General Surgery Flashcards
A 48-year-old man with a background of alcohol dependence presents to the clinic with a 6-month history of persistent abdominal pain that is relieved by bending forward and worse after eating
What is the most likely diagnosis?
Chronic Pancreatitis
6 months
Alcohol History
Relieved by bending forwards
Worse after eating
What is a commonly recognised complication of enteral feeding?
Diarrhoea
A 22-year-old man suffers 20% partial and full thickness burns in a house fire , which I.V fluid is recommended?
Hartmann’s Solution
Want to replace the lost ions
What is Cullen’s Sign?
What does it indicate?
Severe acute peri-umbilical bruising
Indicates Acute Pancreatitis
What is Boas’ Sign?
What does it indicate?
Hyperaesthesia ( Excessive physical sensation) beneath the right scapula
Indicates Acute Cholecystitis
What is Psoas stretch sign?
What does it indicate?
Right thigh is passively extended with the patient lying on their side with their knees extended
Indicates Acute Appendicitis
What is Grey-Turner’s Sign?
What does it indicate?
Bruising in the flanks
Indicates Acute Pancreatitis
What is Murphy’s Sign?
What does it indicate?
There is pain/catch of breath elicited on palpation of the right hypochondrium during inspiration
Indicates Acute Cholecystitis
Where are femoral hernias located?
Inferolateral to the pubic tubercle
What is the first line treatment for a gastric MALT lymphoma?
Triple Eradication therapy
This is a type Non-Hodgkin Lymphoma that is heavily associated with H.Pylori Infection
What blood test marker is a good indicator of Acute Pancreatitis severity?
Hypocalcaemia ( >2mmol/L)
What imaging is best for Acute Pancreatitis and why?
Abdo USS
Important to determine the aetiology as this may affect management (e.g. patients with gallstones/biliary obstruction)
What is the management for Biliary Colic?
Analgesia
Anti-emetics
Low fat diet
First-line treatment will be an elective laparoscopic cholecystectomy as an outpatient in 6 months
What is the management of Chronic Pancreatitis?
Replacement of Pancreatic enzymes (Creon)
Analgesia
What is a respiratory complication of severe Acute Pancreatitis?
Acute Respiratory Distress Syndrome
There is a systemic inflammatory response due to autodigestion and inflammation of the pancreas.
What is the most common organism causing Cholangitis?
E.Coli
What kind of bowel obstruction causes tinkling bowel sounds?
Small bowel obstruction
Which type of hernia is more common in young children?
Indirect inguinal hernia
Which type of blood product gives the highest likelihood of TRALI?
Plasma
What is the treatment for appendicitis?
Prophylactic IV antibiotics
Then laparoscopic appendectomy
What types of cells are seen post splenectomy?
Howell- Jolly bodies
Target cells
Which types of shock cause warm peripheries?
Neurogenic
Septic
Anaphylactic
This is because peripheral vascular resistance is maintained ( widespread vasodilation )
What is Beck’s Triad of Cardiac Tamponade?
Hypotension
Muffled heart sounds
Raised JVP
What is the first and second line treatment for Achalasia?
1st Endoscopic balloon dilation of LOS
2nd line is Heller Cardiomyotomy
What is the appropriate regime for insulin before surgery?
Short acting blouses should be stopping when not eating ( will be NBM so stop them )
Long acting boluses can be continued to prevent hypoglycaemia
A variable rate insulin infusion should be started to keep tight glycemic control
Which bronchus are foreign bodies more likely to be aspirated into ?
Right main bronchus
Wider, shorter and more vertical than the left
What should be performed if a colonoscopy cannot due to adhesions etc?
CT Colonography
What is the rule of 9s for burns?
Used to work out the % of body covered by burns
Back = 18%
Front = 18%
Arm = 9%
Leg = 18%
How does Mesenteric Adenitis usually present?
Younger
Appendix like RLQ pain
Typically following viral or bacterial illness
What is the name of a kidney transplant scar?
Rutherford Morrison scar
Found in iliac fossas , wil feel a palpable mass beneth ( transplanted kidney)
What is a common complication of TPN?
Thrombophlebitis
TPN contains a combination of glucose, lipids and essential electrolytes. It is highly irritant to veins. While it can be given peripherally, it should only be given through central access.
What does an AP Resection involve?
Removal of entire rectum, anal canal and anus. A permanent stoma is left in situ.
What is the first line treatment for angiodysplasia?
Interventional colonoscopy
Diamthery cauterisation, adrenaline injection, photocoagulation, or clipping of blood vessesls
What is the management of a perforated viscus?
Urgent surgical exploration and repair
What gallbladder pathology are riggers and swinging fevers associated with?
Gallbladder empyema
What is the treatment for wound dehiscence?
Apply gauze soaked in sterile water/saline and arrange for re-suturing in theatre
Why might you do an Abdo US in suspected appendicitis
In females to rule out pelvic organ pathology
Why are anti-hypertensives withheld on the day of a surgical procedure?
With general anaesthesia, the patient can get refractory hypotension if they are concurrently on antihypertensives as this also lowers BP
Propfol inhibits the sympathetic nervous system and by impairing baroreflex regulatory mechanisms
What should be checked in all men presenting with Erectile Dysfunction?
Testosterone Levels
What cancers are people with Lynch Syndrome more likely to develop?
Endometrial
Breast
Colon
Prostate
Ovarian
Gastric
What is the Parkland formula for burns victims?
Weight(kg) x % body affected x 4mls
Where is an epigastric hernia anatomically?
In the midline between the umbilicus and the xiphisternum
What does a small bowel obstruction look like on CT?
Multiple loops of dilated small bowel
>3cm
Which types of shock cause warm peripheries?
Distributive
Septic
Neurogenic
Anaphylactic
What test should patients < 50 take before referral to Colorectal Cancer 2WW pathway?
FIT test
What is the management of patients with a diverticulitis flare up ?
Send home with oral antibiotics
Safety netting - Review in 2 days, if hasn’t improved then go to A&E
Given I.V ceftriaxone + metronidazole
How is a Sigmoid Volvulus managed?
Decompression via rigid sigmoidoscopy then insertion of a flatus tube?
What is seen on examination in association with chronic fissures?
Sentinel skin tag around anus
What is used to measure response to treatment in colon cancer?
CEA levels
What do you give for chronic anal fissures after trying conservative measures?
Topical glyceryl trinitrate
What should be done if a colonic tumour caused perforation?
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →( Hartmanns’s )
Weeks or months later, the bowel can be anastomosed
What type of anal fissure would warrant you to look for a n underlying cause?
Lateral ( 3 o’clock , 9 o’clock )
Could be malignancy
Could be Crohn’s
What is the initial treatment for an anal fissure?
Acute-
Soften stool ( Movicol (Macrogrol))
Dietary fibre
Analgesia ( Paracetamol )
Topical Lidocaine
Persists for longer than a week -
Topical Glyceryl Trinitrate
Chronic ( >6 weeks ) -
Sphincterotomy ( dividing anal sphincter )
Botox injection into the anal sphincter
What is the difference between mesenteric ischaemia and ischaemic colitis?
MI - Affects the small bowel
IC - Affects the large bowel
What is the most useful test to check if there any leaks in a colorectal anastomosis ?
Gastrografin enema
How should patients who present with peritonitis secondary to sigmoid volvulus be managed?
Skip the rigid sigmoidoscopy decompression, do urgent laparotomy
What is the treatment for Acute Mesenteric Iscahemia?
Immediate laparotomy
What is the best diagnostic test for a hiatus Hernia?
Barium Swallow fleuroscopy
What complication can TIPSS lead to?
Hepatic encephalopathy
What would be appropriate fluid management of Acute Appendicitis?
IV saline given 4-6 hourly, review fluid status between bags.
Requires aggressive due to vomiting and large third space losses
What class of anti-emetic are Cimetidine and Ranitidine?
Histamine H2 Receptor Antagonist
Has the word dine in it, what do you have with food, water , water is H2O
What class of anti-emetic are Domperidone and Metoclopramide?
D2 Receptor Antagonist
Domperidone has 2Ds in it
Metoclopramide ends in de , think deux like D2
What class of anti-emetic is Cyclizine?
Histamine H1 Receptor Antagonist
Think cycling gold medal = 1st , so 1
What class of anti-emetic is Hyoscine Hydrobromide?
Antimuscarinic
Think if gyms ‘bros’ don’t stay ‘hydr’ated , they won’t get big muscles ( antimuscarinic )
What class of anti-emetic is Ondansetron?
Serotonin ( 5HT3 ) Receptor Antagonist
Has Se in it like Serotonin
What is the most common site of a Carcinoid Tumour?
Appendix
What quickly reverses Warfarin?
Prothrombin Complex Concentrate
Which hormone promotes smooth muscle relaxation? ( Digestive system, urinary system and uterus)
Progesterone
What is the first line for hepatic encephalopathy?
Lactulose PO
Promotes ammonia excretion
Which type of hernia requires surgical repair even in symptomless?
Femoral - there is a high risk of strangulation
What imaging is first line for a small bowel obstruction?
CT Abdo Pelvis with contrast
What are the typical biochemical findings of osteomalacia?
Hypocalcaemia
Low urinary Ca2+
Due to Vitamin D deficiency ( needed in active form to absorb Ca2+ and Phosphate in from bowel)
What are the typical biochemical findings of osteoporosis?
Bone profile is normal
Normal pth
Normal calcium
Normal phosphate
Due to degenerative changes
How do you rememember the causes of post op fever?
5W’s of Post-op Pyrexia:
-Wind (1day): atelectasis/pneumonia
-Water(3days): UTI
-Wound(5days): surgical site infection/abscess
-Walking(7days): DVT/PE
-Wonder-drugs(Anytime): adverse drug reaction
Less than 24 hour - likely to be physiological stress response to surgery
How does dosing work?
Example -
A drug is 2% strength, the dose prescribed is 400mg
If the drug was 1% strength, then there would be 1g of medicine in 100mls of solution.
So if the medication is 2% strength, there will be 2g in 100mls of solution.
You want to administer 400mg (0.4g) , 2/0.4 = 5
100/5 = 20mls of drug solution given
What is Gilcher’s Rule to work out blood volume?
NORMAL
Female = 65ml x body weight (kg)
Male = 70ml x body weight (kg)
FAT
Female = 60ml x kg
Male = 65ml x kg
MUSCULAR
Female = 70ml x kg
Male = 75ml x kg
Why does the pain move from the umbilicus to the RIF in appendicitis?
Peritonism ( local inflammation of peritoneum)
The pain will often migrate from the umbilical region (irritation of visceral peritoneum of the midgut) to the right iliac fossa (irritation of parietal peritoneum)
