Gen Surg Flashcards
Rx of haemorrhoids
hot baths
anusol
avoid constipaton - high fibre diet, hydration
band ligation
haemarrhoidectomy/artery ligation
RF for diverticulosis
NSAIDs, older age, low fibre diet, obesity
Presentation of diverticulitis
Pain and tenderness in the left iliac fossa / lower left abdomen
Fever
Diarrhoea
Nausea and vomiting
Rectal bleeding
Palpable abdominal mass (if an abscess has formed)
Raised inflammatory markers (e.g., CRP) and white blood cells
Rx of diverticulitis
co amoxicillin for 5 days
analgesia (avoid NSAIDs and opiates)
avoid solid food until improved (2-3 days later)
rx of diverticulitis if acute abdomen
Nil by mouth or clear fluids only
IV antibiotics
IV fluids
Analgesia
Urgent investigations (e.g., CT scan)
Urgent surgery may be required for complications
complications of diverticulitis
perforation and peritonitis
abscess
large haemorrhage
fistula
ileus or obstruction
Presentation of acute cholecystitis
fever
RUQ
positive Murphys sign
ix of choice of acute cholecystitis
USS
Presentation of ascending cholangitis
fever, RUQ pain, jaundice (charcots triad)
Ix and Rx of ascending cholangitis
Ix - USS
Rx - IV abx. ERCP after 24-48hrs to relieve any obstruction
rx of acute cholecystitis
IV abx
Lap Cholecystectomy within 1 week
Rx of acute pancreatitis
fluid resus - can have large 3rd space losses. Aggressive fluid resus, Aim for urine output >0.5ml/kg
maintain nutrition
analgesia
RF for biliary colic
Female
Fat
Forty
Fertile (pregnancy rf)
Presentation of biliary colic
RUQ pain, worse with fatty foods
n+v
No fever or deranged LFTS!
Rx of biliary colic/ gallstones
elective lap chole
pathophys of appendicitis
lymphoid hyperplasia or a faecolith → obstruction of appendiceal lumen → gut organisms invading the appendix wall → oedema, ischaemia +/- perforation
Features of acute appendicitis
periumbilical pain radiating to RIF
may vomit
Mild pyrexia - high temp would indicate mesenteric adenitis
Examination signs in acute appendicitis
Rovsings - palpation in the LIF causes pain in the RIF
Rebound tenderness
rx of appendicitis
appendicectomy and abx
if perfed - abdominal lavage
ix in appendicitis
typically raised CRP and WBC combined with clinical hx are enough to diagnose
femoral vs inguinal hernias
femoral - less common, more common in women than men, more likely to strangulate. Located inferolateral to pubic tubercle
inguinal - most common, more common in men, less likely to strangulate. Indirect and direct. Located superomedial to pubic tubercle
ddx for hernias
Lymphadenopathy
Abscess
Femoral artery aneurysm
Hydrocoele or varicocele in males
Lipoma
Femoral vs Inguinal hernia
presentation of strangulated hernia
pain and tender, systemically unwell, irreducible
rx of femoral hernias
surgery bc of high risk of strangulation
RF for hernias
obesity,
increasing age
surgical wounds
complications of TPN
referring syndrome
infection
thrombophlebitis (if used a peripheral vein but usually put centrally)
definition of volvus
torsion of the colon around its mesenteric axis
rf for sigmoid volvulus
older
chronic constipation
parkinsons
rf for PUD
HPylori
NSAIDs
Steroids
Bisphopshonates
SSRIs
H Pylori triple therapy
PPI + amoxicillin + metro or clarithro
if pen allergic - PI, metro and clarithro
indications for upper GI endoscopy
age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss
ddx for dysphagia
oesophageal ca
oesophagitis
myasthenia graves
pharyngeal pouch
achalasia
