Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine finals > General Surgery > Flashcards

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some potential DDx of appendicitis?

A

Ectopic pregnancy
Ovarian cysts
Mittelschmerz syndrome

Meckel’s diverticulitis

Mesenteric adenitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is mesenteric adenitis?

A

Abdominal pain caused by inflamed abdominal lymph nodes

Often associated with cough/cold

No treatment required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should an appendix mass be managed?

A

Conservatively with supportive treatment and abx

Appendicetomy once acute condition has resolved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prior to an appendicetomy, what should be given?

A

Prophylactic IV antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are three causes of obstruction?

A

Adhesions
Malignancy
Hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are symptoms of obstruction?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can obstruction be initially managed?

A

A-E assessment
NBM
IV fluids
NG tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

AXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

3cm small bowel
6cm colon
9cm caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause an ileus?

A 
Post abdo surgery
Intra-abdominal infection/inflammation
Pneumonia
Trauma
Electrolyte imbalance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should an ileus be managed?

A 
NBM
NG tube if vomiting
Mobilise (stimulate peristalsis)
IV fluids
Consider parenteral nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In what direction does a sigmoid volvulus twist?

A

Anti-clockwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In what direction does a caecal volvulus twist?

A

Clockwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications associated with a volvulus?

A

Obstruction
ischaemia
Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What sign on AXR is associated with a sigmoid volvulus?

A

Coffee bean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can a volvulus be treated?

A

Endoscopic compression - if sigmoid volvulus

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a haemorrhoid?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are symptoms of haemorrhoids?

A 
Asymptomatic
Constipation
Bright red outflow bleeding
Sore/itchy anus
Feeling a lump around anus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a thrombosed haemorrhoid?

A

Strangulation at the base of the haemorrhoid causing a clot to form

26
Q

How does a thrombosed haemorrhoid present?

A

Very painful
Purple, very tender, swollen lump

DRE impossible due to pain

27
Q

How can haemorrhoids be examined?

A

External haemorrhoids visible on inspection

Internal haemorrhoids may be hard to feel on DRE

Proctoscopy for proper visualisation and inspection

28
Q

What are potential Ddx of haemorrhoids?

A

Fissure
Cancer
IBD

29
Q

How can haemorrhoids be managed?

A

Increase fluid and fibre intake
Anusol cream
Laxatives

Band ligation - above dentate line

Surgical haemorrhoidectomy

30
Q

What complications are associated with diverticulitis?

A 
Haemorrhage
Perforation
Absces
Fistula
Ileus/obstruction
31
Q

Define cholestasis

A

Blockage to the flow of bile

32
Q

Define cholelithiasis

A

Presence of gallstone(s)

33
Q

Define choledocholithiasis

A

Gallstone(s) in the bile duct

34
Q

Define biliary colic

A

Intermittent RUQ pain caused by gallstones irritating the bile duct

35
Q

Define cholecystitis

A

Inflammation of the gallbladder

36
Q

Define cholangitis

A

Infection and obstruction of the biliary system

37
Q

Define gallbladder empyema

A

Pus in the gallbladder

38
Q

What limits whether an AUS is able to detect gallstones

A

Patients weight
Gaseous bowel obstructing the view
Patients discomfort with prone

39
Q

When is a MRCP indicated in suspected gallstones?

A

USS doesn’t show ductal stones but there is bile duct dilatation or raised bilirubin

40
Q

When is an ERCP indicated in ?gallstone?

A

Established CBD stones

41
Q

Other than established CBD stones, what are the other indications for ERCP?

A

Obstructing ductal tumours on USS or MRCP

Treatment of CBD stones
Stricture dilitation
Biopsy of malignant areas

42
Q

What are the USS findings that are consistent with acute cholecystitis?

A

Thickened gallbladder wall
Stones/sludge in gallbladder
Fluid around gallbladder

43
Q

What is the upper limit of normal for size of the bile duct

A

6mm plus 1mm for every decade after 60

44
Q

What LFTs indicate pathology in the biliary tree?

A

Raised bilirubin
Raised ALP
(may have raised AST/ALT)

45
Q

If a patient has high ALT/AST compared to ALP, what does this indicate?

A

Hepatocellular process

46
Q

What is Murphy’s sign

A

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
Q

How should acute cholecystitis be managed?

A

Fasting
Fluids
ABx (if evidence of an infection)
Delayed lap chole

48
Q

What is a gallbladder empyema?

A

Infected tissue and pus in gallbladder

Treat with cholecystectomy - drain into gallbladder to drain the empyema

49
Q

How is acute cholangitis diagnosed?

A

Charcot’s triad

  1. RUQ pain
  2. Fever
  3. Jaundice
50
Q

How is acute cholangitis managed?

A

IV antibiotics
Treat sepsis
ERCP or PTC to relieve obstruction

51
Q

What is a notable complication of a cholecystectomy?

A

Chronic diarrhoea

52
Q

What is acute mesenteric ischaemia?

A

Blood clots occlude the blood supply in the mesenteric vessels

53
Q

How does acute mesenteric ischaemia present?

A

Non-specific abdo pain (out of proportion to exam findings)

Can develop shock and peritonitis

54
Q

How is acute mesenteric ischaemia diagnosed?

A

Raised blood lactate

Diagnose with CT angiogram

55
Q

What can acute mesenteric ischaemia result in?

A

Gangrene +/- perforation

56
Q

What are risk factors for acute mesenteric ischaemia?

A

AF
Older age
Atherosclerosis
Coag disorders

57
Q

How should acute mesenteric ischaemia be managed?

A 
A-E assessment
Fluid resuscitation
Thrombolysis 
Surgical intervention 
Very poor prognosis
58
Q

What is the Glasgow Pancreas score?

A 
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
Q

What are complications of pancreatitis?

A

Pancreatic necrosis
Pseudocysts
Chronic pancreatitis

60
Q

How should pancreatitis be managed?

A 
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions