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Surgery > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What are the big three causes of bowel obstruction?

A

Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)

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2
Q

What are the main causes of adhesions?

A

Abdominal/pelvic surgery
Peritonitis
Abdominal/pelvic infections (e.g. PID)
Endometriosis

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3
Q

What is a closed loop obstruction?

A

When there are 2 points of obstruction along the bowel. There is a middle bit sandwiched between the 2 points of obstruction

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4
Q

What are the key presenting features of an obstructed bowel?

A

Vomiting (green bilious)
Abdominal distention
Diffuse abdominal pain
Constipation, lack of flatulence
Tinkling bowel sounds

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5
Q

What is the initial management of bowel obstruction?

A

Drip and suck
- Nil by mouth
- IV fluids
- NG tube with free drainage

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6
Q

What is an ileus?

A

A condition that affects the small bowel - the normal peristalsis stops. Presents the same as a bowel obstruction.

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7
Q

How is an ileus managed?

A

Nil by mouth
NG tube
IV fluids
Mobilisation to help re-initiate peristalsis
TPN

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8
Q

What is a volvulus?

A

Occurs when the bowel twists around itself and the mesentery leading to a closed loop obstruction.
Sigmoid and caecal volvulus

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9
Q

What X-ray sign is seen in a sigmoid volvulus?

A

Coffee bean sign

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10
Q

What are the associated with a sigmoid volvulus?

A

Older patients
Chronic constipation
Chagas disease
Neuropsychiatric conditions (e.g. Parkinson’s, Duchene’s muscular dystrophy, schizophrenia)

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11
Q

What is associated with caecal volvulus?

A

Can occur in all ages
Pregnancy
Adhesions

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12
Q

What is the management of a sigmoid volvulus?

A

Rigid sigmoidoscopy with a rectal tube insertion

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13
Q

What is the management of a caecal volvulus?

A

Right hemicolectomy often needed

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14
Q

What is diverticulosis?

A

The presence of diverticula without infection and inflammation

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15
Q

What is diverticulitis?

A

Inflammation and infection of the diverticula

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16
Q

What is the management of uncomplicated diverticulitis?

A

Oral co-amox
Analgesia (avoid NSAIDs and opiates)
Clear liquids
Follow-up, may require IV antibiotics

17
Q

What is the Hinchey classification?

A

Determines the severity of acute diverticulitis
I - para-colonic abscess
II - pelvic abscess
III - purulent peritonitis
IV - faecal peritonitis

18
Q

What is mesenteric ischaemia?

A

Lack of blood flow through the mesenteric vessels that leads to intestinal ischaemia

19
Q

What is the foregut?

A

Stomach, first part of the duodenum, hepatobiliary system, pancreas and spleen

20
Q

What is the midgut?

A

Distal part of the duodenum to the first half of the transverse colon

21
Q

What is the hindgut?

A

Second half of the transverse colon to the rectum

22
Q

What is chronic mesenteric ischaemia?

A

Also called mesenteric angina
Narrowing of the mesenteric vessels as a result of atherosclerosis
Results in intermittent abdominal pain

23
Q

What is the classical triad of chronic mesenteric ischaemia?

A

Central colicky abdominal pain that comes on after eating
Weight loss (due to food avoidance)
Abdominal bruit may be heart on auscultation

24
Q

How is chronic mesenteric ischaemia diagnosed?

A

CT angiography

25
Q

What is the management of acute mesenteric ischaemia?

A

Reduce modifiable risk factors (e.g. stop smoking)
Secondary prevention (statins and antiplatelets)
Revascularisation to improve blood flow (1st line is endovascular procedures e.g. percutaneous mesenteric artery stenting)

26
Q

What is acute mesenteric ischaemia?

A

Typically results from an embolism that occludes artery supplying the small bowel. Typically patients have a history of AF.

27
Q

What is the presentation of acute mesenteric ischaemia?

A

Severe abdominal pain that is sudden onset and out of keeping with physical exam findings

28
Q

What is the management of acute mesenteric ischaemia?

A

Immediate laparotomy to remove necrotic bowel or remove/bypass the thrombus

29
Q

What is used to monitor the response of colon cancer to treatment?

A

CEA (carcinoembryonic antigen)

30
Q

How does an anal fissure present?

A

Bright red rectal bleeding and pain on defecation

31
Q

What is the management of an acute anal fissure?

A

Soften stool
- dietary advice (high fibre + high fluid intake)
- bulk forming laxatives
Lubricants before defecation
Topical anaesthetics
Topical analgesia

32
Q

What is the management of a chronic anal fissure?

A

Topical GTN
If not effective after 8 weeks refer for surgery (sphincterotomy) or botox

33
Q

What are the general rules of thumb for an ileostomy?

A

R iliac fossa
Spouted
Liquid

34
Q

What are the general rules of thumb for an colostomy?

A

L iliac fossa
Flat to the skin
Solids

35
Q

What is the treatment of a perianal abscess?

A

Incision and drainage

36
Q

How might a haemorrhoid present?

A

Usually painless bright red rectal bleeding

Surgery (8 decks)

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