General Surgery Flashcards
What is the definition of a fistula?
An abnormal connection (1) between two epithelial surfaces (1)
What operation describes removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy?
Hartmann’s procedure (1)
What operation involves removal of the head of the pancreas, duodenum, gallbladder and bile duct?
Whipple procedure (1)
What incision is used for an open cholecystectomy?
Kocher incision (1)
What incision is used for a renal transplant?
Hockey-stick incision (1)
What is a Gridiron incision used for?
Open appendicectomy (1)
What two incisions may be used for a caesarean section?
Pfannenstiel (curved) (1) or Joel-Cohen (straight) (1)
What type of diathermy involves the use of a diathermy probe and a grounding plate under the leg or buttock?
Monopolar diathermy (1)
What type of suture technique involves a single absorbable suture side to side just below the skin to pull the skin edges together?
Subcuticular (1)
What checklist is used immediately before and after an operation?
WHO Surgical Safety Checklist (1)
What system classifies the physical status of the patient for anaesthesia?
American Society of Anesthesiologists (ASA) grading system (1)
What pre-operative investigation is required in all patients over 65 years?
ECG (1)
What pre-operative investigation is required specifically in diabetic patients?
HbA1c within the last 3 months (1)
How long should patients avoid food or feeds and avoid any clear fluids before surgery?
6 hours no food or feeds (1) and 2 hours no clear fluids (1)
What is used to reverse the effects of warfarin?
Vitamin K (1)
How long should the combined contraceptive pill be stopped prior to surgery?
4 weeks (1)
What complication is metformin associated with in the perioperative period?
Lactic acidosis (1)
What complication can SGLT2 inhibitors (e.g., dapagliflozin) cause in dehydrated or acutely unwell patients?
Diabetic ketoacidosis (1)
What four criteria are used to assess a patient’s capacity to make a decision?
Their ability to understand (1), retain the information (1), weight up the pros and cons (1) and communicate the decision (1)
What legal status can be given to a nominated person to allow them to make decisions on a patients behalf if they lack capacity?
Lasting power of attorney (1)
What are the contraindications to NSAIDs?
Asthma (1), renal impairment (1), heart disease (1) and stomach ulcers (1)
When would you avoid using ondansetron as a treatment for post-operative nausea and vomiting?
Patients at risk of prolonged QT interval (1)
Name the process of removing and patient’s catheter and assessing whether they can pass urine normally?
Trial without catheter (TWOC) (1)
Name the process of meeting a patient’s full nutritional needs via an intravenous infusion?
Total parenteral nutrition (TPN) (1)
What word describes where a portion of the lung collapses due to under-ventilation?
Atelectasis (1)
What describes where there is separation of the surgical wound, particularly after abdominal surgery?
Wound dehiscence (1)
What complication of surgery involves fluctuating confusion and particularly affects older patients?
Delirium (1)
Why do patients need a post-operative full blood count?
To assess for anaemia (1)
What group of people are likely to refuse blood transfusions?
Jehovah’s Witnesses (1)
What proportion of total body fluids are in the intracellular and extracellular spaces?
2/3 intracellular (1) and 1/3 extracellular (1)
What are the three extracellular spaces?
The intravascular (1), interstitial (1) and “third” (1) spaces
What space is full of fluid with ascites?
Peritoneal cavity (1)
What are common reasons for a patient to be on a fluid restriction?
Heart failure (1), renal failure (1) and hyponatraemia (1)
What term refers to fluid output that is difficult to measure, such as via respiration, stools, burns and sweat?
Insensible fluid losses (1)
Where can you find information on the patient’s fluid intake and output?
Fluid balance chart (1)
What are the main indications for IV fluids?
Resuscitation (1), replacement (1) and maintenance (1)
What are the two main groups of IV fluid?
Crystalloids (1) and colloids (1)
What is the concentration of sodium in normal 0.9% saline?
154 mmol/L (1)
Give two key complications of excessive normal 0.9% saline?
Hypernatraemia (1) and hyperchloraemic metabolic acidosis (1)
What term refers to the osmotic pressure gradient between two fluids across a membrane?
Tonicity (1)
Give three examples of fluids that may be used for resuscitation.
Normal 0.9% saline (1), Hartmann’s solution (1) and Plasma-Lyte 148 (1)
What is the approximate daily maintenance requirements of water?
25-30 ml/kg/day (1)
What is the approximate daily maintenance requirements of sodium, potassium and chloride?
1 mmol/kg/day (1)
What is the approximate daily maintenance requirements of glucose?
50-100g (1)
What volume and type of maintenance fluid do the NICE guidelines suggest starting with?
25-30 ml/kg/day (1) of 0.18% sodium chloride in 4% glucose with 27 mmol/l of added potassium (1)
What needs monitoring daily for patients on a maintenance fluids?
Fluid status (1), fluid balance chart (1) and U&E blood tests (1)
What infusion rate is used to give 1 litre of fluid over 8 hours?
125 ml/hour (1)
What are the key causes of acute right upper quadrant pain?
Biliary colic (1) , acute cholecystitis (1) and acute cholangitis (1)
What are the key causes of acute unilateral testicular pain?
Testicular torsion (1) and epididymo-orchitis (1)
What do guarding and rigidity on examination suggest?
Peritonitis (1)
What examination finding involves rapidly releasing pressure on the abdomen with worse pain than the pressure itself?
Rebound tenderness (1)
What underlying condition is associated with spontaneous bacterial peritonitis?
Ascites in patients with liver disease (1)
What initial assessment is used for acutely unwell patients?
ABCDE assessment (1)
What blood test specifically indicates inflammation of the pancreas?
Amylase (1)
What blood test gives an indication of the synthetic function of the liver and the patient’s clotting function?
International normalised ratio (INR) (1)
What blood test is used in females of child bearing age presenting with abdominal pain? Why?
Serum human chorionic gonadotropin (hCG) (1) to exclude pregnancy (1)
What investigation and finding can be used to assess for intra-abdominal perforation?
Erect chest x-ray (1) showing air under the diaphragm (1)
What is the name of the tender point on examination in appendicitis?
McBurney’s point (1) Where is this located? One third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus (1)
What scoring system can be used to calculate the probability of appendicitis?
Alvarado score (1)
What is the name of the condition where the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa?
Appendix mass (1)
What is the usual definitive management of acute appendicitis?
Laparoscopic appendicectomy (1)
What are the big three causes of bowel obstruction?
Adhesions (1), hernias (1) and tumours (1)
What term describes a situation where there are two points of obstruction along the bowel; meaning that there is a middle section sandwiched between two points of obstruction?
Closed-loop obstruction (1)
When might a closed-loop obstruction occur with a single point of obstruction in the large bowel?
When there is a competent ileocaecal valve (1)
What type of vomiting is suggestive of bowel obstruction?
Green bilious vomiting (1)
What type of bowel sound may be heard in early obstruction?
“Tinkling” (1)
What are the upper limits of the normal diameter of small bowel, colon and caecum?
Small bowel 3 cm (1), colon 6 cm (1) and caecum 9 cm (1)
What is the name for the mucosal folds that form lines extending the full width of the bowel?
Valvulae conniventes (1)
Where are the valvulae conniventes found?
Small bowel (1)
What is the name for the pouches formed by the muscles in the walls of the bowel, which form lines that do not extend the full width of the bowel on an abdominal x-ray?
Haustra (1)
Where are the haustra found?
Large bowel (1)
What does a raised serum lactate suggest in a patient with bowel obstruction?
Bowel ischaemia (1)
What is the name of the condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops?
Ileus (1)
When are you most likely to come across an ileus?
Following abdominal surgery (1)
What are the two types of volvulus?
Sigmoid volvulus (1) and caecal volvulus (1)
Which type of volvulus is more common?
Sigmoid (1)
What characteristic sign may be seen on abdominal x-ray in volvulus?
Coffee bean sign (1)
With which type of volvulus will a coffee bean sign occur on abdominal x-ray?
Sigmoid volvulus (1)
What are the three key complications of hernias?
Incarceration (1), obstruction (1) and strangulation (1)
What is the name for when only part of the bowel wall and lumen herniate through a defect in the abdominal wall, with the other side of that section of the bowel remaining within the peritoneal cavity?
Richter’s hernia (1)
What is the name for when two different loops of bowel are contained within the hernia?
Maydl’s hernia (1)
What are the two types of hernia repair?
Tension-free repair (1) and tension repair (1)
What travels through the inguinal canal in males?
Spermatic cord and it’s contents (1)
Where is the deep inguinal ring located?
The mid-way point from the ASIS to the pubic tubercle (1)
What region does a direct inguinal hernia protrude through?
Hesselbach’s triangle / inguinal triangle (1)
What are the contents of the femoral triangle from lateral to medial across the top of the thigh?
Femoral nerve (1), femoral artery (1), femoral vein (1) and femoral canal (1) (NAVY-C mnemonic)
What type of hernia occurs between the lateral border of the rectus abdominis muscle and the linea semilunaris?
Spigelian hernia (1)
What refers to a widening of the linea alba, forming a larger gap between the rectus muscles?
Diastasis recti / rectus diastasis / recti divarication (1)
What sign refers to pain extending from the inner thigh to the knee when the hip is internally rotated?
Howship–Romberg sign
What causes the Howship-Romberg sign?
Compression of the obturator nerve (1)
What type of hernia may compress the obturator nerve?
Obturator hernia (1)
What are type 1 and type 2 hiatus hernias?
Type 1: sliding (1) and type 2: rolling (1)
What surgical procedure may be used to treat a hiatus hernia?
Laparoscopic fundoplication (1)
What are haemorrhoids?
Enlargement of the anal vascular cushions (1)
Where positions on a clock face are haemorrhoids usually located?
3 (1), 7 (1) and 11 o’clock (1)
Describe 2nd and 3rd degree haemorrhoids.
2nd degree: prolapse when straining and return on relaxing (1), 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back (1)
What procedure involves fitting a tight band around the base of a haemorrhoid to cut off the blood supply?
Rubber band ligation (1)
What common medication increases the risk of diverticulosis and diverticular haemorrhage?
Non-steroidal anti-inflammatory drugs (NSAIDs) (1)
What blood results may be deranged in acute diverticulitis?
Raised inflammatory markers (1) and white blood cell count (2)
What oral antibiotic do the NICE clinical knowledge summaries suggest for uncomplicated acute diverticulitis?
Co-amoxiclav (1)
What dietary changes do the NICE clinical knowledge summaries suggest in the management of uncomplicated acute diverticulitis?
Only taking clear liquids (avoiding solid food) until symptoms improve (1)
What section of the GI tract is included in the midgut?
From the distal part of the duodenum (1) to the first half of the transverse colon (1)
What arteries supply the foregut, midgut and hindgut?
Foregut: coeliac artery (1), midgut: superior mesenteric artery (1) and hindgut: inferior mesenteric artery (1)
What is the “classic triad” of chronic mesenteric ischaemia?
Central colicky abdominal pain after eating (1), weight loss (1) and abdominal bruit on auscultation (1)
What cardiac condition is a key risk factor for acute mesenteric ischaemia?
Atrial fibrillation (1)
What can be seen on a venous blood gas in acute mesenteric ischaemia?
Metabolic acidosis (1) and raised lactate (1)
What three types of cancer are more prevalent than bowel cancer in the UK?
Breast (1), prostate (1) and lung cancer (1)
What is the inheritance pattern of familial adenomatous polyposis (FAP)?
Autosomal dominant (1)
What tumour suppressor gene is malfunctioning in FAP?
Adenomatous polyposis coli (APC) (1)
What procedure involves removing the entire length of the large intestine?
Panproctocolectomy (1)
What is the descriptive name for Lynch syndrome?
Hereditary nonpolyposis colorectal cancer (HNPCC)
What is the inheritance pattern for Lynch syndrome?
Autosomal dominant (1)
What test is used in the bowel cancer screening program in England?
Faecal immunochemical tests (FIT) (1)
What is the gold standard investigation for suspected bowel cancer?
Colonoscopy (1)
What tumour marker relates to bowel cancer?
Carcinoembryonic antigen (CEA) (1)
What part of the colon is removed in a Hartmann’s procedure?
Rectosigmoid colon (1)
Where on the abdomen are you most likely to find a colostomy?
Left iliac fossa (1)
Where on the abdomen are you most likely to find an ileostomy?
Right iliac fossa (1)
What is formed from a section of small bowel in patients with a urostomy?
Ileal conduit (1)
What are most gallstones made of?
Cholesterol (1)
What structure does the common bile duct and pancreatic duct drain into before it opens into the duodenum?
Ampulla of Vater (1)
What is the name of the ring of muscle that surrounds the Ampulla of Vater?
Sphincter of Oddi
What does cholelithiasis mean?
Gallstone(s) are present (1)
What condition involves inflammation of the bile ducts?
Cholangitis (1)
What condition refers to pus in the gallbladder?
Gallbladder empyema (1)
What procedure involves inserting a drain into the gallbladder?
Cholecystostomy (1)
What are the four memorable risk factors for gallstones?
Fat (1), fair (1), female (1) and forty (1) (Four F’s mnemonic)
What is the characteristic symptom of gallstones?
Biliary colic (1)
What hormone is secreted in response to fat entering the digestive system, causing contraction of the gallbladder?
Cholecystokinin (CCK) (1)
Where is CCK secreted from?
Duodenum
What do pale stools and dark urine indicate?
Obstruction to flow within the biliary system
With obstruction to flow within the biliary system, what blood test is likely to be deranged?
Raised bilirubin
What pattern of enzymes will be seen on liver function tests in patients with cholestasis?
ALT and AST can increase slightly (1), with a higher rise in ALP (1) (“an obstructive picture”)
What is the first-line investigation in patients with symptoms of gallstone disease?
Ultrasound (1)
What investigation of the biliary system involves an MRI scan?
Magnetic resonance cholangio-pancreatography (MRCP) (1)
What procedure can be used to assess the biliary system and treat gallstones stuck in the ducts?
Endoscopic retrograde cholangio-pancreatography (ERCP) (1)
What typical incision is used in an open cholecystectomy?
A right subcostal “Kocher” incision (1)
What is the more characteristic presenting symptom in acute cholecystitis?
Right upper quadrant (RUQ) pain (1)
What specific sign is suggestive of acute cholecystitis?
Murphy’s sign (1)
What is Charcot’s triad and what does it indicate?
Right upper quadrant pain (1), fever (1) and jaundice (raised bilirubin) (1), indicating acute cholangitis (1)
Where do cholangiocarcinomas originate?
Bile ducts (1)
What is the typical histological type for cholangiocarcinomas?
Adenocarcinoma (1)
What are the key risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis (1) and liver flukes (1)
What law states that a palpable gallbladder along with jaundice is unlikely to be gallstones?
Courvoisier’s law (1)
What histological type are the majority of pancreatic cancers?
Adenocarcinoma (1)
What organ does pancreatic cancer usually spread to first?
Liver (1)
What sign refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic cancer?
Trousseau’s sign of malignancy (1)
What tumour marker is most relevant in pancreatic cancer?
CA 19-9 (carbohydrate antigen) (1)
What name is given to a pancreaticoduodenectomy procedure, used to treat early pancreatic cancer?
Whipple procedure (1)
What are the three top causes of pancreatitis?
Gallstones (1), alcohol (1) and post-ERCP (1)
What scoring system is used to assess the severity of pancreatitis?
Glasgow score (1)
What enzyme often needs replacing in chronic pancreatitis?
Lipase (1)
What incisions may be used for a liver transplant?
“Rooftop” (1) or “Mercedes Benz” incision (1)
