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General Stuff Flashcards

1
Q

Borders of Hasselbachs triangle

A

Medial border: lateral border of rectus abdominis
Lateral border: Inferior epigastric vessels
Inferior border;inguinal ligament

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2
Q

Wish list for hernia exam

A

1) Auscultate hernia
2) Abdo exam for ascites, masses,palpable bladder
3) Respi exam for chronic cough causes(COPD,asthma)
4) DRE for BPH, constipation, Rectal masses
5) Social Hx

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3
Q

How to differentiate direct and inguinal hernia

A
  1. Medial vs lateral to inf. Epigastric vessels
  2. Cannot vs can extend into scrotum
  3. Emerges from Hasselbachs triangle vs superficial ring
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4
Q

Mid inguinal point vs midpoint of inguinal ligament

A

Location of femoral artery vs location of deep ring(2FBs above)

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5
Q

Femoral hernia vs inguinal hernia

A

Femoral hernia below inguinal ligament, inferio lateral to pubic tubercle

Inguinal hernia above inguinal ligament, superior medial to PT

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6
Q

Risk factors for acquired hernia

A

1) Old age
2) Smoking
3) Connective tissue disease
4) Male
5) High BMI
6) Causes of increased intraabdominal pressure eg pregnancy

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7
Q

Contents of spermatic cord

A

3 arteries: Testicular artery, cremasteric artery, artery to vas deferens

3 nerve: Ilioinguinal nerve,genital branch of genitofemoral nerve, autonomic nerves

3 others: Vas deferens, pampiniform plexus, lymphatics from testes

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8
Q

Mx of hernia

A

Conservative:
-lifestyle mod eg less standing and heavy lifting
-treat underlying causes
-abdominal truss

Surgical
1) tension free mesh repair(lichtenstein)
2) Tissue repair(tension): Shouldice
3) Transabdominal pre peritoneal repair
4) totally extraperitoneal repair

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9
Q

Specific risks of hernia repair

A

Early
1) Hematoma or Seroma
2) ARU
3) Injury to vas deferens

Delayed
1) Chronic pain
2) Mesh infection
3) Mesh migration
4) Hernia recurrence
5) Ischemic orchitis
6)Impotence

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10
Q

Indications for laparoscopic inguinal hernia repair

A

1) Bilateral inguinal hernia
2) Recurrent hernia from OPEN repair
3) Patient preference

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11
Q

General complications of cancers 4Bs

A

Bleed
Block
Burst
Burrow

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12
Q

Threshold to place IDC instead of in and out for ARU

A

Bladder scan shows vol>500ml due to risk of bladder rupture, obstructive uropathy etc

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13
Q

Crescent sign of umblicus suggests

A

Paraumbiliical hernia

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14
Q

Cx of new stomas

A

Ischemia and necrosis
Dehiscence
Retraction

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15
Q

Cx of old/mature stomas

A

Stenosis
Prolapse
Cellulitis
Fistula
Parastomal Hernia

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16
Q

Features that help identify type of stoma

A

Size of lumen
Number of lumens+stoma key
Location of stoma
Stoma effluent(output) type
spouted or not

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17
Q

Complications of hernias

A

Obstruction
Incarceration
Strangulation
Perforation
Sx eg pain

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18
Q

Functions of a stoma

A
  1. Feeding
  2. Diverting
  3. Decompression
  4. Externalisation
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19
Q

Common causes of intestinal obstruction

A
  1. Adhesions
  2. Incarcerated hernia
  3. CR Ca

Rarer: Strictures due to RT, IBD, extrinsic tumors, gallstone,

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20
Q

3 6 9 rule of bowel obstruction

A

SB >3cm

LB >6cm

Caecum >9cm

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21
Q

Signs of SB IO on XR

A
  1. Valvulae conniventes(Stack of coins)
  2. String of beads appearance
  3. Dilated bowel loops
  4. Air fluid levels
  5. These are centrally located
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22
Q

Signs of SB IO on CT

A
  1. Dilated small bowel loops >2.5cm
  2. Small bowel feces sign
  3. Closed loop obstruction
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23
Q

Classification for pelvic ring fractures

A

Young Burgess Classification

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24
Q

Most common type of pelvic ring fx

A

Lateral compression

Commonly pedestrians in RTA

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25
Q

8 parts of extended FAST scan

A
  1. Apical 4 chamber cardiac
  2. Morrison’s pouch
  3. Splenorenal
  4. Bladder/Pouch of Douglas
  5. Lung apices and bases
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26
Q
A
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27
Q

Physiological related cx of stoma

A
  1. High output stoma
  2. Electrolyte imbalances
  3. Dehydration
  4. Nutritional deficiencies
  5. Psychosocial
28
Q

Early cx of stoma

A
  1. Ischemia/necrosis
  2. Retraction
  3. Dehiscence
  4. Stoma bleeding
  5. Ileus
29
Q

Late cx of Stoma

A
  1. Obstruction/adhesions
  2. Prolapse
  3. Stenosis
  4. Parastomal hernia
  5. Parastomal dermatitis
  6. Wound infection
  7. Diversion colitis/diffuse proctitis
30
Q

Landmark differentiating Upper and lower BGIT

A

Ligament of treitz at duodenaljejunal junction

31
Q

Formula for caloric intake

A

Harris Benedict formula

32
Q

Estimated numbers for protein and caloric intake for adults

A

20-30kcal/kg/day
0.8-2.5g/kg/day

33
Q

Complications of TPN

A
  1. Glucose derangements hypo and hyper
  2. Hypertriglyceridemia
  3. PNALD (Associated Liver Disease)
    -steatosis, cholestasis and GB sludge/stones
  4. Infection
  5. Fluid overload
  6. Electrolyte abnormalities
  7. Metabolic bone disease
34
Q

Causes of small bowel IO

A

Adhesions
Hernia
Volvulus

35
Q

Scars for appendicectomy

A

Lower midline,lanz,gridiron

36
Q

Repair of paraumblical hernia

A

Mayo repair “vest over pants repair”

37
Q

Location of ligament of Treitz

A

Duodenojejunal flexure, differentiates UBGIT and LBGIT

39
Q

Principles of Mx of fistula

A
  1. Source control
  2. Delineate anatomy
  3. Prevent recurrence
40
Q

Standard tests for diarrhea workup

A

Stool c/s
OCP
TFT
Fecal calprotectin
C diff

41
Q

Definition of paraneoplastic syndrome

A

Clinical features caused by altered systemic immune response or release of hormones/proteins and not by local tumor cells

42
Q

Classification of CT kidneys for RCC

A

Bosniak classification

43
Q

Mechanism of HyperCa in malignancy

A

1) Paraneoplastic esp SCLC
2) Bone mets/primary
3) Multiple myeloma

44
Q

Most common primary for metastasis to adrenal glands

A

Metastatic melanoma

45
Q

DIfferent forms of BCC

A

Nodular, cystic, pigmented, sclerosing/morpheaform, superficial

46
Q

Margins for melanoma

A

2cm due to high risk of local recurrence

47
Q

Location where lipoma does not give positive slip sign

A

Forehead: lipomas are attached to frontalis?

48
Q

Toxic dose of lignocaine for local anesthesia

A

3mg/kg without adrenaline
7mg/kg with adrenaline

49
Q

Toxic dose of marcaine for local anesthesia

A

2mg/kg without adrenaline
4mg/kg with adrenaline

50
Q

What kind of anesthesia is a Bier’s block

A

Local regional anesthesia

51
Q

Systemic side effects of local anesthesia

A

CNS: Seizures, AMS
CVS: Arrhythmia(lignocaine is a class 1B antiarrhythmic)

52
Q

Eponymous name for omental patch repair

A

Graham patch repair

53
Q

Type of intestinal obstruction best treated by “drip and suck”

A

Adhesion IO

54
Q

Indications for surgery in patient with IO

A
  1. Failure of conservative treatment
  2. Perforation
  3. Closed loop obstruction
  4. Ischemic bowel
  5. Recurrent IO needing adhesiolysis
55
Q

Rigler’s triad of gallstone ileus

A
  1. Gallstone
  2. IO
  3. Pneumobilia
56
Q

Mx of acute anal fissures

A

Medical
1) High fibre diet to reduce constipation
2) Laxatives/ stool softeners
3) Anal sphincter relaxants: Topical GTN or nifedipine

57
Q

Most common site of GIST

58
Q

Area where GIST has best prognosis

59
Q

Mx of chronic anal fissures

A
  1. Botox
  2. Lateral anal sphincterotomy
60
Q

Cancers that require staging laparoscopy

A

Cancers at high risk of transcoelomic spread (Peritoneal metastases)
1. Esophageal esp GEJ
2. Gastric
3. Pancreatic
4. Gallbladder
5. Cholangiocarcinoma

61
Q

High risk lipomas at risk of malignant transformation to liposarcoma

A

Retroperitoneal, groin and in deep subfascial muscles of the extremities(LL>UL)
Large lipoma >7cm

62
Q

What does IPOM repair stand for

A

Intra peritoneal Onlay Mesh Repair

63
Q

Risk factors for Bezoar

A
  1. Poor dentition
  2. Gastrectomy with removal of pylorus
    3.
64
Q

Types of bezoar

A
  1. Phytobezoar
  2. Lactobezoar
  3. Trichobezoar
  4. Pharmacobezoar
65
Q

Management of bezoar

A
  1. Removal via OGD/ Colono
  2. Open/ Laparoscopic surgery if bezoar is stuck in small bowel

GS (11 decks)

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