General surgery Flashcards
Parkland formula calculation
When to do a resection in splenic trauma?
Hilar injuries
Major haemorrhage
Major associated injurie
If a person has anti-HBs what does this suggest?
Previous hepatitis immunisation or immunity
Most common benign tumour of mesenchymal origin?
Haemamgioma
Definitive diagnostic investigation got small bowel obstruction?
Ct abdomen
What is the best investigation to characterise the fistula course in an anal fistula if not clinically unwell?
Pelvic MRI
What is an indirect hernia?
travels ‘indirectly’ through the deep AND superficial inguinal ring to where it presents
What is a direct hernia?
Bowel enters the inguinal canal directly through a weakness in the posterior wall of the canal, termed Hesselbachs triangle
UC with sclerosing cholangitis increases the risk of what?
Cholangiocarcinoma
When does BP fall in haemorrhage shock?
When about 30% of blood volume is lost
What kind of shocks cause warm periperhies?
Neurogentic, septic and anaphylatic shock
What is Boas sign seen in?
Cholecytitis
What is cullens sign seen in?
Pancreatitis
What is grey-turners sign?
Pancreatitis
What is a Kocher’s incision?
Incision under right subcostal margin
What is a lanz incision?
Incision in the right iliac fossa (appendectomy_
What is a gridiron incision?
Oblique incision centre over McBurneys point
What is a gable incision?
Rooftop inicison
What is a pfannenstiel incision?
Transverse supra pubic, primarily used to access pelvic organs
What is a McEvedy’s incision?
Groin incision e.g. Emergency repair strangulated femoral herni
What is a rutherford morrison excision?
Extraperitoneal approach to left or right lower quadrants. Gives excellent access to iliac vessels and is the approach of choice for first time renal transplantation.
Most common urothelial malignancy?
Transitional cell carcinoma
The 24hr fluid requirement for burns is given as what?
50% over 8hrs followed by 50% over 16hrs
Mneumonic for hernias?
MILF
Medial inguinal
Lateral femoral
Signs of an aorta disruption?
Deceleration injuries
Contained haematoma
Widened mediastinum
What does achalsia increase risk of?
SCC
Management of a hiatus hernia?
all patients benefit from conservative management e.g. weight loss
medical management: proton pump inhibitor therapy
surgical management: only really has a role in symptomatic paraesophageal hernias
What is angiodysplasia?
Abnormal, tortuous, dilated small blood vessel in the mucosal and submucosal layers of the GI tract. It is the most common vascular abnormality in the GI tract
What is a Richter Hernia?
occurs when the anti-mesenteric wall of the intestine protrudes, causing strangulation without obstruction
Post splenectomy blood film features:
Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
What is seborrheic keratotisis?
harmless warty spot that appears during adult life as a common sign of skin ageing. Some people have hundreds of them.
What is a pilar cyst?
Cysts that form around hair follicles are known as pilar cysts. They’re often found on the scalp. Pilar cysts typically affect middle-aged adults, mostly women. Unlike epidermoid cysts, they run in families.
What is a dermatofibroma?
common and harmless knot of fibrous tissue which occurs in the skin. Dermatofibromas are firm bumps which feel like small rubbery buttons lying just under the surface of the skin.
Why is Boas sign?
hyperaesthesia felt by the patient to light touch in the right lower scapular region or the right upper quadrant of the abdomen. It is classically seen in patients with acute cholecystitis
What is murphys sign?
asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
What is Cullen’s sign?
Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. This is also known as peri-umbilical ecchymosis. It is most often recognised as a result of haemorrhagic pancreatitis.
What is Grey Turner’s sign?
uncommon subcutaneous manifestation of intra-abdominal pathology that manifests as ecchymosis or discoloration of the flanks. [1] Classically it correlates with severe acute necrotizing pancreatitis, often in association with Cullen’s sign
What is riglers sign seen in?
Pneumoperitoneum (free air in the abdomen)
Complications of TPN?
sepsis, re-feeding syndromes and hepatic dysfunction.
What is the max safe dose of lidocaine?
3mg/kg
How to rember incarcerated vs strangulated hernia?
I think of incarcerated like in prison. You’ve locked that bad boy away with no chance of ‘reduction’ in its sentence. Also when you’re in prison there’s a chance you might end up strangled
Strangulated often has systemic features
What is meckel’s diverticulum?
Meckel’s diverticulum is a small outpouching extending from the wall of the intestine and located in the lower portion of the small intestine. The pouch is a remnant of tissue from the embryonic development of the digestive system.
Management of small bowel obstruction?
intial steps:
NBM
IV fluids
nasogastric tube with free drainage
some patients settle with conservative management but otherwise will require surgery
what are hydatid cysts
endemic in Mediterranean and Middle Eastern countries. They are caused by the tapeworm parasite Echinococcus granulosus. An outer fibrous capsule is formed containing multiple small daughter cysts. These cysts are allergens which precipitate a type 1 hypersensitivity reactio
what is pilonidal disease
relatively common condition where sinuses and cysts form near the upper part of the natal cleft of the buttocks. It is more common in men and typically presents around the age of 20 years.
what is neurogenic shock
spinal cord transection, usually at a high level. There is a resultant interruption of the autonomic nervous system. The result is either decreased sympathetic tone or increased parasympathetic tone, the effect of which is a decrease in peripheral vascular resistance mediated by marked vasodilation.
Treat with vasopressors
What is a giant cell tumour?
benign (noncancerous) tumor that has a wide range of behaviors. These tumors typically grow at the ends of the body’s long bones. Most often, they appear at the lower end of the femur (thighbone) or upper end of the tibia (shinbone), close to the knee joint.
How to remember the renal cancers TCC, adenocarcinoma and SCC?
Transitional cancers tend to be in the urothelium (transitional epithelium in the urinary tract) i.e. renal pelvis, ureter, urethra and bladder
Adenocarcinoma is when the cancer arises from glandular tissue so it secretes something and in Q2, hypertension is likely to be caused by aldosterone secreting cells and the polycythaemia possibly due to excess secretion of EPO
Squamous cell carcinomas arise from skin or the lining of hollow organs in the body (i.e. flat lining squamous cells), these can happen in the kidney but aren’t very common.
Genetic defect in FAP?
Mutation of APC gene cases, dominant
Features of FAP?
Typically over 100 colonic adenomas
Cancer risk of 100%
20% are new mutations
Genetic defect in MYH associated polyposis?
Biallelic mutation of mut Y human homologue (MYH) on chromosome 1p, recessive
Features of MYH associated polyposis?
Multiple colonic polyps
Later onset right sided cancers more common than in FAP
100% cancer risk by age 60
Genetic efect in Peutz-Jeghers syndrome?
STK11 (LKB1) mutation on chromosome 19 in some (but not all) cases, dominant
What is a hamartoma
benign (noncancerous) growth, or mass, that contains the same types of cells located in the part of your body where the growth forms. Unlike cells in the surrounding tissue, the cells that make up a hamartoma grow in a disorganized way. These cells clump together to form an abnormal — but harmless — tumor-like mass.
Features of Peutz-Jeghers syndrome?
Multiple benign intestinal hamartomas
Episodic obstruction and intussusception
Increased risk of GI cancers (colorectal cancer 20%, gastric 5%)
Increased risk of breast, ovarian, cervical pancreatic and testicular cancers
Genetic defect in Cowden disease?
Mutation of PTEN gene on chromosome 10q22, dominant
Features in Cowden disease?
Macrocephaly
Multiple intestinal hamartomas
Multiple trichilemmomas (A benign (not cancer) tumor that begins in the outer cells of a hair follicle and appears as a small, smooth, skin-colored, wart-like or dome-shaped lesion.)
89% risk of cancer at any site
16% risk of colorectal cancer
Genetic defect in HNPCC?
Germline mutations of DNA mismatch repair genes
Features of HNPCC (Lynch syndrome)?
Colo rectal cancer 30-70%
Endometrial cancer 30-70%
Gastric cancer 5-10%
Scanty colonic polyps may be present
Colonic tumours likely to be right sided and mucinous
Tongue and uvula memory aid for deviation of lesion?
Tongue goes t’ side of lesion.
Uvula goes Uver way
What is dumping syndrome?
group of symptoms, such as diarrhea, nausea, and feeling light-headed or tired after a meal, that are caused by rapid gastric emptying. Rapid gastric emptying is a condition in which food moves too quickly from your stomach to your duodenum.
When are thyroid peroxidase antibodies looked at?
Found in autoimmune disease affecting the thyroid (Hashimotos 100%) and Graves (70%)
When are antibodies to TSH receptors looked at?
Individuals with Graves disease (95%)
When are thyroglobulin antibodies looked at?
Not useful for clinically distinguishing between different types of thyroid disease, may be used as part of thyroid cancer follow up
When is calcitonin looked at?
Released from the parafollicular cells
Usually found in patients with medullary carcinoma of the thyroid
WHat differentiates neurogenic shock from other types?
Warm peripheries
When sudden full dehiscence occurs the management is as follows:
Coverage of the wound with saline impregnated gauze (on the ward)
IV broad-spectrum antibiotics
Analgesia
IV fluids
Arrangements made for a return to theatre
Features of a biliary colic?
Pain in the RUQ radiating to the back and interscapular region, may be following a fatty meal. Slight misnomer as the pain may persist for hours
Obstructive jaundice may cause pale stools and dark urine
It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation
Treatment of a fissure in ano?
Stool softeners, topical diltiazem or GTN, botulinum toxin, Sphincterotomy
Mneumonic for paediatrix hernias?
Inguinal hernia - get then IN for surgery
Umbilical hernia - um don’t need to operate
What can a FAST scan be used for?
assess the presence of fluid in the abdomen and thorax
Why does a sinusoidal pattern on an ECG occur?
fusion of wide QRS complexes with T waves.
What is spondylolysis?
Congenital or acquired deficiency of the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/ L5
May be asymptomatic and affects up to 5% of the population
Spondylolysis is the commonest cause of spondylolisthesis in children
Asymptomatic cases do not require treatment
What is spondylolisethesis?
This occurs when one vertebra is displaced relative to its immediate inferior vertebral body
May occur as a result of stress fracture or spondylolysis
Traumatic cases may show the classic ‘Scotty Dog’ appearance on plain films
Treatment depends upon the extent of deformity and associated neurological symptoms, minor cases may be actively monitored. Individuals with radicular symptoms or signs will usually require spinal decompression and stabilisatio
What is achalasia?
rare swallowing disorder that affects the esophagus (the tube between the throat and the stomach). In people with achalasia, the esophagus muscles do not contract properly and do not help propel food down toward the stomach.
