General surgery Flashcards
Causes of dysphagia
Oesophageal cancer
Achalasia
Pharyngeal pouch
Plummer vision
Ix of dysphagia
Barium swallow- achalasia, pouch
OGD- malignancy
Manometry- if achalasia is suspected for diagnosis
Sx of pouch
Gurgling
Halitosis
Regurgitation
GORD sx
Heartburn worse laying down and after meals
Better with antacids
Belching
Tx of GORD
Antacids
PPI- trial 1-2 months
Urgent OGD criteria
Dysphagia
Mass
>55 and wt loss and reflux/dyspepsia
Non urgent OGD
Haematemesis
>55, High plts
>55, Low Hb and pain
>55, N+V and upper GI sx
Dyspepsia Ix and tx
Urea breath test
If +ve triple therapy- amox, clarith, omeprazole
If -ve PPI
Cause of upper GI bleed
Order of likeliness
PUD
Gastritis
MWT
Variceas
Blood diagnosis of pancreatitis
Amylase 3x ULN
Drugs that cause pancreatitis
F-MASS
Furosemide, mesalazine, azathioprine, steroids, sodium valproate
Ix of acute abdomen
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
Types of hernia and location
Femoral- lateral and inferior to tubercle
Inguinal medial and superior
Epigastric- midline between xiphi and umbilicus
Paraumbilical- next to umbilicus in midline
Biliary colic features
Unlikely if first presentation >60
RUQ pain- goes to back
After fatty food
When to order ERCP/MRCP
If bile duct look dilated on USS
If suspected acute cholecystitis what Ix
FBC, U&E, LFT, bilirubin
Urine- bilirubin
USS- if negative HIDA scan
Erect CXR
Sx of pancreatitis
Radiates to the back
Relieved by sitting forward
Vomiting
Biliary colic sx
RUQ pain radiating to scapula
May be following a fatty meal
Obstructive jaundice may occur- pale stools and dark urine
Diverticulitis sx
Colicky pain in LLQ
Fever
Hx of constipation
Causative organism of ascending cholangitis
E coli
Mx of ascending cholangitis
ABx and ERCP after 24-48hrs
Mx of acute cholecystitis
IV ABx
Early lap chole- <1 week
Ix for intestinal obstruction
Abdo CXR
CT AP
Types of colorectal surgical approaches
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
Small bowel causes of obstruction
Adhesions
Hernia
Tumour
LBO causes
Cancer
Volvulus
Strictures- diverticula
Colorectal cancer screening
FIT screening
Every 2 years to 60-74
Colonoscopy once +
Tx of post op ileus
NG and IV fluids
Tx of volvulus
Sigmoidoscopy and rectal tube insertion- sigmoid
Laparotomy and right hemi- caecal
Tx of femoral hernia
Urgent
Elective- lockwood
Emergency- McEvedy
Extra-intestinal features of IBD
A PIE SAC
Aphtous ulcer- Crohns
Pyoderma gangrenosa
Iritis/uveritis- CD
Erythema nodosum
Sclerosing Cholangitis- UC/ stones- CD
Arthritis
Clubbiong- CD
When to give pneumococcal vaccine with splenectomy
2 weeks before
Signs of wound dehiscence and action
Bowel protruding
Pink discharge
Urgent senior help
Tearing chest pain and creps over chest wall dx
Boerhavers
Sudden abdo pain, out of keeping of exam findings and AF
Acute mesenteric ischaemia
Ischaemic colitis sx
Bloody diarrhoea
Less severe
Resolves spontaneously
Sulphonylureas on say of surgery
Withold morning
Give in afternoon
Tx of thromboses haemorrhoid
> 72 hours- stool softener, ice pack, analgesia
<72- excision
Ix for leaking anastomosis
CT PA
Sx of ileus
Hypovolaemic
Electrolytes disturbances
Absent bowel sounds
No emptying of bowels
Anastomotic leak sx
Septic picture
Peritotism
When to refer for colonoscopy for cancer
> 40 unexplained wt loss and pain
50 bleeding
60 IDA or change in bowel habits
Indications for thoracotomy in haemothorax
Blood loss >1.5L
Brown coloured urine, abdo distension and obstruction of bowel
Colovesical fistula ?
CT
Diagnostic test of chronic pancreatitis
CT With IV contrast
Gastric volvulus triad
Vomiting, pain, failed attempts to pass NG tube
Polyp and hypokalaemia
Villous polyp
Mx of strangulated hernia in GP
Call 999- get assessed urgently
DO not attempt to manually reduce
Ruptured AAA blood products
6 units of blood
Test for hernias
Cough impulse
Reducible
Place over deep inguinal ring
See if reappears
If pain and drain with green fluid after cholecystectomy
Biliary leak
Anterior vs AP resection
Anterior- >5cm- or mid to upper tumours
AP- <5cm or lower
Dx of Boerhaaves syndrome
CT contrast swallow
Bsoas sign
Pain beneath right scapula in cholecystitis
Pancreatic cancer sign on USS/CT
Double duct sign- obstruction on CBD and pancreatic duct
Nissen fundoplication tests before surgery
pH and mamonetry
Tx of asymptomatic gallstones
Reassurance- if sx free for 12m
Node in umbilicus and its meaning
St Marys Joseph node
Malignancy in pelvis or abdo
Recurrent natal cleft pain and mx
Pilonodal sinus disease
Cystectomy
Feeding after oesophagectomy
Jejunostomy
When to give FIT test
To new symptoms not meeting 2ww criteria
Or to 60-74 screening every 2 years
What happens in Hartmanns
Resect relevant bowel
End colonostomy
Can have future anastomosis
Dukes staging
A- mucosa
B- muscle
C- lymph
D- Distant mets
Hasselbach triangle
Direct hernia passes through
Made out of
Inguinal ligament
Inferior epigastric
Rectus Abdominis
Unilateral vs bilateral surgical approach
Unilateral- open
Bilateral- laproscopically
Layers in abdomen
Skin, fatty superficial fascia- campers
Membranous- Scarpas
Ext oblique
Int oblique
Transverse abdominus
Arcuate line significance
No posterior rectus sheath underneath umbilicus
Allows immediate access to peritoneum
Sigmoid volvulus with peritonitis
sigmoid volvulus who have bowel obstruction with symptoms of peritonitis, skip the flexible sigmoidoscopy and treat with urgent midline laparotom
Ultrasound of hepatic hemangioma
Hyperechoic
ABx for diverticulitis
IV cef and met
What condition is associated with Squamous cell carcinoma
Achalasia
Pancreatitis nutrition mx
Only NBM if vomitting
Otherwise encourage oral feeding
If procedure to remove gallstone and afterwards febrile what is the dx
Pancreatitis secondary to ERCP
