General Surgery Flashcards
What is meant by Class I shock?
Completely compensated for
What is meant by Class II shock?
Tachycardia only
What is meant by Class III shock?
Tachy, hypotension but conscious
What is meant by Hartmann’s procedure?
Removal of a section of the bowel with a colostomy/ileostomy (rather than anastamoses)
Hernia below and lateral to the pubic tubercle is…
Femoral hernia
What are the causes of pancreatitis?
GET SMASHED - Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion bite, Hypertriglyceride/Hypercalcaemia/Hypothermia, ERCP, Drugs
Bruising of the flanks in acute pancreatitis is called…
Grey-Turner’s sign
Pain/catch of breath elicited on palpation of the right hypochondrium during inspiration is called…
Murphy’s sign
Rigler’s sign (double wall sign) suggests…
Free air in the abdomen
Low rectal cancer is usually treated with…
Low anterior resection
How should congenital inguinal hernias be treated?
Refer to surgery (due to high complication rate)
Reddening and thickening of nipple and areola suggests…
Paget’s disease of the nipple
Which antibiotics should be used in severe diverticulitis?
IV Ceftriaxone and Metronidazole
What is the first-line investigation for bowel perforation?
Erect CXR
What is the best first-line investigation in suspected acute critical limb ischaemia?
Handheld arterial doppler
Give red flag symptoms of bowel cancer.
Change in bowel habit, weight loss, fatigue, blood in stool
Which patients with a change in bowel habit should be referred on the urgent cancer pathway?
> 60 or > 50 with another red flag
What is the gold-standard investigation for diagnosing colorectal cancer?
Colonoscopy
What is the tumour marker for cholangiocarcinoma?
CA 19-9
Give 3 causes of LUQ pain.
Gastric ulcer, lower lobe pneumonia, pyelonephritis
Give 4 causes of epigastric pain.
Peptic ulcer, cholecystitis, pancreatitis, MI
Give causes of RUQ pain.
Cholecystitis, Hepatitis, Pyelonephritis
Which investigations are particularly important in upper abdo pain?
ECG (rule out MI) and erect CXR (exclude perforation)
Give 3 causes of RLQ pain.
Appendicitis, gynae pathology (ectopic pregnancy), IBD, ureteric colic
Give 3 causes of LLQ pain.
Diverticulitis, IBD, Gynae
How can you assess for peritonism?
ask them to cough and see if pain on percussion or light palpation
What is the first-line investigation for gallstones?
USS
Give causes of LBO.
Tumour, strictures, volvulus (sigmoid or caecal)
Give causes of SBO.
Adhesions, Hernia, Strictures, Intussusception, Gallstone ileus, Bazoar
Which method may be used for incomplete bowel obstruction?
‘drip and suck’ method - IV fluids & aspirate NG tube
Give causes of abdo pain with shock.
Ruptured AAA
Upper GI bleed eg. varices, gastric ulcer etc
Rupture ectopic pregnancy
What is the most common cause of upper GI bleed?
Peptic ulcer
Vomiting, abdominal or chest pain, and subcutaneous emphysema suggests…
Boerhaave’s syndrome
What is the definitive investigation for upper GI bleed?
OGD
What is the Glasgow-Blatchford score used for?
Assesses risk pre-endoscopy in upper GI bleed
What is the Rockall score used for?
Assess risk of re-bleeding and death in upper GI bleed post-endoscopy
What are the conservative management options for anal fissures?
laxatives, lubricants, and topical GTN
What is the best investigation for chronic pancreatitis?
CT abdomen
Give causes of fresh red blood in stool.
Haemorrhoids, anal fissure, IBD, Diverticulitis, Colorectal polyps/cancer
Which patients with rectal bleeding should be referred for urgent colonoscopy?
Unexplained rectal bleeding in > 50s
Emphysematous cholecystitis usually occurs in…
Diabetics
What are the risk factors for gallstones?
4F’s:
- Female
- Forty
- Fat
- Fertile
How is cholecystitis managed?
Antibiotics, can use ERCP to remove stones, usually cholecystectomy
What are the two main causes of ascending cholangitis?
secondary to gallstone obstruction or post-ERCP
What are the most common organisms in ascending cholangitis?
E Coli, Klebsiella, Enterococcus
RUQ pain, fever and jaundice =
Ascending cholangitis
How does PSC typically present?
Progressive, obstructive jaundice
Which condition is highly associated with PSC?
UC
PSC increases the risk of…
cirrhosis and cholangiocarcinoma (10-20%)
‘beaded’ or ‘onion-skin’ appearance on MRCP suggests…
PSC
Which auto-antibody is associated with PSC?
ANCA
How does PBC typically present?
Fatigue and itch
PBC is associated with which other conditions?
Sjogren’s, SLE, RA
Which auto-antibody is associated with PBC?
AMA
What are the main risk factors for cholangiocarcinoma?
PSC and liver flukes (parasitic infection)
How does cholangiocarcinoma usually present?
Obstructive jaundice
What does Courvoisieur’s law state?
if jaundice + palpable gallbladder, unlikely to be gallstones → most likely cholangiocarcinoma or pancreatic cancer
What is the tumour marker for cholangiocarcinoma?
CA19-9
How is cholangiocarcinoma usually managed?
Curative surgery not usually possible (only early cases)
Which procedure is undertaken to defunction the bowel following anastamosis?
Loop ileostomy
What is the initial investigation to check for free fluid in trauma?
FAST scan
Are ilestomies typically spouted or flush to the skin?
Spouted
Are colostomies typically spouted or flush to the skin?
Flush to the skin
