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General Surgery Flashcards

1
Q

What are the signs of appendicitis?

A

Tender to McBurney’s point
Guarding to RIF
Rosving’s sign (palpation of the LIF causes pain in RIF)

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2
Q

What are some potential DDx of appendicitis?

A

Ectopic pregnancy
Ovarian cysts
Mittelschmerz syndrome

Meckel’s diverticulitis

Mesenteric adenitis

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3
Q

What is mesenteric adenitis?

A

Abdominal pain caused by inflamed abdominal lymph nodes

Often associated with cough/cold

No treatment required

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4
Q

What are the signs of an appendix mass?

A

Signs of appendicitis with palpable mass in RIF

(omentum and/or bowel surround and stick to the inflamed appendix

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5
Q

How should an appendix mass be managed?

A

Conservatively with supportive treatment and abx

Appendicetomy once acute condition has resolved

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6
Q

What are some of the associated complications of an appendicectomy?

A 
Bleeding 
Infection
Damage to surrounding tissues
Removal of normal appendix
Anaesthetic risk
DVT/PE
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7
Q

Prior to an appendicetomy, what should be given?

A

Prophylactic IV antibiotics

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8
Q

What are three causes of obstruction?

A

Adhesions
Malignancy
Hernias

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9
Q

What are symptoms of obstruction?

A

Abdominal distention and diffuse pain
Absolute constipation and lack of flatulence
Vomiting

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10
Q

How can obstruction be initially managed?

A

A-E assessment
NBM
IV fluids
NG tube

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11
Q

What investigation should be ordered for a patient with ?obstruction?

A

AXR

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12
Q

What are the upper limits of normal for parts of the bowel?

A

3cm small bowel
6cm colon
9cm caecum

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13
Q

What can cause an ileus?

A 
Post abdo surgery
Intra-abdominal infection/inflammation
Pneumonia
Trauma
Electrolyte imbalance
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14
Q

What are signs and symptoms of an ileus?

A 
Similar to obstruction
Abdominal distension and pain
Constipation, no flatulence
Sluggish bowel sounds
Vomiting
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15
Q

How should an ileus be managed?

A 
NBM
NG tube if vomiting
Mobilise (stimulate peristalsis)
IV fluids
Consider parenteral nutrition
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16
Q

In what direction does a sigmoid volvulus twist?

A

Anti-clockwise

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17
Q

In what direction does a caecal volvulus twist?

A

Clockwise

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18
Q

What are risk factors for a volvulus formation?

A 
Psychiatric disorders
Neurological disorders
Nursing home residents
Chronic constipation
Pelvic masses (inc. pregnancy)
Adhesions
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19
Q

What are the complications associated with a volvulus?

A

Obstruction
ischaemia
Perforation

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20
Q

What sign on AXR is associated with a sigmoid volvulus?

A

Coffee bean

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21
Q

How can a volvulus be treated?

A

Endoscopic compression - if sigmoid volvulus

Laparotomy:
Hartmann’s procedure - sigmoid
Right hemicolectomy (caecal)

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22
Q

What is a haemorrhoid?

A

Vascular cushion that becomes enlarged due to pressure (ie straining during defecation, pregnancy)

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23
Q

How can haemorrhoids be classified?

A

1st degree: no prolapse

2nd degree: prolapse on straining, return on relaxing

3rd degree: prolapse when straining, does not return on relaxing but can be pushed back

4th degree: prolapsed permanently

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24
Q

What are symptoms of haemorrhoids?

A 
Asymptomatic
Constipation
Bright red outflow bleeding
Sore/itchy anus
Feeling a lump around anus
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25
What is a thrombosed haemorrhoid?
Strangulation at the base of the haemorrhoid causing a clot to form
26
How does a thrombosed haemorrhoid present?
Very painful Purple, very tender, swollen lump DRE impossible due to pain
27
How can haemorrhoids be examined?
External haemorrhoids visible on inspection Internal haemorrhoids may be hard to feel on DRE Proctoscopy for proper visualisation and inspection
28
What are potential Ddx of haemorrhoids?
Fissure Cancer IBD
29
How can haemorrhoids be managed?
Increase fluid and fibre intake Anusol cream Laxatives Band ligation - above dentate line Surgical haemorrhoidectomy
30
What complications are associated with diverticulitis?
``` Haemorrhage Perforation Absces Fistula Ileus/obstruction ```
31
Define cholestasis
Blockage to the flow of bile
32
Define cholelithiasis
Presence of gallstone(s)
33
Define choledocholithiasis
Gallstone(s) in the bile duct
34
Define biliary colic
Intermittent RUQ pain caused by gallstones irritating the bile duct
35
Define cholecystitis
Inflammation of the gallbladder
36
Define cholangitis
Infection and obstruction of the biliary system
37
Define gallbladder empyema
Pus in the gallbladder
38
What limits whether an AUS is able to detect gallstones
Patients weight Gaseous bowel obstructing the view Patients discomfort with prone
39
When is a MRCP indicated in suspected gallstones?
USS doesn't show ductal stones but there is bile duct dilatation or raised bilirubin
40
When is an ERCP indicated in ?gallstone?
Established CBD stones
41
Other than established CBD stones, what are the other indications for ERCP?
Obstructing ductal tumours on USS or MRCP Treatment of CBD stones Stricture dilitation Biopsy of malignant areas
42
What are the USS findings that are consistent with acute cholecystitis?
Thickened gallbladder wall Stones/sludge in gallbladder Fluid around gallbladder
43
What is the upper limit of normal for size of the bile duct
6mm plus 1mm for every decade after 60
44
What LFTs indicate pathology in the biliary tree?
Raised bilirubin Raised ALP (may have raised AST/ALT)
45
If a patient has high ALT/AST compared to ALP, what does this indicate?
Hepatocellular process
46
What is Murphy's sign
RUQ tenderness exacerbated by deep inspiration Place hand in RUQ and apply pressure Ask patient to take a deep breath in Gallbladder will move downwards under your hand and cause pain
47
How should acute cholecystitis be managed?
Fasting Fluids ABx (if evidence of an infection) Delayed lap chole
48
What is a gallbladder empyema?
Infected tissue and pus in gallbladder Treat with cholecystectomy - drain into gallbladder to drain the empyema
49
How is acute cholangitis diagnosed?
Charcot's triad 1. RUQ pain 2. Fever 3. Jaundice
50
How is acute cholangitis managed?
IV antibiotics Treat sepsis ERCP or PTC to relieve obstruction
51
What is a notable complication of a cholecystectomy?
Chronic diarrhoea
52
What is acute mesenteric ischaemia?
Blood clots occlude the blood supply in the mesenteric vessels
53
How does acute mesenteric ischaemia present?
Non-specific abdo pain (out of proportion to exam findings) | Can develop shock and peritonitis
54
How is acute mesenteric ischaemia diagnosed?
Raised blood lactate | Diagnose with CT angiogram
55
What can acute mesenteric ischaemia result in?
Gangrene +/- perforation
56
What are risk factors for acute mesenteric ischaemia?
AF Older age Atherosclerosis Coag disorders
57
How should acute mesenteric ischaemia be managed?
``` A-E assessment Fluid resuscitation Thrombolysis Surgical intervention Very poor prognosis ```
58
What is the Glasgow Pancreas score?
``` PaO2 <60 Age >55 Neutrophils (WBC >15) Calcium <2 uRea >16 Enzymes (LDH >600 or AST/ALT >200) Albumin <32 Sugar (glucose >10) ``` ``` <2 = mild 2 = moderate >2 = severe ```
59
What are complications of pancreatitis?
Pancreatic necrosis Pseudocysts Chronic pancreatitis
60
How should pancreatitis be managed?
``` Careful monitoring IV fluids - third space losses Analgesia Endoscopic drainage of large pseudocysts ABx only if evidence of infected pancreatic necrosis ``` Escalate care depending on Glasgow score

Medicine finals (12 decks)

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