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CS INT > Gen Surg > Flashcards

Gen Surg Flashcards

1
Q

<p>Sengstaken- Blakemore tube (or Minnesota tube)</p>

A

<p>Rx for variceal bleed when sclerotherapy or banding failed</p>

<p>Inflate the gastric part then oesophageal part of the balloon</p>

<p>Deflate after 12 hours or oesophageal necrosis</p>

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2
Q

<p>DUKE classifiacation mortality</p>

A

<p>5 year survival</p>

<p>A- 95%</p>

<p>B- 75%</p>

<p>C- 50%</p>

<p>D- 25% (if resectable) 6% if not</p>

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3
Q

<p>Indication for conservative mx of splenic trauma</p>

A

<p>Small subcapsular haematoma</p>

<p>Minimal intra abdo blood</p>

<p>No hilar injuries</p>

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4
Q

<p>Refeeding syndrome mx</p>

A

<p>Start at up to 10 kcal/kg/day increasing to full needs over 4-7 days</p>

<p>+ oral thiamine 200-300mg/day</p>

<p>+ vitamin B co strong 1 tds</p>

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5
Q

<p>Pseudo-obstruction def</p>

A

<p>progressive and painless dilation of the colon.</p>

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6
Q

<p>Dx of pseudo-obstruction</p>

A

<p>Excluding obstruction with X ray and contrast enema</p>

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7
Q

<p>Mx of pseudo obstruction</p>

A

<p>Electrolyte level correction</p>

<p>If not effective: try decompressing colonoscopy/neostigmine</p>

<p></p>

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8
Q

<p>Ogilvies syndrome</p>

A

<p>aka psuedo-obstruction</p>

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9
Q

<p>Difference between pseudo-obstruction and ilieus</p>

A

<p>Ilieus affects both large and small bowel vs just large bowel</p>

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10
Q

<p>Indication for Abdominoperineal vs low anterior resection</p>

A

<p>if <5cm from anal verge, abdominoperineal</p>

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11
Q

<p>Hinchey grading of diverticular perforation</p>

A

<p>I- localised (paracolic) abscess (1a phlegmen 1b pericolic or mesneteric abscess</p>

<p>II- pelvic abscess</p>

<p>III- Pus in abdo (purulent peritonitis)</p>

<p>IV- Faeculent peritonitis</p>

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12
Q

<p>Hinchey III mx</p>

A

<p>Sometimes may be managed laproscopically through inserting a drain</p>

<p>It may be appropriate to perfrom resection later as an elective procedure and avoid stoma formation</p>

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13
Q

<p>Hinchey IV mx</p>

A

<p>Hartman's procedure: resected section + proximal bowel to skin as an end stoma</p>

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14
Q

<p>Pancreatic necrosis mx</p>

A

<p>If infection suspected: FNA and culture to confirm</p>

<p>If infection confirmed: nectosectomy/radiological drainage</p>

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15
Q

<p>Acute pancreatitis mx</p>

A

<p>Keep enteral feeding</p>

<p>Consider abx</p>

<p>Early cholecystectomy if gallstones</p>

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16
Q

<p>Why does pancreatitis lead to low calcium</p>

A

<p>Pancreatic enzymes enter circulation, leading to fat necrosis and saponification (free fatty acids released bind to calcium result in hypocalcaemia)</p>

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17
Q

<p>Calcium and pancreatitis</p>

A

<p>Hypo - complication</p>

<p>Hyper: cause</p>

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18
Q

<p>Cholangiocarcinoma mx</p>

A

<p>resection</p>

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19
Q

<p>Mx of bile duct injury following cholecystectomy</p>

A

<p>Reconstruction</p>

<p>If the operating surgeon does not regularly practise this type of surgery then the area should be drained and the patient transferred to an HPB uni</p>

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20
Q

<p>Anastomic leak presentation</p>

A

<p>New AF<br></br>

| Raised inflam markers 5 days post op</p>

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21
Q

<p>Anastomic leak ix</p>

A

<p>CT abdo</p>

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22
Q

<p>Anastomic leak mx</p>

A

<p>If pt septic and leak, op to undo anastomosis and bring bowel ends to skin</p>

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23
Q

<p>Anastomatic leak diagnosis</p>

A

<p>Gastrigraffin enema (not barrium as causes peritonitis)</p>

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24
Q

<p>Inguinal hernia treatments</p>

A

<p>1st time: open inguinal herniotomy + mesh posterior to cord</p>

<p>Recurrent/bilateral: laproscopic herniotomy + mesh posterior to deep ring</p>

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25
Q

<p>Herniotomy vs herniorraphy vs hernioplasty</p>

A

<p>Herniotomoy- only in children</p>

<p>Herniorraphy- herniotomoy + posterior wall repair</p>

<p>Hernioplasty- herniorraphy + mesh</p>

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26
Q

<p>Indication for laproscopy+conservationmx of splenic trauma</p>

A

<p>Modertate amount of intra abdo blood<br></br>
Moderate haemodynamic compromise<br></br>
Tears or lacerations affecting <50%</p>

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27
Q

<p>Indications for splenectomy for splenic trauma</p>

A

<p>Hilar injuries</p>

<p>Major haemorrhage</p>

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28
Q

<p>Duodonal ulcers</p>

A

<p>Anterior - perforates</p>

<p>Posterior - bleeds</p>

29
Q

<p>Why posterior duodenal ulcers bleed</p>

A

<p>erode into gastroduodonal artery</p>

30
Q

<p>Source of bleeding in ulcer on posterior wall body of stomach</p>

A

<p>Splenic artery</p>

31
Q

<p>Management of complete abdo wound dehiscence</p>

A

<p>Analgesia<br></br>
IV fluids + abx<br></br>
Cover with saline impregnated gauze (on the ward)<br></br>
Arrangements made for a return to theatre</p>

32
Q

<p>When does abdominal wound dehiscence occur</p>

A

<p>6 days post op</p>

33
Q

<p>Blatchford score components</p>

A

<p>Urea</p>

<p>Hb</p>

<p>BP</p>

<p>HR</p>

34
Q

<p>Rockall score interpretation</p>

A

<p>Predicts mortality and risk of rebleeding</p>

<p><3 = <4% risk</p>

35
Q

<p>Rockall score component</p>

A 
<p style="text-align:center;">ABCDE<br>
A: Age<br>
B: Blood pressure drop (Shock)<br>
C: Co-morbidity<br>
D: Diagnosis<br>
E: Evidence of bleeding</p>
36
Q

<p>Blatchford score interpretation</p>

A

<p>0< =high risk</p>

<p>predicts need for admission and endoscopy</p>

37
Q

<p>Lichtenstein hernia repair</p>

A

<p>Open anterior approach</p>

<p>Mesh placement deep to the cord</p>

38
Q

<p>Shouldice hernia repair</p>

A

<p>Anterior approach</p>

<p>No mesh</p>

<p>Anterior wall repair with sutures</p>

<p>(used for small hernias)</p>

39
Q

<p>TEP hernia repair</p>

A

<p>Laparoscopic hernial repair (hernia pulled into the peritoneum laparoscopically)</p>

<p>Mesh place deep to the deep ring</p>

<p></p>

<p></p>

40
Q

<p>Abdominoperineal resection (APR)</p>

A

<p>Resection of rectum and anus and formation of an end colostomy</p>

<p>For tumours within 5cm of the anal verge</p>

41
Q

<p>Lower anterior resection (LAR)</p>

A

<p>Resection of rectum and anastomisis to anus</p>

<p>Better quality of life than APR</p>

<p>For tumours more than 5 cm away from anal verge</p>

42
Q

<p>In what scenario, can a fistula be treated conservatively for spontaneous healing</p>

A

<p>Absence of IBD</p>

<p>No distal obstruction (assessed by gastrograffin enema)</p>

43
Q

<p>Mx of infected perianal fistula caused by crohns</p>

A

<p>Drain the acute sepsis</p>

<p>Maintain the drainage using setons</p>

44
Q

<p>Timing to surgery for large bowel obstruction</p>

A

<p>Sun should not rise and set on unrelieved large bowel obstruction</p>

<p>A caecal diameter >12cm and competent ileocaecal valve is a sign of impending perforation and needs prompt surgery</p>

45
Q

<p>Goodsalls rule</p>

A

<p>Fistulas with their external openign within 3 cm of anal verge</p>

<p>If posterior, they open in 6 o clock, no matter where from</p>

<p>If anterior, open in wherever they originate</p>

46
Q

<p>Use of fistulotomy</p>

A

<p>For low fistulas that do not involve the anal sphincter</p>

<p></p>

47
Q

<p>Types of setons</p>

A

<p>Loose (goes through fistula)</p>

<p>Cutting (cuts through the sphincter)</p>

48
Q

<p>Use of seton</p>

A

<p>To allow a passage for drainage of the infection and to induce fibrosis</p>

49
Q

<p>The theory behind cutting seton</p>

A

<p>To slowly re-tighten to bring down a high fistula</p>

50
Q

<p>The issue with cutting seton</p>

A

<p>12% long term incontinence rate<br></br>
</p>

51
Q

<p>Stoma option for colectomy and colorectal anastomosis</p>

A

<p>You do a temporary loop ileostomy to allow defunctionign of the anastomosis as high leak rate in left-sided anastomosis</p>

52
Q

<p>Anastomotic leak mx</p>

A

<p>CT to confirm</p>

<p>Abx + laparotomy to take down the anastomosis and exteriorize the bowel ends</p>

53
Q

<p>Mx of cholangitis</p>

A

<p>IV abx</p>

<p>ERCP and stent</p>

<p>(happens in bile duct obstruction where there is no drainage of bile, leading to infection. Needs to be unobstructed or it will get worse and perforate)</p>

54
Q

<p>Treatment of obstructive jaundice in presence of malignancy</p>

A

<p>ERCP and stent</p>

<p>If failed, percutaneous transhepatic cholangiogram anddrain (propensity to displacement)</p>

55
Q

<p>Mx of jaundice caused by gallstones</p>

A

<p>ERCP to remove intraductal stones followed by cholecystectomy</p>

<p>If doubt about the efficacy of the ERCP, an intra-operative cholangiogram can be done</p>

<p>If stones within the duct intraoperatively, bile duct exploration needed.</p>

<p>When bile duct formally opened, options are closing over a T tube or choledochoduodonostomy or choledochojejunostomy.</p>

56
Q

<p>Pancreatic pseudocyst mx</p>

A

<p>Observe for up to 12 wks as 50% resolve</p>

<p>If not, endoscopic/surgical: cystogastrostomy or aspiration</p>

57
Q

<p>Biliary colic vs acute cholecystitis vs cholangitis</p>

A

<p>Biliary colic- colicky abdo pain</p>

<p>Cholecystitis- RUQ pain + fever</p>

<p>Cholangitis- RUQ pain + Fever + jaundice</p>

58
Q

<p>What to do if during cholecystectomy, Calot's triangle is not easy to identify (due to an empyema or inflammation)</p>

A

<p>Undertake an operative cholecystostomy to relieve the obstruction and a later date to try and do cholecystectomy</p>

59
Q

<p>Time frame for doing a hot cholecystectomy</p>

A

<p>Within 72 hours</p>

60
Q

<p>Why proximal enterotomy to the site of impaction is done in gallstone ileus</p>

A

<p>Bowel at the site of obstruction is inflamed and may not heal well</p>

61
Q

<p>Mx of gallstone ileus</p>

A

<p>Proximal site enterotomy to remove the stone and leave gallbladder and fistula untouched (hostile anatomy)</p>

62
Q

<p>Closure options after bile duct exploration</p>

A

<p>When bile duct formally opened, options are closing over a T tube or choledochoduodonostomy or choledochojejunostomy.</p>

63
Q

<p>Timing for endoscopy in UGI bleed</p>

A

<p>All pts within 24hrs,</p>

<p>If haemodynamically unstable, immediately after resus</p>

64
Q

<p>Mx of variceal bleed</p>

A

<p>Banding or sclerotherapy</p>

<p>If not, Minnesota tube</p>

<p>Reduce portal pressure by medical therapy (IV terlipressin in vaoesophageal varices reduces splanchnic blood flow + abx) +/- TIPPS</p>

65
Q

<p>Use of PPIs in UGI bleed</p>

A

<p>72 hrs of IV omeprazole</p>

<p>Reduces the risk of rebleed in ulcers</p>

66
Q

<p>Surgical option for bleeding duodenal ulcer</p>

A

<p>Laparatomy, duodenotomy and under running of the ulcer</p>

<p>Duodenotomy is done longitudinally and closed transversely to reduce risk of stenosis</p>

67
Q

<p>Surgical options for bleeding gastric ulcers</p>

A

<p>Under running or partial or total gastrectomy</p>

68
Q

<p>Chiladitis sign</p>

A

<p>Loop of bowel between liver and diaphragm giving the impression of perforation and air leak</p>

69
Q

Chiladitis sign

A

<p>Loop of bowel between liver and diaphragm giving the impression of perforation and air leak</p>

CS INT (13 decks)

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