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AH2 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Causes of jaundice

pre, intra and post hepatic

A

pre - gilbert’s disease, haemolytic anaemia, physiological in neonate

hepatic - alcohol, cirrhosis, NAFLD, hepatitis, PBC, PSC, carcinoma, heart failure, haemochromatosis

post - choledocholithiasis, head of pancreas cancer, biliary stricture

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2
Q

Labs for pre, intra and post hepatic jaundice

A

pre - unconjugated bilirubin, normal transaminases, intravascular haemolysis has Hb and hemosoderin in urine, IV and EV haemolysis has urobilinogen

hepatic - mixed bilirubin, tranaminitis, deranged synthetic function

post - conjugated, increased ALP/GGT, bilirubinuria (no urobilinogen; not making it to the SI)

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3
Q

types of biliary stones

A

mixed cholesterol (80%)
pure cholesterol
pigment stones - bilirubin
brown - infection

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4
Q

complications of gallstones

A 
biliary cholic
cholecystitis
choledocholithiasis
cholangitis
pancreatitis
gallstone ileum
gallbladder empyema
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5
Q

common bacteria in biliary tract

A 
klebsiella
enterococcus
e coli
enterobacter
proteus
pseuodmonas
serratia
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6
Q

pathogenesis of biliary colic vs acute cholecystitis

A

biliary colic - transient obstruction of GB neck or cystic duct, contraction against obstruction causes pain

acute cholecystitis - sustained obstruction of GB neck or cystic duct, obstruction leads to inflammation and bacterial inflammation, inflammation is detected by parietal peritoneum

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7
Q

management of acute cholecystitis

A

medical - gentamicin and amoxycillin

surgical - lap cholecystectomy with IOC or percutaneous cholecystostomy for those unfit for surgery

supportive - U/O, NBM, IV, analgesia, anti emetics, VTE prophylaxis

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8
Q

signs of CBD obstruction

A 
jaundice
raised bilirubin 
pale stool
dark urine
deranged LFTs
dilated bile ducts
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9
Q

complications of CBD obstruction

A 
cholangitis
pancreatitis
perforation 
biliary stricture
biliary cirrhosis
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10
Q

what is charcot triad and Reynolds pentad

A

for cholangitis

RUQ pain, fever, jaundice

pentad - add hypotension and altered LOC

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11
Q

Counselling for laparoscopic cholecystectomy

A

brief history

before - NBM, bloods, GA, prophylactic antibiotics

during - key hole, a few ports, IOC performed, GB removed

after - monitoring, ward, analgesia, chest physio, discharge next day
long term - recovery around 2 weeks, no heavy lifting, no driving until pain free

benefits - definitive, simple

risks - general, bleeding of cystic artery, perforation of biliary tree or gut, conversion to open, incisional hernias and adhesions

alternatives - open surgery, oral dissolution, watch and wait

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12
Q

what is courvoisier’s law

A

painless dilated palpable gallbladder with jaundice is unlikely gallstones

indicated head of pancreas or gallbladder malignancy

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13
Q

risk factors for hepatocellular carcinoma

A

chronic liver inflammation - viral hep, alcoholism, NAFLD, haemochromatosis, PBC

other - smoking, OCP, fam hx, aflatoxin

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14
Q

cancers that metastasise to the liver

A 
colorectal
stomach
pancreas
breast
lung
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15
Q

contraindications to liver transplant

A 
malignancy that is extra hepatic
severe cardioresp disease
ongoing alcohol or drug use
AIDS
sepsis
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16
Q

scoring of cirrhosis

A

child pugh

albumin
bilirubin 
coagulation - INR
distension - ascites
encephalopathy
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17
Q

clinical signs and management of splenic trauma

A

LUQ pain and tenderness

Kehr’s sign - radiating left shoulder pain

hypovolemic shock
peritonism

mx - bloods, fast USS, CT CAP with contrast, resuscitations, laparotomy

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18
Q

post splenectomy management

A

vaccinations

amoxycillin given to take at first sign of infection

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19
Q

general cause of the following patterns of onset for acute abdomen
- sudden, cramps and slow, severe and worsening, colicky

A

sudden - visceral perforation
crampy and slow - visceral obstruction
severe and steadily worsening - intestinal ischaemia
colicky - bowel obstruction or ureteric stones

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20
Q

red flag symptoms for upper GIT

A

ALARMS

anaemia
loss of weight
age >55
recent onset
malena or haematochezia
swallow difficulty
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21
Q

aetiology of PUD

A 
h.pylori
NSAIDs
physiological stress 
ischaemic 
zollinger-ellison
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22
Q

pathogenesis of PUD from h.pylori

A

stimulates acid hyper secretion from parietal cells
breaks down mucosal layer
inflammatory response
gastric metaplasia

protease - breaks down mucous
urease - converts urea to NH3 to neutralise acid
flagella - motile in mucus

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23
Q

diagnosis and eradication of h.pylori

A

dx - urea breath test, serology, stool Ag, biopsy

eradication - esomeprazole, clarithromycin, amoxicillin (PPI + gram -ve + gram +ve)

24
Q

duodenal vs gastric ulcers

A

duodenal - most common, epigastric pain relieved by eating, worse at night and before meals

gastric - lesser curvature, epigastric pain worse with meals, relieved with antacids

25
Q

complications of PUD

A 
IDA
haemorrhage
perforation 
gastric outlet obstruction 
gastric cancer
26
Q

Ddx hematemesis

A 
varices
oesophagitis
mallory weiss tear 
PUD
gastritis
gastric or oesophageal cancer
27
Q

classification of hiatus hernias

A

sliding (90%) - GOJ +/- cardia hernias through oesophageal hiatus

rolling - fundus herniates alongside normal GEJ creating a bubble of stomach

28
Q

management of hiatus hernias

A

conservative - weight loss, smaller meals, smoking cessation, PPI

surgery - if severe symptoms, fundoplication

29
Q

pathophysiology of indirect inguinal hernia

A

incomplete obliteration of processus vaginalis leaves open communication with internal peritoneum

30
Q

course of the inguinal canal

A

inferiorly and medially, deep to superficial, through abdominal wall

superior and parallel to inguinal ligament

lateral to inferior epigastric artery

31
Q

location of deep and superficial inguinal ring

A

deep - mid inguinal point between ASIS and pubic symphysis

superficial - opening of external oblique superior to pubic tubercle

32
Q

walls of the inguinal canal

A

posterior - transversalis fascia
anterior - external oblique
roof - transversalis fascia, transversus abdomens and internal oblique
floor - inguinal ligament

33
Q

contents of inguinal canal in males and females

A

male - spermatic cord, ilioinguinal nerve

female - round ligament, ilioinguinal nerve

34
Q

contents of spermatic cord

A

3 arteries - cremasteric, ductus deferens, testicular
3 nerves - genital branch of genitofemoral, sympathetic fibres, cremasteric
3 other - ductus deferens, lymphatics, pampiniform plexus

35
Q

what is hesselbach’s triangle and what the the borders

A

direct hernias go through here

superolateral - inferior epigastric vessels
medial - rectus abdominus lateral border
inferior - inguinal ligament

36
Q

risk factors for hernias

A 
male
weak abdominal wall - scar, congenital
chronic cough
constipation
straining to urinate
vomiting
pregnancy and childbirth 
heavy lifting 
obesity
37
Q

management options for hernias

A

conservative

  • if hernia is reducible and asx
  • abdominal binder
  • correct cause of raised IAP

surgery
- incarceration, obstruction, strangulation

38
Q

indirect vs direct vs femoral hernia

A

indirect - most common, superior to inguinal ligament, medial to pubic tubercle, cough impulse positive over deep ring

direct - less common, through hasselbachs triangle, less complications, bulge will be medial in cough impulse

femoral - more in females, inferior to inguinal ligament, lateral to pubic tubercle, no cough impulse, often irreducible, medial to femoral artery and vein

39
Q

specific complications of hernia repair

A 
scrotal haematoma
urinary retention 
scar - hernia, adhesion
infection of mesh
chronic inguinal pain 
nerve injury - ilioinguinal and femoral 
testicular atrophy 
damage to vas deferens
40
Q

causes of SBO

A

extramural - adhesion, hernia, mass

intramural - intussusception, stricture, ischaemia, neoplasm

intraluminal - gallstone ileum, FB

41
Q

4 hallmarks of SBO

A

abdominal pain - colicky and cramping, central
vomiting - bilious then feculent
absolute constipation
abdominal distension

42
Q

red flags for SBO

A

constant pain
increased severity
generalised peritonsim
feculent emesis

43
Q

Ix for SBO

A

bedside - dipstick, VBG, bHCG

bloods - FBC, UEC, CMP, LFT, lipase, G&H

imaging - erect CXR, AXR, CT abdo

44
Q

CT findings for SBO

A

dilated small bowel loops >3cm, mucosal folds go across entire lumen, distal bowel decompression

45
Q

management of SBO

A

conservative

  • drip and suck
  • NGT with suction and NBM
  • IVF

surgical

  • obstruction >48hrs conservative
  • strangulation, perforation
  • triple Abx therapy
46
Q

causes of LBO

A

most common - CRC, diverticular disease, volvulus

extramural - volvulus, adhesion
intramural - CRC, diverticulitis, stricture
intraluminal - faecal impaction, FB
pseudo-obstruction

47
Q

management of LBO

A

IVF
drip and suck
surgery
supportive

48
Q

gastric cancer

diffuse (hereditary) vs adenocarcinoma (sporadic)

A

diffuse - rare, genetic mutation, diffuse thickening of stomach wall, infiltrates entire stomach, poor prognosis

adenocarcinoma - more common, lifestyle risk factors, projectile tumour, better prognosis

49
Q

symptoms and signs of appendicitis

A

sx - migratory abdo pain, n&v, anorexia

signs - still, febrile, involuntary guarding, peritonism, mcburney’s point, rousing’s, psoas and obturator sign

50
Q

management of appendicitis

A

active - lap appendicectomy with cephazolin and metro

supportive

51
Q

specific risks of appendicectomy

A 
abdominal abscess 
adhesions
incisional hernia 
damage to bowel (resect bowel)
conversion to open 
if appendix is adhered to colon, need to remove part of that too
52
Q

types of neoplastic and non neoplastic polyps

A

neoplastic - adenomas (tubular, tubulovillous, villous), hamartomas

non neoplastic - hyperplastic, inflammatory pseudopolyps

53
Q

hyperplastic polyp vs adenoma

A

hyperplastic polyp - common, <5mm, no malignancy potential

adenoma - 3-10mm, can become malignant, dysplastic

54
Q

Types of benign breast conditions

A

Inflammatory - mastitis, abscess, ductal ectasia, fat necrosis
Benign neoplasms - fibrocystic change, fibroadenoma, lipoma

55
Q

Treatment of mastitis and breast abscess

A

Flucloxacillin and continued breast feeding for both

Abscess - I&D

Paracetamol, hot and cold packs, correct breastfeeding positioning and attachment

56
Q

2 types of invasive breast cancers

A

ductal - dense fibrous stroma with radiating bands

lobular - pleomorphic small cells form linear single-line clusters, stromal pattern of spread

AH2 (5 decks)

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