General Surgery Crash Course Flashcards
What sign?
Coffee bean sign
AXR - diagnosis is Sigmoid volvulus
coffee bean sign - means..
Sigmoid volvulus
… accounts for approx 5% of cases of large bowel obstruction
Volvulus
Sigmoid most common, can be caecum also
Sigmoid volvulus may be treated with decompression +/- surgery
Caecum volvulus - surgical only
62 YO accountant - LLQ pain, general malaise and intermittent fevers
Suspect diverticulitis - which part of intestines does this most commonly effect?
Sigmoid colon
Diverticula are …
Sac like protrusions of the mucosa through the muscular wall
Diverticulitis refers to
Symptomatic acute inflammation and infection of diverticula
Common with advancing age
Most commonly in sigmoid colon
4025% lifetime risk of diverticulitis if diverticulosis
Management of diverticulitis
ABs, supportive care or surgical intervention (drainage, surgical washout or hartmann’s procedure)
Acute mesenteric ischaemia -
Collection of conditions causing acute intestinal hypoperfusion
Occlusive arterial AMI - usually embolic disease
Risk factors - AF, MI and IE
Necrosis necessitates intervention or palliation, typically via laparotomy
Abdo pain and constipation - change in bowel habit, 4kg of weight loss
HTN - previous surgeries
Low HB, low MCV, CRP up and lactate up
Large bowel on AXR - finding on X-ray?
Haustra - large bowel
AXR small vs large bowel
AXR - smalll bowel has valvulae conniventes, white lines which cross the entire lumen
Large bowel has haustra - white lines which do not cross the lumen of the large bowel
3,6,9 cm rule can be used to identify dilated bowel
Bowel dilatation -
3,6,9cm rule
Bowel obstruction is the presenting symptom in up to … of cases of colorectal cancer
1/3rd
What is the most common cause of large bowel obstruction
Colorectal cancer
Surgical options for colorectal cancer
Defunctioning stoma or resection with anastomosis
Non surgical - endoscopic stenting
Small bowel obstruction causes - post appendectomy
Adhesions
Adhesional SBO
May resolve with conservative measures , may need surgery
NG tube and IV fluid = conservative
Gastrografin is often given therapeutically if uncomplicated
Emergency surgery may be indicated if persistent or risk of complications
Positive cough impulse, dragging in right groin
What describes the surface landmarks for the deep inguinal ring?
6cm oblique passage through the abdominal wall
Transmits the spermatic cord in men and round ligament in women
Deep ring - mid point between the asis and pubic tubercle (mid point of inguinal ligament)
The superficial ring - triangular opening in external oblique aponeurosis
During laparoscopic surgery a direct inguinal hernia does what in relation to the inferior epigastric vessels?
Passes medically - inguinal hernias are either direct or indirect (60%(
Direct protrude directly through the posterior wall of the inguinal canal
Indirect hernias
Protrude through the deep ring and into the inguinal canal
Inguinal hernias
Symptomatic - operative management
Inguinal hernia open vs laparoscopic
Complication of inguinal hernia repair
Chronic pain, infection, recurrence
Ilioinguinal nerve damage possible during surgery - relates to chronic pain
