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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
A patient with PVD complains of buttock and thigh pain. What artery is likely to be occluded?
Aortiliac
26
What drug is used as a peripheral vasodilator but must be avoided in patients with renal stones or hyperoxaluria?
Nafitrdrofuryl oxalate
27
What is the biggest risk factor/underlying medical condition when developing an arterial ulcer?
Peripheral vascular disease
28
Where do arterial ulcers commonly form?
Tips of toes, between toes, bony prominences, shin, lateral side of leg
29
Where do venous ulcers commonly form?
Gaiter area around malleolus
30
What are the risk factors for a venous leg ulcer?
DVT, OA, obesity, leg surgery, varicose veins
31
What does an arterial ulcer look like?
Symmetrical with well-defined borders
32
What does a venous leg ulcer look like?
Discrete/circumferential borders, shallow ulceration, fibrous with granulomatous layer, gently irregular sloping edges
33
What is the management for arterial leg ulcers?
Vascular bypass, skin grafting
34
What is the management for venous leg ulcers?
Compression bandaging, corticosteroid cream for varicose eczema
35
What criteria must be met for venous leg ulcer referral?
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
36
What are causes of peritonitis?
Perforation, pancreatitis, ulcers, cirrhosis/ascites, appendicitis
37
GI perforations are commonly caused by what 2 conditions
Sigmoid diverticulum and peptic ulcers
38
What signs are present in GI perforations?
Rigler's sign (double bowel wall due to air) and Psoas sign
39
What are common causes of GI haemorrhage?
Peptic ulcer, oesophageal varices, oesophagitis, Mallory-Weiss tear
40
What are the RF for peptic ulcers and what is a relieving factor?
NSAIDs, corticosteroids. Pain improves with food.
41
What are the RF for oesophagitis?
Hiatus hernia, radiotherapy, aspirin, allergies, alcohol.
42
A patient presents with melaena and a hoarse voice. They say they have been suffering from heartburn. What is the diagnosis?
Oesophagitis
43
Diverticular disease tends to affect the...
Sigmoid colon
44
What is the most common sign of asymptomatic diverticular disease?
Leukocytosis
45
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?
Diverticulitis
46
What are the RF for diverticulitis?
Age, low fibre, low fluid, smoking, FH, NSAIDs.
47
What are the RF of acute mesenteric ischaemia?
Clot - CVS RF (mitral stenosis, aortic aneurysm, AF)
48
What are the RF of chronic mesenteric ischaemia?
Atherosclerosis - Smoking, hypertension, diabetes.
49
What are the RF of ischaemic colitis?
Compromised blood supply - Hernia, trauma, vasculitis, SCA.
50
Left iliac fossa pain with N&V and haematemesis is a sign of
Ischaemic colitis
51
2 causes of small bowel obstruction
1. Adhesions | 2. Hernia
52
3 causes of large bowel obstruction
1. Malignancy 2. Diverticulosis 3. Volvulus
53
Raised lactate with colicky abdominal pain is a sign of
Large bowel obstruction
54
Abdominal symptoms alongside infection symptoms is a sign of
Toxic megacolon
55
Pseudomembranous colitis is caused by
C. diff infection due to overuse of antibiotics
56
Right-sided CRC presents with
RIF mass, bleeding, anaemia, abdominal pain
57
Left sided CRC presents with
LIF mass, bleeding, bowel habit changes, tenesmus
58
3 causes of RUQ pain
1. Biliary colic 2. Cholecystitis 3. Cholangitis
59
3 causes of RIF pain
1. Appendicitis 2. Ectopic pregnancy 3. Diverticulitis (Meckel's)
60
What investigations should you order for acute pancreatitis?
1. ABG - assess pO2 2. Calcium 3. Amylase
61
What ABG finding would you expect in an elderly patient with severe N&V?
Raised lactate - could indicate severe tissue ischaemia/ischaemic colitis
62
3 causes of obstruction
1. Adhesions 2. Hernia 3. Malignancy
63
Define ileus
Temporary pause in peristalsis/reduced bowel motility in absence of a mechanical obstruction
64
3 causes of ileus
1. Post-abdominal surgery 2. Intra-abdominal infection 3. Trauma/stress
65
A post-op patient complains of constipation and not passing wind. What's the diagnosis?
Ileus
66
General management for patient with ileus
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
Volvulus presents with what finding on an AXR?
Coffee bean sign
68
Sigmoid volvulus involves twisting in what way
Counter-clockwise
69
Most common cause of sigmoid volvulus
Faecal overloading
70
Caecal volvulus twists in what way
Clockwise
71
What's the management for a patient with sigmoid volvulus +/- peritonitis
1. With peritonitis: Hartmann's (surgical resection of the bowel, with formation of an end-colostomy) 2. Without peritonitis: Endoscopic decompression
72
Where is the caecum and sigmoid located?
Caecum - start of large bowel, before ascending colon | Sigmoid - end of large bowel, before rectum
73
What's the management for a patient with caecal volvulus?
Right hemicolectomy
74
Why is the small bowel often obstructed by adhesions and hernias compared to the large bowel?
The small bowel is not tethered in place, allowing it to become obstructed easier
75
4 symptoms of bowel obstruction
1. Abdominal pain - colicky 2. Vomiting (suggests high small bowel obstruction) 3. Abdominal distension (low small bowel obstruction) 4. Constipation (large bowel obstruction)
76
2 symptoms of high small bowel obstruction
Colicky abdo pain and vomiting
77
2 symptoms of low small bowel obstruction
Colicky abdo pain and distension
78
2 symptoms of large bowel obstruction
Colicky abdo pain and constipation/obstipation
79
Biggest complication of obstructed bowel (particularly in large bowel at thin-walled caecum)
Perforation
80
What will an abdo-pelvis CT scan show in obstruction?
Contrast will not pass through transition zone
81
2 AXR findings in large bowel obstruction
1. Dilated bowel loops > 6cm | 2. Incomplete hausta/surface markings
82
In sigmoid volvulus, what shape is the coffee bean finding on AXR?
V shape coffee bean, points from LIF to RUQ
83
2 AXR findings in small bowel obstruction
1. Dilated central loops of bowel > 4cm | 2. Complete valvular conniventes markings
84
4 absolute indications for laparotomy in bowel obstruction
1. Generalised peritonitis 2. Perforation 3. Irreducible hernia 4. Caecal volvulus
85
What part of the bowel becomes ischaemic in acute mesenteric ischaemia (AMI) and what 2 arteries are commonly affected?
Small bowel | Superior mesenteric artery (SMA) or occasionally coeliac artery
86
Causes of AMI
Thromboembolism from left heart/aorta - Post MI - AF - I.E
87
Most common underlying pathology of CMI
Atherosclerosis of superior or inferior MA, coeliac artery
88
What bowel is affected in CMI?
Both - small and large
89
Ischaemic colitis affects the ... bowel
Large
90
Sudden onset of severe colicky pain could indicate
AMI
91
Gradual onset of severe colicky pain with tenderness over LIF could indicate
Ischaemic colitis
92
2 steps of management for AMI
1. Opioid antispasmodic - papaverine | 2. Urgent laparoscopy/laparotomy
93
What is Rovsing's sign and what does it indicate?
RIF pain when pressing LIF | Appendicitis
94
What is Psoas sign?
Pain on extending hip

Module 3 (6 decks)

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