General Flashcards
Acute pancreatitis: causes
GET SMASHED Gallstones EToH Trauma Steroids Mumps AI (polyarteritis nodosa) Scorpion venom Hyperlipidaemia / hypercalcaemia ERCP Drugs (oestrogens, sulphonamides, azathioprine etc)
Acute pancreatitis: severity criteria
Modified Glasgow criteria: PANCREAS PaO2 <8kPa Age >55 Neutrophilia WBC >15x10^9/L Calcium <2mmol/L Renal: urea >16mmol/L Enzymes: LDH >600iu/L (or ASP>200iu/L) Albumin <32/L Sugar BM>10mmol/L
What anaesthetic scoring system is used to assess a pt’s fitness for surgery?
American Society of Anaesthesiologist’s score:
- ASA I - healthy pt
- ASA II - mild systemic dx with no functional limitations
- smoker, pregnancy, 30<bmi></bmi>
- ASA III - moderate/severe systemic dx
- BMI>40, poorly controlled asthma/T2DM/HTN, COPD, ESRD (on dialysis), active hepatitis, alcohol dependence, CVA/MI >3m ago
- ASA IV - life-threatening chronic disease
- CVA/MI <3m ago, ongoing IHD, severe valve dysfunction, ESDR (not on dialysis), DIC, ARDS, sepsis
- ASA V - moribund pt needing life-saving surgery
- Ruptured AAA, massive trauma, intracranial bleed
- ASA VI - brain-dead pt for organ donation
Identify the possible complications of hernias (femoral, inguinal, miscellaneous)
Incarceration: irreducibilty
Obstruction: constriction of bowel loops
Strangulation: arterial occlusion –> infarction –> peritonitis +/- abscess
(AS, Adam)
Generate a management plan for inguinal hernias
- Surgical
- Open: Lichtenstein Tension Free Mesh Repair
- Laparoscopic: Totally ExtraPeritoneal (TEP), Trans-Abdominal Pre-Peritoneal (TAPP) . Better for bilateral
(AS)
Generate a management plan for femoral hernias
- Surgical
- Elective: Lockwood Low Approach
- Emergency: McEvedy High Approach
- Elective: Lockwood Low Approach
(AS)
What are the different type of hiatus hernia?
- Type 1: sliding (95%): displacement of GOJ above diaphragm
- Type 2: Rolling: displacement of gastric fundus through defect in phrenooesophageal membrane
- Type 3: 1+2
- Type 4: stomach + another abdominal organ herniated
(AS, Adam)
What repair is usually used for a paraumbilical hernia?
Mayo Repair
(AS)
What is a hydrocoele? What are the different types?
accumulation of fluid within the tunica vaginalis
- vaginal: doesn’t extend up cord
- congenital: patent processus vaginalis
- infantile: processus vaginalis closed at deep ring, open along the cord –> hydrocoele of the cord
(AS)
What are the indications for a stoma?
- Exteriorisation
- Perforated or contaminated bowel (eg Hartmann’s)
- Permanent (AP resection)
- Diversion
- Protection of distal anastomosis
- Contamination: eg faecal peritonitis
- Anatomical: eg ileorectal anastomosis
- Acute Crohn’s
- Urinary diversion following cystectomy
- Protection of distal anastomosis
- Decompression: bypass of distal obstructing lesion
- Feeding: gastrostomy / jejunostomy
(AS)
What is a stoma?
An artificial opening between an internal viscera and the external environment
What are the potential complications of having a stoma
- Early: ‘FOUL’
- Fluid loss: haemorrhage + high-output stoma (–> dehydration)
- Odour
- Ulceration of skin
- Leakage
- Late: ‘SHITS’
- Stenosis
- Herniation + prolapse
- Ischaemia
- Terminal ileum loss –> impaired absoprtion of bile salts + B12
- Social, sexual and psychological impact
(AS, Adam)
How do you examine a stoma?
- Inspect: (‘SCARS’)
- Site
- Contents: ask pts to remove bag (solid stool, liquid stool, urine)
- Appearance:
- spout, prolapse
- lumen (number)
- mucosal health, surrounding skin
- Rod (in loop ileostomy, keeps both open)
- Scars: no scar suggests colonoscopy-assisted trephine colostomy
- Palpate:
- for parastomal hernia
- offer to digitate stoma for strictures
- Examine perineum
(AS)
