General Surgery Flashcards
Formula for calculating fluid volume for resuscitation after burns?
Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml
What is the spectrum of gallbladder disease?
- Biliary colic
- Cholecystitis
- Ascending cholangitis
- ?Pancreatitis
What is biliary colic?
Results from transient cystic duct blockage from impacted stones, can have transient ALT rise.
Biliary colic presentation?
RUQ pain, can radiate to shoulder, can come on spontaneously, may be related to fatty food, can last from 15mins to 24 hours.
Biliary colic investigations?
USS is really good at seeing stones, MRCP is next stage and then ERCP can be diagnostic and treatment.
Biliary colic and cholecystitis management?
Manage patient symptoms - pain control.
Abx if needed
Cholecystectomy
Sphincterectomy
Consider biliary stent if stones are irretrievable
Most common cause of rectal bleeding?
Haemorrhoids
Typical causes of rectal bleeding?
Benign:
- Haemorrhoids
- Anal fissures
- Fistulae
Diverticulosis/itis
Colonic polyps
Colorectal/anal cancer
Investigations for rectal bleeding?
Flexible sigmoidoscopy
Colonoscopy
CT colonography
Red flags for colorectal cancer?
Main
- PR bleeding
- Anaemia
- Change in Bowel habit
Others:
- Weight loss
- Abdo discomfort
- Mass
Suspected colorectal cancer investigations?
Colonoscopy with biopsy is gold standard
Would also do FBC and LFT
CT colonoscope
Different surgery available for colorectal cancer, according to location?
Resection, depends on affected region:
- Hemicolectomy (right or left)
- Sigmoid colectomy
- Anterior resection
When is the bowel screening programme offered?
Offered flexible sigmoidoscopy at 55
Home testing kit every 2 years from 60 to 74 years old (and can do after 75 too)
What is the home testing kit of the bowel cancer screening programme looking for?
Occult blood in the sample
Tumour marker for colorectal cancer?
CEA
Q’s for a bowel habit history?
- How are they generally?
- Are you going everyday?
- Are they formed movements?
- Has anything changed?
What is the role of the tunica (processus) vaginalis in men?
Forms a capsule around the testes
In what tissue do hydrocele’s form?
The tunica vaginalis
What are LUTS? Examples?
Lower Urinary Tract Symptoms:
- Frequency
- Dysuria
- Hesitancy
- Urgency
What is urinary hesitancy?
Delay in initial urination.
Types/classifications of haematuria?
Blood can arise from anywhere in the renal tract.
Classed as visible and non-visible
Non-visible further into:
- Symptomatic (LUTS)
- Non-symptomatic
What type of urinary sample is more sensitive to haematuria?
Dipstick of fresh urine (rather than MSU)
Painless haematuria is indicative usually of what?
Bladder cancer
Transient causes of Haematuria?
UTI, Vigorous exercise, menstruation
Renal causes of haematuria? (non-transient)
neoplasia, glomerulonephritis, tubulointerstitial nephritis, PCKD, Papillary necrosis, pyelonephritis, trauma
ExtraRenal causes of haematuria?
Renal stones
infection
neoplasia
trauma (e.g. catheter)
Some drugs e.g. cephalosprins, NSAIDS
What is polycythaemia?
Larger than usual concentration of haemoglobin in the blood.
Increases chance of blood clot formation and can have unpleasant symptoms such as a headache
Normal PSA range for men through their life?
40-50: <2
50-60: <3
60-70: <4
> 70: <5
Role of LH and FSH in men?
LH stimulates testosterone production and FSH testicle enlargement
Anaemia definition?
Low haemoglobin concentration (<135 in Men and <115 in women)
Types of anaemia?
Microcytic (low MCV), normocytic and macrocytic (high MCV)
Haemolytic
Causes of Microcytic anaemia?
Iron deficiency anaemia (most common)
Thalassaemia, Sideroblastic anaemia
Causes of Normocytic anaemia?
Acute blood loss, anaemia of chronic disease
Bone marrow failure, renal failure, Hypothyroidism, Haemolysis, pregnancy
Causes of Macrocytic anaemia?
B12 or folate deficiency
Alcohol excess
Reticulocytosis
Cytotoxics
hypothyroidism
Maximum lidocaine dose?
500 micrograms (if given with Adrenaline)
Appendicitis presentation?
Early periumbilical pain that moves to the RIF, MOVEMENT makes it WORSE
N&V
RIF guarding and rebound tenderness (pain upon removal of pressure - indicative of peritonitis (blumbergs sign))
Causes of acute pancreatitis?
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids Mumps/malignancy Autoimmune Scorpion sting Hypercalcaemia ERCP Drugs e.g. azothioprine
Key features of bowel obstruction?
Vomiting, nausea and anorexia.
Colic, constipation and distension
Can have tinkling bowel sounds
Common causes of palmar erythema?
Primary idiopathic
Pregnant (high oestrogen)
Liver cirrhosis
Rheumatoid arthritis
SLE
Causes of bowel obstruction?
Small Bowel
- Adhesions
- Hernias
- Gallstone ileus
Large bowel
- Colon Cancer
- Diverticular stricture
- Volvulus
Action of warfarin, how long does it take to work?
Antagonises Vit k, takes 2-3 days to take effect.
Difference between Heparin and Warfarin?
Warfarin antagonises vit K. Warfarin needs monitoring of the INR. It is a once daily dose.
Heparin is more fast acting.
Unfractionated heparin (UFH) works very fast and has a short half life. Needs some monitoring
LMWH (e.g. dalteparin), also works fast and does not require monitoring. It works by inactivating factor Xa. It has a longer half life than UFH
What are functional bowel disorders?
Functional bowel disorders are functional gastrointestinal disorders with symptoms attributable to the middle or lower gastrointestinal tract.
These include the IBS, functional bloating, functional constipation, functional diarrhoea, and unspecified functional bowel disorder.
Must have occurred for the first time ≥6 months before the patient presents, and their presence on ≥3 days a month during the last 3 months indicates current activity