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Module 3 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What cell type covers external haemorrhoids (found below the dentate line)?

A

Squamous epithelium

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2
Q

What tissue type covers internal haemorrhoids (found above the dentate line)?

A

Rectal mucosa

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3
Q

What is the most common symptom of an internal haemorrhoid?

A

Painless bleeding

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4
Q

What are the symptoms of external haemorrhoids?

A

Itching, fresh blood on tissue paper/stool, pain around anus.

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5
Q

What are 3 causes of appendicitis?

A

Impacted faeces, infection or lymphoid hyperplasia secondary to IBD.

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6
Q

A patient presents with severe epigastric pain that radiates to the lower right quadrant. What’s the diagnosis?

A

Appendicitis - the appendix is found at the end of the caecum in the LRQ.

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7
Q

What would you expect on (abdominal) examination of a patient with appendicitis?

A

Pain, rigidity and guarding

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8
Q

What are common causes of intussusception?

A

Pre-existing GI conditions (Meckels diverticulum, submucosal haematoma), genetic disorders (cystic fibrosis - thick stools; haemophilia - increases risk of submucosal haematoma; Henoch-Schonlein purpura).

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9
Q

What age group and sex is most at risk of intussusception?

A

Males < 3 years

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10
Q

A child presents with colicky type abdominal pain, bile stained vomit and blood/mucus in their stools. They have a PMH of haemophilia. What is the diagnosis?

A

Intussusception

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11
Q

There are 3 types of ischaemic bowel disease …

A
  1. Acute mesenteric ischaemia (AMI) - Embolus/thrombus
  2. Chronic mesenteric ischaemia (CMI) - Intestinal angina, due to atherosclerosis
  3. Ischaemic colitis: Compromised blood supply to colon - trauma, drugs, vasculitis, SCA.
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12
Q

A hiatus hernia is caused by…

A

The stomach falling through the diaphragm

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13
Q

Signs/symptoms of a hiatus hernia include

A

Heartburn, dysphagia, dyspnoea

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14
Q

Incisional hernias are caused by

A

Surgical scar

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15
Q

Inguinal hernias are found

A

In the inguinal canal (v-lines)

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16
Q

What are the 5 types of hernia?

A
  1. Hiatus
  2. Incisional
  3. Inguinal
  4. Umbilical
  5. Ventral
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17
Q

Ventral hernias are commonly found

A

Between the abdominal muscles

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18
Q

Generally, what are the risk factors for hernias development?

A

Heavy lifting, chronic cough/COPD, obesity, constipation, pregnancy.

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19
Q

What is the management for abdominal aortic aneurysms?

A

Surveillance if 3-5.4 cm

Surgical repair/endovascular grafting if > 5.5 cm or 4.5 cm and increased by > 0.5 in the past 6 months

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20
Q

Chest pain that radiates into the back and ST depression on an ECG indicates

A

Dissected aortic aneurysm

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21
Q

What is a sign of dissected aortic aneurysm on a chest x-ray?

A

Widened mediastinum

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22
Q

What is the surgical management of dissected aortic aneurysm?

A

Stents

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23
Q

What arteries are affected in peripheral vascular disease?

A

Large peripheral arteries

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24
Q

A patient with PVD complains of calf pain. What artery likely to be occluded?

A

Femoropopliteal

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25
Q

A patient with PVD complains of buttock and thigh pain. What artery is likely to be occluded?

A

Aortiliac

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26
Q

What drug is used as a peripheral vasodilator but must be avoided in patients with renal stones or hyperoxaluria?

A

Nafitrdrofuryl oxalate

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27
Q

What is the biggest risk factor/underlying medical condition when developing an arterial ulcer?

A

Peripheral vascular disease

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28
Q

Where do arterial ulcers commonly form?

A

Tips of toes, between toes, bony prominences, shin, lateral side of leg

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29
Q

Where do venous ulcers commonly form?

A

Gaiter area around malleolus

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30
Q

What are the risk factors for a venous leg ulcer?

A

DVT, OA, obesity, leg surgery, varicose veins

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31
Q

What does an arterial ulcer look like?

A

Symmetrical with well-defined borders

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32
Q

What does a venous leg ulcer look like?

A

Discrete/circumferential borders, shallow ulceration, fibrous with granulomatous layer, gently irregular sloping edges

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33
Q

What is the management for arterial leg ulcers?

A

Vascular bypass, skin grafting

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34
Q

What is the management for venous leg ulcers?

A

Compression bandaging, corticosteroid cream for varicose eczema

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35
Q

What criteria must be met for venous leg ulcer referral?

A
  1. Ulcer does not heal within 2 weeks despite active treatment.
  2. Ulcer reoccurs
  3. ABPI < 0.8 or > 1.2
  4. Compression is contraindicated
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36
Q

What are causes of peritonitis?

A

Perforation, pancreatitis, ulcers, cirrhosis/ascites, appendicitis

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37
Q

GI perforations are commonly caused by what 2 conditions

A

Sigmoid diverticulum and peptic ulcers

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38
Q

What signs are present in GI perforations?

A

Rigler’s sign (double bowel wall due to air) and Psoas sign

39
Q

What are common causes of GI haemorrhage?

A

Peptic ulcer, oesophageal varices, oesophagitis, Mallory-Weiss tear

40
Q

What are the RF for peptic ulcers and what is a relieving factor?

A

NSAIDs, corticosteroids. Pain improves with food.

41
Q

What are the RF for oesophagitis?

A

Hiatus hernia, radiotherapy, aspirin, allergies, alcohol.

42
Q

A patient presents with melaena and a hoarse voice. They say they have been suffering from heartburn. What is the diagnosis?

A

Oesophagitis

43
Q

Diverticular disease tends to affect the…

A

Sigmoid colon

44
Q

What is the most common sign of asymptomatic diverticular disease?

A

Leukocytosis

45
Q

A patient presents with sharp iliac fossa pain with tenderness, guarding and pain that worsens on movement. They have general GI upset. What is the diagnosis?

A

Diverticulitis

46
Q

What are the RF for diverticulitis?

A

Age, low fibre, low fluid, smoking, FH, NSAIDs.

47
Q

What are the RF of acute mesenteric ischaemia?

A

Clot - CVS RF (mitral stenosis, aortic aneurysm, AF)

48
Q

What are the RF of chronic mesenteric ischaemia?

A

Atherosclerosis - Smoking, hypertension, diabetes.

49
Q

What are the RF of ischaemic colitis?

A

Compromised blood supply - Hernia, trauma, vasculitis, SCA.

50
Q

Left iliac fossa pain with N&V and haematemesis is a sign of

A

Ischaemic colitis

51
Q

2 causes of small bowel obstruction

A
  1. Adhesions

2. Hernia

52
Q

3 causes of large bowel obstruction

A
  1. Malignancy
  2. Diverticulosis
  3. Volvulus
53
Q

Raised lactate with colicky abdominal pain is a sign of

A

Large bowel obstruction

54
Q

Abdominal symptoms alongside infection symptoms is a sign of

A

Toxic megacolon

55
Q

Pseudomembranous colitis is caused by

A

C. diff infection due to overuse of antibiotics

56
Q

Right-sided CRC presents with

A

RIF mass, bleeding, anaemia, abdominal pain

57
Q

Left sided CRC presents with

A

LIF mass, bleeding, bowel habit changes, tenesmus

58
Q

3 causes of RUQ pain

A
  1. Biliary colic
  2. Cholecystitis
  3. Cholangitis
59
Q

3 causes of RIF pain

A
  1. Appendicitis
  2. Ectopic pregnancy
  3. Diverticulitis (Meckel’s)
60
Q

What investigations should you order for acute pancreatitis?

A
  1. ABG - assess pO2
  2. Calcium
  3. Amylase
61
Q

What ABG finding would you expect in an elderly patient with severe N&V?

A

Raised lactate - could indicate severe tissue ischaemia/ischaemic colitis

62
Q

3 causes of obstruction

A
  1. Adhesions
  2. Hernia
  3. Malignancy
63
Q

Define ileus

A

Temporary pause in peristalsis/reduced bowel motility in absence of a mechanical obstruction

64
Q

3 causes of ileus

A
  1. Post-abdominal surgery
  2. Intra-abdominal infection
  3. Trauma/stress
65
Q

A post-op patient complains of constipation and not passing wind. What’s the diagnosis?

A

Ileus

66
Q

General management for patient with ileus

A
  1. NBM - sips of water or IV fluids
  2. NG tube if vomiting
  3. IV nutrition (parenteral) if prolonged time without food
  4. Slowly re-introduce food
67
Q

Volvulus presents with what finding on an AXR?

A

Coffee bean sign

68
Q

Sigmoid volvulus involves twisting in what way

A

Counter-clockwise

69
Q

Most common cause of sigmoid volvulus

A

Faecal overloading

70
Q

Caecal volvulus twists in what way

A

Clockwise

71
Q

What’s the management for a patient with sigmoid volvulus +/- peritonitis

A
  1. With peritonitis: Hartmann’s (surgical resection of the bowel, with formation of an end-colostomy)
  2. Without peritonitis: Endoscopic decompression
72
Q

Where is the caecum and sigmoid located?

A

Caecum - start of large bowel, before ascending colon

Sigmoid - end of large bowel, before rectum

73
Q

What’s the management for a patient with caecal volvulus?

A

Right hemicolectomy

74
Q

Why is the small bowel often obstructed by adhesions and hernias compared to the large bowel?

A

The small bowel is not tethered in place, allowing it to become obstructed easier

75
Q

4 symptoms of bowel obstruction

A
  1. Abdominal pain - colicky
  2. Vomiting (suggests high small bowel obstruction)
  3. Abdominal distension (low small bowel obstruction)
  4. Constipation (large bowel obstruction)
76
Q

2 symptoms of high small bowel obstruction

A

Colicky abdo pain and vomiting

77
Q

2 symptoms of low small bowel obstruction

A

Colicky abdo pain and distension

78
Q

2 symptoms of large bowel obstruction

A

Colicky abdo pain and constipation/obstipation

79
Q

Biggest complication of obstructed bowel (particularly in large bowel at thin-walled caecum)

A

Perforation

80
Q

What will an abdo-pelvis CT scan show in obstruction?

A

Contrast will not pass through transition zone

81
Q

2 AXR findings in large bowel obstruction

A
  1. Dilated bowel loops > 6cm

2. Incomplete hausta/surface markings

82
Q

In sigmoid volvulus, what shape is the coffee bean finding on AXR?

A

V shape coffee bean, points from LIF to RUQ

83
Q

2 AXR findings in small bowel obstruction

A
  1. Dilated central loops of bowel > 4cm

2. Complete valvular conniventes markings

84
Q

4 absolute indications for laparotomy in bowel obstruction

A
  1. Generalised peritonitis
  2. Perforation
  3. Irreducible hernia
  4. Caecal volvulus
85
Q

What part of the bowel becomes ischaemic in acute mesenteric ischaemia (AMI) and what 2 arteries are commonly affected?

A

Small bowel

Superior mesenteric artery (SMA) or occasionally coeliac artery

86
Q

Causes of AMI

A

Thromboembolism from left heart/aorta

  • Post MI
  • AF
  • I.E
87
Q

Most common underlying pathology of CMI

A

Atherosclerosis of superior or inferior MA, coeliac artery

88
Q

What bowel is affected in CMI?

A

Both - small and large

89
Q

Ischaemic colitis affects the … bowel

A

Large

90
Q

Sudden onset of severe colicky pain could indicate

A

AMI

91
Q

Gradual onset of severe colicky pain with tenderness over LIF could indicate

A

Ischaemic colitis

92
Q

2 steps of management for AMI

A
  1. Opioid antispasmodic - papaverine

2. Urgent laparoscopy/laparotomy

93
Q

What is Rovsing’s sign and what does it indicate?

A

RIF pain when pressing LIF

Appendicitis

94
Q

What is Psoas sign?

A

Pain on extending hip

Module 3 (6 decks)

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