GEN SURG 1 Flashcards
assessment of breast lumps
- clinical history and examination
- imagined USS for under 40s and mam for over 40s
- pathology - FNA and core biopsy
what is a fibroadenoma peak when and who sump ix what can it be mistaken as and whats the difference treatment
distortion of normal development biphasic E and S
30s and early repro life. african
painless, firm discrete mobile mass, rubbery
solid on USS
phyllodes tumour but phyllodes tumour larger and in older women
conservative if <40. excise if over 40 or >4cm or increasing in size, patient choice
what is a cyst
common in who
symptoms
dx and rx
enlarged involuted lobule
common in perimenopausal women, late repro life
lump soft, mobile, smooth, tender esp before menstruation
FNA to diagnose and treat
duct papilloma is what
symp
ix
treatment
benign neoplasma - intracystic papillary proliferation
bloody cystic fluid
USS core biopsy is increacystic solid lesion or irregular cytic wall
conservative or microductomy
abscess symptoms
ix
treatment
bulging mass usually in centre of mastitis
focal USS - pus filled
aspirate
glalactocele is what
cause
treatment and dx
palpable milk filled cyst
preg/lactation
FNA to diagnose and treat
lipoma has what kind of borders on mam
biopsy
thin smooth borders
adipose cells on biopsy
mordorors is what
symp
treatment
inflammation or vein under chest wall
firm vertical rods and history of trauma
resolves spontaneously in 8-12 weeks
gynacamastia is what common in who causes ix and when risk of breast cancer in males treatment
breast development in males
elderly and puberty
idiopathic, endogenous/exogenous hormones, cannabis, liver disease, renal disease, digoxin, spinoronolactone, testicular tumours
mammogram if suspicious
1%
remove underlying cause, surgery occasionally
fibrocystic change how many are asymp RF symptoms dx/ix cysts are what treatment
1/3
menstrual abnormlaities, early menarche, late menopause
cyclic pain, lumps, smooth and discrete, sudden pain from rupture of cysts
incidental finding, screening
blue domed with pale fluid, intervening fibrosis
exclude malignancy, treasure, excise if necessary
haemartoma is what
treatment
cicumscribed lesion composed of cell types normal to breast
not troublesome - left alone
sclerosiing lesions are what can cause what that mimic what sclerosinign adenosis symp radial scar complex sclerosis lesion risk ix rx
benin disorderly proliferation of acini and storm
mass or calcicfication which may mimic cancer
pain/tender, lump, thickness, often asymp
1-9mm
>10mm
insitu carcinoma/invasive cancer can occur within the lesion
vacuum biopsy
excise/biopsy
fat necrosis cause assoc with what process ix rx
local trauma like seatbelt injury
assoc w warfarin
damage to adipocytes -> scarring -> mass
confirm dx w imaging
exclude cancer, reassure
duct ectasia is what caused by what symp RF treatment
keratin plugging causing stasis of secretion - can lead to infection
blockage of lactiferous duct
green/bloody/purulent dc, nipple retraction/distortion, sub alveolar dilatation
smoking
treat acute infection w ABs, exclude malignancy, self limiting - can excise
phyllodes tumour cut surface looks like what
ix
symp
complicatons
leaf
biphasic
slow growing, unilateral, mass
can be malignant -> like fibroadenoma but stroll parts neoplastic
angiosarcoma cause
post XRT, prev radio for breast cancer
mets to breast
malig melanoma, bronchial carcinoma, ovarian carcinoma, clear cancer of kidney, leiomyosarcoma
breast cancer risk factors
female, over 40, BRCA1/2, smoking, obesity, early menarche, late first birth, late menopause, exogenous homrones OCP/HRT, endogenous, not breast feeding, prev breast disease, FH, alcohol
symptoms/signs of breast cancer
screening
mets to where
dimpled/depressed skin, lump, discharge, pain, nipple change, texture/colour/controur change
50-70 3 yearly
liver, lung, bone, brain, skin
DCIS commonest what usually type hyperplasia atypical hyperplasia DCIS what doe in situ mean
commonest in situ carcinoma
2 x RR to invasive carcinoma
4x
not invaded basement membrane
microinvaive carcinoma is what
grade what with what
rare
DCIS high grade with invasion of under 1mm
lobular in situ carcinoma is what and what may it do atypical lobular hyperplasia lobular carcinoma ix gene
incidental, may calcify
<50%
>50%
MRI gold standard. ER pos
E cadherin negative, CDH1 gene deletion - cel adhesion gene
pagets is what
in situ?
ix
eczematous changes to nipple
still in situ - extends alone ducts - epidermis of nipple
cytokerin to stain
invasive carcinoma is what local spread lymph blood ix
breached BM
stroma or breasts, skin, muscles of chest wall
axillary
bone, liver, brain, abd viscera, genital tract
TNM, grade, ER, HER2, Prog
treatment surgery
implants
flaps
lumpectomy or mastectomy +/- reconstruction
no scar doesn’t last as long and doesn’t feel like breast
LD commonest risk of flap failure and scars
treatment nodes
complications of node removal
axillary node clearance or biopsy - sentinal node biopsy using blue dye
lymphodema, nerve damage
radiotherapy types
adjuvant
neojuvent - reduce size of tumour pre op
hormone therapy
oestrogen
HER2
post meno
temoxifen/anastrazole
herceptin
aromatase inhibitors - letrozole
stomas ileostomy
colostomy
urostomy
complications
usually in RLQ w sprout
LLQ hart mans can be reversed
drainage through bladder not possible
D/C, electrolyte imbalance, necrosis, prolapse, stenosis of stoma, parastomal hernia, infection
intermittent claudication is what cause who RF symp 1/3 1/3 1/3 ix treatment
early stage PVD, atherosclerosis, M over 45
DM, htn, smoking
get better stay the same get worse
duplex USS, ABPI normla is 0.9 to 1.2. CTMRA
secondary prevention - aspirin, exercise, stent, bypass, NAftidofury / oxolate if not suitable for surgery
varicose veins are what
ix
treatment
cx
incompetence of venous veins
venous duplex USS
compression stockings for 3months, surgery if pain (thrombophlebtiits) sclerotherapy, laser ablation
can reoccur after treatment
AAA symptoms
ix
treatment
back pain, collapse and shock if rupture, pulsatile mass
USS, CT
repair if >1cm every year or >=5.5cm - EVAR
aortic dissection is what RF symp ix treatment of type A treatment of type B
blood breaches intima parallel true and false lumens
chronic htn
tearing chest pain -> back, hemiplegia, paraplegia, limb ischaemia
ECG, CXR, CT, ECHO
type A involving ascending aorta - replace affected aorta using cardiopulmonary bypass
type B starts at origin of left subclavian - manage htn, surgery repair with graft if distal ischaemia occurs
diabetic foot severe septic treatment
2g Fluclox IV, IV Gent and IV metro
PA - give vanc
Burns ABCD
surgery
A - may require intubation
b - oxygen
C fluid replacement, analgesia
escharotomy graft
obesity oral meds
surgery and indications
orlistat, lorcevserin, liroglitide
BMI 40 or over OR 35 or over and cormobidities
gastric sleeve, bypass, band
