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gen surg Flashcards

1
Q

adhesions

A

scar tissue that binds surfaces together

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2
Q

fistula

A

abnormal connection between 2 epithelial surfaces

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3
Q

tenesmus

A

sensation of needed to topen bowels without being able to produce stools

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4
Q

hemocolectomy

A

removing portion ofLI

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5
Q

hartmanns procedure

A

proctosigmoidectomy=removal rectosigmoid colon with closure anorectal stump and formation colostomy

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6
Q

anterior resection

A

removal of rectum

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7
Q

whipple procedure

A

removal of head of pancreas, duodenum, GB and bile duct

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8
Q

what is kocher incision used in

A

open cholecytectomy

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9
Q

what is chevron/rooftop incision used in

A

liver transplant, whipple, pancreatic, upper GI

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10
Q

what is mercedes benz incision used in

A

liver transplant

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11
Q

what is midline incision used in

A

general laparotomy

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12
Q

what is hockey stick incision used in

A

renal transplant

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13
Q

incisions that can be used for open appendicectomy

A

battle incision=paramedian
cridiron/mcburnery=oblique
lanz=transverse

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14
Q

what is rutherford morrison incision for

A

open appendicectomy
colectomy

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15
Q

incisions for CS

A

pfannestiel=curved above pubic symphysis
joel-cohen=straight, higher. RECOMMENDED

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16
Q

laparoscopic incisions

A

5-10mm incisions for ports

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17
Q

monopolar diathermy

A

grounding plate/pad

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18
Q

when is bipolar diathermy used

A

microsurgery
if have pacemaker

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19
Q

WHO Surgical checklist

A

do before anaesthesia, incision, leave theatre
identity, allergies, oepration, bleeding risk, intro to team, anticipated critical events, counts

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20
Q

consent form types

A
  1. for yourself
  2. parent for child
  3. won’t have impaired consciousness
  4. lacks capacity
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21
Q

what can cause generalised abdo pain

A

peritonitis
ruptured AAA
intestinal obstruction
ischaemic colitis

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22
Q

causes RUQ pain

A

biliary colic
acute cholecystitis
acute cholangitis

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23
Q

causes epigastric pain

A

acute gastritis
peptic ulcer disease
pancreatitis
ruptured AAA

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24
Q

causes central abdo pain

A

ruptured AAA
intestinal obstruction
ischaemic colitis
early appendicitis

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25
Q

causes R iliac fossa pain

A

appendicitis
ectopic pregnancy
ruptured ovarian cyst
ovarian torsion
meckels diverticulitis

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26
Q

causes L iliac fossa pain

A

appendicitis
ectopic pregnancy
ruptured ovarian cyst
ovarian torsion
meckels diverticulitis

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27
Q

causes suprapubic pain

A

UTI
urinaru retention
PID
prostatitis

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28
Q

causes loin to groin pain

A

renal colic
ruptured AAA
pyelonephritis

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29
Q

causes testicular pain

A

torsion
epididymo-orchitis

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30
Q

sx peritonitis

A

guarding
rigidity
rebound tenderness
cough test
percussion tenderness

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31
Q

causes peritonitis

A

localised=organ inflammation, e.g. appendiciits
generalised=perforation

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32
Q

what is spontaneous bacterial peritonitis

A

infection of ascites

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33
Q

ix before theatre

A

FBC (Hb, WCC)
U+Es
LFTs
CRP
amylase
INR
Ca
hCG
ABG
lactate
group and save
+/- cultures, XR, USS, CT

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34
Q

sx appendicitis

A

central abdo pain ->RIF
tender McBurnerys pont
anorexia
N+V
fever
Rovsings sign
guarding
rebound tenderness
percussion tenderness

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35
Q

McBurneys point

A

1/3 way from ASIS to umbilicus

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36
Q

Rovsings sign

A

positive in appendicitis
palpation LIF = pain in RIF

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37
Q

ix appendicitis

A

bloods
USS

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38
Q

mx appendicitis

A

appendicectomy

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39
Q

complicatios appendicectomy

A

bleeding
infection
damage to bowel/bladder
VTE

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40
Q

causes bowel obstruction

A

main= adhesions (SBO), hernias (SBO), malignancy (LBO)
other=volvulus (LBO), diverticular disease, strictures, intussusception

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41
Q

main causes small bowel obstruction

A

adhesions
hernias

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42
Q

main cause large bowel obstruction

A

malignancy

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43
Q

what is closed loop obstruction

A

2 points obstruction
adhesions, hernias, volvulus
or with a competent ileocaecal valve
will continue to expand leading to ischaemia and perforation

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44
Q

features bowel obstruction

A

vomiting- green bilious
abdo distension
abdo pain
constipation and no flatulence
‘tinkling’ bowel sounds in early obstruction

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45
Q

XR features bowel obstruction

A

distended loops bowel

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46
Q

mx bowel obstructio

A

if stable=conservative
definitive=surgery - laparoscopy or laparotomy

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47
Q

what is ileus

A

peristalsis temporarily stops

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48
Q

causes ileus

A

injury to bowel
post op
infection
electrolytes - low K/Na

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49
Q

features ileus

A

green bilious vom
abdo distension and pain
absolute constipation
abent bowel sounds

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50
Q

mx ileus

A

nil by mouth
NG tube
IV fluids
mobilise

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51
Q

what happens in volvulus

A

bowel twists around itself and mesentery leading to closed loop obstruction

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52
Q

where does volvulus occut

A

sigmoid - more common
caecal

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53
Q

RF sigmoid volvulus

A

older patient
due to chronic constipation/laxatives/high fibre

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54
Q

who is caecal volvulus more common in

A

younger patient

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55
Q

RF volvulus

A

neuropsych
in nursing home
adhesions in pregnancy
chronic constipation
high fibre

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56
Q

features volvulus

A

green bilious vom
abdo distension and pain
absolute constipation

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57
Q

diagnosis volvulus

A

AXR=coffee bean sign in sigmoid
contrast CT

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58
Q

mx volvulus

A

endoscopic decompression
surgery: hartmanns for sigmoid, ileocaecal resection

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59
Q

sx abdo hernia

A

soft lump
protrude on cough
aching/pulling

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60
Q

complications hernias

A

incarceration ->obstruction or strangulation

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61
Q

richters hernia

A

partial herniation ->strangulation ->ischaemia bowel wall

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62
Q

maydls hernia

A

2 different loops of bowel

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63
Q

mx abdo hernias

A

conservative
tension free repair - mesh
tension repair

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64
Q

indirect inguinal hernias

A

through inguinal canal
pressure on deep inguinal ring stops herniation

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65
Q

direct inguinal hernias

A

through abdo wall at hesselbachs triangle

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66
Q

which hernias are at high risk complications

A

femoral

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67
Q

hesselbachs triangle

A

rectus abdominus medially
inferior epigastric vessels sup/laterally
inguinal ligament inferiorly

68
Q

femoral canal

A

femoral vein laterlaly
lacunar ligament medially
inguinal ligament anteriorly
pectineal ligament posteriorly

69
Q

femoral triangle

A

sartorius laterally
adductor longus medially
inguinal ligament superiorly

70
Q

what does femoral triangle contain

A

femoral nerve, arterl and vein and femoral canal (lymphatics)

71
Q

incisional hernias

A

from previous surgery - hard to repair

72
Q

mx umbilical hernias

A

resolve spontaneouslt

73
Q

who gets umbilical hernias

A

neonates
older adults

74
Q

spigelian hernia

A

between rectus abdominus andspigelian fascia

75
Q

features spigelian hernia

A

narrow base
pain +/- lump

76
Q

diastasis recti

A

widening linea alba
midline bulge

77
Q

causes diastasis recti

A

pregnant
congenital

78
Q

obturator hernias

A

through obturator foramen

79
Q

RF obturator hernias

A

pregnancy

80
Q

howship romberg sign

A

pain from inner thigh -> knee when hip internally rotated due to compression on pbturator nerve from obturator hernia

81
Q

sign for obturator hernias

A

howship romberg sign

82
Q

hiatus hernia

A

stomach through diaphragm

83
Q

types hiatus hernia

A

1=sliding
2=rolling
3=sliding and rolling
4=large and other organs

84
Q

sx hiatus hernia

A

dyspepsia
halitosis
reflux

85
Q

mx hiatus hernia

A

conservative
surgery

86
Q

haemorrhoids

A

enlarged anal vascular cushions

87
Q

RF haemorrhoids

A

pregnant
obese
cough
constipation

88
Q

degrees of haemorrhoids

A
  1. no prolapse
  2. prolapse when strain
  3. prolapse when strain that needs to be pushed back
  4. permanent prolapse
89
Q

sx haemorrhoids

A

bright red blood
pain

90
Q

ix haemorrhoids

A

protoscopy

91
Q

mx haemorrhoids

A

topical
laxatives
rubber band ligation
artery ligation

92
Q

cause thrombosed haemorrhoids

A

due to strangulation

93
Q

features thrombosed haemorrhoids

A

purple
painful

94
Q

mx thrombosed haemorrhoids

A

may need surgery

95
Q

diverticulosis

A

diverticula (pouch in bowel wall) present

96
Q

RF diverticula

A

age
low fibre
obesity
nsaids

97
Q

diverituclar disease

A

diverticula cause sx e.g. pain, constipation, bleeding

98
Q

diverticulitis

A

inflammation diverticula

99
Q

sx diverticulitis

A

LIF pain
N+V
fever
rectal bleeding

100
Q

mx diverticulitis

A

uncomlicated=oral co-amox, only clear liquids 2-3d
complicated = IV fluids and abx

101
Q

what does coeliac artery supply

A

foregut: liver, pancreas, spleen, stomach, proximal duodenum, billiary system

102
Q

what does superior mesenteric artery supply

A

midgut: distal duodenum to first 1/2 transverse colon

103
Q

what does inferior mesenteric artery supply

A

hindgut: 2nd half transverse colon to rectum

104
Q

cause chronic mesenteric ischaemia

A

narrow vessels due to atherosclerosis

105
Q

sx chronic mesenteric ischaemia

A

colicky abdo pain after eating
wt loss
abdo bruit

106
Q

mx chronic mesenteric ischaemia

A

reduce RF
revascularisation - stent

107
Q

cause acute mesenteric ischaemia

A

thrombus

108
Q

RF acute mesenteric ischaemia

A

AF

109
Q

features acute mesenteric ischaemia

A

non sepcific abdo pain -> shock, sepsis, necrosis, perforation

110
Q

ix acute mesenteric ischaemia

A

contrast CT
met acidosis
high lactate

111
Q

mx acute mesenteric ischaemia

A

surgery to remove necrotic bowel and thrombus

112
Q

RF bowel cancer

A

fhx
familial adenomatous polyposis
HNPCC/lynch syndrome
IBD
age
diet
obese
smoking
alcohol

113
Q

features bowel cancer

A

change bowel habit
wt loss
bleeding
abdo pain
iron deficiency anaemia

114
Q

when to 2ww for bowel cancer

A

> 40 and abdo pain and wt loss
50 and rectal bleeding
60 and change in bowel habits or iron deficiency anaemia

115
Q

ix bowel cancer

A

FIT (faecal immunochemical) - screening
colonoscopy and biopsy
staging = CT TAP

116
Q

mx bowel cancer

A

staging TNM
surgical resection
chemo
radio
palliative

117
Q

follow up after bowel cancer

A

serum carcinoembryonic antigen (marker(
CT

118
Q

lower anterior resection syndrome

A

urgency and frequency bowels
incontinence
difficulty controlling flatulence

119
Q

colostomy

A

LI
more solid stools
usually LIF

120
Q

end colostomy

A

portion removed and proximal end brought to skin

121
Q

loop colostomy

A

temporary - 6-8w
both ends brought to skin

122
Q

ileostomy

A

SI
more liquid
RIF

123
Q

gastrostomy

A

fitted using PEG
connection between stomach and abdo wall

124
Q

urostomy

A

urinary system
RIF

125
Q

stoma complications

A

psych
skin irritated
parastomal hernia
loss bowel length -> dehydration and malnutrition
constipation
stenosis
obstruction
retractio
prolapse
bleeding
granuloma

126
Q

cholestasis

A

blockage to bile flow

127
Q

cholelithiasis

A

gallstones

128
Q

choledocholithiasis

A

gallstones in bile duct

129
Q

biliary colic

A

RUQ pain caused by gallstones irritating bile ducts
triggered by fatty meals
lasts 30m-8h
N+V

130
Q

cholecytitis

A

inflammation gallbladder

131
Q

cholangitis

A

inflammation bile ducts

132
Q

RF gallstones

A

fat
fair
F
40+

133
Q

sx gallstones

A

biliary colic
acute cholecysitis
acute cholangitis
obstructive jaundice
pancreatitis

134
Q

ix gallstones

A

LFTs: increased bilirubin, increased ALP, slightly increased ALT/AST
USS
MRCP

135
Q

mx gallstones

A

ERCP
cholecystectomy

136
Q

features post-cholecystectomy syndrome

A

due to changes in bile flow
diarrhoea
RUQ pain
nausea
intolerance fatty foods
flatulence

137
Q

causes acute cholecystitis

A

usually gallstones

138
Q

sx acute cholecystitis

A

RUQ pain
fever
N+V
increased HR and RR
murphys sign

139
Q

ix acute cholecystitis

A

USS=thickened GB, stones/sludge in GB, fluids around GB
MRCP

140
Q

mx acute cholecystitis

A

IV fluids
abx
tx gallstones

141
Q

complications acute cholecystitis

A

sepsis
GB empyema
gangrenous GB
perforation

142
Q

cause acute cholangitis

A

e.coli
klebsiella
enterococcus

143
Q

features acute cholangitis

A

CHARCOTS TRIAD
RUQ pain
fever
jaundice (increased bilirubin)

144
Q

mx acute cholangitis

A

IV fluidss and abx
abdo USS
MRCP

145
Q

cholangiocarcinoma

A

bile duct cancer
mainly adenocarcinoma

146
Q

RF cholangiocarcinoma

A

UC
primary sclerosing cholangitis
liver flukes (parasite)

147
Q

sx cholangiocarcinoma

A

obstructive jaundice
wt loss
RUQ pain
palpable GB
hepatomegaly

148
Q

ix cholangiocarcinoma

A

CT
biopsy
Ca19-9

149
Q

mx cholangiocarcinoma

A

surgery (rarely curative)
chemo
radio

150
Q

courvoisers law

A

palpable GB and jaundice unlikely to be gallstones
usualy cholangiocarcinoma or pancreatic cancer

151
Q

trousseas sign of malignancy

A

migratory thrombophlebitis (vessel inflamation due to clot)
particularly in pancreatic adenocarcinoma

152
Q

pancreatic cancer

A

usually head
usually adenocarcinoma
metastasises early to liver, peritoneum, lungs, bones

153
Q

where does pancreatic cancer metastasise to

A

early to liver, peritoneum, lungs, bones

154
Q

sx pancreatic cancer

A

painless obstructive jaundice
abdo/back pain
wt loss
change bowels
new DM

155
Q

ix pancreatic cancer

A

CT
biopsy
Ca19-9

156
Q

mx pancreatic cancer

A

surgery - whipple if just head

157
Q

causes pancreatitis

A

main: gallstones, alcohol post-ERCP
other: trauma, steroids, mumps, AI, scorpion sting, hyperlipidaemia, drugs (furosemide, thiazide like diuretics, azathioprine)

158
Q

score for pancreatitis

A

GLASCOW SCORE
PaO2 <8
age >55
neutrophils >15
Ca<2
urea >16
enzymes: LDH >600 or AST/ALT >200
albumin <32
sugar (glucose) >10

159
Q

interpreting glascow score for pancreatitis

A

0/1=mild
2=mod
3=sev

160
Q

mx acute pancreatitis

A

IV fluids
tx gallstones
abx

161
Q

complications acute pancreatitis

A

necrosis
abscess
acute perippancreatic fluid collection
psuedocysts
chronic pancreatitis

162
Q

cause chronic pancreaittis

A

alcohol

163
Q

complications chronic pancreatitis

A

chronic epigastric pain
loss exocrine function
loss endocrine function (no insulin)
abscness

164
Q

mx chronic pancreaitis

A

replace enzymes (creon)
insulin
surgery

165
Q

what does patient require after liver transplant

A

lilfelong immunosuppression: steroids, azathioprine, tacrolimus

166
Q

rejection sx after liver transplant

A

abnormal LFTs
fatigue
fever
jaundice

167
Q

incision for liver transplant

A

rooftop or mercedes benz

finals (31 decks)

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