General Surgery Flashcards
what are stomas?
they are artificial openings of hollow organs - opened onto the surface of abdomen and contents are collected into bag
what is the difference between colostomy and ileostomy?
ileostomy has more irritant contents so has a spout, is more likely to be in RIF and has liquid contents, colostomy is in LIF, solid and flat to skin
when is an end stoma permanent?
after APR or panproctocolectomy
what are complications of stomas?
hernia, psychosocial, local skin irritation, loss of bowel length, dehydration, malnutrition, constipation, stenosis, obstruction, retraction, prolapse, bleeding, granulomas
list differentials for acute abdominal pain?
generalised: ischaemic colitis, ruptured AAA, peritonitis, intestinal obstruction
RUQ: biliary colic, cholecystitis, cholangitis
epigastric: gastritis, peptic ulcers, pancreatitis, ruptured AAA
loin to groin: ruptured AAA, renal colic, UUTI
testicular: torsion, epididymo-orchitis
central: ruptured AAA, ischaemic colitis, early appendicitis, intestinal obstruction
RIF: appendicitis, ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, Meckel’s diverticulum
LIF: diverticulitis, ectopic, ruptured cysts, torsion
suprapubic: LUTI, retention, PID, prostatitis
what are the signs of peritonitis?
guarding, rigidity, rebound tenderness, coughing test, percussion test
how is the acute abdomen investigated?
A-E
FBC, U&Es, LFTs, CRP, amylase, INR, Ca, hcg, ABG, lactate, G&S, cultures
AXR, CXR, A USS, CT abdo
how is the acute abdomen managed?
A-E, escalate, NBM, NGT, IVf, IV ABx, analgesia, VTE risk assess, prescribe regular meds, XM
what are the risk factors for bowel cancer?
FHx, FAP, increasing age, HNPCC, IBD, diet, obesity, sedentary lifestyle, smoking, alcohol
how does bowel cancer present?
mass (abdo/rectal), weight loss, unexplained abdominal pain, rectal bleeding, iron deficiency anaemia, change in bowel habit
what is the 2 ww criteria for bowel cancer?
> 40y with unexplained abdominal pain and weight loss
50 with unexplained PR bleeding
60 with change in bowel habit or anaemia
how is bowel cancer investigated?
screening: FIT >60-60 as per 2ww or 60-74 every 2 years
colonoscopy and biopsy, sigmoidoscopy, CT colonography, regular screening if RFs, staging CTTAP, CEA for relapse
what classification is used for bowel cancer?
Duke’s and TNM
how is bowel cancer managed?
surgical resection - lap, open, robotic
hemi colectomy, APR, anterior resections, Hartmann’s
chemotherapy, radiotherapy, palliation
how is bowel cancer followed up?
CEA, CTTAP
what are some complications of surgery for bowel cancer?
pain, bleeding, infection, damage to structures, ileus, anaesthetic risks, risk of changing to open, leak or fail of anastamoses, VTE, change in bowel habit, failure to remove, adhesions, stoma, hernia, lower anterior resection syndrome
what is volvulus?
it is when the bowel twists around itself and mesentery - closed loop bowel obstruction - ischaemia, necrosis and perforation
investigated with AXR and CT
summarise sigmoid volvulus?
it is more common and in older patients
it is caused by chronic constipation and lengthening of mesentery attached to sigmoid - faecal overload - sinks down
associated with high fibre and laxatives
shows coffee bean sign on AXR
summarise caecal volvulus?
less common, more in younger patients
foetal sign on AXR
what are the risk factors for volvulus?
neuropsychiatric disorders, nursing home, chronic constipation, high fibre, pregnancy, adhesions
how does volvulus present?
vomiting (green bilious), distension, diffuse pain, absolute, constipation, no flatulence
how is volvulus managed?
NBM, NGT, conservative - endoscopic decompression for sigmoid
surgical - laparotomy, Hartmann’s (sigmoid), ileocaecal resection, right hemicolectomy (caecal)
what is cholangitis?
it is infection and inflammation of bile ducts - emergency - sepsis
what causes cholangitis and how does it present?
it is caused by obstruction, infection, ERCP
E coli, enterococci, Klebsiella
it presents with RUQ pain, fever and jaundice
