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6th Year Surgery MJ > general > Flashcards

general Flashcards

1
Q

fistula define

A

abnormal connection between 2 epithelial surfaces

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2
Q

can fistula resolve spontaneously

A
  • as a general RULE, all fistulae will RESOLVE SPONTANEOUSLY as long as there is no DISTAL OBSTRUCTION
  • especially true for intestinal fistulae
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3
Q

what ABs can be used to screen for thyroid cancer reccurence

A

thyroglobulin ABs

  • this is the major constituent of colloid + precursor of thyroid hormones
  • can be elevated in those with mets or recurr thyroid C
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4
Q

Boas’s sign in acute cholecystitis

A

hyperaesthesia beneath right scapula in acute cholecystitis

-occurs as abdo wall innervation of this region is from SPINAL ROOTS that LIE at this LEVEL

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5
Q

epigastric pain that worsens on lying down + radiates to back is typical of what

A

pancreatitis

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6
Q

what are the 3 primary malignant tumours of bone causing pathological #

A
  1. Chondrosarcoma
  2. Osteosarcoma
  3. Ewing’s tumour
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7
Q

inguinal hernia define

A

protrusion of viscera or abdominal contents through the superficial inguinal ring
-either INDIRECTLY through deep inguinal ring OR DIRECT ING H protruding through defect in posterior wall of inguinal canal

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8
Q

what is it called if a hernia cannot be reduced

A

INCARCERATED

-these hernias are at risk of strangulation = surg emergency

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9
Q

strangulated hernia presentation

A

SURG EMERG - where blood supply to herniated T is compromised –> ischaemia or necrosis
-Sx: pain, F, incr in size of hernia or erythema of overlying skin, peritonitis, bowel obstruction eg N, V, distension, bowel ischaemia eg bloody stools

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10
Q

MW tear features

A
  • usu antecedent vomiting
  • then vomit small am of blood
  • usu little systemic disturbance or prior sx
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11
Q

Hiatus hernia of gastric cardia features

A
  • often longstanding hx of dyspepsia, pts often OVERWEIGHT

- uncomplicated hiatus H should not be assoc with dysphagia or haematemesis

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12
Q

Oesophageal rupture features

A
  • complete disruption of oesophageal wall in absence of pre-existing pathology
  • left postero-lateral oesophagus is commonest site (2-3cm from OG jtn)
  • sx: severe CP without cardiac dx + signs suggestive of pneumonia without convincing hx, where there is hx of vomiting
  • erect CXR shows infiltrate or effusion in 90% cases
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13
Q

SCC of oesophagus features

A

History of PROGRESSIVE DYSPHAGIA

  • Often signs of W.LOSS
  • Usually little or NO hx of previous GORD type sx
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14
Q

Adenocarcinoma of oesophagus features

A

PROGRESSIVE DYSPHAGIA, may have previous Sx of GORD or Barretts oesophagus

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15
Q

Peptic stricture features

A
  • Longer hx of dysphagia, often not progressive
  • Usually sx of GORD
  • Often lack systemic feat seen with malignancy
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16
Q

Dysmotility disorder features

A
  • May have dysphagia that is EPISODIC and NON-PROGRESSIVE

- Retrosternal pain may accompany the episodes.

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17
Q

when to request a NON-URGENT OGD in pts

A

=Patients with HAEMATEMESIS

=Patients aged >= 55Y who’ve got:

  • -treatment-resistant dyspepsia or
  • -upper abdo pain with low haemoglobin levels or
  • -raised platelet count with any of: N, VOM, W.LOSS, reflux, dyspepsia, upper abdominal pain
  • -N or VOM with any of the following: W.LOSS, REFLUX, DYSPEPSIA, upper abdominal pain
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18
Q

MX pts who do not meet referral criteria = UNDIAGNOSED DYSPEPSIA

A

DYSPEPSIA = complex of UGI tract sx which are typically pres for 4+ weeks, including upper abdo pain or discomfort, heartburn, acid reflux, N and/or V

Mx: step wise

  1. review meds for poss cause
  2. lifestyle advice
  3. trial of full dose PPI for 1m OR a test + treat approach for H.Pylori - if sx persist after either of the above approaches then try alt
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19
Q

red flags requiring urgent OGD - within 2weeks

A

1-ALL patients who’ve got DYSPHAGIA
2-ALL pts who’ve got an upper abdominal mass consistent with STOMACH C
3-Patients aged >= 55 years who’ve got W.LOSS, AND any of the following:
–upper abdominal pain
–reflux
–dyspepsia

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20
Q

SBO sx + raised amylase, what is dx

A

SBO

  • amylase can be raised in SBO not just pancreatitis
  • another differentiator is that in pancreatitis you wouldn’t get problems passing stools or flatus
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21
Q

wehn to do a thoracotomy in haemothorax

A

> 1.5L blood initially or losses of >200ml per hour for >2 hours

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22
Q

when to do a thoracotomy in haemothorax

A

> 1.5L blood initially or losses of >200ml per hour for >2 hours

23
Q

blockage of which ducts commonly does NOT cause jaundice and WHY

A

Blockage of CYSTIC DUCT or GALLBLADDER does NOT cause jaundice

  • bile can still flow down from liver (where it is made) to the common hepatic duct, to common bile duct and then to sphincter of Oddi –> secreted into duodenum
  • This is why CHOLECYSTITIS is RARELY assoc with JAUNDICE
24
Q

gastric volvulus triad

A

1/VOMITING
2/PAIN
3/failed attempts to pass an NGT

25
Q

Haemorrhoids locations + tx

A

PAINLESS BRIGHT RED RECTAL BLEEDING
3,7, 11 o clock
internal or external
tx: conservative, rubber band ligation, haemorrhoidectomy

26
Q

Anal fissure pres + location

A

PAINFUL rectal bleeding
-location: midline 6 (90%) + 12 o clock position
distal to dentate line

27
Q

chronic anal fissure triad

A

> 6/52

1.ulcer 2.sentinel pile 3.enlarged anal papillae

28
Q

proctitis causes x3

A

Chrons
UC
C.Diff

29
Q

ano rectal abscess organisms + posoitions

A
  • org’s: E.coli, Staph aureus
  • positions: perianal, ischiorectal, pelvirectal, intersphincteric
  • present with fever + severe ano-rectal pain
  • mx: Examination under GA + drainage of sepsis
30
Q

anal fistula

A

Fistulas usually occur following previous ano-rectal sepsis

  • The discharge may be foul smelling and troublesome
  • Mx: Pts should be listed for EUA. Fistulas which are low and have little or no sphincter involvement are usually laid open.
  • goodsalls rule determines location (use MRI to figure out path)
31
Q

rectal prolapse

A

Associated with childbirth and rectal intussceception

-May be internal or external

32
Q

pruritis ani

A

v. common

- in children often related to worms, in adults, idiopathic or related to other causes eg haemorrhoids

33
Q

anal neoplasm

A

SCC commonest unlike adenocarcinoma in rectum

34
Q

solitary rectal ulcer

A
  • Assoc with chronic straining and constipation
  • Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)
35
Q

Surgical Jaundice: Gallstones - features

A

Typically hx of biliary colic or ep of chlolecystitis

-Obstructive type hx + test results

36
Q

Surgical Jaundice: Gallstones - pathogenesis

A

Usually small calibre gallstones which can pass through the cystic duct
-In Mirizzi syndrome the stone may compress the bile duct directly- one of the RARE times that cholecystitis may present with jaundice

37
Q

Surgical Jaundice: Cholangitis

A

Features - Usually obstructive and will have Charcots triad of symptoms (pain, fever, jaundice)
-patho: Ascending infection of the bile ducts usually by E. coli and by definition occurring in a pool of stagnant bile.

38
Q

Surgical Jaundice: pancr C - features

A

Typically painless jaundice with palpable gallbladder (Courvoisier’s Law)

39
Q

Surgical Jaundice: pancr C - pathogenesis

A

Direct occlusion of distal bile duct or pancreatic duct by tumour. Sometimes nodal disease at the portal hepatis may be the culprit in which case the bile duct may be of normal calibre.

40
Q

Surgical Jaundice: TPN associated jaundice featurs + pathogenesis

A

features - Usually follows long term use and is usually painless with non obstructive features
patho - Often due to hepatic dysfunction and fatty liver which may occur with long term TPN usage.

41
Q

Surgical Jaundice: Bile Duct Injury features + patho

A

Depending upon the type of injury may be of sudden or gradual onset and is usually of obstructive type
-patho: Often due to a difficult cholecystectomy when anatomy in CALOTS triangle is not appreciated. In the worst scenario the bile duct is excised and jaundice offers rapidly post operatively. More insidious is that of bile duct stenosis which may be caused by clips or diathermy injury.

42
Q

Surgical Jaundice: Cholangiocarcinoma features + patho

A

feat - gradual onset obstructive pattern

patho: Direct occlusion by disease and also extrinsic compression by nodal disease at the porta hepatis.

43
Q

Surgical Jaundice: Septic surgical patient - feat + patho

A

usu hepatic features

patho - Combination of impaired biliary excretion and drugs such as ciprofloxacin which may cause cholestasis.

44
Q

metastatic disease - feat + patho

A

feat - mixed hepatic+ post-hepatic
patho -Combination of liver synthetic failure (late) and extrinsic compression by nodal disease and anatomical compression of intra hepatic structures (earlier)

45
Q

how to mx pt with sigmoid volvulus with sx of peritonitis

A

skip flexi sig

treat with urgent midline laporotomy - to avoid bowel necrosis or perforation

46
Q

modified GLASGOW scofe - use acronym PANCREAS

A 
Po2 <8
AGE >55
Neutrophilia WBC>15x10^9
Calcium <2
Renal ftn Urea>16
Enzymes - LDH>600, AST>200
Albumin <32
Sugar (bl gl) >10
47
Q

what procedure in acutely unwell UC pt with fulminant disease that has developed TMColon

A

SUB TOTAL COLECTOMY

-safest - rectum left in situ as resection of rectum in acutely unwell pts –> high risk of complications

48
Q

what procedure is best for severe rectal chrons with complications

A

PROTECTOMY

-Not with ileoanal pouch best to use ileostomy

49
Q

what is a useful test of exocrine function of chronic pancreatitis

A

faecal elastase

50
Q

red flags for colon c requiring 2 WW referral x5

A
  1. Weight loss
  2. Persistent change in bowel habits
  3. Unexplained rectal bleeding
  4. IDA
  5. Abdo mass on examination
51
Q

what to do if concerns about new sx of possible colorectal c but not meeting 2 WW criteria

A

FIT TEST
can request in:
>= 50 years with unexplained abdominal pain OR weight loss
< 60 years with changes in their bowel habit OR iron deficiency anaemia
>= 60 years who have anaemia even in the absence of iron deficiency

52
Q

thrombosed haemorrhoids

A

SIGNIF PAIN + TENDER LUMP

  • O/E: purple, oedematous, tender SC perianal mass
  • if pts present within 72h then referral should be considered for EXCISION
  • otherwise Mx pts with STOOL SOFTNERS, ICE packs + ANALGESIA
  • sx usu settle wtihin 10d
53
Q

Hiatus Hernia define + types + RF

A

define = herniation of part of stomach above the diaphragm

sliding = 95% - GOJ moves aboves D
rolling = paraoesophageal = GOJ remains below D but seperate part of stomach herniates through oesophagela hiatus

RF: Obesity, incr intraabdominal pressure eg ascites, multiparity

54
Q

Hiatus Hernia features, Ix + Mx

A 
Features: 
heartburn
dysphagia
regurgitation
chest pain

Ix:

  • barium swallow is the most sensitive test
  • given the nature of the symptoms many patients have an endoscopy first-line, with a hiatus hernia being found incidentally

Mx:

  • all patients benefit from conservative management e.g. weight loss
  • medical management: PPI therapy
  • surgical mx: only really has a role in symptomatic paraesophageal hernias

6th Year Surgery MJ (6 decks)

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