianal abscesses most painful?

A

When sitting or passing stool

26
Q

What are the causes of perianal abscesses?

A

Often idopathic (infective cause but unknown intiating factor)

27
Q

What condition do perianal abscesses have an association with?

A

Crohn’s disease

28
Q

How are perianal abscesses diagnosed?

A

History and examination

29
Q

Why must perianal abscesses be treated promptly?

A

If left untreated they can lead to fistulae or necrotising fasciitis of the perineum

30
Q

What is another name for necrotising fasciitis of the external genitalia and perineum?

A

Fournier’s gangrene

31
Q

What other condition can lead to Fournier’s gangrene?

A

Epididymo-orchitis

32
Q

In what demographic is Fournier’s gangrene most common?

A

Elderly men

33
Q

Is Fournier’s gangrene a surgical emergency?

A

YES

34
Q

What types of bacteria are responsible for Fournier’s gangrene?

A

Mixed anaerobes and aerobes

35
Q

How is Fournier’s gangrene treated?

A
  • Debridement of dead tissue
  • IV antibiotics
36
Q

How is a perianal abscess treated?

A
  • Surgical drainage
  • Post-op antibiotics
  • Maintenance of good wound hygeine
37
Q

What types of organisms are targetted by antibiotics used to treat perianal abscesses?

A

Normally anaerobes

38
Q
A

Year 3 - Junior Surgery (12 decks)

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