General Surgery Flashcards
What is the pathogenesis of acute appendicitis?
Lymphoid hyperplasia or a faecolith—> obstruction of the appendiceal lumen —> gut organisms invading the appendix wall —> oedema +/- perforation
What is the classical sign seen in acute appendicitis?
Rovsing’s sign - palpation in the LIF causes pain the the RIF
What is the diagnostic investigation for small bowel obstruction?
CT abdomen
What is the first line imaging for small bowel obstruction?
Abdominal X-Ray
What is the most common cause of small bowel obstruction?
Adhesions are the most common cause, therefore ask about previous abdominal surgeries
What is a fistula?
An abnormal connection between two epithelial surfaces
Main causes of SBO?
- Adhesions
- Hernias
- Malignancy (large bowel)
Upper limits of bowel diabetes on X-Ray?
- 3 cm small bowel
- 6 cm colon
- 9 cm caecum
What is the pathophysiology of Paralytic ileus?
Peristalsis temporarily stops during post operative period
What X-Ray sign would you expect to see with Volvulus?
Coffee-bean sign
What is the conservative management option for volvulus?
Endoscopic decompression
What surgery is required for a sigmoid volvulus?
Hartmann’s procedure
What surgery is required for a caecal volvulus?
- Ileocaecal resection or
- Right hemicolectomy
What are the boundaries of Hesselbach’s triangle?
- Rectus Abdominis (medial)
- Inferior epigastric vessels (superior/lateral)
- Poupart’s (inguinal) ligament (inferior)
Risk factors for Diverticulosis?
- Increased age
- Low fibre diet
- Use of NSAIDs
- Obesity
First line oral antibiotic for Diverticulitis?
Co-Amoxiclav
What are the presenting features of chronic mesenteric ischaemia?
“Classic triad” of presenting features
- Colicky abdominal pain after eating
- Weight loss
- Abdominal Bruit
What imaging would you do to detect Chronic mesenteric ischaemia?
CT Angiogram
What is the key risk factor for Acute mesenteric ischaemia?
Atrial Fibrillation
What ABG finding would you expect with acute mesenteric ischaemia?
- Metabolic acidosis
- Raised lactate
What is the foregut supplied by?
Coeliac artery
- Includes stomach, part of duodenum, biliary system, liver, pancreas and spleen
What is the midgut supplied by?
Superior mesenteric artery
- Includes distal duodenum to the first half of the transverse colon
What is the hindgut supplied by?
Inferior mesenteric artery
- Includes the second half of the transverse colon to the rectum
What is the screening for Bowel Cancer in england?
- Age 60-74 years
- Frequency - Every 2 years
- Test FIT test on stoolWh
What is the tumour marker for Bowel cancer?
Carcinoembryonic antigen (CEA)
What is Charcot’s triad?
- RUQ pain
- Fever
- Jaundice
What organisms would you expect in Acute Cholangitis?
- E.Coli
- Klebsiella Species
- Enterococcus species
What is Trousseau’s sign and what does it indicated?
Migratory thrombophlebitis
Indicates Pancreatic cancer
What scar would you expect if a patient had had an open appendicectomy?
Lanz
What is Achalasia?
It is a rare neuromuscular disorder of the oesophagus characterised by the inability of the Lower Oesophageal sphincter to relax, often resulting in difficulty swallowing
What are the signs and symptoms of Achalasia?
- Dysphagia - usually has a gradual onset, over a period of years to months
- Regurgitation of undigested food
- Aspiration pneumonia (secondary to regurgitation)
- Retrosternal chest pain or heartburn
- Weight loss
What investigations can be used to diagnose Achalasia?
- Endoscopy: may reveal a dilated oesophagus.
- Oesophageal Manometry: GOLD STANDARD for diagnosis, demonstrating high resting pressure and incomplete relaxation of the LES
- Barium swallow: In advanced cases, a ‘birds beak’ appearance may be observed.
What are the treatment options for Achalasia?
- Medical therapy with botox or CCB or nitrates
- Surgical intervention with Oesophageal dilatation or Heller’s Myotomy
What are the causes of Acute Mesenteric Ischaemia?
- Arterial Embolism: This is the most common cause, often resulting from AF or IE
- Arterial Thrombosis: Usually associated with Atherosclerosis, especially in patients with a history of IHD or PVD
- Venous Thrombosis: Occurs less commonly and is often linked to hypercoagulable states
- Non-Occlusive Mesenteric Ischaemia: Typically linked with low flow states such as HF, shock or during major surgery
What are the signs and symptoms of Acute Mesenteric Ischaemia?
- Sudden Severe Abdominal pain and guarding, often out of proportion to the physical examination
- Nausea and vomiting
- Signs of shock, such as hypotension, tachycardia, altered mental state
- Metabolic acidosis on ABG
- Rectal bleeding can occasionally be seen in advanced ischaemia
What is the investigation of choice for Acute Mesenteric Ischaemia?
- CT Angiography