general surgery Flashcards
retractile testis fx
retractile testis can be brought into the scrotum by the clinician and when released remains in the scrotum. If the examining clinician notes the testis to return rapidly into the inguinal canal when released then surgery is probably indicated.
duodenal ulcer presentation and artery
gastric
pain a few hours after eating, gastroduodenal (posterior)
pain on eating, left gastric (lesser curve)
Blatchford score vs
Rockall score
to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy.
used at endoscopy to assess possible prognosis in light of the patients diagnosis and other variables.
renal cancers:
polycythaemia
hydronephrosis, dilation irregular
4 yo
adenocarcinoma
transitional cell carcinoma (commonly painless haematuria)
nephroblastoma
liver cyst differential
simple cysts, cancers (cystic hepatocellular carcinoma or metastases), amoebic abscesses, hydatid cysts, pyogenic abscesses, and fungal microabscesses
femoral canal
Laterally Femoral vein
Medially Lacunar ligament
Anteriorly Inguinal ligament
Posteriorly Pectineal ligament
Dieulafoy Lesion
Often no prodromal features prior to haematemesis and malaena, but this arteriovenous malformation may produce quite considerable haemorrhage and may be difficult to detect endoscopically
ix for fistulae
MRI
CT and barium?
burns fluid resus
4ml x tbsa x body weight
50% first 8h 50% next 16h
cryptorchidism (undescended testes)
ddx
tx
retractile testes
Orchidopexy at 6- 18 months of age. The operation usually consists of inguinal exploration, mobilisation of the testis and implantation into a dartos pouch.
Intra-abdominal testis should be evaluated laparoscopically and mobilised. Whether this is a single stage or two stage procedure depends upon the exact location.
After the age of 2 years in untreated individuals the Sertoli cells will degrade and those presenting late in teenage years may be better served by orchidectomy than to try and salvage a non functioning testis with an increased risk of malignancy.
Lynch syndrome
hereditary non-polyposis colorectal cancer
hyperkalaemia on ecg
Peaked or 'tall-tented' T waves (occurs first) Loss of P waves Broad QRS complexes Sinusoidal wave pattern Ventricular fibrillation
complication of achalasia
SCC
nerves:
burning pain of her anterior thigh which worsens on walking. There is a positive tinel sign over the inguinal ligament
She has pain over the inguinal ligament which radiates to the lower abdomen. There is tenderness when the inguinal canal is compressed.
weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh.
lateral cutaneous nerve
inguinal hernia surgery and ilioinguinal nerve.
femoral nerve
left chest pain and epigastric tenderness
boerhaaves
definition of upper gi bleed
proximal to ligament of treitz
Dumping syndrome
can be divided into early and late, may occur following gastric surgery. It occurs as a result of a hyperosmolar load rapidly entering the proximal jejunum. Osmosis drags water into the lumen, this results in lumen distension (pain) and then diarrhoea. Excessive insulin release also occurs and results in hypoglycaemic symptoms.
use of:
calcitonin
thyroglobulin antibodies
thyroid peroxidase antibodies
- completeness of surgical resection
- elevated in thyroid cancer
- found in graves and hashimoto’s
management of bleeding peptic ulcer that has not responded to endoscopy
laparotomy
indication for splenectomy
haemodynamic instability and complete devascularisationof the spleen
AFP associated with
HCC
hepatic haemangioma
Most common benign tumours of mesenchymal origin
Incidence in autopsy series is 8%
Cavernous haemangiomas may be enormous
Clinically they are reddish purple hypervascular lesions
Lesions are normally separated from normal liver by ring of fibrous tissue
On ultrasound they are typically hyperechoic
deccekeration injury
haemodynamically stable
free fluid abdomen
Duodeno-jejunal flexure disruption
dermato fibroma
bigger on palpation, slightly pigmented
hesselbachs triangle boundaries
Medial: Rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament
cullens sign
boas sign
peri umbilical haemorrhage- pancreatitis
hyperaesthesia under right scapula cholecystitis
Spondylolisthesis features
This occurs when one vertebra is displaced relative to its immediate inferior vertebral body
May occur as a result of stress fracture or spondylolysis
Traumatic cases may show the classic ‘Scotty Dog’ appearance on plain films
Treatment depends upon the extent of deformity and associated neurological symptoms, minor cases may be actively monitored. Individuals with radicular symptoms or signs will usually require spinal decompression and stabilisation
pseudomyxoma peritonei
Pseudomyxoma peritonei is a rare mucinous tumour most commonly arising from the appendix. The disease is characterised by the accumulation of large amounts of mucinous material in the abdominal cavity. It is rare, with an incidence of 1-2/1,000,000 per year
retroperitoneal fibrosis
an uncommon condition and its aetiology is poorly understood. In a significant proportion the ureters are displaced medially. In most retroperitoneal malignancies they are displaced laterally. Hypertension is another common finding. A CT scan will often show a para-aortic mass
Peptic stricture
Longer history of dysphagia, often not progressive. Usually symptoms of GORD. Often lack systemic features seen with malignancy
peutz jeghers syndrome
STK11 (LKB1) mutation on chromosome 19 in some (but not all) cases, dominant
Multiple benign intestinal hamartomas
Episodic obstruction and intussusception
Increased risk of GI cancers (colorectal cancer 20%, gastric 5%)
Increased risk of breast, ovarian, cervical pancreatic and testicular cancers
Cowden disease
Mutation of PTEN gene on chromosome 10q22, dominant Macrocephaly Multiple intestinal hamartomas Multiple trichilemmomas 89% risk of cancer at any site 16% risk of colorectal cancer
Angiodysplasia
Apart from bleeding, which may be massive, these arteriovenous lesions cause little in the way of symptoms. The right side of the colon is more commonly affected.
Meckel’s diverticulitis
A Meckel’s diverticulum is a congenital abnormality that is present in about 2% of the population
Typically 2 feet proximal to the ileocaecal valve
May be lined by ectopic gastric mucosal tissue and produce bleeding
Pilonidal sinus
Usually in the natal cleft of male patients after puberty.
It is more common in Caucasians related to their hair type and growth patterns.
The opening of the sinus is lined by squamous epithelium, but most of its wall consists of granulation tissue. Up to 50 cases of squamous cell carcinoma have been described in patients with chronic pilonidal sinus disease.
Hairs become trapped within the sinus.
Clinically the sinus presents when acute inflammation occurs, leading to an abscess. Patients may describe cycles of being asymptomatic and periods of pain and discharge from the sinus.
Treatment is difficult and opinions differ. Definitive treatment should never be undertaken when acute infection or abscess is present as this will result in failure.
Definitive treatments include the Bascom procedure with excision of the pits and obliteration of the underlying cavity. The Karydakis procedure involves wide excision of the natal cleft such that the surface is recontoured once the wound is closed. This avoids the shearing forces that break off the hairs and has reasonable results.
classes of shock
Class I shock would be completely compensated for.
Class II shock would cause tachycardia.
Class III shock causes tachycardia and hypotension as well as confusion.
Class IV shock causes loss of consciousness as well as severe hypotension.
