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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
Q

History of volvulus

A

Similar to bowel obstruction
Vomiting (bilious green)
Diffuse abdo pain
Absolute constipation

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26
Q

Investigations in volvulus

A

B - Inflamatory, VBG (lactate for ischaemic bowel)
O -
X - Abdo xr, CT
S -

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27
Q

What is seen on abdo XR in volvulus

A

Coffee bean sign

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28
Q

Management of volvulus

A

Conservative
Endoscopic decompression
Sigmoidoscope can be inserted
Surgical - laparotomy, Hartmann’s, Ileocecal resection, right hemicolectomy.

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29
Q

Define hernia

A

Outpouching of an organ normally contained within a cavity through that cavity wall. Occurs at weak spots in this wall.

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30
Q

History of hernia

A

Soft lump protruding
Aching pulling or dragging sensation

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31
Q

Clinical signs of hernia

A

Protruding lump
May protrude further on coughing or standing.

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32
Q

Complications of hernia

A

Incarceration
Obstruction
Strangulation.

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33
Q

What is an incarcerated hernia

A

Where the hernia can not be reduced back into the proper position.

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34
Q

What is a strangulated hernia

A

Where a hernia is non reducible and the base of the hernia becomes so tight the blood supply is cut off causing ischaemia.

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35
Q

Management of hernias

A

Conservative
Surgical - mesh!

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36
Q

What are the main types of hernia

A

Inguinal
Femoral
Umbilical
Hiatus

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37
Q

What are the types of inguinal hernia

A

Indirect and direct

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38
Q

What is an indirect hernia

A

Where bowel herniates through the deep and superficial inguinal ring.

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39
Q

What is a direct inguinal hernia

A

Where the bowel herniates directly through the abdominal wall and only passes through the superficial inguinal ring.

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40
Q

Through what weakness do direct hernias portrude through

A

Hesselbach’s triangle

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41
Q

What are the boundaries of hesselbach’s triangle

A

RIP
Rectus abdominis - medial
Inferior epigastric vessels - lateral
Poupart’s (inguinal) ligament - inferior

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42
Q

What are the boundaries of the femoral canal

A

FLIP
Femoral vein - laterall
Lacunar ligament - medially
Inguinal ligament - anteriorly
Pectineal ligament - posteriorly

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43
Q

What are the boundaries of the femoral triangle

A

SAIL
Sartorius - laterally
Adductor longus - medially
Inguinal Ligament - superiorly.

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44
Q

What is the contents of the femoral triangel

A

NAVY-C
Nerve
Artery
Vein
Y-fronts
Canal

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45
Q

What is the contents of the femoral triangle

A

NAVY-C
Nerve
Artery
Vein
Y-fronts
Canal

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46
Q

Define haemorrhoids

A

Haemorrhoids are enlarged anal vascular cushions.

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47
Q

What are anal cushions

A

Specialised submucosal tissue that contains connections between arteries and veins = very vascular.

48
Q

What is the classification of haemorrhoids

A

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
Q

History of haemorrhoids

A

OFten asymptomatic
Pain
Bright red bleeding - typically on wiping.
Sore/itchy anus
Feeling a lump

50
Q

Clinical signs of haemorrois

A

External haemorrhoid - visible
Internal - felt on pr

51
Q

Differentials of rectal bleeding

A

Anal fissures
Diverticulosis
Inflammatory bowel disease
Colorectal cancer

52
Q

Define diverticulum

A

A pouch or pocket within the bowel wall.

53
Q

Define diverticulosis

A

The presence of diverticula

54
Q

Define diverticular disease

A

Symptomatic diverticulosis

55
Q

Define diverticulitis

A

The inflammation of diverticula.

56
Q

What is the most common site of bowel to see diverticula

A

The sigmoid (In western world)

57
Q

Risk factors for diverticulosis

A

Old age!
Low fibre diet
Obesity
NSAIDs

58
Q

History of diverticula disease

A

Often asymptomatic - incidental finding on CT
LIF pain
Constipation
Bleeding

59
Q

Management of diverticula disease

A

Conservative
Lifestyle management
Bulk forming laxatives

60
Q

History of diverticulitis

A

Pain in LIF
Fever
Diarrhoea
Nausea and vomiting
Rectal bleeding

61
Q

Clinical signs of diverticulitis

A

Tenderness in LIF
Fever
Abdo mass

62
Q

Investigations of diverticulitis

A

B - inflammatory, ?VBG
O - urine dip
X - CT, ?XR

63
Q

Management of diverticulitis

A

Conservative
Abx - co-amox
Bowel rest
Analgesia
Laxatives

64
Q

Complications of diverticulitis

A

Perforation
Peritonitis
Abscess
Fistula
Ileus/obstruction

65
Q

Define mesenteric ischaemia

A

Obstruction to the blood flow in mesenteric vessels supplying the intestines resulting in ischaemia

66
Q

What is the blood supply to the foregut

A

coeliac artery
(stomach, biliary system and some duodenum)

67
Q

What is the blood supply of the mid gut

A

Superior mesenteric
(distal duodenum, to 2/3 transverse colon)

68
Q

What is the blood supply to the hind gut

A

Inferior mesenteric artery
(distal 1/3 transvers colon to rectum)

69
Q

History of mesenteric ischaemia

A

Central colicky abdo pain
Shock
Peritonitis
Sepsis
Necrosis

70
Q

Risk factors for mesenteric ischaemia

A

Old age
FH
Smoking
Diabetes
HTN
Raised cholesterol
Risk of clots - AF!!

71
Q

Investigations of mesenteric ischaemia

A

CT angiogram !! CT contrast if acute
B - Lactate necrosis + acidosis,

72
Q

Management of mesenteric ischaemia

A

Conservative
Reduce risk factors + secondary prevention
Revascularisation - PCI, open
Acute - remove necrotic bowel/remove thrombus (or blocked vessel)

73
Q

Risk factors for bowel cancer

A

FH - poylposis (FAP, HNPCC)
IBD
Old age
Diet - red processed meat, low fibre
Obesity
Smoking
Alcohol

74
Q

Red flags of bowel cancer

A

Change in bowel habit - often more loose and frequent
Unexplained weight loss
Rectal bleeding
Unexplained abdo pain
Iron deficiency anaemia
Abdo/rectal mass

75
Q

Investigations in bowel cancer

A

Colonoscopy! - biopsy
CT colonography
CT TAP

76
Q

What is the classification system for bowel cancer

A

TNM

77
Q

What is the T in bowel cancer classifiation

A

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
Q

What is the N in bowel cancer classification

A

Nodes
NX - unable to assess nodes
N0 - no nodal spread
N1 - Spread to 1-3 nodes
N2 - spread to more than 3 nodes

79
Q

What is the M in bowel cancer classification

A

Metastasis
M0 - no metastasis
M1 - metastasis

80
Q

Management options in bowel cancer

A

Surgical resection
Chemo
Radio
Palliative

81
Q

Define stoma

A

Artificial openings of a hollow organ - often bowel.

82
Q

What is a colostomy

A

The large bowel is brought onto the skin to drain more solid faces. Often more flat to skin and in LIF.

83
Q

What is an ileostomy

A

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
Q

What is a gastrostomy

A

A connection between the stomach and skin

85
Q

Define gall stones

A

Gallstones are small stones that form in the gall bladder. The stones form from concentrated bile mostly made of cholesterol.

86
Q

Define cholestasis

A

Blockage to the flow of bile

87
Q

Define cholelithiasis

A

Gallstones are present

88
Q

Define biliary colic

A

Intermittent RUQ pain caused by gall stones iritating the bile ducts

89
Q

Define cholecystitis

A

Inflammation of the gall bladder

90
Q

Define cholangitit

A

Inflammation of the bile ducts

91
Q

Risk factors for gall stones

A

4 F’s
Fat
Fair
Female
Forty

92
Q

History of gall stones

A

Asymptomatic
Biliary colic
RUQ, epigastric pain
Triggered by meals - fatty
Associated with nausea and vomiting

93
Q

Investigations in gall stones

A

LFTs
Bilirubin - raised = obstruction
ALP - non specific
ALT + AST = hepatocellular
US!!!
MRCP

94
Q

Management of gall stones

A

Conservatively
ERCP
Cholecystectomy

95
Q

Define acute cholecystitis

A

Inflammation of the gall bladder which is caused by a blockage of the cystic duct preventing the gallbladder from draining.

96
Q

History of acute cholecystitis

A

Fever
RUP pain - radiate to shoulder?
Fever
Nausea
Vomiting
Tachycardia + tachypnoea

97
Q

What is Murphy’s sign

A

When applying pressure to the RUQ, during inspiration the gallbladder will descend and contact the hand causing pain
Acute cholecystitis

98
Q

Investigations

A

B - Inflammatory markers, LFTs
O - urinalyis?
X - US Thickened wall, gall stones, fluid - MRCP

99
Q

Management of acute cholecystitis

A

Conservative
Nill by mouth
Fluids
Abx
NG

ERCP - remove blockage
Cholecystectomy - within 72hr or delays 6-8 weeks

100
Q

Define acute cholangitits

A

Is the infection and inflammation in the bile ducts.

101
Q

What are the main causes of acute cholangitis

A

Obstuction - gallstones
Infection introduced during ERCP

102
Q

What is Charcot’s triad

A

Acute cholangitis!
RUQ pain
Fever
Jaundice

103
Q

Management of acute cholangitits

A

Nil by mouth
IV fluids
Abx
HDU/ITU aware

104
Q

Investigations in acute cholangitits

A

US
CT
MRCP
Endoscopic ultrasound
Bloods - cultures (commonly causes sepsis)

105
Q

Define cholangeocarcinoma

A

A type of cancer that originates in the bile ducts. Majority are adenocarcinomas

106
Q

Risk factors for cholangeopcarinomas

A

Primary sclerosing cholangitis
Liver flukes (parasitic infection)

107
Q

Presentation of obstructive jaundice

A

Pale stool
Dark urine
Generalised itching

108
Q

Red flags of cholangiocarcinoma

A

Obstructive jaundice patter
Unexplained weight loss
RUQ pain
Palpable gallbladder
Hepatomegaly

109
Q

Investigations in cholangiocarcinoma

A

B
O
X - CT, CT TAP, MRCP, ERCP
S - CA-19

110
Q

Management of cholangiocarcinoma

A

Surgical removal - curative
Chemo, radio
Palliatice
Symptomatic management

111
Q

Define pancreatitis

A

Inflammation of the pancrease

112
Q

Common causes of pancreatitis

A

I GET SMASHED
Idiopathic
Ethanol - alcohol
Trauma
Steroids
Mumps
Autoimmune
Scorpion vennom
Hyperlipidaemia
ERCP
Drugs - furosemide, thiazides azothioprine

113
Q

History of acute pancreatitis

A

Severe epigastric pain radiating to the back
Nausea and vomiting
Abop pain
Systemically unwell.

114
Q

Investigations in acute pancreatitis

A

Clinical diagnosis
Amylase
Bloods - FBC, UE, LFT, Calcium, ABG
US, CT abdo

115
Q

What score is used to assess the severity of acute pancreatitis

A

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
Q

Management of acute pancreatitis

A

ABCDE
IV fluids
Nil by mouth
Anaglesia
Monitoring
Treatment of gallstones (ERCP)
Abx

117
Q

Complications of acute pancreatitits

A

Necrosis
Infection
Abscess
Pseudocysts
Chronic pancreatitis

Med Finals - Surgery (7 decks)

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