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Phase 2 - Perioperative Care > General Surgery > Flashcards

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

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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.

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3
Q

Describe the presentation of acute pancreatitis

A

Pain - rapid onset, radiating to the back, severe and epigastric
Profuse vomiting

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4
Q

Give 5 signs of acute pancreatitis

A 
Tachycardia
Pallor (shock)
Rigid abdomen
Ileus
Jaundice
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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

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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
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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

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8
Q

Give four risk factors for chronic pancreatitis

A

Alcoholism
Malnutrition
Hereditary
Hypercalcemia

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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

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10
Q

What are the non-surgical management options for chronic pancreatitis?

A

Analgesics - long term opiates

Diet - low fat diet with pancreatin

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11
Q

What are the surgical options for chronic pancreatitis?

A

Partial/total pancreatectomy
Roux-en-Y reconstruction
Whipple’s pancreaticoduodenectomy

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12
Q

Give 5 risk factors for pancreatic carcinoma

A 
Smoking
Alcoholism
Carcinogens
Diabetes mellitus
Chronic pancreatitis
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13
Q

Give the common type of pancreatic tumour and the most likely locations.

A

Ductal adenocarcinoma
60% head
25% body
15% tail

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14
Q

What is the classical presentation of pancreatic cancer?

A

Painless, obstructive jaundice (Courvoisier’s law)

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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

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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

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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

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18
Q

What is the common presentation of cholangiocarcinoma?

A

Painless, progressive jaundice - dark urine and pale stools

Epigastric pain, steatorrhoea and weight loss

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19
Q

What imaging would be used in cholangiocarcinoma?

A

MRCP
ERCP ( can also stent at this point)
CT guided needle biopsy

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20
Q

Give the classical presentation of biliary colic

A

RUQ pain radiating to the back +/- jaundice

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21
Q

What is the standard treatment for biliary colic?

A

Laparoscopic cholecystectomy

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22
Q

What is the underlying pathology of acute cholecystitis?

A

Impaction of stone/sludge in the neck of the gallbladder.

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23
Q

What differs between acute cholecystitis and biliary colic?

A

Inflammatory component - raised WCC and fever

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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

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25
Q

Give three risk factors for cholesterol stones

A

Female, Fat, Forty

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26
Q

What would an ultrasound show in acute cholecystitis?

A

Thick walled, shrunken gall bladder

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27
Q

Outline the management of acute cholecystitis

A

NBM/Analgesia
Antibiotics - 1.5g/8hr Cefuroxime
Lap Chole

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28
Q

What is chronic cholecystitis

A

Chronic inflammation +/- colic

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29
Q

What is the presentation of chronic cholecystitis?

A

Flatulent dyspepsia - abdo discomfort, distension, nausea, flatulence + fat intolerance

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30
Q

What investigations would be done in chronic cholecystitis?

A

Ultrasound

MRCP

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31
Q

What is the general management of chronic cholecystitis

A

Lap chole

US shows dilated CBD with stones -> ERCP with sphincterotomy

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32
Q

What is the triad of symptoms for Cholangitis

A

RUQ pain, Fever, Jaundice

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33
Q

Management of Cholangitis?

A

Cefuroxime 1.5g/8hr or Metronidazole 500mg/8hr IV/PR

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34
Q

Give four risk factors for hepatocellular carcinoma

A
  1. Hepatitis B/C
  2. Autoimmune hepatitis
  3. Cirrhosis
  4. Males:Females 3:1
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35
Q

What investigations would be ordered in suspected HCC?

A

4-phase CT
MRI
Biopsy

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36
Q

Give three prevention mechanisms for HCC

A
  1. HBV vaccine
  2. Don’t reuse needles
  3. Screen blood for BBV
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37
Q

How does a cholangiocarcinoma of the liver present?

A

Fever, abdo pain, malaise, increased bilirubin and ALP

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38
Q

What are the most common malignancies to metastasise to the liver?

A

Men - stomach/lung/colon
Women - breast/colon/stomach/uterus
Other - leukaemia/lymphoma/pancreas and carcinoid

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39
Q

Give four signs of secondary liver tumours

A
  1. Hepatomegaly - irregular, hard border
  2. Leukonychia
  3. Clubbing
  4. Palmar erythema
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40
Q

What investigations would you order for suspected secondary liver tumours?

A

US/CT

ERCP - if cholangiocarcinoma

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41
Q

What organs in the abdomen can rupture?

A

Spleen
Liver
(Ectopic pregnancy)
Appendix

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42
Q

What is Peritonism?

A

Acute abdominal pain
Guarding
Tenderness

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43
Q

What investigations should be done with an acute abdomen?

A

FBC/U+E/CRP/Amylase/LFTs
AXR and erect CXR
ABG (lactate)
USS - can show perforation or fluid

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44
Q

Outline the presentation of generalised peritonitis?

A 
Peritonism
Lying still
\+ve cough test
Prostratism
No bowel sounds
Abdominal rigidity
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45
Q

Give three causes of local peritonitis

A

Appendicitis
Salpingitis
Cholecystitis
DIverticulitis

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46
Q

List the management steps in the acute abdomen

A 
Treat shock
Crossmatch
Blood culture
Analgesia
Antibiotics (Cefuroxime + Metronidazole) 
IVI
AXR
Erect CXR (if peritonitic/>50years old)
ECG >50yrs
Consent
NBM
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47
Q

Give the presentation of bowel obstruction and how it differs in small and large bowel

A

Vomiting/Colic/Distension/Constipation

Small - vomiting occurs early on/less distension/upper abdo pain

Large - pain is more constant

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48
Q

Give two causes of SBO

A

Adhesions

Hernia

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49
Q

Give three causes of LBO

A

Colon Ca
Constipation
Diverticular stricture
Volvulus

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50
Q

Give the differences between SBO and LBO on AXR

A

Small - central gas patterns with valvular conniventes

Large - peripheral gas patterns with haustra

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51
Q

What contrasts ileus and bowel obstruction?

A

Ileus is a functional obstruction due to lack of peristalsis.

No bowel sounds and painless.

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52
Q

In which situations would a bowel obstruction warrant immediate surgery?

A

Strangulated

LBO

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53
Q

What is a closed loop obstruction?

A

Obstruction at two points, producing a dilated loop of bowel that is at increased risk of perforation.

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54
Q

What features would indicate a strangulated bowel obstruction?

A

Pt is more ill than expected.

Sharper, more constant and localised pain.
Peritonism
May be fever and raised WCC.

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55
Q

Outline the management of a bowel obstruction

A

NGT, IVI and catherisation
Analgesia and blood tests
Further imaging (CT)

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56
Q

Give three systemic causes for GI haemorrhage

A

Leukaemia
Thrombocytopenia
Haemophilia

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57
Q

Give three causes of lower GI haemorrhage

A

Diverticulitis
Cancer
Colitis

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58
Q

Give three causes of haemorrhage from the stomach

A

Mallory Weiss
Gastritis
Acute erosions
Ulceration

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59
Q

How is haemorrhage from a gastric ulceration treated?

A

Endoscopy and injection of adrenaline into surrounding blood vessels.

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60
Q

Give two causes of oesophageal haemorrhage

A

Acute oesophagitis

Varices

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61
Q

How are oesophageal varices treated?

A

Endoscopy with sclerotherapy or banding

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62
Q

Outline the presentation of GI haemorrhage

A

Haematmesis/Malaena
Fainting/Dizziness
Reduced urine output

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63
Q

What is the definition of Shock?

A

Circulatory collapse leading to inadequate organ perfusion

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64
Q

Outline the quantitative definitions of Shock

A

Low BP (systolic 2mmol/L

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65
Q

Give 7 signs of shock

A 
Low GCS/Agitation
Pallor
Cool peripheries
Tachycardia
Oliguria
Slow cap refill
Tachypnoea
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66
Q

Outline the management of Shock

A

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)

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67
Q

Describe the pathology behind Crohn’s disease

A

Chronic inflammatory disorder characterised by patchy, transmural granulomatous inflammation.

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68
Q

Give 4 symptoms of Crohn’s disease

A

Diarrhoea +urgency
Abdominal pain
Fever/malaise/weight loss

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69
Q

What organisms would you need to rule out in a stool sample when assessing a patient with potential crohn’s disease?

A

C difficile, Campylobacter and E coli.

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70
Q

What is the best diagnostic option for Crohn’s disease?

A

Colonoscopy + biopsy

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71
Q

Outline the three management strategies for Crohn’s disease

A

Lifestyle - quit smoking/optimise nutrition
Pharmacological - ASA/Steroid/Immunosuppression/TNF inhibitors
Surgical

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72
Q

Give a normal dose of steroid for a patient with mild Crohn’s disease

A

Prednisolone PO 30mg/daily, for 1/52. Then reduce to 20mg/daily for 4/52.

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73
Q

Why should you not suddenly stop giving steroids for Crohns?

A

Risk of addisonian crisis - suppression of the HPA axis.

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74
Q

Describe the pathology of Ulcerative colitis

A

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.

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75
Q

Describe the general presentation of Ulcerative colitis

A

Episodic/chronic diarrhoea (+/-blood and mucus)
Abdominal pain
Acute - fever, tachycardia and distended abdomen

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76
Q

What is the common surgical procedure used in Ulcerative colitis?

A

Proctocolectomy + terminal ileostomy

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77
Q

What are the indications for surgical intervention in Ulcerative Colitis

A

Perforation
Massive haemorrhage
Toxic dilatation
Failed medical therapy

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78
Q

What pharmacological management is used in Ulcerative colitis?

A

5-ASAs - good for inducing remission

Steroids - Prenisolone PO/Steroid enema/Rectal steroids

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79
Q

What are the three causes of Acute Appendicitis?

A

Faecolith
Lymphoid hyperplasia
Filanial worms

80
Q

What is the typical presentation of acute appendicitis?

A

Periumbilical pain, migrating to the RIF.

Tachycardia/Fever/Furred tongue/peritonism

81
Q

What is Rovsking’s sign?

A

Press on LIF. Pain in RIF>LIF.

82
Q

What are the typical blood results for acute appendicitis?

A

Neutrophil leukophilia and elevated CRP

83
Q

What antibiotics are used in Acute appendicitis?

A

Metronidazole 500mg/8hr and Cefuroxime 1.5g/8hr

84
Q

Give three complications of acute appendicitis

A

Perforation
Appendix mass
Abscess

85
Q

How is an appendiceal abscess treated?

A

Drainage (percutaneous or surgical) and antibiotics

86
Q

Give three differential diagnoses for acute appendicitis

A

Ectopic pregnancy
UTI
Mesenteric adenitis

87
Q

What is a diverticulum?

A

An out pocketing of the gut wall, usually at the area of entry of perforating arteries.

88
Q

What is the difference between Diverticulosis, Diverticular disease and Diverticulitis

A

Diverticulosis -> presence of diverticula
Diverticular disease -> symptomatic diverticula
Diverticulitis -> inflammation of diverticula

89
Q

Give some of the presentation of diverticular disease

A

Altered bowel habits

Left side colic -> relieved by opening bowels

90
Q

Outline the presentation of diverticulitis

A

Pyrexia/increased WCC/CRP+ESR increase/ Tender abdomen and localised or general peritonism

91
Q

What is the general management of Diverticulitis

A

Analgesia/NBM/IVI
CT-guided percutaneous drainage (if abscess)
If perforated -> treat as acute abdomen (+Hartman’s procedure)

92
Q

Give four risk factors for Colorectal cancer

A

Neoplastic polyps
IBD
Genetic predisposition
Previous malignancy

93
Q

What is the general presentation of patients with left sided colorectal cancer?

A

Bleeding/mucus +lump on PR
Altered bowel habit
Obstruction
Tenesmus

94
Q

What is the general presentation of patients with right sided colorectal cancer?

A 
Weight loss
Unexplained iron deficiency anaemia
Abdominal pain (vague)
95
Q

What investigations should be carried out in patients with suspected colorectal malignancy?

A

FBC
Faecal occult blood test
Sigmoidoscopy/Colonoscopy
Barium enema

96
Q

What is the standard chemotherapy regime for colorectal malignancy?

A

FOLFOX (5-FU/Folinic acid and oxaliplatin)

97
Q

Outline the Dukes staging of colorectal cancer

A

A -> confined to the mucosa
B -> invasion through muscularis mucosa
C -> spread to surrounding lymphatics
D -> metastatic spread

98
Q

List the three types of haemorrhoids and what distinguishes between them

A

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
Q

What is the most common cause of haemorrhoids?

A

Constipation with prolonged straining

100
Q

What is the general presentation of haemorrhoids?

A

Bright, red PR bleeding - tissue/coating/bowl

Anaemia

101
Q

What investigations would you do for haemorrhoids?

A

Abdominal exam
PR exam
Proctoscopy
Sigmoidoscopy

102
Q

Outline the non-operative treatment for haemorrhoids

A

Increase fluids and fibre + stool softener
Rubber band ligation (bleeding/infection/pain)
Sclerosants - injected above dentate line

103
Q

Outline the surgical management of haemorrhoids

A

Excisional haemorrhoidectomy

Complications - constipation/infection/stricture and bleeding

104
Q

What is a ‘fissure in ano’?

A

Tears of the squamous lining of the anal canal, 90% are posterior.

105
Q

What causes an anal fissure?

A

Hard faeces. Spasm causes constriction of the inferior rectal artery, leading to reduced wound healing.

106
Q

How are anal fissures managed?

A

Lidocaine + GTN ointment
Topical diltiazem
Increased fibre, fluids + stool softener

107
Q

What is a fistula in ano?

A

Track persists between the skin and the anal/rectal canal.

108
Q

List four causes of anal fistula

A

Perianal sepsis
TB
Crohns
Diverticular disease

109
Q

What tests can you do for anal fistulas?

A

MRI

Endocanal US scan

110
Q

What is the treatment of anal fistulas?

A

Fistulotomy + excision

111
Q

Give three risk factors for anal cancer

A

Syphilis
Anal warts
Anoreceptive individuals

112
Q

Describe the varying histology of anal cancers

A

Margin - well differentiated,keratinised

Canal - poorly differentiated, arising above the dentate line and non-keratinising

113
Q

What is the lymphatic spread of the two types of anal cancer?

A

Above dentate line -> pelvic lymph nodes

Below dentate line -> inguinal lymph nodes

114
Q

What is the general presentation of anal cancer?

A

Bleeding
Pain
Change in bowel habits
Pruritis ani

115
Q

What is the non-surgical management option for anal cancer?

A

Chemo-irradiation -> radiotherapy + 5-FU/cisplatin

116
Q

What is the surgical management for anal cancer?

A

Anorectal excision and colostomy

117
Q

What is the definition of a Hernia?

A

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
Q

What is an irreducible hernia?

A

Cannot be pushed into the right place

119
Q

What is an incarcerated hernia?

A

Contents of hernial sac are stuck inside due to adhesions

120
Q

What is an obstructed hernia?

A

Bowel contents cannot pass through

121
Q

What is a strangulated hernia?

A

If ischaemia occurs within a hernia

122
Q

What is ‘reduction en masse’?

A

When a strangulated hernia is reduced however the bowel within the hernia is still strangulated

123
Q

Describe an indirect inguinal hernia

A

Pass through the deep inguinal ring, lateral to the inferior epigastric vessels

124
Q

Describe a direct inguinal hernia

A

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
Q

Give three causes of inguinal herniae

A

Cough
Constipation
Increased intraabdominal pressure

126
Q

Where would you examine the deep inguinal ring?

A

Midpoint of the inguinal ligament

127
Q

Where would you examine the superficial inguinal ring?

A

Superomedial to the pubic tubercle

128
Q

What are the borders of the inguinal canal?

A

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
Q

What would you look for in examination for inguinal hernia?

A

Previous scars
External genitalia
Visible - reducible
Cough impulse +ve

130
Q

What are the lifestyle management options for inguinal herniae?

A

Reduce weight

Stop smoking prior to surgical intervention

131
Q

What are the surgical repair options for inguinal hernia?

A

Mesh
TAPP - transabdominal pre-peritoneal
TEP - totally extra-peritoneal

132
Q

What are the post-surgical recommendations following inguinal hernia repair?

A

Rest for 4 weeks. If ok/comfortable, back within 2 weeks.

133
Q

Where can you usually feel the neck of a femoral hernia?

A

inferior and lateral to the pubic tubercle

134
Q

What are the borders of the femoral canal?

A

Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectineus and pectineal ligament

135
Q

Give three Ddx of femoral herniae

A

Inguinal hernia, lipoma, saphena varix

136
Q

What is a Herniotomy?

A

Ligation and excision of the herniated sac

137
Q

What is a Herniorrhaphy?

A

Repair of the hernial defect

138
Q

What is the surgical repair technique for Paraumbilical herniae?

A

Mayo repair

139
Q

How common are incisional herniae?

A

11-20% of muscle closures breakdown post surgery

140
Q

Give four causes of reflux oesophagitis

A

Repeated vomiting
Long-term NG intubation
Resections of the cardia with gastro-oesophageal anastomosis
Barrett’s oesophagus

141
Q

What investigations can be used for reflux oesophagitis?

A

Fibreoptic oesophagoscopy
24 hour oesophageal pH studies
Barium swallow

142
Q

Give three Ddx for oesophagitis

A

Cholecystitis
MI
Peptic ulcer

143
Q

What lifestyle modifications can be made in reflux oesophagitis?

A

Weight loss, smoking cessation, dietary manipulation.

Pt advised to sleep up in bed

144
Q

What pharmacological treatment can be given in reflux oesophagitis?

A

Alginate antacids
H2 receptor antagonists/PPIs
Metoclopramide - increases gastric emptying

145
Q

What happens in a sliding hiatus hernia?

A

Stomach and lower oesophagus slide through the oesophageal hiatus in the diaphragm

146
Q

What happens in a rolling hiatus hernia?

A

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
Q

What clinical features are present in hiatus herniae?

A

Mechanical - cough/dyspnoea/palpitations
Reflux - burning, rising retrosternal chest pain
Oesophagitis - stricture formation with dysphagia and bleeding

148
Q

How are sliding hiatus herniae treated?

A

Treated if symptomatic.

Laparoscopic repair

149
Q

What is Barrett’s oesophagitis?

A

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
Q

What surveillance is used for patients with Barrett’s oesophagus?

A

Regular endoscopy - with biopsies to examine for dysplasia.

151
Q

Give four risk factors for Oesophageal cancer

A

Tobacco/alcohol
Achalasia
Coeliac disease
Barrett’s oesophagus

152
Q

Give three clinical features of Oesophageal cancer

A

Progressive dysphagia
Hoarseness of voice
Anaemia, weight loss.

153
Q

What investigations are used for Oesophageal cancer

A

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
Q

Give the two treatment options for oesophageal cancer

A

Curative resection - neoadjuvant chemo and anastomosis across the defect
Palliative - intubation with a stent

155
Q

What is Achalasia?

A

Failure of relaxation of the lower end of the oesophagus with progressive dilatation, tortuosity, incoordination of peristalsis and hypertrophy of the oesophagus above.

156
Q

How does Achalasia present?

A

Most in women

Progressive dysphagia with spasm like chest pain

157
Q

What investigations would you use for Achalasia?

A

Chest XR - dilated oesophagus shows as a mediastinal mass
Barium swallow - shows dilatation and tortuosity of oesophagus
Oesophagoscopy
Oesophageal manometry - reduced LOS pressure

158
Q

What management options are there for Achalasia?

A

Hellers operation - laparoscopic cardiomyotomy

Dilatation of the oesophagus through radioactive guidance of an endoscopic balloon

159
Q

What is the definition of an Aneurysm?

A

Permanent localised dilatation of an artery, greater than 50% of it’s original diameter

160
Q

What is Ectasia?

A

Localised area of enlargement in an artery, but less than 1.5x

161
Q

What is the difference between a true and a false aneurysm?

A

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
Q

Give four causes of aneurysms

A 
Congenital
Degenerative
Caucasian
Connective tissue disease
Infective
Dissection
163
Q

What is the general rate of expansion of an aneurysm?

A

10% per year (0.5cm)

164
Q

Give four presentations of AAA

A

Asymptomatic
Distal embolisation
Abdominal pain, malaise and weight loss
Rupture - abdo pain, pulsatile mass and hypovolemia

165
Q

What are the two surgical options for AAA?

A

Endovascular aneurysm repair

Open repair

166
Q

What is EVAR?

A

Radiologically guided intraluminal placement of a stent.

Avoids laparotomy, intraperitoneal manipulation and aortic occlusion

167
Q

Give five complications of aneurysm repair

A 
Haemorrhage
Cardiac events
Renal failure
Embolisation
Colonic ischaemia
168
Q

Give four complications of EVAR

A

Graft migration
Endoleak
Fracture of supporting wires
Endotension

169
Q

Outline the screening programme for AAA

A

Men over 65 offered an ultrasound scan.

Diagnosed when aorta >3cm. Referral occurs at >5.5

170
Q

What are the two treatment options for Popliteal aneurysms?

A

Hunterian ligation and bypass surgery

Endovascular stenting

171
Q

What is intermittent claudication?

A

Cramping pain felt in the lower limb (buttock, thigh, calf) upon walking a certain distance

172
Q

What is the claudication distance?

A

Distance someone can walk before getting claudication pain

173
Q

What are the three cardinal signs of critical limb ischaemia?

A

Ulceration, gangrene and rest pain

174
Q

What is the fontaine classification?

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Ischaemic rest pain
  4. Gangrene/ulceration
175
Q

What is the normal ABPI readings, and what can it be in limb ischaemia

A

1-1.2

0.5-0.9 in peripheral arterial disease

176
Q

Give four non-surgical management options in limb ischaemia

A

Modify risk factors
Start Clopidogrel
Supervised exercise programmes - improve collateral blood flow
Vasoactive drugs

177
Q

What are the two surgical interventions for limb ischaemia?

A

Percutaneous transluminal angioplasty - single arterial segment

Surgical reconstruction - arterial reconstruction with a bypass graft

178
Q

What are the clinical signs of acute limb ischaemia?

A

Pale, Pulseless, Painful, Paralysis, Paraesthetic, Perishing cold

179
Q

Give four causes of acute limb ischaemia

A

Thrombosis
Emboli
Graft/angioplasty occlusion
Trauma

180
Q

What two complications can you get after surgery for acute limb ischaemia?

A

Post-operation reperfusion injury

Compartment syndrome

181
Q

What is Gangrene?

A

Tissue necrosis due to ischaemia

182
Q

What is Dry gangrene?

A

Gangrene without infection

183
Q

What is the treatment for dry gangrene?

A

Restoration of blood supply +/- amputation

184
Q

What is the treatment for wet gangrene?

A

Analgesia, broad spectrum IV antibiotics, debridement +/- amputation

185
Q

What is gas gangrene?

A

Spore forming clostridium species

Myonecrosis, muscle swelling, gas production, sepsis and severe pain.

Debridement, benzylpenicillin + clindamycin.

186
Q

What is Necrotising fasciitis?

A

Rapidly progressing infection of the deep fascia. Caused by group A - B haemolytic strep.

Treatment is radical debridement and IV antibiotics.

187
Q

Give three signs of neuropathic disease (diabetes)

A

Loss of sensation in stocking distribution
Absent ankle jerk
Deformity

188
Q

Give four signs of arterial disease (diabetes)

A

Absent foot pulses
Painful
Punched out edges
Deep

189
Q

What are neuropathic ulcers?

A

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
Q

What are the four management options for ulceration

A

Education - daily inspection, comfortable shoes
Regular chiropody
Treatment of fungal infection
Surgery - endovascular angioplasty balloons, stents and subintimal recanalisation

191
Q

Give three symptoms of varicose veins

A

Visible
Tiredness
Aching/throbbing in the legs
Swelling of the ankles

192
Q

What is a Saphena Varix?

A

Prominent dilatation at the saphenofemoral junction. Gives a thrill when the patient is asked to cough

193
Q

What is the tap test

A

Fingers placed at the saphenofemoral junction, tapping distal varies will transmit a thrill

194
Q

What is Trendelenbergs test

A

Pt lies flat, leg elevated to empty superficial veins, tourniquet applied, pt stands up.

Varicosities remain empty is saphenofemoral junction is incompetent.

195
Q

What investigations can be used for varicose veins?

A

Doppler

Duplex scanning

196
Q

Give two non-surgical treatments for varicose veins

A

Graded compression stockings - minor varicosities.

Sclerotherapy - causes fibrosis of the veins, can give bruising, phlebitis, ulceration and DVT

197
Q

When is surgery indicated with patients with varicose veins?

A

Haemorrhage
Grossly dilated/symptomatic
Skin changes - indicate deep venous insufficiency
Incompetent perforator veins

Phase 2 - Perioperative Care (1 decks)

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