Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 surgery > Common general surgical problems > Flashcards

Common general surgical problems Flashcards

1
Q

What is a hernia?

A

A protrusion of all or part of a viscus through it’s coverings and into an abnormal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are there natural weaknesses in the abdomen?

A

Due to structures entering and leaving the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiology of inguinal hernias?

A

100,000 hernia repairs
70,000 are inguinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common type of abdominal wall hernia?

A

Inguinal hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for inguinal hernias?

A

Older age
Patent processus vaginalis
Connective tissue variations
BMI
Daily lifting and standing/walking may increase risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which BMI may be a risk factor for inguinal hernias?

A

Low may be more risk compared to high
High BMI carries significant risk for hernia recurrence after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the types of inguinal hernias?

A

Indirect
Direct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which type of inguinal hernia is more common?

A

Indirect - 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an indirect hernia?

A

Failure of the embryonic closure of the deep inguinal ring after passage to the testicle.
Sac originates through the deep ring (lateral to inferior epigastric)
May also pass through superficial ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a direct inguinal hernia?

A

Sac originates medial to the inferior epigastric artery in Hasselbach’s triangle
May also pass through the superficial ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What symptoms would you get with an inguinal hernia?

A

May be asymptomatic
Groin pain
Bulge/lump in groin
Referred pain to testes of thigh
May be worse after physical activity
May have bowel or bladder symptoms if larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you examine a patient for an inguinal hernia?

A

Patient standing - assess for any lumps.
Lay down - Reduce hernia. Check cough impulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you differentiate between direct and indirect inguinal hernias?

A

Reduce hernia.
Apply pressure over deep inguinal ring (midway between ASIS and pubic tubercle).
Ask patient to stand whilst keeping pressure on
Indirect hernia will be controlled whereas a direct hernia will not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the differential diagnoses for an inguinal hernia?

A

Femoral hernia
Lymph node
Skin lesion
Psoas abscess
Vascular abnormality
Malignancy
Testicular pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first line investigation for an inguinal hernia?

A

USS but miss 10-15% of hernias.
CT + MRI more useful to r/o alternative pathology as MSK cause of groin pain or assess anatomy if complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are inguinal hernias treated?

A

Mostly conservatively if asymptomatic as low strangulation risk.
Risk of chronic pain after surgery up to 10%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the surgical options for inguinal hernia repair?

A

Open
Laparoscopic - Trans-abdominal approach or Extra-peritoneal approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risks of hernia repair surgery?

A

Recurrence - 15%
Mesh infection - <1%
Chronic pain - 10%
Nerve injury
Haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an incarcerated hernia?

A

Irreducible
May be more painful + bigger than normal
May present with bowel obstruction
Surgery likely needed to prevent recurrence or progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does gangrene occur in hernias?

A

Bowel loop incarcerates in hernia
Increasing pressure inside hernia
Pressure exceeds venous blood pressure
Arterial blood continues to flow in
Pressure rapidly rises in hernia - exceeding arterial pressure
Causing gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does a strangulated inguinal hernia present?

A

Painful
Irreducible
Bowel obstruction if bowel involved
Systemically unwell
Hernia feels warm, may be red skin change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Should you reduce a strangulated hernia?

A

No - there is risk of gangrenous bowel being reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is a strangulated inguinal hernia managed?

A

Emergency surgery
Repair hernia
Resect gangrenous bowel if present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which side do femoral hernias most commonly occur?

A

60% on the right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which sex is more at risk of femoral hernias?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the risk factors for femoral hernias?

A

Increased abdominal pressure - twice as common in porous women compared with nulliparous
Connective tissue disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the risk of strangulation in femoral hernias?

A

20-40%

30
Q

Which canal does a femoral hernia travel through?

A

Femoral canal

31
Q
A
32
Q

Why do femoral hernias strangulate more than inguinal?

A

Because of the anatomy of the femoral ring;
Three sides are inflexible structures
1. Inguinal ligament anterior
2. Pectineus/pectineal ligament posterior
3. Lacunar ligament medial
This reduces the pace available for expansion of the contents at the hernia neck

33
Q
A
34
Q

Where are femoral hernias located?

A

Below and lateral to the pubic tubercle (site of femoral ring)

35
Q

Where are the neck of inguinal hernias located?

A

Above and medial to the pubic tubercle (site of external inguinal ring)

36
Q

How are femoral hernias managed?

A

Mainly surgical unless patient very unfit for surgery

37
Q

What are ventral hernias?

A

Ventral = front
Non-groin hernia in the anterior abdominal wall
Paraumbilical/umbilical
Epigastric
Incisional

38
Q
A
39
Q

What is a paraumbilical/umbilical hernia?

A

A midline defect in linea alba close to the umbilicus

40
Q

What are the risk factors for a paraumbilical/umbilical hernia?

A

Increased abdominal pressure (pregnancy, ascites)
Females (3:1)
Men have higher strangulation risk - so 70% of repairs carried out in men
10% congenital
90% acquired
Majority are asymptomatic

41
Q

How does a congenital paraumbilical/umbilical hernia occur?

A

Failure of closure of the abdominal wall after involution of umbilical vessels

42
Q

What are the differentials for paraumbilical hernias?

A

Sister Mary Joseph nodule (malignant peritoneal nodule at umbilicus. 50% GI malignancy, 25% gynae malignancy)
Divarication of the rectus muscles

43
Q

What is a divarication of the rectus muscles?

A

Increase in distance between the two rectus abdominis muscles - usually umbilicus to xiphoid.
Stretches but does not breach line alba - therefore not a hernia.

44
Q

What are the risk factors of a divarication of the rectus muscles?

A

Obesity
Increasing age
Increasing abdominal pressure

45
Q

What is an epigastric hernia?

A

Defect in the line alba between the peri-umbilical region and the xiphoid process.
2-3% of abdominal hernias in adults

46
Q

Is bowel present in epigastric hernias?

A

Not usually as posteriorly lies falciform ligament.

47
Q

A healed scar is never more than what % of the original tissue strength?

A

70%

48
Q

What are the risk factors for incisional hernias?

A

Would infections
Would closed under tension
Diabetes
Immunosuppression
Obesity
Midline incisions (Up to 20% for midline laparotomies)
Pervious repair
Smoking

49
Q

What is the gold standard test for incisional hernias?

A

Small - USS
Big - CT

50
Q

What is an abscess?

A

Collection of pus (dead + dying neutrophils in proteinaceous exudate)

51
Q

What bacteria most commonly causes abscesses?

A

Staphylococcus aureus

52
Q

What are the risk factors for abscess formation?

A

Immunosuppression
Skin breach (IVDU, 60% will get abscess)
Smoking
Obesity

53
Q

What is the pathogenesis of abscesses?

A

Pyogenic bacteria introduced into tissue
Commonest bacteria - Staph. aureus, Strep. pyogenes. E-coli.
Attracts neutrophils
Resistant to phagocytosis and lysosomal destruction
Infection contained by defence mechanisms

Also localised tissue necrosis and foreign bodies

54
Q

What is the term called when pus reaches the epithelial surface in abscesses?

A

Pointing

55
Q

How can infection spread in abscesses?

A

Locally e.g. cellulitis
Generally e.g. sepsis

56
Q

How do abscesses present?

A

Warm, pain, red, swelling
Pointing
Spreading cellulitis
Patient systemically unwell
Advanced changes e.g. necrosis

57
Q

What are the differential diagnoses for abscess?

A

Malignancy
Vascular abnormality - pseudoaneurysm in groin of IVDU
Infection without abscess
Collection arising from deeper structure - Psoas abscess, Diverticular disease

58
Q

How are abscesses diagnosed?

A

Mostly clinical. CT/MRI to check for complexity e.g. post-op

59
Q

How are abscesses treated?

A

Abxs may treat some
Drainage if some fail - Spontaneous, Surgical, Percutaneous, Pus for micro.

60
Q

What does a recurrence of an abscess indicate?

A

ongoing pathology

61
Q

What is pilonidal disease?

A

Inflammatory skin condition, mainly affecting natal cleft

62
Q

What are the risk factors for pilonidal disease?

A

Male 4:1
Age 15-40
White ethnicity
Hirsutism
Obesity
Deep natal cleft

63
Q

What is the aetiology for pilonidal disease?

A

Uncertain
Thought to be loose hair driven into natal cleft, causing foreign body reaction.
Pit then forms (Fistulous opening) and fills with debris, causing chronic inflammation and sinus formation.
Can get secondary openings in midline or laterally

64
Q

How does pilonidal disease present?

A

Asymptomatic
Acute abscess (50% develop chronic sinus)
Intermittent swelling or discharge
Pain

65
Q

How is pilonidal disease managed?

A

Drainage of acute abscess
Elective excision of sinus (15-40% recurrence rate) to remove pits and abnormal skin. May need skin flap if significant skin loss.

66
Q

How are lumps assessed?

A

Size
Shape
Site
Surface
Consistency (hard/soft)
Pulsatility (direct or transmitted)
Compressibility
Reducibility
Fluctuation
Transillumination
Mobility
Percussion
Auscultation (bruits or bowel sounds)

67
Q

What are some common benign epidermal lesions?

A

Skin tags
Wards
Naevi

68
Q

What are some common benign cystic lesions?

A

Epidermoid cysts (also called sebaceous cysts, but don’t originate from sebaceous glands).
- Filled with sebum and keratin.
- Excision must include cutaneous punctum and cyst sac

Dermoid cysts
- Congenital usually in midline
- Remnants at lines of embryological fusion
- Risk of inflammation or infection so removal usually needed

69
Q

What are lipomas?

A

Benign tumours of fat
Encapsulated
Soft to palpate
Can feel tethered if intramuscular
Differentiate from soft tissue sarcoma

70
Q

What is a ganglia?

A

Mucin-filled cysts attached to joint capsule or tendon sheaths
Firm
Attached to deeper tissues
Can be painful
Surgical excision if symptomatic or needle aspiration (but recurrence common)

71
Q
A

Year 3 surgery (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions