General Surgery Flashcards
1
Q
List the causes of Acute Pancreatitis
A
Gall-stones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP Diabetes
ALSO IDIOPATHIC
2
Q
Why do you get fat necrosis with acute pancreatitis?
A
If caused by gallstones, duodenopancreatic reflux causes the activation of enzymes in the pancreatic duct.
3
Q
Describe the presentation of acute pancreatitis
A
Pain - rapid onset, radiating to the back, severe and epigastric
Profuse vomiting
4
Q
Give 5 signs of acute pancreatitis
A
Tachycardia Pallor (shock) Rigid abdomen Ileus Jaundice
5
Q
What are the two skin changes seen in acute hemorrhagic pancreatitis
A
Grey turners sign - in the flanks
Cullen’s sign - around the umbilicus
6
Q
What results of investigations would you see in acute pancreatitis?
A
Raised serum amylase Raised serum lipase ABG AXR - no psoas shadow/sentinel loop of proximal jejunum from ileus CT
7
Q
Give the management of pancreatitis
A
NBM
Analgesia - Pethidine
Observations - every hour
Daily - FBC/U&E/Ca/Glucose/Amylase and ABG
Abscess/Necrosis - parenteral nutrition and laparotomy
8
Q
Give four risk factors for chronic pancreatitis
A
Alcoholism
Malnutrition
Hereditary
Hypercalcemia
9
Q
What investigations would you do for chronic pancreatitis?
A
AXR - calcifications
MRCP
ERCP - dilatation/irregular pancreatic duct and compression of bile duct by the pancreatic head
EUS
10
Q
What are the non-surgical management options for chronic pancreatitis?
A
Analgesics - long term opiates
Diet - low fat diet with pancreatin
11
Q
What are the surgical options for chronic pancreatitis?
A
Partial/total pancreatectomy
Roux-en-Y reconstruction
Whipple’s pancreaticoduodenectomy
12
Q
Give 5 risk factors for pancreatic carcinoma
A
Smoking Alcoholism Carcinogens Diabetes mellitus Chronic pancreatitis
13
Q
Give the common type of pancreatic tumour and the most likely locations.
A
Ductal adenocarcinoma
60% head
25% body
15% tail
14
Q
What is the classical presentation of pancreatic cancer?
A
Painless, obstructive jaundice (Courvoisier’s law)
15
Q
What is the most common presentation of pancreatic cancer?
A
Dull, aching epigastric pain that radiates to the back, relieved by sitting forwards
16
Q
What imaging techniques would be useful in diagnosing pancreatic cancer?
A
US/CT - would show pancreatic mass +/- biliary dilatation +/- liver metastases
EUS is the best for diagnosis and staging
17
Q
Give the common locations and presentations of a direct spread of a pancreatic tumour
A
Common bile duct - obstructive jaundice
Duodenum - occult/overt intestinal bleeding or obstruction
Portal vein - portal vein thrombosis/portal hypertension and ascites
IVC - bilateral leg oedema
18
Q
What is the common presentation of cholangiocarcinoma?
A
Painless, progressive jaundice - dark urine and pale stools
Epigastric pain, steatorrhoea and weight loss
19
Q
What imaging would be used in cholangiocarcinoma?
A
MRCP
ERCP ( can also stent at this point)
CT guided needle biopsy
20
Q
Give the classical presentation of biliary colic
A
RUQ pain radiating to the back +/- jaundice
21
Q
What is the standard treatment for biliary colic?
A
Laparoscopic cholecystectomy
22
Q
What is the underlying pathology of acute cholecystitis?
A
Impaction of stone/sludge in the neck of the gallbladder.
23
Q
What differs between acute cholecystitis and biliary colic?
A
Inflammatory component - raised WCC and fever
24
Q
What is Murphy’s sign
A
Two fingers placed on RUQ (painful area). Patient asked to breath in deeply, pain is felt and inspiration halted when gallbladder impacts on hand.
Must be compared to the LUQ
25
Give three risk factors for cholesterol stones
Female, Fat, Forty
26
What would an ultrasound show in acute cholecystitis?
Thick walled, shrunken gall bladder
27
Outline the management of acute cholecystitis
NBM/Analgesia
Antibiotics - 1.5g/8hr Cefuroxime
Lap Chole
28
What is chronic cholecystitis
Chronic inflammation +/- colic
29
What is the presentation of chronic cholecystitis?
Flatulent dyspepsia - abdo discomfort, distension, nausea, flatulence + fat intolerance
30
What investigations would be done in chronic cholecystitis?
Ultrasound
| MRCP
31
What is the general management of chronic cholecystitis
Lap chole
US shows dilated CBD with stones -> ERCP with sphincterotomy
32
What is the triad of symptoms for Cholangitis
RUQ pain, Fever, Jaundice
33
Management of Cholangitis?
Cefuroxime 1.5g/8hr or Metronidazole 500mg/8hr IV/PR
34
Give four risk factors for hepatocellular carcinoma
1. Hepatitis B/C
2. Autoimmune hepatitis
3. Cirrhosis
4. Males:Females 3:1
35
What investigations would be ordered in suspected HCC?
4-phase CT
MRI
Biopsy
36
Give three prevention mechanisms for HCC
1. HBV vaccine
2. Don't reuse needles
3. Screen blood for BBV
37
How does a cholangiocarcinoma of the liver present?
Fever, abdo pain, malaise, increased bilirubin and ALP
38
What are the most common malignancies to metastasise to the liver?
Men - stomach/lung/colon
Women - breast/colon/stomach/uterus
Other - leukaemia/lymphoma/pancreas and carcinoid
39
Give four signs of secondary liver tumours
1. Hepatomegaly - irregular, hard border
2. Leukonychia
3. Clubbing
4. Palmar erythema
40
What investigations would you order for suspected secondary liver tumours?
US/CT
| ERCP - if cholangiocarcinoma
41
What organs in the abdomen can rupture?
Spleen
Liver
(Ectopic pregnancy)
Appendix
42
What is Peritonism?
Acute abdominal pain
Guarding
Tenderness
43
What investigations should be done with an acute abdomen?
FBC/U+E/CRP/Amylase/LFTs
AXR and erect CXR
ABG (lactate)
USS - can show perforation or fluid
44
Outline the presentation of generalised peritonitis?
```
Peritonism
Lying still
+ve cough test
Prostratism
No bowel sounds
Abdominal rigidity
```
45
Give three causes of local peritonitis
Appendicitis
Salpingitis
Cholecystitis
DIverticulitis
46
List the management steps in the acute abdomen
```
Treat shock
Crossmatch
Blood culture
Analgesia
Antibiotics (Cefuroxime + Metronidazole)
IVI
AXR
Erect CXR (if peritonitic/>50years old)
ECG >50yrs
Consent
NBM
```
47
Give the presentation of bowel obstruction and how it differs in small and large bowel
Vomiting/Colic/Distension/Constipation
Small - vomiting occurs early on/less distension/upper abdo pain
Large - pain is more constant
48
Give two causes of SBO
Adhesions
| Hernia
49
Give three causes of LBO
Colon Ca
Constipation
Diverticular stricture
Volvulus
50
Give the differences between SBO and LBO on AXR
Small - central gas patterns with valvular conniventes
| Large - peripheral gas patterns with haustra
51
What contrasts ileus and bowel obstruction?
Ileus is a functional obstruction due to lack of peristalsis.
No bowel sounds and painless.
52
In which situations would a bowel obstruction warrant immediate surgery?
Strangulated
| LBO
53
What is a closed loop obstruction?
Obstruction at two points, producing a dilated loop of bowel that is at increased risk of perforation.
54
What features would indicate a strangulated bowel obstruction?
Pt is more ill than expected.
Sharper, more constant and localised pain.
Peritonism
May be fever and raised WCC.
55
Outline the management of a bowel obstruction
NGT, IVI and catherisation
Analgesia and blood tests
Further imaging (CT)
56
Give three systemic causes for GI haemorrhage
Leukaemia
Thrombocytopenia
Haemophilia
57
Give three causes of lower GI haemorrhage
Diverticulitis
Cancer
Colitis
58
Give three causes of haemorrhage from the stomach
Mallory Weiss
Gastritis
Acute erosions
Ulceration
59
How is haemorrhage from a gastric ulceration treated?
Endoscopy and injection of adrenaline into surrounding blood vessels.
60
Give two causes of oesophageal haemorrhage
Acute oesophagitis
| Varices
61
How are oesophageal varices treated?
Endoscopy with sclerotherapy or banding
62
Outline the presentation of GI haemorrhage
Haematmesis/Malaena
Fainting/Dizziness
Reduced urine output
63
What is the definition of Shock?
Circulatory collapse leading to inadequate organ perfusion
64
Outline the quantitative definitions of Shock
Low BP (systolic 2mmol/L
65
Give 7 signs of shock
```
Low GCS/Agitation
Pallor
Cool peripheries
Tachycardia
Oliguria
Slow cap refill
Tachypnoea
```
66
Outline the management of Shock
Airway, NBM and 2 large bore cannulas
FBC/U+E/LFT/Glucose/Clotting/Crossmatch 6 units
Rapid IV crystalloid (1L)
III/IV shock - ORh-ve blood/crossmatched blood
Transfuse
Correct clotting abnormalities
ICU/HDU with CVC
Catheterise and measure urine output (>30ml/hr)
Observations every 15 mins
Surgery if indicated (haemorrhage)
67
Describe the pathology behind Crohn's disease
Chronic inflammatory disorder characterised by patchy, transmural granulomatous inflammation.
68
Give 4 symptoms of Crohn's disease
Diarrhoea +urgency
Abdominal pain
Fever/malaise/weight loss
69
What organisms would you need to rule out in a stool sample when assessing a patient with potential crohn's disease?
C difficile, Campylobacter and E coli.
70
What is the best diagnostic option for Crohn's disease?
Colonoscopy + biopsy
71
Outline the three management strategies for Crohn's disease
Lifestyle - quit smoking/optimise nutrition
Pharmacological - ASA/Steroid/Immunosuppression/TNF inhibitors
Surgical
72
Give a normal dose of steroid for a patient with mild Crohn's disease
Prednisolone PO 30mg/daily, for 1/52. Then reduce to 20mg/daily for 4/52.
73
Why should you not suddenly stop giving steroids for Crohns?
Risk of addisonian crisis - suppression of the HPA axis.
74
Describe the pathology of Ulcerative colitis
Inflammation of the colonic mucosa - not spreading past the ileocaecal valve. Inflammation is confined to the mucosa and is typically hyperaemic/haemorrhagic granular colonic mucosa +/- pseudo polyps.
75
Describe the general presentation of Ulcerative colitis
Episodic/chronic diarrhoea (+/-blood and mucus)
Abdominal pain
Acute - fever, tachycardia and distended abdomen
76
What is the common surgical procedure used in Ulcerative colitis?
Proctocolectomy + terminal ileostomy
77
What are the indications for surgical intervention in Ulcerative Colitis
Perforation
Massive haemorrhage
Toxic dilatation
Failed medical therapy
78
What pharmacological management is used in Ulcerative colitis?
5-ASAs - good for inducing remission
| Steroids - Prenisolone PO/Steroid enema/Rectal steroids
79
What are the three causes of Acute Appendicitis?
Faecolith
Lymphoid hyperplasia
Filanial worms
80
What is the typical presentation of acute appendicitis?
Periumbilical pain, migrating to the RIF.
| Tachycardia/Fever/Furred tongue/peritonism
81
What is Rovsking's sign?
Press on LIF. Pain in RIF>LIF.
82
What are the typical blood results for acute appendicitis?
Neutrophil leukophilia and elevated CRP
83
What antibiotics are used in Acute appendicitis?
Metronidazole 500mg/8hr and Cefuroxime 1.5g/8hr
84
Give three complications of acute appendicitis
Perforation
Appendix mass
Abscess
85
How is an appendiceal abscess treated?
Drainage (percutaneous or surgical) and antibiotics
86
Give three differential diagnoses for acute appendicitis
Ectopic pregnancy
UTI
Mesenteric adenitis
87
What is a diverticulum?
An out pocketing of the gut wall, usually at the area of entry of perforating arteries.
88
What is the difference between Diverticulosis, Diverticular disease and Diverticulitis
Diverticulosis -> presence of diverticula
Diverticular disease -> symptomatic diverticula
Diverticulitis -> inflammation of diverticula
89
Give some of the presentation of diverticular disease
Altered bowel habits
| Left side colic -> relieved by opening bowels
90
Outline the presentation of diverticulitis
Pyrexia/increased WCC/CRP+ESR increase/ Tender abdomen and localised or general peritonism
91
What is the general management of Diverticulitis
Analgesia/NBM/IVI
CT-guided percutaneous drainage (if abscess)
If perforated -> treat as acute abdomen (+Hartman's procedure)
92
Give four risk factors for Colorectal cancer
Neoplastic polyps
IBD
Genetic predisposition
Previous malignancy
93
What is the general presentation of patients with left sided colorectal cancer?
Bleeding/mucus +lump on PR
Altered bowel habit
Obstruction
Tenesmus
94
What is the general presentation of patients with right sided colorectal cancer?
```
Weight loss
Unexplained iron deficiency anaemia
Abdominal pain (vague)
```
95
What investigations should be carried out in patients with suspected colorectal malignancy?
FBC
Faecal occult blood test
Sigmoidoscopy/Colonoscopy
Barium enema
96
What is the standard chemotherapy regime for colorectal malignancy?
FOLFOX (5-FU/Folinic acid and oxaliplatin)
97
Outline the Dukes staging of colorectal cancer
A -> confined to the mucosa
B -> invasion through muscularis mucosa
C -> spread to surrounding lymphatics
D -> metastatic spread
98
List the three types of haemorrhoids and what distinguishes between them
Internal -> origin above the dentate line, from the internal rectal plexus
External -> origin below the dentate line, from the external rectal plexus
Mixed -> origin above and below the dentate line
99
What is the most common cause of haemorrhoids?
Constipation with prolonged straining
100
What is the general presentation of haemorrhoids?
Bright, red PR bleeding - tissue/coating/bowl
| Anaemia
101
What investigations would you do for haemorrhoids?
Abdominal exam
PR exam
Proctoscopy
Sigmoidoscopy
102
Outline the non-operative treatment for haemorrhoids
Increase fluids and fibre + stool softener
Rubber band ligation (bleeding/infection/pain)
Sclerosants - injected above dentate line
103
Outline the surgical management of haemorrhoids
Excisional haemorrhoidectomy
| Complications - constipation/infection/stricture and bleeding
104
What is a 'fissure in ano'?
Tears of the squamous lining of the anal canal, 90% are posterior.
105
What causes an anal fissure?
Hard faeces. Spasm causes constriction of the inferior rectal artery, leading to reduced wound healing.
106
How are anal fissures managed?
Lidocaine + GTN ointment
Topical diltiazem
Increased fibre, fluids + stool softener
107
What is a fistula in ano?
Track persists between the skin and the anal/rectal canal.
108
List four causes of anal fistula
Perianal sepsis
TB
Crohns
Diverticular disease
109
What tests can you do for anal fistulas?
MRI
| Endocanal US scan
110
What is the treatment of anal fistulas?
Fistulotomy + excision
111
Give three risk factors for anal cancer
Syphilis
Anal warts
Anoreceptive individuals
112
Describe the varying histology of anal cancers
Margin - well differentiated,keratinised
| Canal - poorly differentiated, arising above the dentate line and non-keratinising
113
What is the lymphatic spread of the two types of anal cancer?
Above dentate line -> pelvic lymph nodes
| Below dentate line -> inguinal lymph nodes
114
What is the general presentation of anal cancer?
Bleeding
Pain
Change in bowel habits
Pruritis ani
115
What is the non-surgical management option for anal cancer?
Chemo-irradiation -> radiotherapy + 5-FU/cisplatin
116
What is the surgical management for anal cancer?
Anorectal excision and colostomy
117
What is the definition of a Hernia?
Protrusion of a viscus or part of a viscus through a defect of the wall of it's containing cavity into an abnormal position.
118
What is an irreducible hernia?
Cannot be pushed into the right place
119
What is an incarcerated hernia?
Contents of hernial sac are stuck inside due to adhesions
120
What is an obstructed hernia?
Bowel contents cannot pass through
121
What is a strangulated hernia?
If ischaemia occurs within a hernia
122
What is 'reduction en masse'?
When a strangulated hernia is reduced however the bowel within the hernia is still strangulated
123
Describe an indirect inguinal hernia
Pass through the deep inguinal ring, lateral to the inferior epigastric vessels
124
Describe a direct inguinal hernia
Pass through the posterior wall of the inguinal canal, through Hesselbach's triangle (medial to inferior epigastric vessels and lateral to the rectus abdominus)
125
Give three causes of inguinal herniae
Cough
Constipation
Increased intraabdominal pressure
126
Where would you examine the deep inguinal ring?
Midpoint of the inguinal ligament
127
Where would you examine the superficial inguinal ring?
Superomedial to the pubic tubercle
128
What are the borders of the inguinal canal?
Anterior - external oblique aponeurosis and internal oblique (lat 1/3)
Posterior - transversalis fascia (laterally) conjoint tendon (medial)
Floor - inguinal ligament and lacunar ligament medially
Roof - Fibres of transversalis and internal oblique
129
What would you look for in examination for inguinal hernia?
Previous scars
External genitalia
Visible - reducible
Cough impulse +ve
130
What are the lifestyle management options for inguinal herniae?
Reduce weight
| Stop smoking prior to surgical intervention
131
What are the surgical repair options for inguinal hernia?
Mesh
TAPP - transabdominal pre-peritoneal
TEP - totally extra-peritoneal
132
What are the post-surgical recommendations following inguinal hernia repair?
Rest for 4 weeks. If ok/comfortable, back within 2 weeks.
133
Where can you usually feel the neck of a femoral hernia?
inferior and lateral to the pubic tubercle
134
What are the borders of the femoral canal?
Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectineus and pectineal ligament
135
Give three Ddx of femoral herniae
Inguinal hernia, lipoma, saphena varix
136
What is a Herniotomy?
Ligation and excision of the herniated sac
137
What is a Herniorrhaphy?
Repair of the hernial defect
138
What is the surgical repair technique for Paraumbilical herniae?
Mayo repair
139
How common are incisional herniae?
11-20% of muscle closures breakdown post surgery
140
Give four causes of reflux oesophagitis
Repeated vomiting
Long-term NG intubation
Resections of the cardia with gastro-oesophageal anastomosis
Barrett's oesophagus
141
What investigations can be used for reflux oesophagitis?
Fibreoptic oesophagoscopy
24 hour oesophageal pH studies
Barium swallow
142
Give three Ddx for oesophagitis
Cholecystitis
MI
Peptic ulcer
143
What lifestyle modifications can be made in reflux oesophagitis?
Weight loss, smoking cessation, dietary manipulation.
Pt advised to sleep up in bed
144
What pharmacological treatment can be given in reflux oesophagitis?
Alginate antacids
H2 receptor antagonists/PPIs
Metoclopramide - increases gastric emptying
145
What happens in a sliding hiatus hernia?
Stomach and lower oesophagus slide through the oesophageal hiatus in the diaphragm
146
What happens in a rolling hiatus hernia?
Cardia remains in position, stomach rolls anteriorly through the hiatus alongside the lower oesophagus.
Cardio-oesophageal junction remains intact therefore there is no reflux
147
What clinical features are present in hiatus herniae?
Mechanical - cough/dyspnoea/palpitations
Reflux - burning, rising retrosternal chest pain
Oesophagitis - stricture formation with dysphagia and bleeding
148
How are sliding hiatus herniae treated?
Treated if symptomatic.
Laparoscopic repair
149
What is Barrett's oesophagitis?
Lower oesophageal metaplasia to intestinal type columnar epithelium as a result of long term oesophageal reflux.
This can eventually progress to dysplasia, and produce a malignancy.
150
What surveillance is used for patients with Barrett's oesophagus?
Regular endoscopy - with biopsies to examine for dysplasia.
151
Give four risk factors for Oesophageal cancer
Tobacco/alcohol
Achalasia
Coeliac disease
Barrett's oesophagus
152
Give three clinical features of Oesophageal cancer
Progressive dysphagia
Hoarseness of voice
Anaemia, weight loss.
153
What investigations are used for Oesophageal cancer
Oesophagoscopy +/- biopsy
CT thorax/abdomen - local invasion and secondary spread
Endoscopic ultrasound - depth of invasion and local spread, aspiration of local lymph nodes
PET - metastatic disease/staging
154
Give the two treatment options for oesophageal cancer
Curative resection - neoadjuvant chemo and anastomosis across the defect
Palliative - intubation with a stent
155
What is Achalasia?
Failure of relaxation of the lower end of the oesophagus with progressive dilatation, tortuosity, incoordination of peristalsis and hypertrophy of the oesophagus above.
156
How does Achalasia present?
Most in women
Progressive dysphagia with spasm like chest pain
157
What investigations would you use for Achalasia?
Chest XR - dilated oesophagus shows as a mediastinal mass
Barium swallow - shows dilatation and tortuosity of oesophagus
Oesophagoscopy
Oesophageal manometry - reduced LOS pressure
158
What management options are there for Achalasia?
Hellers operation - laparoscopic cardiomyotomy
| Dilatation of the oesophagus through radioactive guidance of an endoscopic balloon
159
What is the definition of an Aneurysm?
Permanent localised dilatation of an artery, greater than 50% of it's original diameter
160
What is Ectasia?
Localised area of enlargement in an artery, but less than 1.5x
161
What is the difference between a true and a false aneurysm?
True - pathological degeneration involving all layers of a vessel wall
False - leakage of blood out of an artery into a cavity surrounded by connective tissue, which is expansile and pulsatile
162
Give four causes of aneurysms
```
Congenital
Degenerative
Caucasian
Connective tissue disease
Infective
Dissection
```
163
What is the general rate of expansion of an aneurysm?
10% per year (0.5cm)
164
Give four presentations of AAA
Asymptomatic
Distal embolisation
Abdominal pain, malaise and weight loss
Rupture - abdo pain, pulsatile mass and hypovolemia
165
What are the two surgical options for AAA?
Endovascular aneurysm repair
| Open repair
166
What is EVAR?
Radiologically guided intraluminal placement of a stent.
Avoids laparotomy, intraperitoneal manipulation and aortic occlusion
167
Give five complications of aneurysm repair
```
Haemorrhage
Cardiac events
Renal failure
Embolisation
Colonic ischaemia
```
168
Give four complications of EVAR
Graft migration
Endoleak
Fracture of supporting wires
Endotension
169
Outline the screening programme for AAA
Men over 65 offered an ultrasound scan.
Diagnosed when aorta >3cm. Referral occurs at >5.5
170
What are the two treatment options for Popliteal aneurysms?
Hunterian ligation and bypass surgery
| Endovascular stenting
171
What is intermittent claudication?
Cramping pain felt in the lower limb (buttock, thigh, calf) upon walking a certain distance
172
What is the claudication distance?
Distance someone can walk before getting claudication pain
173
What are the three cardinal signs of critical limb ischaemia?
Ulceration, gangrene and rest pain
174
What is the fontaine classification?
1. Asymptomatic
2. Intermittent claudication
3. Ischaemic rest pain
4. Gangrene/ulceration
175
What is the normal ABPI readings, and what can it be in limb ischaemia
1-1.2
0.5-0.9 in peripheral arterial disease
176
Give four non-surgical management options in limb ischaemia
Modify risk factors
Start Clopidogrel
Supervised exercise programmes - improve collateral blood flow
Vasoactive drugs
177
What are the two surgical interventions for limb ischaemia?
Percutaneous transluminal angioplasty - single arterial segment
Surgical reconstruction - arterial reconstruction with a bypass graft
178
What are the clinical signs of acute limb ischaemia?
Pale, Pulseless, Painful, Paralysis, Paraesthetic, Perishing cold
179
Give four causes of acute limb ischaemia
Thrombosis
Emboli
Graft/angioplasty occlusion
Trauma
180
What two complications can you get after surgery for acute limb ischaemia?
Post-operation reperfusion injury
| Compartment syndrome
181
What is Gangrene?
Tissue necrosis due to ischaemia
182
What is Dry gangrene?
Gangrene without infection
183
What is the treatment for dry gangrene?
Restoration of blood supply +/- amputation
184
What is the treatment for wet gangrene?
Analgesia, broad spectrum IV antibiotics, debridement +/- amputation
185
What is gas gangrene?
Spore forming clostridium species
Myonecrosis, muscle swelling, gas production, sepsis and severe pain.
Debridement, benzylpenicillin + clindamycin.
186
What is Necrotising fasciitis?
Rapidly progressing infection of the deep fascia. Caused by group A - B haemolytic strep.
Treatment is radical debridement and IV antibiotics.
187
Give three signs of neuropathic disease (diabetes)
Loss of sensation in stocking distribution
Absent ankle jerk
Deformity
188
Give four signs of arterial disease (diabetes)
Absent foot pulses
Painful
Punched out edges
Deep
189
What are neuropathic ulcers?
Loss of sensation in the tissues, leading to loss of awareness of trauma. Deep ulcers found over the pressure points, the surrounding tissues are often warm and healthy. The ulcers are painless
190
What are the four management options for ulceration
Education - daily inspection, comfortable shoes
Regular chiropody
Treatment of fungal infection
Surgery - endovascular angioplasty balloons, stents and subintimal recanalisation
191
Give three symptoms of varicose veins
Visible
Tiredness
Aching/throbbing in the legs
Swelling of the ankles
192
What is a Saphena Varix?
Prominent dilatation at the saphenofemoral junction. Gives a thrill when the patient is asked to cough
193
What is the tap test
Fingers placed at the saphenofemoral junction, tapping distal varies will transmit a thrill
194
What is Trendelenbergs test
Pt lies flat, leg elevated to empty superficial veins, tourniquet applied, pt stands up.
Varicosities remain empty is saphenofemoral junction is incompetent.
195
What investigations can be used for varicose veins?
Doppler
| Duplex scanning
196
Give two non-surgical treatments for varicose veins
Graded compression stockings - minor varicosities.
| Sclerotherapy - causes fibrosis of the veins, can give bruising, phlebitis, ulceration and DVT
197
When is surgery indicated with patients with varicose veins?
Haemorrhage
Grossly dilated/symptomatic
Skin changes - indicate deep venous insufficiency
Incompetent perforator veins
