Gen Surgery

Question 1

Haemorrhoids

Answer 1

Mucosal vascular cushions at 3,7,11 o’clock positions on anus

Presenters with painless bleeding

External: below dentate line, prone to thrombosed which is painful
Internal: above dentate line

Grade: 
1 not prolapse
2 prolapse but reduce by itself
3 prolapse but can be reduced by hand
4 can’t be reduced

Mx: soften stools with dietary fibre and fluid
Topical analgesia and steroids
Rubber band ligation as O/P better than injection sclerotherapy
Surgery

Acute thrombosed external ones: severe pain
If<72 hrs then refer for excision otherwise stool softeners+ice pack+analgesia, symptoms usually settle in 10 days

3

Question 2

Anal fissure

Answer 2

Midline crack(posterior midline)
Equally in men and women
Usually caused by constipation, but also Crohn’s disease

Presents with pain after defecation, painful+ bright red+ rectal bleeding

Mx: dietary advice(high-fibre diet with high fluid intake)
Bulk- forming laxatives(Fybogel)
Topical anaesthetics
Analgesia
1st line is Topical GTN for chronic anal fissure

Question 3

Septic arthritis

Answer 3

Causes: staphylococcus aureus(most common), strep, gonococcal(in sexually active teenagers)
Px: painful joints(especially on passive movements), fever, swollen and hot joint,
in contrast to transient synovitis(preceding viral infection, painful joint-usually hip in a kid)
Dx: clinical
Tx: IV abx +joint washout