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Year 6 > General surgery > Flashcards

General surgery Flashcards

1
Q

Causes of dysphagia

A

Oesophageal cancer
Achalasia
Pharyngeal pouch
Plummer vision

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2
Q

Ix of dysphagia

A

Barium swallow- achalasia, pouch
OGD- malignancy
Manometry- if achalasia is suspected for diagnosis

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3
Q

Sx of pouch

A

Gurgling
Halitosis
Regurgitation

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4
Q

GORD sx

A

Heartburn worse laying down and after meals
Better with antacids
Belching

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5
Q

Tx of GORD

A

Antacids
PPI- trial 1-2 months

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6
Q

Urgent OGD criteria

A

Dysphagia
Mass
>55 and wt loss and reflux/dyspepsia

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7
Q

Non urgent OGD

A

Haematemesis
>55, High plts
>55, Low Hb and pain
>55, N+V and upper GI sx

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8
Q

Dyspepsia Ix and tx

A

Urea breath test
If +ve triple therapy- amox, clarith, omeprazole
If -ve PPI

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9
Q

Cause of upper GI bleed

A

Order of likeliness
PUD
Gastritis
MWT
Variceas

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10
Q

Blood diagnosis of pancreatitis

A

Amylase 3x ULN

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11
Q

Drugs that cause pancreatitis

A

F-MASS

Furosemide, mesalazine, azathioprine, steroids, sodium valproate

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12
Q

Ix of acute abdomen

A

PREG TEST
FBC, U&E, LFT, amylase, CRP, calcium, glucose, bilirubin
Faecal elastase- chronic panc, IBD
X match and G+S- suspected bleed
ABG
AXR- if suspected obstruction
Stool testing

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13
Q

Types of hernia and location

A

Femoral- lateral and inferior to tubercle
Inguinal medial and superior
Epigastric- midline between xiphi and umbilicus
Paraumbilical- next to umbilicus in midline

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14
Q

Biliary colic features

A

Unlikely if first presentation >60
RUQ pain- goes to back
After fatty food

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15
Q

When to order ERCP/MRCP

A

If bile duct look dilated on USS

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16
Q

If suspected acute cholecystitis what Ix

A

FBC, U&E, LFT, bilirubin
Urine- bilirubin
USS- if negative HIDA scan
Erect CXR

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17
Q

Sx of pancreatitis

A

Radiates to the back
Relieved by sitting forward
Vomiting

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18
Q

Biliary colic sx

A

RUQ pain radiating to scapula
May be following a fatty meal
Obstructive jaundice may occur- pale stools and dark urine

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19
Q

Diverticulitis sx

A

Colicky pain in LLQ
Fever
Hx of constipation

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20
Q

Causative organism of ascending cholangitis

A

E coli

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21
Q

Mx of ascending cholangitis

A

ABx and ERCP after 24-48hrs

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22
Q

Mx of acute cholecystitis

A

IV ABx
Early lap chole- <1 week

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23
Q

Ix for intestinal obstruction

A

Abdo CXR
CT AP

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24
Q

Types of colorectal surgical approaches

A

Right hemicolectomy- tumour in caecum- ileocolic AN
Left- tumour in descending
Hartmann- diverticulitis- stoma in LIF
AP resection - rectal Ca <5cm to verge- stoma in LIF
Anterior Resection- double lumen loop ileostomy in RIF
Pan-procto colectomy- ileostomy

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25
Q

Small bowel causes of obstruction

A

Adhesions
Hernia
Tumour

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26
Q

LBO causes

A

Cancer
Volvulus
Strictures- diverticula

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27
Q

Colorectal cancer screening

A

FIT screening
Every 2 years to 60-74
Colonoscopy once +

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28
Q

Tx of post op ileus

A

NG and IV fluids

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29
Q

Tx of volvulus

A

Sigmoidoscopy and rectal tube insertion- sigmoid
Laparotomy and right hemi- caecal

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30
Q

Tx of femoral hernia

A

Urgent
Elective- lockwood
Emergency- McEvedy

31
Q

Extra-intestinal features of IBD

A

A PIE SAC
Aphtous ulcer- Crohns
Pyoderma gangrenosa
Iritis/uveritis- CD
Erythema nodosum

Sclerosing Cholangitis- UC/ stones- CD
Arthritis
Clubbiong- CD

32
Q

When to give pneumococcal vaccine with splenectomy

A

2 weeks before

33
Q

Signs of wound dehiscence and action

A

Bowel protruding
Pink discharge
Urgent senior help

34
Q

Tearing chest pain and creps over chest wall dx

A

Boerhavers

35
Q

Sudden abdo pain, out of keeping of exam findings and AF

A

Acute mesenteric ischaemia

36
Q

Ischaemic colitis sx

A

Bloody diarrhoea
Less severe
Resolves spontaneously

37
Q

Sulphonylureas on say of surgery

A

Withold morning
Give in afternoon

38
Q

Tx of thromboses haemorrhoid

A

> 72 hours- stool softener, ice pack, analgesia

<72- excision

39
Q

Ix for leaking anastomosis

A

CT PA

40
Q

Sx of ileus

A

Hypovolaemic
Electrolytes disturbances
Absent bowel sounds
No emptying of bowels

41
Q

Anastomotic leak sx

A

Septic picture
Peritotism

42
Q

When to refer for colonoscopy for cancer

A

> 40 unexplained wt loss and pain
50 bleeding
60 IDA or change in bowel habits

43
Q

Indications for thoracotomy in haemothorax

A

Blood loss >1.5L

44
Q

Brown coloured urine, abdo distension and obstruction of bowel

A

Colovesical fistula ?

CT

45
Q

Diagnostic test of chronic pancreatitis

A

CT With IV contrast

46
Q

Gastric volvulus triad

A

Vomiting, pain, failed attempts to pass NG tube

47
Q

Polyp and hypokalaemia

A

Villous polyp

48
Q

Mx of strangulated hernia in GP

A

Call 999- get assessed urgently
DO not attempt to manually reduce

49
Q

Ruptured AAA blood products

A

6 units of blood

50
Q

Test for hernias

A

Cough impulse
Reducible
Place over deep inguinal ring
See if reappears

51
Q

If pain and drain with green fluid after cholecystectomy

A

Biliary leak

52
Q

Anterior vs AP resection

A

Anterior- >5cm- or mid to upper tumours

AP- <5cm or lower

53
Q

Dx of Boerhaaves syndrome

A

CT contrast swallow

54
Q

Bsoas sign

A

Pain beneath right scapula in cholecystitis

55
Q

Pancreatic cancer sign on USS/CT

A

Double duct sign- obstruction on CBD and pancreatic duct

56
Q

Nissen fundoplication tests before surgery

A

pH and mamonetry

57
Q

Tx of asymptomatic gallstones

A

Reassurance- if sx free for 12m

58
Q

Node in umbilicus and its meaning

A

St Marys Joseph node
Malignancy in pelvis or abdo

59
Q

Recurrent natal cleft pain and mx

A

Pilonodal sinus disease
Cystectomy

60
Q

Feeding after oesophagectomy

A

Jejunostomy

61
Q

When to give FIT test

A

To new symptoms not meeting 2ww criteria

Or to 60-74 screening every 2 years

62
Q

What happens in Hartmanns

A

Resect relevant bowel
End colonostomy
Can have future anastomosis

63
Q

Dukes staging

A

A- mucosa
B- muscle
C- lymph
D- Distant mets

64
Q

Hasselbach triangle

A

Direct hernia passes through

Made out of
Inguinal ligament
Inferior epigastric
Rectus Abdominis

65
Q

Unilateral vs bilateral surgical approach

A

Unilateral- open
Bilateral- laproscopically

66
Q

Layers in abdomen

A

Skin, fatty superficial fascia- campers
Membranous- Scarpas
Ext oblique
Int oblique
Transverse abdominus

67
Q

Arcuate line significance

A

No posterior rectus sheath underneath umbilicus
Allows immediate access to peritoneum

68
Q

Sigmoid volvulus with peritonitis

A

sigmoid volvulus who have bowel obstruction with symptoms of peritonitis, skip the flexible sigmoidoscopy and treat with urgent midline laparotom

69
Q

Ultrasound of hepatic hemangioma

A

Hyperechoic

70
Q

ABx for diverticulitis

A

IV cef and met

71
Q

What condition is associated with Squamous cell carcinoma

A

Achalasia

72
Q

Pancreatitis nutrition mx

A

Only NBM if vomitting
Otherwise encourage oral feeding

73
Q

If procedure to remove gallstone and afterwards febrile what is the dx

A

Pancreatitis secondary to ERCP

Year 6 (28 decks)

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