gen surg Flashcards
1
Q
adhesions
A
scar tissue that binds surfaces together
2
Q
fistula
A
abnormal connection between 2 epithelial surfaces
3
Q
tenesmus
A
sensation of needed to topen bowels without being able to produce stools
4
Q
hemocolectomy
A
removing portion ofLI
5
Q
hartmanns procedure
A
proctosigmoidectomy=removal rectosigmoid colon with closure anorectal stump and formation colostomy
6
Q
anterior resection
A
removal of rectum
7
Q
whipple procedure
A
removal of head of pancreas, duodenum, GB and bile duct
8
Q
what is kocher incision used in
A
open cholecytectomy
9
Q
what is chevron/rooftop incision used in
A
liver transplant, whipple, pancreatic, upper GI
10
Q
what is mercedes benz incision used in
A
liver transplant
11
Q
what is midline incision used in
A
general laparotomy
12
Q
what is hockey stick incision used in
A
renal transplant
13
Q
incisions that can be used for open appendicectomy
A
battle incision=paramedian
cridiron/mcburnery=oblique
lanz=transverse
14
Q
what is rutherford morrison incision for
A
open appendicectomy
colectomy
15
Q
incisions for CS
A
pfannestiel=curved above pubic symphysis
joel-cohen=straight, higher. RECOMMENDED
16
Q
laparoscopic incisions
A
5-10mm incisions for ports
17
Q
monopolar diathermy
A
grounding plate/pad
18
Q
when is bipolar diathermy used
A
microsurgery
if have pacemaker
19
Q
WHO Surgical checklist
A
do before anaesthesia, incision, leave theatre
identity, allergies, oepration, bleeding risk, intro to team, anticipated critical events, counts
20
Q
consent form types
A
- for yourself
- parent for child
- won’t have impaired consciousness
- lacks capacity
21
Q
what can cause generalised abdo pain
A
peritonitis
ruptured AAA
intestinal obstruction
ischaemic colitis
22
Q
causes RUQ pain
A
biliary colic
acute cholecystitis
acute cholangitis
23
Q
causes epigastric pain
A
acute gastritis
peptic ulcer disease
pancreatitis
ruptured AAA
24
Q
causes central abdo pain
A
ruptured AAA
intestinal obstruction
ischaemic colitis
early appendicitis
25
causes R iliac fossa pain
appendicitis
ectopic pregnancy
ruptured ovarian cyst
ovarian torsion
meckels diverticulitis
26
causes L iliac fossa pain
appendicitis
ectopic pregnancy
ruptured ovarian cyst
ovarian torsion
meckels diverticulitis
27
causes suprapubic pain
UTI
urinaru retention
PID
prostatitis
28
causes loin to groin pain
renal colic
ruptured AAA
pyelonephritis
29
causes testicular pain
torsion
epididymo-orchitis
30
sx peritonitis
guarding
rigidity
rebound tenderness
cough test
percussion tenderness
31
causes peritonitis
localised=organ inflammation, e.g. appendiciits
generalised=perforation
32
what is spontaneous bacterial peritonitis
infection of ascites
33
ix before theatre
FBC (Hb, WCC)
U+Es
LFTs
CRP
amylase
INR
Ca
hCG
ABG
lactate
group and save
+/- cultures, XR, USS, CT
34
sx appendicitis
central abdo pain ->RIF
tender McBurnerys pont
anorexia
N+V
fever
Rovsings sign
guarding
rebound tenderness
percussion tenderness
35
McBurneys point
1/3 way from ASIS to umbilicus
36
Rovsings sign
positive in appendicitis
palpation LIF = pain in RIF
37
ix appendicitis
bloods
USS
38
mx appendicitis
appendicectomy
39
complicatios appendicectomy
bleeding
infection
damage to bowel/bladder
VTE
40
causes bowel obstruction
main= adhesions (SBO), hernias (SBO), malignancy (LBO)
other=volvulus (LBO), diverticular disease, strictures, intussusception
41
main causes small bowel obstruction
adhesions
hernias
42
main cause large bowel obstruction
malignancy
43
what is closed loop obstruction
2 points obstruction
adhesions, hernias, volvulus
or with a competent ileocaecal valve
will continue to expand leading to ischaemia and perforation
44
features bowel obstruction
vomiting- green bilious
abdo distension
abdo pain
constipation and no flatulence
'tinkling' bowel sounds in early obstruction
45
XR features bowel obstruction
distended loops bowel
46
mx bowel obstructio
if stable=conservative
definitive=surgery - laparoscopy or laparotomy
47
what is ileus
peristalsis temporarily stops
48
causes ileus
injury to bowel
post op
infection
electrolytes - low K/Na
49
features ileus
green bilious vom
abdo distension and pain
absolute constipation
abent bowel sounds
50
mx ileus
nil by mouth
NG tube
IV fluids
mobilise
51
what happens in volvulus
bowel twists around itself and mesentery leading to closed loop obstruction
52
where does volvulus occut
sigmoid - more common
caecal
53
RF sigmoid volvulus
older patient
due to chronic constipation/laxatives/high fibre
54
who is caecal volvulus more common in
younger patient
55
RF volvulus
neuropsych
in nursing home
adhesions in pregnancy
chronic constipation
high fibre
56
features volvulus
green bilious vom
abdo distension and pain
absolute constipation
57
diagnosis volvulus
AXR=coffee bean sign in sigmoid
contrast CT
58
mx volvulus
endoscopic decompression
surgery: hartmanns for sigmoid, ileocaecal resection
59
sx abdo hernia
soft lump
protrude on cough
aching/pulling
60
complications hernias
incarceration ->obstruction or strangulation
61
richters hernia
partial herniation ->strangulation ->ischaemia bowel wall
62
maydls hernia
2 different loops of bowel
63
mx abdo hernias
conservative
tension free repair - mesh
tension repair
64
indirect inguinal hernias
through inguinal canal
pressure on deep inguinal ring stops herniation
65
direct inguinal hernias
through abdo wall at hesselbachs triangle
66
which hernias are at high risk complications
femoral
67
hesselbachs triangle
rectus abdominus medially
inferior epigastric vessels sup/laterally
inguinal ligament inferiorly
68
femoral canal
femoral vein laterlaly
lacunar ligament medially
inguinal ligament anteriorly
pectineal ligament posteriorly
69
femoral triangle
sartorius laterally
adductor longus medially
inguinal ligament superiorly
70
what does femoral triangle contain
femoral nerve, arterl and vein and femoral canal (lymphatics)
71
incisional hernias
from previous surgery - hard to repair
72
mx umbilical hernias
resolve spontaneouslt
73
who gets umbilical hernias
neonates
older adults
74
spigelian hernia
between rectus abdominus andspigelian fascia
75
features spigelian hernia
narrow base
pain +/- lump
76
diastasis recti
widening linea alba
midline bulge
77
causes diastasis recti
pregnant
congenital
78
obturator hernias
through obturator foramen
79
RF obturator hernias
pregnancy
80
howship romberg sign
pain from inner thigh -> knee when hip internally rotated due to compression on pbturator nerve from obturator hernia
81
sign for obturator hernias
howship romberg sign
82
hiatus hernia
stomach through diaphragm
83
types hiatus hernia
1=sliding
2=rolling
3=sliding and rolling
4=large and other organs
84
sx hiatus hernia
dyspepsia
halitosis
reflux
85
mx hiatus hernia
conservative
surgery
86
haemorrhoids
enlarged anal vascular cushions
87
RF haemorrhoids
pregnant
obese
cough
constipation
88
degrees of haemorrhoids
1. no prolapse
2. prolapse when strain
3. prolapse when strain that needs to be pushed back
4. permanent prolapse
89
sx haemorrhoids
bright red blood
pain
90
ix haemorrhoids
protoscopy
91
mx haemorrhoids
topical
laxatives
rubber band ligation
artery ligation
92
cause thrombosed haemorrhoids
due to strangulation
93
features thrombosed haemorrhoids
purple
painful
94
mx thrombosed haemorrhoids
may need surgery
95
diverticulosis
diverticula (pouch in bowel wall) present
96
RF diverticula
age
low fibre
obesity
nsaids
97
diverituclar disease
diverticula cause sx e.g. pain, constipation, bleeding
98
diverticulitis
inflammation diverticula
99
sx diverticulitis
LIF pain
N+V
fever
rectal bleeding
100
mx diverticulitis
uncomlicated=oral co-amox, only clear liquids 2-3d
complicated = IV fluids and abx
101
what does coeliac artery supply
foregut: liver, pancreas, spleen, stomach, proximal duodenum, billiary system
102
what does superior mesenteric artery supply
midgut: distal duodenum to first 1/2 transverse colon
103
what does inferior mesenteric artery supply
hindgut: 2nd half transverse colon to rectum
104
cause chronic mesenteric ischaemia
narrow vessels due to atherosclerosis
105
sx chronic mesenteric ischaemia
colicky abdo pain after eating
wt loss
abdo bruit
106
mx chronic mesenteric ischaemia
reduce RF
revascularisation - stent
107
cause acute mesenteric ischaemia
thrombus
108
RF acute mesenteric ischaemia
AF
109
features acute mesenteric ischaemia
non sepcific abdo pain -> shock, sepsis, necrosis, perforation
110
ix acute mesenteric ischaemia
contrast CT
met acidosis
high lactate
111
mx acute mesenteric ischaemia
surgery to remove necrotic bowel and thrombus
112
RF bowel cancer
fhx
familial adenomatous polyposis
HNPCC/lynch syndrome
IBD
age
diet
obese
smoking
alcohol
113
features bowel cancer
change bowel habit
wt loss
bleeding
abdo pain
iron deficiency anaemia
114
when to 2ww for bowel cancer
>40 and abdo pain and wt loss
>50 and rectal bleeding
>60 and change in bowel habits or iron deficiency anaemia
115
ix bowel cancer
FIT (faecal immunochemical) - screening
colonoscopy and biopsy
staging = CT TAP
116
mx bowel cancer
staging TNM
surgical resection
chemo
radio
palliative
117
follow up after bowel cancer
serum carcinoembryonic antigen (marker(
CT
118
lower anterior resection syndrome
urgency and frequency bowels
incontinence
difficulty controlling flatulence
119
colostomy
LI
more solid stools
usually LIF
120
end colostomy
portion removed and proximal end brought to skin
121
loop colostomy
temporary - 6-8w
both ends brought to skin
122
ileostomy
SI
more liquid
RIF
123
gastrostomy
fitted using PEG
connection between stomach and abdo wall
124
urostomy
urinary system
RIF
125
stoma complications
psych
skin irritated
parastomal hernia
loss bowel length -> dehydration and malnutrition
constipation
stenosis
obstruction
retractio
prolapse
bleeding
granuloma
126
cholestasis
blockage to bile flow
127
cholelithiasis
gallstones
128
choledocholithiasis
gallstones in bile duct
129
biliary colic
RUQ pain caused by gallstones irritating bile ducts
triggered by fatty meals
lasts 30m-8h
N+V
130
cholecytitis
inflammation gallbladder
131
cholangitis
inflammation bile ducts
132
RF gallstones
fat
fair
F
40+
133
sx gallstones
biliary colic
acute cholecysitis
acute cholangitis
obstructive jaundice
pancreatitis
134
ix gallstones
LFTs: increased bilirubin, increased ALP, slightly increased ALT/AST
USS
MRCP
135
mx gallstones
ERCP
cholecystectomy
136
features post-cholecystectomy syndrome
due to changes in bile flow
diarrhoea
RUQ pain
nausea
intolerance fatty foods
flatulence
137
causes acute cholecystitis
usually gallstones
138
sx acute cholecystitis
RUQ pain
fever
N+V
increased HR and RR
murphys sign
139
ix acute cholecystitis
USS=thickened GB, stones/sludge in GB, fluids around GB
MRCP
140
mx acute cholecystitis
IV fluids
abx
tx gallstones
141
complications acute cholecystitis
sepsis
GB empyema
gangrenous GB
perforation
142
cause acute cholangitis
e.coli
klebsiella
enterococcus
143
features acute cholangitis
CHARCOTS TRIAD
RUQ pain
fever
jaundice (increased bilirubin)
144
mx acute cholangitis
IV fluidss and abx
abdo USS
MRCP
145
cholangiocarcinoma
bile duct cancer
mainly adenocarcinoma
146
RF cholangiocarcinoma
UC
primary sclerosing cholangitis
liver flukes (parasite)
147
sx cholangiocarcinoma
obstructive jaundice
wt loss
RUQ pain
palpable GB
hepatomegaly
148
ix cholangiocarcinoma
CT
biopsy
Ca19-9
149
mx cholangiocarcinoma
surgery (rarely curative)
chemo
radio
150
courvoisers law
palpable GB and jaundice unlikely to be gallstones
usualy cholangiocarcinoma or pancreatic cancer
151
trousseas sign of malignancy
migratory thrombophlebitis (vessel inflamation due to clot)
particularly in pancreatic adenocarcinoma
152
pancreatic cancer
usually head
usually adenocarcinoma
metastasises early to liver, peritoneum, lungs, bones
153
where does pancreatic cancer metastasise to
early to liver, peritoneum, lungs, bones
154
sx pancreatic cancer
painless obstructive jaundice
abdo/back pain
wt loss
change bowels
new DM
155
ix pancreatic cancer
CT
biopsy
Ca19-9
156
mx pancreatic cancer
surgery - whipple if just head
157
causes pancreatitis
main: gallstones, alcohol post-ERCP
other: trauma, steroids, mumps, AI, scorpion sting, hyperlipidaemia, drugs (furosemide, thiazide like diuretics, azathioprine)
158
score for pancreatitis
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
interpreting glascow score for pancreatitis
0/1=mild
2=mod
3=sev
160
mx acute pancreatitis
IV fluids
tx gallstones
abx
161
complications acute pancreatitis
necrosis
abscess
acute perippancreatic fluid collection
psuedocysts
chronic pancreatitis
162
cause chronic pancreaittis
alcohol
163
complications chronic pancreatitis
chronic epigastric pain
loss exocrine function
loss endocrine function (no insulin)
abscness
164
mx chronic pancreaitis
replace enzymes (creon)
insulin
surgery
165
what does patient require after liver transplant
lilfelong immunosuppression: steroids, azathioprine, tacrolimus
166
rejection sx after liver transplant
abnormal LFTs
fatigue
fever
jaundice
167
incision for liver transplant
rooftop or mercedes benz
