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Surgery > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What are the three most common causes of small bowel obstructions?

A

Adhesions
Hernias
Cancer

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2
Q

Where are anal fissures most commonly found?

A

Below the dentate line on the posterior midline, typically from repetitive local trauma (child birth, anal sex, constipation, etc)

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3
Q

What is a common sign of anal fissure?

A

Blood on toilet paper and pain at the anus, post BM

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4
Q

What is the most effective therapy? What if it fails?

A

Conservative – increased fiber, stool softeners, lidocaine gel
Failure requires – lateral interal sphincterotomy or botulinum toxin (to loosen the sphincter)

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5
Q

If an anal fissure recur and fail to heal, what might be suspected?

A

Crohn’s Disease

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6
Q

What is the cause of an perianal abscess?

A

Obstruction of a crypt in the anus, causing bacterial overgrowth and infection – walling off abscess formation

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7
Q

What are the signs of a perianal abscess compared to anal fissure?

A

Severe anal pain with fluctuant mass and overlaying erythema, not always associated with BMs and commonly a fever is present.
Anal fissure is usually only associated with BMs with pain at that time and blood.

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8
Q

What are risk factors associated with perianal abscess?

A

Constipation / Diarrhea
Inflammatory bowel disease
Immune suppression, chemotherapy
DM

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9
Q

What are complications that can arise from perianal abscess?

A

Necrotizing tissue infection

Ruptured abscess can cause re-epithelialization of a tract from anus to the skin – fistula

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10
Q

What kind of individual risk factors contribute to perianal fistula formation?

A

Perianal abscess (most common)
Inflammatory bowel disease
Radiation
FB in the anus

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11
Q

What are the symptoms present with a perianal fistula?

A

Perianal drainage of fecal matter
Itching and irritation of the area
Intermittent pain, unhealing tract

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12
Q

What are the differences in anterior vs posterior perianal fistulas?

A

Anterior – straight line connects with rectum
Posterior – bend toward midline opening of the rectum
If the fistulas diverge from these trends, then Crohn’s disease is highly suspect.

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13
Q

What is the most common cause of anal cancer?

A

immunosuppression / HIV – HPV Type 16

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14
Q

What are the risk factors associated with anal cancer?

A
  • Anal Sex
  • HPV16
  • Smoking
  • Multiple sexual partners
  • HIV / Immunosuppression (AIDS defining illness)
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15
Q

What are the signs that can make you suspicious of anal cancer?

A
  • Bleeding from the anus
  • Perianal fullness
  • Frequently asymptomatic
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16
Q

What is the most common treatment of anal cancer?

A

5-FU and Mitomycin – initial treatment

– if refractory, then surgery is required (abdominal-perineal resection)

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17
Q

What is Ogilvie syndrome?

A

Significant diffuse dilation of the colon, usually associated with severe illness and medications (anticholinergics/narcotics).
Also referred to as – Acute Megacolon

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18
Q

What is the biggest concern if a large bowel obstruction is diagnosed?

A

Cancer – most concerning
Hernia/Adhesions
Diverticulosis
Inflammatory Bowel (Crohn’s/UC)

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19
Q

What is visualized on X-ray in a large bowel obstruction?

A

Multiple air-fluid levels with air in the proximal distended colon and absent air in the distal colon

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20
Q

Where is a femoral hernia most commonly located and why?

A

Typically females, or age/injury.

    • Medial in the femoral ring
    • Lateral to lacunar ligament
    • Inferior to inguinal ligament
21
Q

Richter’s hernia is when only a portion of the intestinal wall is protruding, what type of hernias is this most commonly present in?

A

Femoral and Obturator Hernia

22
Q

What type of hernia sac has a Meckel’s Diverticulum with it?

A

Littrel Hernia

23
Q

Femoral and Inguinal hernias that contain the appendix, are considered what?

A

Garengoff’s and Amyand’s Hernia

24
Q

What is the cause of a pantaloon hernia?

A

Where the inferior epigastric vessel is in the middle of the hernia sac and the bowel goes on each side of it, appearing as a pair of pants.

25
Q

What makes a spigelian hernia unique?

A

The hernia sac passes through the spigelian fascia (semilunaris)

26
Q

What is it called when a femoral hernia has two hernia sacs where one is in the femoral canal and the other is through the superficial fascia?

A

Cooper’s Hernia

27
Q

What would the physical exam findings be concerning for small bowel obstruction?

A
    • hyperactive bowel sounds (initiall)
    • abdominal distention / tenderness
    • abdominal masses
  • ** Dehydration Signs – (usually from vomiting)
28
Q

How are symptoms for proximal vs distal obstruction different?

A

Proximal obstruction more commonly associated with nausea and vomiting – need for fluid replacement
Distal obstruction more commonly with abdominal pain and distention

29
Q

When is surgery indicated for a small bowel obstruction?

A

Complete obstruction

Signs of ischemia, necrosis, or perforation

30
Q

What kind of skin lines internal hemorrhoids?

A

columnar epithelial

31
Q

What kind of skin lines external hemorrhoids?

A

squamous epithelial

32
Q

What are risk factors that can contribute to hemorroids?

A
  • prolonged sitting (pooling of blood)
  • constipation
  • pregnancy
    Rare – portal hypertension, age, pelvic tumors obstructing flow
33
Q

What are common presentations of hemorrhoids?

A
  • hematochezia
  • rectal prolapse
  • sense of fullness in the rectum
  • itching
    If external – acute pain with thrombosis
34
Q

What are surgical indications of hemorrhoids?

A
  • hemorrhoids that are refractory to therapy
  • thrombose
  • necrotic external
35
Q

What are the surgical managements of hemorrhoids?

A

Internal – Rubberband ligation

External – Hemorrhoidectomy

36
Q

What are complications if hemorrhoids are left untreated?

A
    • strangulation leading to necrosis
    • thrombosis
    • repeated bleeding, iron deficiency anemia
37
Q

What are benefits of performing a laproscopic surgery over open?

A
    • less bleeding, lower risk for adhesions
    • smaller incisions, less need for pain meds
    • reduced hospital stay
    • less risk of scaring
38
Q

What are the disadvantages of laproscopic procedures?

A
    • typically longer surgery duration
    • need for longer anesthesia care
    • less dexterity with manipulation of internal organs
    • RISK of IVC compression from inflation of abdomen
39
Q

What are the increased risks associated with laproscopic procedures?

A
    • blind insertion of ports can injure vessels and underlying structures
    • inadvertent damage to surrounding structures
    • CO2 in abdomen is absorbed in the blood increasing the pCO2 inducing increased work of breathing (CO2 sensors induce this)
40
Q

Why might a patient have shoulder pain after surgery?

A

There is irritation or damage to the diaphragm from the CO2 inflation and the phrenic nerve distributes into the shoulder.

41
Q

When performing a surgical graft of tissue without blood supply to a new location, how and when does it restore vascularization?

A

Initially – Plasmatic Imbibition
– the skin graft absorbs nutrients passively from the surrounding area
Within 48 hours capillaries develop, then 7 days full vascular supply should have developed

42
Q

What is the difference between split thickness and full thickness skin grafts?

A

Split Thickness – epidermis and partial dermis

Full thickness – includes complete epidermis and dermis

43
Q

What are the different uses of full vs partial thickness skin grafts?

A

Full Thickness – placed in locations where cosmetic appearance is important or mobility
However – donor site requires skin flap to heal properly
Partial Thickness – used when large grafts are required, such as large burns, however these partial thickness grafts contract significantly – less desirable in cosmetic areas

44
Q

What are the most common causes of skin graft failure?

A
  • too much movement
  • infection
  • DM
  • malnutrition
  • SMOKING
  • steriod therapy
45
Q

How do you manage a graft that is beginning to fail?

A

– partial loss can be combated with moist dressings, but complete loss requires surgical resection / assessment

46
Q

What are the indications for a surgical flap placement for a wound?

A
  • area is poorly vascularized
  • unable to be closed without high tension
  • cosmetic sensative area wound
47
Q

How are surgical flaps different than full thickness skin grafts?

A

Surgical Flaps – skin transferred to new location WITH it’s blood supply
Skin Grafts – Are not transferred with blood supply

48
Q

What are the differences in simple, regional, distant flaps?

A

Simple – skin flap from adjacent tissue
Regional – skin is found nearby, but not adjacent to wound
Distant – tissue taken from distant region of body

49
Q

What are the differences between free flaps and prefabricated flaps?

A

Free Flaps – blood supply was reconnected microvascularly

Prefabricated – blood supply connected from distal site

Surgery (7 decks)

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