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Sheff Phase 4 > Gen / Uro Surgery > Flashcards

Gen / Uro Surgery Flashcards

1
Q

Why appendicitis pain 1st periumbilical and then moves to right iliac fossa ?

A

initially irritation of visceral peritoneum by inflammed appendix -> T10 dermatome (midgut) (periumbilical)

As progresses - parietal peritoneum affected and slowly localises to there

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2
Q

Define hernia

A

the protrusion of a structure through the wall of the cavity in which it is usually contained

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3
Q

Direct vs indirect inguinal in relation to inferior epigastric vessles

A 
Indirect = lateral 
direct = medial
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4
Q

2 options for haemorrhoids Mx

A

conservative - increase fluid / fibre

medical - laxatives

surgical - rubber band ligation, cryotherapy, haemorrhoidectomy

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5
Q

foregut, midgut, hindgut blood supply

A

F - Celiac trunk
m - superior mesenteric
h - inferior mesenteric

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6
Q

Seen on bloods of mesenteric ischemia

A

metabolic acidosis

Raised:
Amylase 
WCC 
lactate
hB
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7
Q

Mx of mesenteric ischemia surgery aim?

mx pre surgery?

A

remove necrotic tissue
revascularise

Fluid resus
Abx
heparin
Analgesia

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8
Q

Function of red pulp / white plup of spleen?

A

Red - destroys defunct RBCs

White - lymphoid tissue for immune system

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9
Q

2 indications for splenectomy?

What organisms suseptable to after and therefore Mx?

A

Trauma, spontaneious rupture, hypersplenism, Ca, abscess

Encapulated bacteria

  • lifelong prophylactic Abx (penV / eryth)
  • Vaccinations
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10
Q

What are howell-jolly bodies ? When seen?

A

RBCs where nuclear remenant is still seen

No spleen - as would usually filter these out

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11
Q

Acute pancreatitis key Blood test?

A

Serum Lipase

amylase good but can be normal

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12
Q

2 early and 2 late comps of acute pancreatitis

A

Shock, ARDS, sepsis, DIC, renal failure

abscess, chronic pancreatitis, necrosis, thrombosis of spenic/duodenal arteries

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13
Q

clinical sign to differentiate ileus / mechanical obstruction

A

No bowel sounds - ileus

tinkling - obstruction

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14
Q

How to differentiate small and large bowel obstruction

A

axr

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15
Q

immediate Mx of bowel obstruction

A

drip and suck

[NBM
NG tube -suck gastiric contents produced
IV fluids ]

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16
Q

name 2 things found in bile

A 
bile salt 
bile pigment 
cholesterol 
phospholipid 
water
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17
Q

Name 2 types of bile stone

A

pigment stone
cholesterol stone
mixed

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18
Q

Name the 4 lobes of the liver and the ligament that divides the anterior 2 segments

A

right, left, caudate, quadrate

falciform ligament

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19
Q

4 causes of acute urinary retention?

2 key examinations to do?

A

UTI, BPH, pelvic nerve damage, constipation
anticholinergic/opiate/antidepressants

Abdo / peripheral nerve (Cauda equina)

20
Q

Acute vs chronic rentention - volume/pain?

A

Chronic = bigger Eg 1.5L and painless

21
Q

What is post-obstructive diuresis ? mx?

A

post retention -> keep producing large volumes of urine

Hourly urine output monitoring with IV replacement of fluid loss

22
Q

2 classes + drug for BPH + mech

A

alpha-1 receptor antagonist - tamulosin
->relaxes smooth muscle

anti-androgen 5-alpha reductase inhibitor - finasteride
->inhibits conversion of testosterone -> dihydrotestoterone

23
Q

Suspicious of bladder Ca
2 initial Ix after urinanalysis?
2Mx?
3 ways it can spread?

A

Renal tract USS
Flexible cystoscopy
urinary cytology
[KUB XR/CT]

TURBT
Intravesical chemo

Local: Pelvic Eg ureters, rectum, pelvic wall
Lymp: Iliac / paraaortic nodes
Haem: liver, lungs, bones

24
Q

Why Abx cover for prostate biopsy

A

prevent bowel flora as transrectal biopsy

25
Q

Score for prostate Ca prognosis

A

gleason

26
Q

Likely histology of renal Ca in child? adult?

A

c - nephroblastoma

Adult - RCC

27
Q

2 Factors which affect suitability for major surgery

A

Stage of tumour

Comorbidities - IHD, COPD, Obesity

28
Q

2 pros and 2 cons of laparoscopic

A

Reduced perioperative pain
Reduced hospital stay
Reduced bleeding
Less visible scar

Increased length of op
poorer operative views
need specialist equipment and training

29
Q

3 RFs for RCC

A 
VHL 
Age 
male 
smoking
obesity
HTN
30
Q

Suspect renal stone
1st bedside test?
Dx ix?

A

Urinalaysis

CTKUB

31
Q

Why pain in uretic stones?

Why pain radiate to groin ?

A

Spasm from peristalsis trying to relieve obstruction
-> ischemia and pain

Visceral pain to kidney + ureter follows similar path to somantic nerve supply to gonads

32
Q

renal Stone -> fever

post ABCDE + fluids + abx what Mx?

A

percutaneous nephrostomy

-> relieve infected obstruction of urine

33
Q

Where is a hydrocoele?
Initial Ix?
Radiolgical?

A

In the tunica vaginalis

Transilluminate with a torch

USS

34
Q

2 secondary causes of hydrocoele

A

trauma
infection
tumour

35
Q

hydrocoele in <1 indicates? Mx?

A

indicates a patent process vaginalis

conservative - most will resolve by 1

36
Q

2 TURP specific complications

A

TURP syndrome
bladder wall injury
retrograde ejaculation

37
Q

Pros of spinal over GA

A

Less resp complications
quicker dischage
better pain relief post op
less bleeding

38
Q

What happens in TURP

A

irrigation fluid enters prostatic bed

-> fluid overload and hypoNa (seizures etc.)

39
Q

Define stress and urge incontinence

A

Stress - Urine leaks when raised abdo pressure + vesical pressure > urethral spnincter

Urge - Sudden urge due to overactive nerve supply

40
Q

3 causes of stress incontinence

A

pelvic floor damage - eg childbirth / surgery
chronic cough
obesity

41
Q

conservative mx of incontinece

A

weight loss, smoking cessation, less drinks / alcohol / caffine,
pelvic floor exercises
pessaries

42
Q

2 psychological impacts of incontinece

A

Embarrassment in public
cant do activities as need to be near toilet
social stigma of incontince

43
Q

incontinece - 1 drug + mechanism + 3 SE

A

oxybutinin / desmopressin
anticholinergic - less spasms

Dry mouth, constipation, difficulty urinating, blurred vision, acute closed angle glaucoma, drowsie, dizzy

44
Q

2 causes of reccurent UTI

A

immunsupression
bladder outlet obstruction
neuropathic bladder
colovesical fistula

45
Q

2 causes of urethral stricture

A 
trauma 
insertion of foreign bodies 
long term catheter 
gonno/chlamid
lichen sclerosis [usually at meatus]
46
Q

2 Ix for urethral stricture

1mx

A

cystoscopy
urinanalysis
renal function
urodynamic testing with flow cystometry

Urethroplasty
urethotomy

47
Q

Why would you get bladder diverticulum and what happens?

A

high pressures eg stricture -> outpouching

-> chronic infection with Ecoli / pseudomonas /

Sheff Phase 4 (26 decks)

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