General Surgery Flashcards
Summarise the managment of an upper GI bleed.
- Admission to hospital
- Careful monitoring
- Cross match blood (if haemodynamically unstable, likely to require ONeg)
- FBC, LFTs, U&Es
- Clotting
- If varicose Souspected, give terlipressin
- Upper GI endoscopy within 24 hours, or immediately after resuscitation (may be performed in theatre with an naesthetist present)
- Varices should be banded or sclerotherapy. If this is not possible, then a Sengaksten-Blakemore Tube (Minnesota Tube) should be inserted.
- Patients with erosive oesophagitis should receive a PPI IV
- Mallory-Weiss tear will resolve spontaneously
- Pateitns that cannot be managed endoscopically may require laparoscopic surgery (e.g. for ulcer underfunding)
Summarise the indications for surgery (as opposed to endoscopic treatment) with haematemesis?
- Age >60
- Continued bleeding despite endoscopic intervention
- Recurrent bleeding
- Known cardiovascular disease with poor response to hypotension
What is a piloidal sinus?
They occur as a result of hair debris creating sinuses in the skin.
They are usually found in the midline in very hairy individuals
What is the management for an asymptomatic inguinal hernia?
Routine referral to surgery.
Studies have shown that many patients would eventually become symptomatic and therefore surgery is advised.
What type of hernias are common in children?
Congenital inguinal hernia: indirect hernias resulting from a patent processus vaginalis. Should be repaired surgically soon after diagnosis due to high risk of incarceration.
Infantile umbilical hernia: usually self resolving by age 4-5.
What is dumping syndrome?
Dumping syndrome is the result of a hyperosmolar load rapidly entering the proximal Jejunum. Osmosis drags water into the lumen, resulting in luminal distension and diarrhoea.
Excessive insulin release also occurs and results in hypoglycaemic symptoms.
What is a dieulafoy lesion?
This is caused by a large tortuous arterielle most commonly located in the stomach wall - these can rupture and bleed.
What is Boas’ sign?
Boas’ sign is the phenomenon of hyperparaesthesia beneath the scapula with cholecstitis.
This is due to abdominal wall innervation from the spinal root that lies at this level.
What tumour marker is raised in hepatocellular carcinoma?
Alfa feto protein, AFP.
What is the annual risk of strangulation with inguinal hernias?
< 5%.
Which mAb is anti-VEGF?
Bevacizumab. It is used in colorectal cancer, as well as renal cancers and glioblastoma.
Talk yourself through the interpretation of hepatitis B serology.
Hep B surface antibody is what provides immunity.
Hep B core antibody is what shows exposure to the actual virus.
Hep B surface antigen means there is virus in the bloods with potential infectivity.
What do the classes of haemorrhagic shock indicate?
Class I:
- <15% blood loss.
- Pulse < 100
- BP normal
- UO normal
Class II: (pt feels anxious)
- 15-30% blood loss.
- Pulse > 100
- BP normal
- UO 20-30 mL
Class III:
- 30-40% blood loss
- Pulse >120
- BP Decreased
- Urine output 5-15 mL/hr
Class IV:
- >40% blood loss
- Pulse >140
- BP Decreased
- Urine output neglegible
What is an abdominal wall haematoma?
Abdominal wall/rectus sheath haematoma can occur following trauma, either directly to the abdominal wall or iatrogenic trauma from surgery, or can be spontaneous following excessive strainign of the rectus muscle.
It is more common in people on anticoagulation.
What does this AXR show?
It shows small bowel obstruction (valvulae conniventes) as well as a perforation (Rigler’s sign - you can see the bowel wall on both sides of the lumen).
What type of transplant would a twin donating a kidney to their other twin be?
Isograft.
What is the likely cause of recurrent UTIs and bubbly urine?
An enterovesical fistula. This can frequently be due to a colorectal malignancy.
What anatomical landmark demarcates upper from lower GI?
The ligament of Treitz.
It is found at the duodenojejunal flexure. It marks the boundary between the first and second parts of the small intestine and is the formal boundary between the upper and lower GI tracts.
What are pilar cysts?
Pilar cysts are epidermoid cysts with the outer lining being a sheath of a hair follicle.
What are dermatofibromas?
These are solitary dermal nodules that usually affect the extremities of young adults.
Lesions characteristically are larger than they appear and histologically consist of proliferating fibroblasts merging with sparsely cellular dermal tissues.
Frequently appear at sites of previous trauma.
What does this image of a barium swallow show?
What symptoms does this patient likely suffer from?
A hiatus hernia. This is when part of the stomach herniates above the diaphragm.
- Sliding: 95% of hiatus hernias. The gastro-oesophageal junction moves above the diaphragm
- Rolling: Gastro-oesophageal junction remains below the diaphragm, but a seperate part of the stomach herniates through the oesophageal hiatus.
Symptoms include persistent heartburn.
Summarise when surgery is indicated for splenic trauma.
Conservative:
- Recommended for small subcapsular haematoma with minimal intra abdominal blood and no hilar disruption
Laparotomy with conservation:
- Indicated if there are increased amounds of intra-abdominal blood with moderate haemodynamic compromise. Overall tears/lacerations affect <50%
Resection:
- Indicated if there are hilar injuries or major haemorrhage or major associated injuries
What is spondylolisthesis?
Spondylolisthesis is the displacement of one verterbae compared to another.
Which nerve can be damaged during total hip replacement?
How can you test for damage to this nerve?
The sciatic nerve.
This manifests as inability to dorsiflex (via common peroneal/fibular nerve) and plantarflex (tibial nerve).
What does this abdominal radiograph show?
Small bowel obstruction.
What is the name of the classification used for the severity of diverticulitis?
Hinchey classification
