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1. Fellowship Written - SAQ > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Diagnosis?
Why?

A

SBO

  1. dilated loops of bowel
  2. multiple fluid levels
  3. small bowel - central/3mm/valvular coneventes
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2
Q

what are the common causes of SBO obstruction and their examination findings?

A
  • adhesions - old scars
  • hernias - hernia on exam
  • malignancy - systemic sx
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3
Q

what are the metabolic complications of SBO and why?

A
  • metabolic alkalosis - loss of HCL from vomming
  • hypoK - vomiting
  • hypoNa - 3rd spacing to gut
  • lactic acidosis - from iscahemia and hypoperfusion
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4
Q

abdo pain and guarding:
What ate the abnormalities?

Diagnosis?

A

IP free fluid
IP free air
fat stranding around stomach
gallstones
thick walled stomach

diagnosis
Perforated peptic ulcer

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5
Q

what is the initial management of perforated abdominal viscous?

A

IV fluid - bolus and aim over 100
Anagelsea eg fent
IV abx
urgent surgical input

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6
Q

diagnosis?

3 positive and two neg findings

A

gastric volvulus

Pos:
* hiatus hernia
* multiple bowel loops in intrathoraic region
* air fluid in lower loop suggesting obstruciton
* mediastinal shift

Neg
* no pneumothorax
* no free air under diaphragm

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7
Q

management priorities?

A

analgesia
antiemetic
fluid
abx
surgical input

?GOC

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8
Q

what clinical features of history and exam make appendicitis more likely in a child?

A

RIF pain
pain migrating to RIF
pain less than 3 days
anorexia
pain on coughing/moving/hopping

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9
Q

with suspected appendicits in child what tests could you do to rule out other things?

A

urine - UTI
US - mesenteric adenitis
CXR - LRTI
lipase - pancreatitis
glucose - DM

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10
Q

what is the maintennce fluid for kids?

A

normal saline plus 5% dextrose

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11
Q

what are the pros and cons of CT/US for RUQ pain?

A
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12
Q

key findings

Diagnosis

A
  • high glob and low alb- in infection/inflammation, high glob and low albumin in negative acute phase reaction
  • jaudince from biliary obstuction
  • ductal enzymes high than intrahepatic suggesting post hepatic pathology

Diagnosis
Cholangitis with biliary obstruction

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13
Q

diagnosis and abnormal radiological findings

A

Sigmoid volvulus

  • massively dilated sigmoid colon - coffee bean sign
  • no rectal gas - dilated proximal large bowel
  • Axis to LIF
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13
Q

what are the management options for sigmoid volvulus?

A
  1. PR deflation eg sigmoidoscope
  2. percutaneous deflation
  3. laparatomy
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14
Q

with elderly and bowel obstructions what are the considerations for treatment plans?

A
  1. Patients wishes if competent
  2. advanced care directive
  3. substitute decision maker if competent
  4. patients QOL
  5. reversibility of condition
  6. nature of intervention
  7. access to intervention eg in the sticks
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15
Q

key abnormalities and explanations?

overall clinical interpretation

A
  • low na and Cl - GI losses
  • HAGMA- renal failure or lactate from hypoperfusion
  • renal failure - pre renal hypoperfusio
  • low alb normal protein - negative acute phase
  • high conj bili - hepatic obstruction
  • obstructuve LFT pattern

Summary:

Ascending cholangitis with signs of multi organ failiure/sepsis

16
Q

interpretation of wound

A

midline laparatomy wound with significant dehiscence

17
Q

list three patient and surgical factors that could contribute to post op wound dehiscence

A

Patient
* Smoker
* steroid use
* obesity
* immunocompromised
* diabetic
* poor self care
* over 65
* anaemia

Surgical
too much wound tension
inappropriate sutures
inappropriate technique
haematoma at site
FB
non sterile procedure

18
Q

what are the advantages and disadvantages of common methods of wound closure in ED

A
19
Q

what are the two most common causes of pancreatitis

A

GS
Alcohol

GETSMASHED

20
Q

What is a common scoring system for pancreatitis and its components

A

Glasgow >3 severe
glucose over 10
calcium under 2
wcc over 15
ast over 200
ldh over 600
urea over 16
albumin less than 32

21
Q

what are the local and systemic compliations of pancreatitis?

A

Local
* pancreatic pseudocyst
* abscess
* ileus
* splenic vein thrombosis
* chronic pancreatitis
* duodenal obstruction

Systemic
* Shock
* ARDS
* hypocalcaemia
* metaolic acidosis
* pleural effusion
* multi organ failure

22
Q

what CT featues of pancreatitis are associated with severe disease?

A

focal or diffuse enlargement
fat stranding
single or multiple fluid collections
necrosis

23
Q
  1. Diagnosis?
  2. Imprtant investigations?
  3. Management
A
  1. Ascending cholangitis
  2. LFTs,lipase, cultures, US
  3. IV abx (cef 1g BD), fluid(NaCl 1l 4/24), surgical opinion, analgesia( paracetamol, fentanul or bupe)
24
Q

likely diagnosis?

3 other differentials

A

mesenteric ischaemia/bowel infarct

any cause of abdo pain:
Ruptured AAA
cholecystts
ascending cholangitis
appendicitis
diverticulitis

25
Q

two positives and two negatives?

A

Positives
* dilated small bowel loops
* thumbprinting

Negatives
* no fecal loading
* no free air
* no rigleers sign

26
Q

what is the mangement of mesenteric ischaemia/bowel infarct?

A
  1. Analgesia
  2. NBM and IV fluid
  3. heparin infusion
  4. early sirgical input
27
Q

What is this?

A

Pneumatosis intestinalis (presence of gas within wall of bowel)

28
Q

what can cause pneumatosis intestinalis?

A

submucosal cysts
infective enteritis
coeliac
COPD
AIDS
sarcoid
post chemo

29
Q

what could indicate a bad prognosis in mesenteric infarct/bowel ischaemia

A

metabolic acidosis
bloody diarrheoa
portal venous gas
thickened bowel wall on imaging

30
Q

if a patient is NBM what are the analgesia options in ED?

A

ketamine 0.2mg/kg
fentanyl 25mcg aliquts
IV panadol
PR indomethacin

31
Q

causes of SBO

A

malignancy
adhesions
hernia
stricture eg crohns

32
Q

what are the complications of SBO with management principles?

A

perforation - abx and surgery
hypovoaemia - fluid replacement
hypok - replacement
aspiration - cxr

33
Q

3 year old in abdo pain
describe abnormalities and diagnosis

A

dilated bowel loop with telescoping

Intersusscpetion

34
Q

what is the management of intersussception?

A
  • Analgesia - IV morphine 1mg aliquots or fentanyl
  • IV fluid - 20ml/kg aiming for pulse under 120
  • urgent surgical paeds referral
35
Q

what are the mangement options for intersusscpetion and when would you use them?

A

gas insufflation PR - first line when uncomplicated

Surgical - if first line fails or complicated eg perforation

36
Q

what are the complications of intersussception?

A

perforation
sepsis
intestinal ischaemia

1. Fellowship Written - SAQ (25 decks)

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