Generic surgical topics Flashcards
Definition, cause and managment of Abdominal Compartment Sydrome?
1) Sustained intra abdominal pressure coupled with new organ dysfunction/failure 2) Intestinal ischmia or following a surgical procedure. Diagnosed by transvesical pressure measurements 3) Gastric decompression, muscle relaxants/sedation for increase in abdominal wall compliance, Drain abdominal fluid collections, consider fluid restriction/diuretics if clinically indicated. 4) Failure of non surgical treatment, laparatomy,laparostomy, delayed closure
Borders of the femoral canal
Laterally- Femoral vein Medially- Lacunar ligament Anteriorly- Inguinal ligament Posteriorly- Pectineal ligament
Spigelian hernia
Interparietal hernia occurring at the level of the arcuate line Rare May lie beneath internal oblique muscle. Usually between internal and external oblique Equal sex distribution Position is lateral to rectus abdominis Both open and laparoscopic repair are possible, the former in cases of strangulation
Lumbar hernia
The lumbar triangle (through which these may occur) is bounded by: Crest of ilium (inferiorly) External oblique (laterally) Latissimus dorsi (medially) Primary lumbar herniae are rare, most are incisional hernias following renal surgery - Direct anatomical repair with or without mesh re-enforcement is the procedure of choice
Obturator hernia
Herniation through the obturator canal Commoner in females Usually lies behind pectineus muscle Elective diagnosis is unusual most will present acutely with obstruction When presenting acutely most cases with require laparotomy or laparoscopy (and small bowel resection if indicated)
Richters hernia
Condition in which part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type) They do not present with typical features of intestinal obstruction as lumenal patency is preserved Where vomiting is prominent it usually occurs as a result of paralytic ileus from peritonitis (as these hernias may perforate)
Incisional hernia
Occur through sites of surgical access into the abdominal cavity Most common following surgical wound infection To minimise following midline laparotomy Jenkins Rule should be followed and this necessitates a suture length 4x length of incision with bites taken at 1cm intervals, 1 cm from the wound edge Repair may be performed either at open surgery or laparoscopically and a wide variety of techniques are described
Bochdalek hernia
Typically congenital diaphragmatic hernia 85% cases are located in the left hemi diaphragm Associated with lung hypoplasia on the affected side More common in males Associated with other birth defects May contain stomach May be treated by direct anatomical apposition or placement of mesh. In infants that have severe respiratory compromise mechanical ventilation may be needed and mortality rate is high
Morgagni Hernia
Rare type of diaphragmatic hernia (approx 2% cases) Herniation through foramen of Morgagni Usually located on the right and tend to be less symptomatic More advanced cases may contain transverse colon As defects are small pulmonary hypoplasia is less common Direct anatomical repair is performed
Paraumbilical hernia
Usually a condition of adulthood Defect is in the linea alba More common in females Multiparity and obesity are risk factors Traditionally repaired using Mayos technique - overlapping repair, mesh may be used though not if small bowel resection is required owing to acute strangulation
Umbilical hernia
Hernia through weak umbilicus Usually presents in childhood Often symptomatic Equal sex incidence 95% will resolve by the age of 2 years Surgery performed after the third birthday
Littres hernia
Hernia containing Meckels diverticulum
Resection of the diverticulum is usually required and this will preclude a mesh repair
Common causes of Biliary disease in HIV
sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia Pancreatitis in the context of HIV infection may be secondary to anti-retroviral treatment (especially didanosine) or by opportunistic infections e.g. CMV
Mnemonic for the assessment of the severity of pancreatitis: PANCREAS
P a02 < 60 mmHg A ge > 55 years N eutrophils > 15 x 10/l C alcium < 2 mmol/l R aised urea > 16 mmol/l E nzyme (lactate dehydrogenase) > 600 units/l A lbumin < 32 g/l S ugar (glucose) > 10 mmol/l >3 means severe
Parotid- What is Benign pleomorphic adenoma? How is it treated?
Most common. Pleomorphic adenomas a usually benign tumours. However, they will enlarge over time and a proportion can undergo malignant transformation. superficial parotidectomy
Warthin tumor (papillary cystadenoma lymphoma or adenolymphoma)
Second most common Biilateral enlargement of parotid glands Marked male as compared to female predominance Occurs later in life (sixth and seventh decades)
Monomorphic adenoma
Account for less than 5% of tumours Slow growing Consist of only one morphological cell type (hence term mono) Include; basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas
Haemangioma
Should be considered in the differential of a parotid mass in a child Accounts for 90% of parotid tumours in children less than 1 year of age Hypervascular on imaging Spontaneous regression may occur and malignant transformation is almost unheard of
Nerves at risk of Branchial cyst excision?
Greater auricular Mandibular branch of facial nerve accessory nerve
What is the blood supply of dura?
Middle meningeal, passing through foramen spinosum
Ruptured ACL presentation
Sport injuries High twisting force applied to a bent knee Typically presents with oud crack, pain and rapid joint swelling (Haemoarthrosis) Poor Healing Mx: Physio or surgery
Ruptured posterior cruciate ligament
Hypertension in juries Tibia sinks back Paradoxical anterior draw test
Ruptered medial collateral
Forced valgus via force Knee unstable when put inot valgus
Menisceal tear
Rotational sporting injuries Delayed knee swelling Joint locking when knee extended
Recurrent episodes of pain and effusions Minor trauma
Dislocation of patella
Traumatic primary event, Either through direct trauma or through severe contraction of quadriceps with knee valgus and external rotation Genu valgum, tibial torsion and high riding patella are risk Skyline x-ray views of patella are required, although displaced patella are risk factors An osteochondral fracture is present in 5% The condition has a 20% recurrence rate
Fractured patella
2 types 1) Direct blow to patella causing undisplaced fragments 2) Avulsion fracture
Schatzer Classification?
