Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

taz year 3 surgery > General Surgery (Lower GI) > Flashcards

General Surgery (Lower GI) Flashcards

1
Q

Describe the pathophysiology of Appendicitis

A

Usually caused by luminal obstruction (secondary to faecoliths/lymphoid hyperplasia/impacted stool/tumour)

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

What are Faecoliths?

A

Faecal Debris and Calcium Salts

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

Give three risk factors of Appendicitis

A

Family History
Ethnicity (Caucasians)
Environmental (Seasonal - Summer)

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

Give 4 clinical features of Appendicitis

A

Pain (initial dull periumbilical, then later sharp in RIF)
Vomiting
Nausea
Anorexia

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

What is McBurney’s Point?

A

2/3 from Umbilicus to ASIS

Focus of peritoneal pain in late appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State three features OE of a patient with Appendicitis

A

Tachycardic
Tachypnoeic
Pyrexial

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

State two exams which would be positive in an Appendicitis patient

A

Psoas Sign - RIF pain with right hip extension (retrocoecal appendix irritates psoas muscle)
Rovsing’s Sign - RIF pain when LIF is palpated

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

Give 5 differentials for Appendicitis

A 
Ectopic Pregnancy
Ovarian Cyst Rupture
Ureteric Stones
Diverticulitis
IBS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you manage an Appendicitis patient?

A

Laproscopic Appendicectomy

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

Describe 3 complications of Appendicitis. How could we reduce the risk?

A

Perforation
Appendiceal Mass
Pelvic Abscess

Antibiotic Treatment

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

Describe the pathophsyiology of Colorectal Cancer

A

Occurs via progression
Normal Mucosa to Colonic Adenoma (Polyps)
Colonic Adenoma to Invasive Adenocarcinoma

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

Describe the two genetic mutations associated with Colorectal Cancer

A

APC (Adenomatous Polyposis Coli) - Normally a tumour supressor gene, associated with FAP

HNPCC - DNA mismatch repair gene, associated with Lynch Syndrome

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

Give four risk factors for Colorectal Cancer

A

Age
IBD
Family History
Low Fibre Diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe 3 presentations of Right Sided Colorectal Cancer

A

Late Presentation
Abdo Pain
Occult Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe 3 presentations of Left Sided Colorectal Cancer

A

Rectal Bleeding
Tenesmus
Change in bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the marker of Colorectal Cancer?

A

CEA

Not used in diagnosis but used to monitor progression

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

Give three possible imaging techniques for Colorectal Cancer

A

Colonoscopy
CT Scan
MRI Rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe Duke’s Staging of Colorectal Cancer

A

A - Confined to muscularis mucosa
B - Trough muscularis mucosa
C - Regional Lymph Nodes
D - Distant Metastases

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

Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a RIGHT Hemicolectomy?

A

Ileocolic
Right Colic
Right Middle Colic

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

Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a LEFT Hemicolectomy?

A

IMV
Left Colic
Left branch of middle colic

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

Surgery is the mainstay of treatment for Colorectal Cancer. What blood vessels would have to be dissected and reanastamosed in a Sigmoidectomy?

A

Inferior Mesenteric Artery

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

Give an example of when an Anterior Resection is used

A

High rectal tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give an example of when an AP Resection is used

A

Low Rectal Tumours

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

What is the Hartmann’s Procedure?

A

Used in emergency bowel surgery

Complete resection of rectosigmoid colon with formation of end colosomy and closure of rectal stump

Reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What other treatment can be used in Rectal Colorectal Carcinomas?
Radiotherapy
26
Describe the screening for Colorectal Cancer
Every 2 years for Men and Women aged 60-75 Uses Faecal Immunochemistry Test (Antibodies against Human Haemoglobin in Stools) If positive then it is referred for Colonoscopy
27
What is a Diverticulum?
Outpouching of the bowel wall, commonly in Sigmoid
28
Describe the four manifestations of Diverticular Disease
Diverticulosis - Presence of Diverticula Diverticular Disease - Symptomatic Diverticula Diverticulitis - Inflammation of Diverticula Diverticular Bleed - Diverticular erodes into vessels and cause large painless bleed
29
Describe the pathophysiology of Diverticular Disease
Bowel naturally weakens therefore stool passage increases intraluminal pressure Outpouching where nutrient arteries perforate Bacteria overgrow in outpouchings causing Diverticulitis
30
Describe the manifestations of Chronic Diverticulitis
Fistulae (Colovesicle and Colovaginal)
31
Describe the two types of Diverticulitis
Simple | Complicated (Abscess, Fistulae, Strictures)
32
Diverticula are often asymptomatic, describe three Diverticular pain
Intermittent lower abdominal pain (may be relieved by defaecation) Altered Bowel Habit Nausea & Flatulence
33
Describe the presentation of Diverticulitis
Acute Abdominal pain (usually sharp in LIF) | Systemic Upset
34
What two imaging techniques would you use for Diverticular disease
Flexible Sigmoidoscopy | CT Abdo Pelvis (showing thickening of colonic wall, localised air bubbles)
35
What is the Hinchey Classification?
Used to stage Diverticulitis 1 - Diverticulitis with pericolic abscess 2 - Diverticulitis with pelvic abscess 3 - Diverticulitis with purulent peritonitis 4 - Diverticulitis with faecal peritonitis
36
Describe the management of uncomplicated, diverticulitis and diverticular bleeds respectively
Uncomplicated - Analgesia and fluids Diverticulitis - Abx Diverticular Bleeds - Embolisation and Surgical resection
37
When is surgical management of Diverticular Disease required?
If stage 4 Hinchey or overwhelming Sepsis Hartmann Procedure
38
When is surgery indicated in Crohns?
Failed Medical Treatment Severe Complications Growth Impairment in younger patients
39
Describe four different possible surgeries for Crohns disease
Ileocaecal Resection Surgery for peri-anal disease (abscess drainage, fistulae resection) Stricturoplasty Small or large bowel resection
40
Why does Crohns increase the risk of Renal Stones?
Fat Malabsorption causes calcium to remain in the lumen and oxalate to be freely absorbed Resulting in Oxalate Stone formation
41
Why should you avoid anti-motility drugs in IBD?
They can precipitate Toxic Megacolon
42
What are the indications for surgery in Ulcerative Colitis?
Refractory to medical management Toxic Megacolon Bowel Perforation Dysplastic Cells when monitoring
43
What are the two surgical options for Ulcerative Colitis?
``` Total Protocolectomy (can use ileostomy, or can create ileal pouch anal anastamoses to maintain faecal continence) Subtotal Colectomy (Rectum sparing) ```
44
Describe three complications of UC
Toxic Megacolon Colorectal Carcinoma Osteoporosis
45
Define Pseudo-Obstruction (AKA Ogilvie Syndrome)
Dilation of the colon due to adynamic bowel in absence of mechanical obstruction Commonly affects caecum and ascending colon
46
Give four causes of Pseudo-Obstruction
Thought to be due to interruption of autonomic supply to bowel Electrolyte Imbalances, Hypothyroidism, Medication, Neurological Disease
47
Describe four clinical features of Pseudo-Obstruction
Abdominal Pain Abdominal Distension Constipation Late Vomiting
48
What is the gold standard investigation for Pseudo-Obstruction?
Abdo CT with IV contrast
49
Describe the conservative management of Pseudo-Obstruction
NBM and IV Fluids If vomiting - NG tube to aid decompression If not resolved in 48h - Endocscopic decompression (via flatus tube) and IV Neostigmine
50
Describe the two surgical options for Pseudo - Obstruction
Segmental Resection | Caecostomy/Ileostomy to decompress bowel
51
Define Volvulus
Twisting of bowel around its mesentery, and can compromise blood supply leading to infarction and necrosis
52
Give four risk factors for Volvulus
Age Neuropsychiatric Disorders Chronic Constipation OR Laxative Use Previous Abdo Surgery
53
Describe the clinical features of Sigmoid Volvulus
Early - Colicky Pain, Abdo Distension, Absolute Constipation | Late - Vomiting
54
What imaging would you use if you suspected Volvulus?
CT Abdo Pelvis with Contrast - Whirl Sign | Abdominal Xray - Coffee Bean Sign in LIF
55
Describe the conservative management of a Volvulus
Fluids | Decompression by sigmoidoscope and insertion of flatus tube
56
What indicates surgical management in Volvulus?
Ischaemia/Perforation Failed attempts at decompression Necrotic bowel Hartmann
57
Describe the bimodal age distribution for Caecal Volvulus
10 - 29 | 60 - 79
58
What are Haemorrhoids?
Abnormal swelling/enlargement of anal vascuar cushions
59
Describe the normal anatomy of anal vascular cushions
Assist anal sphincter in maintaining continence | 3 vascular cushions (3,7,11)
60
Describe the classification of Haemorrhoids
1st degree - remain in rectum 2nd degree - prolapse through anus on defaecation but spontaneously reduce 3rd degree - prolapse through anus on defaecation and requires digital reduction 4th degree - Permanently prolapsed
61
Give three risk factors of Haemorrhoids
Chronic Constipation Increased age Increased intra-abdo pressure
62
Describe three features of Haemorrhoids
Painless bright red rectal bleeding (on paper) Pruritus Rectal fullness
63
What happens when Haemorrhoids become painful?
The Haemorrhoids have become thrombosed, will appear purple/blue which is an emergency
64
Describe the conservative management of Haemorrhoids
Fluid/Fibre/Lacatives Topical Lidocaine 1st and 2nd Degree - Rubber band ligation
65
When would you treat Haemorrhoids with surgery?
If unresponsive to conservative but not suitable for banding | Stapled of Milligan Morgan Technique
66
What is a Pilonoidal Sinus?
Formation of a sinus in the cleft of the buttocks, commonlly affecting males aged 16-30
67
Describe the pathophysiology of a Pilonoidal Sinus in three steps
1) Hair follicle in intergluteal cleft becomes infected/inflamed 2) Inflammation obstructs opening, extending inwards to form a pit 3) Inflammation tracks to form a cavity connected by epithelial sinus to surface
68
Give 3 risk factors for the formation of a Pilonoidal Sinus
Caucasian males with coarse dark hair Those who sit for prolonged periods Increased sweating
69
Describe three clinical features of Pilonoidal Sinuses
Intermittent red/painful/swollen mass in sacrococcygeal region Discharge and signs of infection Opens up to skin but does not communicate with anal canal
70
Describe the non surgical management of Pilonoidal Sinuses
Plucking the affected region | Any abscess requires draining
71
Describe the two surgical methods of managing Pilonoidal Sinuses (if chronic)
- Excise tract and lay open to heal by secondary intention | - Excise tract and close the wound (higher rates of recurence)
72
Define Anal Fistula
Abnormal connection between anal canal and perianal skin
73
Give 3 causes of Anal Fistulae
IBD History of Trauma Previous Radiation to the area
74
Describe the clinical features of Anal Fistulae
Recurrent Perianal Abscesses | Intermittent/Continuous discharge onto perineurium
75
Describe the Goodsall Rule
Predicts the trajectory of an Anal Fistula tract Closer to the post aspect - curved course Closer to the ant aspect - straight course
76
Describe the Park's Classification of Anal Fistulae
Intersphincteric (between internal and external anal sphincter) Transphincteric (across sphincter horizontally) Suprasphincteric Extrasphincteric
77
Describe two surgical managements of Anal Fistulae
Fistulotomy - lay it open and allow to heal by secondary intention Seton Placement - Rubber sling goes through anal sphincter and fistula entrance to bring it closer together
78
Define Anorectal Abscess
Collection of pus in anal or rectal region Caused by plugging of anal ducts (which normally produce mucous to lubricate anal canal) Can be in four different areas (Perianal, Intersphincteric, Ischiorectal, Supralevator)
79
How would an Anorectal Abscess present?
Pain in perineum (exacerbated by sitting down) Localised swelling/itching/discharge If severe - systemic symptoms
80
How would you manage an Anorectal Abscess?
Antibiotic Therapy and Analgesia | Incision and drainage
81
Define Anal Fissure
Tear in the mucosal lining of anal canal Primary - No underlying disease Secondary - Underlying disease (IBD)
82
Describe the clinical features of Anal Fissures
Intense pain on defaecation (can last several hours) Bleeding (bright red on paper) 90% on posterior midline
83
Describe the conservative management of Anal Fissures
Increase fibre and fluids Stool softening laxatives Hot Baths GTN/Diltiazem cream (promotes blood supply to area and hence healing)
84
Describe the surgical management of Anal Fissures
Generally only reserved for chronic fissures Botox - causing internal and external sphincter to relax, promoting healing Lateral Sphincterotomy - Divides internal anal sphincter
85
What is a Rectal Prolapse? What are the two types?
Protrusion of rectal tissue out of the anus Partial Thickness - Rectal Mucosa protrudes out of anus Full Thickness - Rectal wall protrudes out of anus
86
Describe the pathophysiology of a Full Thickness Rectal Prolapse
Form of sliding hernia through defect in fascia
87
Describe the pathophysiology of a Partial Thickness Rectal Prolapse
Loosening and stretching of Connective Tissue (normally due to haemorrhoidal disease)
88
Describe the presentation of a Rectal Prolapse
Rectal Discharge/Bleeding Faecal Incontinence Full Thickness - Fullness, Tenesmus
89
How would you examine a suspected Rectal prolapse?
DRE under anaesthesia
90
Surgery is the definitive treatment for Rectal Prolapse, describe the two approaches
Perineal Approach | Abdominal Approach
91
Describe the histological difference in Anal Cancers
Below Dentate Line - Squamous Cell Carcinomas (AIN is precancerous conditions) Above Dentate Line - Adenocarcinomas
92
Give three risk factors for Anal Cancers
HPV HIV Crohns
93
Give four features of Anal Cancer
Rectal Pain/Bleeding Anal Discharge Pruritus Sphincters involved - tenesmus
94
What imaging is best for Anal Cancer?
MRI Pelvis
95
Describe the management of Anal Cancer
Chemoradiotherapy for all of them except T1N0 (where excision is normally sufficient) Surgery - AP Resection
96
Give 3 complications of Anal Cancer
ED Rectovaginal Fistula Proctitis
97
What is a common differential for Appendicitis in children?
Mesenteric Adenitis
98
What is Chilidaiti’s Sign?
Loop of bowel between the liver and diaphragm | Normal

taz year 3 surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions