General surgery Flashcards
Acute abdomen sieve
ABC->P
- Appendix
- Bleeding/bowel obstruction/BV obstruction
- GI bleed
- Obstruction - small/large, mechanical/non-mechanical, complete/incomplete
- Ischaemia/infarct
- Cholecystitis/angiitis
- Pancreatitis/Perforation (upper/lower GI)
Hernia (surgery) - def? types? Mx?
Def: protrusion of a viscus through its wall
Types:
- Incisional hernia - iatrogenic following surgery
- Groin hernia - ASIS & pubic tubercle palpated:
- Femoral (W>M) - below and lateral to the pubic tubercle, requires more urgent repair than inguinal hernia - high risk of strangulation
-
Inguinal - above & medial to the pubic tubercle
- Direct = weakness in posterior wall of inguinal canal, abdo contents emerge medial to deep ring and through superficial ring
- Indirect (75%, most common hernias in M/W) = abdo contents passes through inguinal canal through deep ring and exits via superficial ring
- Reduce hernia & compression on deep inguinal ring ask the patient to cough if it is direct it will reappear
- Other groin lumps:
- Lymphadenopathy - along inguinal ligament
- Vascular - pulsatile varicose veins below inguinal ligament
Mx: surgical (mesh)
NOTE: hernias are safer the larger the defect as less likely to strangulate
What are the borders of Hesselbach’s triangle?
Abdominal scars
- Midline sternotomy - AAA, laparotomy
- Rooftop scar - liver transplant, Whipple’s procedure, gastric surgery, oesophagectomy
- Kocher – open gallbladder surgery
- Nephrectomy can also be subcostal (like Kocher) or Rutherford-Morrison (hockey stick)
- Lanz/McBurney’s = Appendicectomy
- Pfannenstiel = C-section/prostatectomy/cystectomy
RUQ pain investigations & Mx? Think biliary
US abdo
- Stone in CBD (common bile duct) –> ERCP
- Deranged LFTs/dilated ducts –> MRCP
- None of above –> cholecystectomy
Gallstone complications
- Biliary colic
- Cholecystitis
- Mirizzi syndrome
- Ascending Cholangitis
- Pancreatitis
What is TNM classification?
- TNM (tumour, nodes, mets)
Colorectal cancer - Presentation? Ix? Mx? Screen?
Presentation:
- Bowel habit change
- Palpable mass
- IDA, PR bleed (clots, fresh)
- Acute (obstruction, perforation)
Ix: colonoscopy
Mx: based on TNM staging post-CT
- Colon cancer
- T4 (local advancement) –> neoadjuvant Tx
- Otherwise –> colonic resection –> if T3+/nodal disease –> adjuvant chemo
- Rectal cancer
- T3-4 –> neoadjuvant Tx –> colonic resection –> if T3+/nodal disease –> adjuvant chemo
- T1-2NOMO –> transanal excision
Screen: 60-74yrs FIT testing (or FOB)
Painless, palpable gallbladder + jaundice = Courvoisier’s law –> indicates what?
Not gallstone-related
Most likely head of pancreas tumour
Small bowel obstruction after cholecystitis - Dx?
Gallstone ileus
Small bowel obstruction - key Sx? Evidence of ischaemia? Mx Pathway?
Key Sx: distension, vomiting, colicky abdo pain, absolute constipation
SBO highly suspected on AXR:
- Acutely unstable patient + imminent risk of death –> emergency laparotomy
- Otherwise –> CT abdo & pelvis with contrast (if eGFR <30 = no contrast)
- Bowel ischaemia/obstructive lesion/closed loop obstruction –> emergency laparotomy
- Otherwise –> adhesional SBO –> conservative Mx (drip & suck = Ryles NG decompression & IV fluids)
‘Beads on string’ on ERCP - Dx?
Primary sclerosing cholangitis (PSC)
Thousands of colonic polyps & AD APC gene mutation
FAP
Mx: Panproctocolectomy
3 cardinal signs of small bowel obstruction?
Vomiting
Colicky abdo pain
absolute constipation (including gas)
± distension
AD mutation in mismatch repair gene (MMR) - Dx?
HNPCC (Lynch syndrome)