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Med Finals - Surgery > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Define appendicitis

A

Inflammation of appendix

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2
Q

History of appendicits

A

Pain - periumbilical -> RLQ (McBurney’s Point)
N+V
Fever

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3
Q

Appendicitis clinical signs

A

Fever
Rovsing’s sign - palation of LIF causes pain in RIF
Rebound tenderness
Percussion tenderness
Guarding

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4
Q

Appendicitis investigations

A

Clinical!
B - Inflammatory markers
O - n/a
X - CT, US (rule out gynae)
S - Diagnostic laparoscopy

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5
Q

Differentials of appendicitis

A

Gynae - ectopic (Serum HCG), ovarian cysts
Paeds - Meckel’s Diverticulum, Mesenteric adenitis

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6
Q

Management of appendicitis

A

Appendicectomy
Symptomatic control

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7
Q

Define bowel obstruction

A

Passage of food, fluid and gas through the bowel becomes blocked.

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8
Q

What is third spacing?

A

Gi tract secretes fluid which is normally reabsorbed.
Due to blockage is is not reabsorbed resulting in loss of intravascular volume.
Leads to hypovolaemia and shock.

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9
Q

Causes of bowel obstruction

A

HAM
Hernias - small
Adhesions - small
Malignancy - large

Volvulus, diverticular, strictures, intussusception

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10
Q

Define adhesions

A

Pieces of scar tissue that bind the abdominal contents together.
Cause kinking or squeezing of the bowel to cause obstruction

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11
Q

Define closed loop obstruction

A

Describes a situation where there are two points of obstruction along the bowel.

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12
Q

Causes of a closed loop obstruction

A

Adhesions
Hernias
Volvulus
Obstruction with competent ileocaecal valve.

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13
Q

History of bowel obstruction

A

Vomiting - bilious green (small)
Not opened bowels.
Pain - diffuse

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14
Q

Clinical signs of bowel obstruction

A

Diffuse tenderness
Abdominal distension
Tinkling bowel sounds

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15
Q

Investigations in bowel obstruction

A

B - U+Es, VBG (metabolic alkalosis from vomiting, lactate for ischaemia), inflammatory markers
O - n/a (empty rectum?)
X-ray - 3-6-9 rule
S -

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16
Q

Signs of bowel obstruction on X-ray

A

Distended loops of bowel - 3cm small, 6cm colon, 9cm caecum

Valvulae conniventes -mucosal folds that form lines extending the full width of the small bowel.

Haustra - form lines not extending the full width of the large bowel.

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17
Q

Management of bowel obstruction

A

Emergency - ABCDE!
Drip and suck - nil by mouth, IV fluids, NG tube with free drainage.
Conservative if possible.
Surgery - exploratory, to remove obstruction or emergency resection. Stenting is possible in malignancy.

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18
Q

Define ileus

A

Condition affecting the small bowel where normal peristalsis stops.

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19
Q

Causes of ileus

A

Injury to bowel
Handling during surgery
Inflammation or infection
Electrolyte imbalance

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20
Q

Clinical signs of ileus

A

Abdo distension
Diffuse abdo pain
Constipation (+vomiting, pseudo obstruction)
Absent bowel sounds.

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21
Q

Management of ileus

A

Drip and suck - nil by mouth, NG free drainage, IV fluids
Mobilisation
TPN
Laxative late stage (metoclopramide, erythromycin)

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22
Q

Define volvulus

A

Condition where the bowel twists around itself and the mesentery its attached to.
This causes a closed loop obstruction and can cut off blood supply.

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23
Q

What the main types of volvulus

A

Sigmoid (most common)
Caecal

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24
Q

Risk factors for volvulus

A

Neuropsychiatric disorders - Parkinson’s.
Nursing home residents
Chronic constipation
High fibre diet
Pregnancy
Adhesions

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25
History of volvulus
Similar to bowel obstruction Vomiting (bilious green) Diffuse abdo pain Absolute constipation
26
Investigations in volvulus
B - Inflamatory, VBG (lactate for ischaemic bowel) O - X - Abdo xr, CT S -
27
What is seen on abdo XR in volvulus
Coffee bean sign
28
Management of volvulus
Conservative Endoscopic decompression Sigmoidoscope can be inserted Surgical - laparotomy, Hartmann's, Ileocecal resection, right hemicolectomy.
29
Define hernia
Outpouching of an organ normally contained within a cavity through that cavity wall. Occurs at weak spots in this wall.
30
History of hernia
Soft lump protruding Aching pulling or dragging sensation
31
Clinical signs of hernia
Protruding lump May protrude further on coughing or standing.
32
Complications of hernia
Incarceration Obstruction Strangulation.
33
What is an incarcerated hernia
Where the hernia can not be reduced back into the proper position.
34
What is a strangulated hernia
Where a hernia is non reducible and the base of the hernia becomes so tight the blood supply is cut off causing ischaemia.
35
Management of hernias
Conservative Surgical - mesh!
36
What are the main types of hernia
Inguinal Femoral Umbilical Hiatus
37
What are the types of inguinal hernia
Indirect and direct
38
What is an indirect hernia
Where bowel herniates through the deep and superficial inguinal ring.
39
What is a direct inguinal hernia
Where the bowel herniates directly through the abdominal wall and only passes through the superficial inguinal ring.
40
Through what weakness do direct hernias portrude through
Hesselbach's triangle
41
What are the boundaries of hesselbach's triangle
RIP Rectus abdominis - medial Inferior epigastric vessels - lateral Poupart's (inguinal) ligament - inferior
42
What are the boundaries of the femoral canal
FLIP Femoral vein - laterall Lacunar ligament - medially Inguinal ligament - anteriorly Pectineal ligament - posteriorly
43
What are the boundaries of the femoral triangle
SAIL Sartorius - laterally Adductor longus - medially Inguinal Ligament - superiorly.
44
What is the contents of the femoral triangel
NAVY-C Nerve Artery Vein Y-fronts Canal
45
What is the contents of the femoral triangle
NAVY-C Nerve Artery Vein Y-fronts Canal
46
Define haemorrhoids
Haemorrhoids are enlarged anal vascular cushions.
47
What are anal cushions
Specialised submucosal tissue that contains connections between arteries and veins = very vascular.
48
What is the classification of haemorrhoids
1st degree - no prolapse 2nd degree - prolapse when straining and return on relaxing 3rd degree - prolapse when straining and do not return on relaxation, but can be reduced. 4th degree - prolapsed permanently
49
History of haemorrhoids
OFten asymptomatic Pain Bright red bleeding - typically on wiping. Sore/itchy anus Feeling a lump
50
Clinical signs of haemorrois
External haemorrhoid - visible Internal - felt on pr
51
Differentials of rectal bleeding
Anal fissures Diverticulosis Inflammatory bowel disease Colorectal cancer
52
Define diverticulum
A pouch or pocket within the bowel wall.
53
Define diverticulosis
The presence of diverticula
54
Define diverticular disease
Symptomatic diverticulosis
55
Define diverticulitis
The inflammation of diverticula.
56
What is the most common site of bowel to see diverticula
The sigmoid (In western world)
57
Risk factors for diverticulosis
Old age! Low fibre diet Obesity NSAIDs
58
History of diverticula disease
Often asymptomatic - incidental finding on CT LIF pain Constipation Bleeding
59
Management of diverticula disease
Conservative Lifestyle management Bulk forming laxatives
60
History of diverticulitis
Pain in LIF Fever Diarrhoea Nausea and vomiting Rectal bleeding
61
Clinical signs of diverticulitis
Tenderness in LIF Fever Abdo mass
62
Investigations of diverticulitis
B - inflammatory, ?VBG O - urine dip X - CT, ?XR
63
Management of diverticulitis
Conservative Abx - co-amox Bowel rest Analgesia Laxatives
64
Complications of diverticulitis
Perforation Peritonitis Abscess Fistula Ileus/obstruction
65
Define mesenteric ischaemia
Obstruction to the blood flow in mesenteric vessels supplying the intestines resulting in ischaemia
66
What is the blood supply to the foregut
coeliac artery (stomach, biliary system and some duodenum)
67
What is the blood supply of the mid gut
Superior mesenteric (distal duodenum, to 2/3 transverse colon)
68
What is the blood supply to the hind gut
Inferior mesenteric artery (distal 1/3 transvers colon to rectum)
69
History of mesenteric ischaemia
Central colicky abdo pain Shock Peritonitis Sepsis Necrosis
70
Risk factors for mesenteric ischaemia
Old age FH Smoking Diabetes HTN Raised cholesterol Risk of clots - AF!!
71
Investigations of mesenteric ischaemia
CT angiogram !! CT contrast if acute B - Lactate necrosis + acidosis,
72
Management of mesenteric ischaemia
Conservative Reduce risk factors + secondary prevention Revascularisation - PCI, open Acute - remove necrotic bowel/remove thrombus (or blocked vessel)
73
Risk factors for bowel cancer
FH - poylposis (FAP, HNPCC) IBD Old age Diet - red processed meat, low fibre Obesity Smoking Alcohol
74
Red flags of bowel cancer
Change in bowel habit - often more loose and frequent Unexplained weight loss Rectal bleeding Unexplained abdo pain Iron deficiency anaemia Abdo/rectal mass
75
Investigations in bowel cancer
Colonoscopy! - biopsy CT colonography CT TAP
76
What is the classification system for bowel cancer
TNM
77
What is the T in bowel cancer classifiation
Tumour TX - unable to assess size T1 - Submucosa involvement T2 - involvement of muscularis T3 - Involvement of the subserosa and serosa but not through the serosa T4 - spread through the serosa (4a) reaching other tissues (4b)
78
What is the N in bowel cancer classification
Nodes NX - unable to assess nodes N0 - no nodal spread N1 - Spread to 1-3 nodes N2 - spread to more than 3 nodes
79
What is the M in bowel cancer classification
Metastasis M0 - no metastasis M1 - metastasis
80
Management options in bowel cancer
Surgical resection Chemo Radio Palliative
81
Define stoma
Artificial openings of a hollow organ - often bowel.
82
What is a colostomy
The large bowel is brought onto the skin to drain more solid faces. Often more flat to skin and in LIF.
83
What is an ileostomy
A portion of small bowel is brought onto the skin to drain more liquid faeces. They have spouts as the liquid can irritate surrounding skin and are normall found in the RIF
84
What is a gastrostomy
A connection between the stomach and skin
85
Define gall stones
Gallstones are small stones that form in the gall bladder. The stones form from concentrated bile mostly made of cholesterol.
86
Define cholestasis
Blockage to the flow of bile
87
Define cholelithiasis
Gallstones are present
88
Define biliary colic
Intermittent RUQ pain caused by gall stones iritating the bile ducts
89
Define cholecystitis
Inflammation of the gall bladder
90
Define cholangitit
Inflammation of the bile ducts
91
Risk factors for gall stones
4 F's Fat Fair Female Forty
92
History of gall stones
Asymptomatic Biliary colic RUQ, epigastric pain Triggered by meals - fatty Associated with nausea and vomiting
93
Investigations in gall stones
LFTs Bilirubin - raised = obstruction ALP - non specific ALT + AST = hepatocellular US!!! MRCP
94
Management of gall stones
Conservatively ERCP Cholecystectomy
95
Define acute cholecystitis
Inflammation of the gall bladder which is caused by a blockage of the cystic duct preventing the gallbladder from draining.
96
History of acute cholecystitis
Fever RUP pain - radiate to shoulder? Fever Nausea Vomiting Tachycardia + tachypnoea
97
What is Murphy's sign
When applying pressure to the RUQ, during inspiration the gallbladder will descend and contact the hand causing pain Acute cholecystitis
98
Investigations
B - Inflammatory markers, LFTs O - urinalyis? X - US Thickened wall, gall stones, fluid - MRCP
99
Management of acute cholecystitis
Conservative Nill by mouth Fluids Abx NG ERCP - remove blockage Cholecystectomy - within 72hr or delays 6-8 weeks
100
Define acute cholangitits
Is the infection and inflammation in the bile ducts.
101
What are the main causes of acute cholangitis
Obstuction - gallstones Infection introduced during ERCP
102
What is Charcot's triad
Acute cholangitis! RUQ pain Fever Jaundice
103
Management of acute cholangitits
Nil by mouth IV fluids Abx HDU/ITU aware
104
Investigations in acute cholangitits
US CT MRCP Endoscopic ultrasound Bloods - cultures (commonly causes sepsis)
105
Define cholangeocarcinoma
A type of cancer that originates in the bile ducts. Majority are adenocarcinomas
106
Risk factors for cholangeopcarinomas
Primary sclerosing cholangitis Liver flukes (parasitic infection)
107
Presentation of obstructive jaundice
Pale stool Dark urine Generalised itching
108
Red flags of cholangiocarcinoma
Obstructive jaundice patter Unexplained weight loss RUQ pain Palpable gallbladder Hepatomegaly
109
Investigations in cholangiocarcinoma
B O X - CT, CT TAP, MRCP, ERCP S - CA-19
110
Management of cholangiocarcinoma
Surgical removal - curative Chemo, radio Palliatice Symptomatic management
111
Define pancreatitis
Inflammation of the pancrease
112
Common causes of pancreatitis
I GET SMASHED Idiopathic Ethanol - alcohol Trauma Steroids Mumps Autoimmune Scorpion vennom Hyperlipidaemia ERCP Drugs - furosemide, thiazides azothioprine
113
History of acute pancreatitis
Severe epigastric pain radiating to the back Nausea and vomiting Abop pain Systemically unwell.
114
Investigations in acute pancreatitis
Clinical diagnosis Amylase Bloods - FBC, UE, LFT, Calcium, ABG US, CT abdo
115
What score is used to assess the severity of acute pancreatitis
Glasgow score PANCREAS PaO2 - <8 Age >55 Neuts >15 Calcium <2 uRea >16 Enzymes AST/ALT >200 Albumin <32 Sugar BM>10 0 to1 - mild 2 - moderate 3 or more - severe
116
Management of acute pancreatitis
ABCDE IV fluids Nil by mouth Anaglesia Monitoring Treatment of gallstones (ERCP) Abx
117
Complications of acute pancreatitits
Necrosis Infection Abscess Pseudocysts Chronic pancreatitis

Med Finals - Surgery (7 decks)

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