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Surgery Block > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What is the definition of a hernia?

A

Protrusion of viscera through it’s covering to an abnormal location

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2
Q

What is the definition of an emboli?

A

Solid or gas which has been carried in the bloodstream to a location different to its origin

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3
Q

What is the function of the ilioinguinal nerve?

A

Sensory supply of upper anteromedial thigh

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4
Q

What is the function of the genitofemoral nerve?

A

Sensory innervation of the upper thigh (anterior scrotum, mons pubis and labia majora)

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5
Q

What are things to look for on inspection during a DRE examination?

A 
Skin tags
Pilonidal sinus
Abscess
Anal warts
Fissures
Fistulas
Excoriation 
External haemorrhoids
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6
Q

What are four potential causes of a right iliac fossa mass?

A

Caecal carcinoma, appendix abscess, Crohn’s disease, ovarian tumour/cyst

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7
Q

What would be the first investigation if you are considering an oesophageal carcinoma?

A

Uppper gastro-intestinal endoscopy

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8
Q

Manometry can be used to diagnose what condition which causes dysphagia?

A

Achalasia

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9
Q

What would achalasia look like on a barium swallow?

A

‘Bird’s beak’ appearance with a smooth tapering distally and possible oesophageal dilation above the lesion

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10
Q

How would a peptic stricture appear on barium swallow?

A

As a short pinch point (small area of narrowing)

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11
Q

How would oesophageal spasm appear on barium swallow?

A

One or more smooth areas of contraction in the oesophagus

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12
Q

What three investigations are used in staging oesophageal carcinoma?

A

Endoscopic ultrasound, PET scan, CT chest, abdomen and pelvis

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13
Q

Where are metastatic lesions likely to spread in oesophageal malignancy?

A

Liver and lung

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14
Q

What can commonly cause free intra-peritoneal air?

A

Perforated duodenal ulcer, perforated diverticulum, laparotomy 24 hours ago

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15
Q

Perforation of what structures cause gas to accumulate in the retroperitoneum?

A

Ascending colon, descending colon, 3rd part of the duodenum

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16
Q

What initial management is used for a volvulus of the sigmois colon?

A

Sigmoidoscopy and passage of decompressing flatus tube

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17
Q

What surgery may be required for recurrent sigmoid volulus?

A

Sigmoid colectomy

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18
Q

What causes a sigmois volulus?

A

Twisting of the bowel on lax mesentery

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19
Q

Which patients are more commonly affected by sigmoid volvulus?

A

Elderly or psychiatric patients

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20
Q

What percentage of colonic obstructions are from sigmoid volvulus?

A

1-2%

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21
Q

What are the six criteria for acute severe colitis established by Truelove and Witts?

A
  1. Frequency of stool >6 daily
  2. Overtly bloody stool
  3. Fever (>37.5)
  4. Tachycardia (>90)
  5. Anaemia (Hb<105)
  6. Raised ESR (>30)
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22
Q

In acute severe disease of UC why would a sigmoidoscopy be used over colonoscopy?

A

Colonoscopy increases risk of perforation

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23
Q

Why would you give heparin to a patient with acute severe colitis, what would make you not give it?

A

Patients with acute severe colitis are at high risk of thromboembolic events
Would give unless there is a significant haemorrhage

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24
Q

What medication is used in treatment of acute severe colitis?

A

Intravenous hydrocortisone 100mg every 6 hours
Bone protection from high steroids
Heparin as prophylactic

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25
Q

Why do patinets with long-standing ulcerative colitis need surveillance colonoscopies?

A

They are at increased risk of colonic carcinoma and need to be screened regularly with colonoscopy

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26
Q

What is thumbprinting on abdominal X-ray?

A

Radiographic sign of large bowel wall thickening from oedema or inflammation, the normal haustra become tickened appearing like thumbprint projections into lumen

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27
Q

What conditions are associated with toxic megacolon?

A

UC, Crohn’s, infective colitis

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28
Q

What is included in the standard trauma X-ray series?

A

Chest X-ray, lateral cervical spine, X-ray pelvis

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29
Q

What imaging modality is best for detection of splenic injuries?

A

CT

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30
Q

What is the most commonly injured solid organ in the abdomen?

A

The spleen

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31
Q

What precautions would you advice a patient about following splenectomy?

A

Vaccination (pneumococcal, meningococcal, haemophilus influenzae), long term penicillin V prophylaxis, caution with travel to areas of endemic malaria

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32
Q

Is achlasia associted with oesophageal malignancy?

A

Yes

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33
Q

What is achalasia?

A

Disease due to failure of normal peristalsis and relaxation of the lower oesophgeal sphincter

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34
Q

What tropical disease may cause similar clinical and imaging appearances to achalasia?

A

Chaga’s disease (trypanosomiasis)

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35
Q

Can achalasia cause painful dysphagia?

A

Yes

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36
Q

Can achalasia cause aspiration pneumonia?

A

Yes

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37
Q

What are treatments frequently used for achalasia?

A

Balloon dilatation, botox injections, Heller’s myotomy

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38
Q

What are the different types of gallstones?

A

Cholesterol stones, pigment stones, mixed stones

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39
Q

Haemolytic anaemia is associated with which type of gallstone?

A

Pigment

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40
Q

Which two ducts come together to form the common bile duct?

A

The cystic duct and common hepatic duct

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41
Q

What are common risk factors for gallstone disease? (The 5 Fs)

A 
Fat
Female
Fertile (being pregnant)
Forty (peak age for women to present)
Family history
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42
Q

What causes biliary colic?

A

Impaction of gallbladder neck by a gallstone, there is no inflammation but pain on contraction of gallbladder

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43
Q

Why do patients often experience biliary colic after a fatty meal?

A

Fatty acids stimulate the duodenum endocrine cells to produce CCK which stimulates the gallbladder to contract

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44
Q

How does pain usually differ between biliary colic and acute cholecystitis?

A

Biliary colic: sudden, dull, colicky

Acute cholecystitis: constant

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45
Q

What is a positive Murphy’s sign?

A

Whilst applying pressure to the RUQ, ask the patient to inspire. There will be a halt in inspiration due to pain with a positive test

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46
Q

What can a positive Murphy sign indicate?

A

An inflamed gallbladder

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47
Q

What are three things to look for on abdominal ultrasound when suspecting gallstone disease?

A

Gallbladder wall thickening, presence of gallstones/sludge, bile duct dilatation

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48
Q

What is charcot’s triad?

A

Jaundice, fever and RUQ pain

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49
Q

What is Reynold’s pentad?

A

Jaundice, fever, RUQ pain, hypotension, confusion

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50
Q

What is Alvarado scoring system used to help diagnose?

A

Appendicitis

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51
Q

What are some categories in alavadro scoring system?

A

Pain moving to RIF, anorexia, N+V, RIF tenderness, fever, raised WCC

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52
Q

Which out of biliary colic, acute cholecystitis and cholangitis will caise jaundice?

A

Cholangitis

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53
Q

What is often observed on ultrasound when cholangitis is present?

A

Common bile duct dilatation

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54
Q

What is the most common cause of cholangitis?

A

Gallstones- blocking biliary tract

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55
Q

Following an open appendectomy would you be concerned if there was free air beneath the diaphragm?

A

This is a normal finding after surgery

56
Q

What are the 4HTs for reversible causes of cardiac arrest?

A

Hypovolaemia, hypo/hyperkalaemia, hypothermia, hypoxia

Toxins, cardiac Tamponade, Thrombus, Tension pneumothorax

57
Q

What are indications for dialysis in patient with AKI using mneumonic AEIOU?

A 
Acidosis
Electrolytes
Intoxications
Overload
Uraemia
58
Q

What causes the majority of acute pancreatitis cases?

A

Gallstones and excess alchol consumption

59
Q

What are causes of pancreatitis? (GET SMASHED)

A 
G-gallstones
E- ethanol
T- trauma
S- steroids
M- mumps
A- autoimmune
S- scorpion sting
H- hypercalcaemia 
E- ERCP
D- drugs (e.g azathioprine, NSAIDs, diuretics)
60
Q

What is pancreatitis?

A

Inflammation of the pancreas

61
Q

What is the pathophysiology of acute pancreatitis?

A

Digestive enzymes are activated within the pancreas resulting in an inflammatory response

62
Q

How does fat necrosis occur in acute pancreatitis?

A

Enzymes released from the pancreas into ystemic circulation causing autodigestion of fats which results in fat necrosis

63
Q

Why can you get hameorrhage in retroperitoneal space with acute pancreatitis?

A

Enzymes released from pancreas into systemic circultion autodigest blood vessels

64
Q

How do patients typically present with acute pancreatitis?

A

Severe epigastric pain which can radiate to the back, with nausea and vomiting

65
Q

What do Cullen’s and Grey Turner’s signs suggest?

A

Retroperitoneal haemorrhage

66
Q

Where does bruising occur with Cullen’s and Grey Turner’s signs?

A

Cullen’s: peri umbilical

Grey Turner’s: the flanks

67
Q

What are some causes of abdominal pain which radiates to the back?

A

AAA, renal calculi, chronic pancreatitis, aortic dissection, peptic ulcer disease

68
Q

Do serum amylase levels directly correlate with acute pancreatitis disease severity?

A

No

69
Q

What intial labatory test would you consider for acute pancreatitis?

A

Serum amylase, LFTs, serum lipase (if available at the hospital)

70
Q

What is the management of acute pancreatits?

A

IV fluid resuscitation, analgesia, NG tube if vomiting profusely, encourage oral intake as soon as tolerated

71
Q

What level of serum amylase is diagnostic of acute pancreatitis?

A

3 times the normal upper limit

72
Q

What is a pancreatic pseudocyst?

A

A collection of fluid containg pancreatic enzymes, blood and necrotic tissue, forming typically a few weeks post acute pancreatitis episode

73
Q

What surgery may be required for pancreatic necrosis?

A

Necrosectomy

74
Q

What is an adhesion?

A

Fibrous tissue that binds two surfaces of the body which are usually separate

75
Q

What is a fistula?

A

An abnormal connection between two epithelial surfaces

76
Q

What is tenesmus?

A

The sensation of needing to open bowels without being able to produce stools

77
Q

What happens in a hemicolectomy?

A

Removal of a portion of the colon

78
Q

What is a Hartmann’s procedure?

A

Proctosigmoidectomy- removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy

79
Q

What is an anterior resection in general surgery?

A

Removal of the rectum

80
Q

What is a Whipple procedure?

A

Pancreaticoduodenectomy- removal of the head of the pancreas, duodenum, gallbladder and bile duct

81
Q

What type of diathermy would you use for surgery on a patient with a pacemaker?

A

Bipolar diathermy

82
Q

What is the ASA grading system?

A

ASA grading system classifies physical status of the patient for anaesthesia from 1 (normal healthy) to 6 (brain-dead undergoing organ donation)

83
Q

Where is the most common area of duodenal ulceration?

A

The cap (first section) which ascends superiorly from pylorus of stomach

84
Q

How are the different sections of the duodenum categorised?

A

D1- superior
D2- descending
D3- inferior
D4 ascending

85
Q

What are the two most common causes of duodenal ulcers?

A

H. Pylori infection and chronic NSAID therapy

86
Q

What are some ways to reduce post op ileus?

A

Limit bowel handling and opiate use
Mobilise ASAP
Avoid fluid overload (bowel oedema)

87
Q

Extensive small bowel resections for Crohn’s disease can lead to what syndrome?

A

Short bowel syndrome

88
Q

What is a Hartmann’s procedure?

A

Complete resection of the rectum and sigmoid colon with the formation of an end colostomy and closure of rectal stump

89
Q

How should abdominal wound dehiscence initially be managed?

A

Cover wound with saline-soaked gauze and give Iv broad-spectrum antibiotics

90
Q

What is wound dehiscence?

A

When a surgical wound reopens

91
Q

What is the management of anal fissure?

A

(1st line) GTN ointment or diltiazem cream applied topically
Botulinum toxin
Then internal sphincterotomy if fail to respond to others

92
Q

What are some typical spinal features seen in ankylosing spondylitis?

A

Loss of lumbar lordosis and progressive kyphosis of cervical-thoracic spine

93
Q

What are the 3 categories of spina bifida?

A

Myelomeningocoele, spina bifida occulta and meningocoele

94
Q

What are features of anal fissures?

A

Painful, bright red rectal bleeding

Most commonly on posterior midline (if in other location consider underlying cause)

95
Q

What are some general risk factors for VTE?

A

Cancer/chemo, over 60, high BMI, dehydration, clotting disorder, HRT or COCP, pregnant, varicose veins, significant medical comorbidity

96
Q

What are two types of mechanical VTE prophylaxis?

A

Compression stockings

Intermittent pneumatic compression device

97
Q

What are some pharmacological options for VTE prophylaxis?

A

Low molecular weight heparin (e.g enoxiparin)
Unfractionated heparin
Fondaparinux sodium

98
Q

How long would you advice women to stop their COCP before surgery?

A

4 weeks before surgery

99
Q

What test is helpful to assess the exocrine function in chronic pancreatitis?

A

Faecal elastase

100
Q

Patients with a cholangiocarcinoma may have a raise in which tumour marker?

A

CA 19-9

101
Q

Levels of what enzyme are best for investigating suspected acute pancreatitis of a late presentation >24 hours

A

Serum lipase (has a longer half life than amylase)

102
Q

Where are diverticula most commonly found in the bowel?

A

Sigmoid colon

103
Q

What are the four different disease manifestations of diverticulum?

A

Diverticulosis, diverticular disease, diverticulitis, diverticular bleed

104
Q

What is diverticulitis?

A

Inflammation of a diverticula from bacterial overgrowth within the outpouching

105
Q

What is a diverticular bleed?

A

When a diverticula erodes into a vessel and causes a large volume painless bleed

106
Q

What are some risk factors for the formation of diverticula?

A

Low fibre diet, smoking, obesity, family history, NSAID use

107
Q

What are some clinical features of diverticular disease?

A

Intermittent lower abdo pain (typically colicky and relieved by defecation)
May also have associated change in bowel habit, nausea and flatulence

108
Q

What drugs that a patient may be taking can mask symptoms of diverticulitis?

A

Corticosteroids or immunosuppressants

109
Q

What is obturator sign when looking for appendicitis?

A

Pain with right knee flexed and right hip rotated internally
Positive sign indicates potential appendicitis

110
Q

What is psoas sign when looking for appendicitis?

A

Pain on extension of the hip (if retrocaecal appendix)

111
Q

What investigation would you request to rule out a post-operative intra-abdominal collection?

A

CT

112
Q

What size would a diverticular/pericolic abscess need to be for you to consider radiological drainage over IV antibiotics?

A

5cm

113
Q

What are some findings on CT that may been seen with diverticulitis?

A

Thickening of colonic wall, pericolonic fat stranding, abscesses, free air

114
Q

Would you do a colonoscopy for a presenting case of suspected diverticulitis?

A

No because of the risk of perforation

115
Q

How would you manage a patient with uncomplicated diverticular disease?

A

Simple analgesia, encourage oral fluid intake

116
Q

If a diverticular bleed fails to respond to conservative management, what are the surgical options?

A

Embolisation, surgical resection

117
Q

How would you manage acute diverticulitis conservatively?

A

Fluids, antibiotics, analgesia- should improve in a few days

118
Q

What surgical procedure may be required in diverticulitis patients with perforation with faecal peritonitis or overwhelming sepsis?

A

Hartmann’s procedure: sigmoid colectomy with formation of end colostomy

119
Q

How may a colovesical fistula present?

A

Recurrent UTIs, pneumoturia, or faecal matter in urine

120
Q

What are the most common complications of diverticular disease?

A

Strictures and fistula formation

121
Q

What is a peptic ulcer?

A

a break in the lining of the GI tract extending to the muscularis mucosae

122
Q

Where are peptic ulcers most likely to occur?

A

The lesser curvature of the stomach and 1st part of duodenum

123
Q

How does H-pylori infection lead to peptic ulcer disease?

A

Induces release of histamine which cause parietal cells to produce more acid
Down-regulates bicarbonate production

124
Q

What symptoms may a patient have with peptic ulcer disease?

A

Epigastric/retrosternal pain, nausea, bloating, post-prandial discomfort, early satiety

125
Q

With regards to eating when is the pain worse for gastric ulcers and duodenal ulcers?

A

Pain from gastric ulcers exacerbate by eating

Pain from duodenal ulcers are worse 2-4 hours after eating or are alleviated by eating

126
Q

When would you consider an urgent referral for upper oesophageal-gastro-duodenoscopy?

A

New-onset dysphagia
>55 with weight loss and abdo pain/reflux/dyspepsia
New onset dyspepsia not responding to PPI

127
Q

What is Zollinger-Ellison syndrome?

A

A triad of severe peptic ulcer disease, gastric acid hypersecretion, gastrinoma

128
Q

What is the characteristic finding in Zollinger-Ellison syndrome?

A

Fasting gastrin of >1000 pg/ml

129
Q

What should patients do about their current medication before a H.Pylori test?

A

Stop any current medical therapy for their symptoms 2 weeks prior to investigation

130
Q

What lifestyle advice would you give a patient with peptic ulcer disease?

A

Smoking cessation, reduce alcohol intake, weight loss, avoid NSAIDs

131
Q

What medication would we give a patient with peptic ulcer disease (not caused by H.Pylori)?

A

PPI e.g omeprazole

132
Q

What is the triple therapy we use for H.pylori infection?

A

PPI with oral amoxicillin and clarithromycin/metronidazole for 7 days

133
Q

What is the most common organism to cause cholangitis?

A

E Coli

134
Q

Where is McBurney’s point?

A

Two thirds of the way from the umbilicus to the ASIS

135
Q

What is the howship-Romberg sign and what pathology is this specific to?

A

Pain extending from the inner thigh to the knee when the hip is internally rotated.
This is due to compression of the obturator nerve e.g obturator hernia

Surgery Block (6 decks)

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