GI surgery Flashcards

1
Q

discuss abdominal trauma

A

either blunt or penetrating

blunt e.g- car crash, sports, assult–> divide into solid organ and hollow organ issues.
concern for splenic injury.

sharp- gunshot/ stab.
–> refractory hemorrhagic shock the leading cause of death.

Ix: clinically- are they bleeding, hypotensive, lactate levels etc.

bedside- dipstick for blood- renal injury
FAST- USS by bedside.
CT trauma

Rx: if unstable- lap
if stable but- signs of peritonitis, gunshot wounds,– also lap.

otherwise watchful waiting.

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2
Q

discuss anal fissure

A

tear in mucosal lining of the anal canal

poo trauma most common

acute (<6/52)
chronic (>6/52)

primary or 2’(underlying disease)

RF: constipation, dehydration, Inflam bowel disease.

S+S: intense pain post defacation. bleeding on wiping (fresh)

visible/ palpable usually. 90% posterior midline.
Ix: DRE or proctoscopy.

Rx: manage the RF and analgesia (stool softeners, fibre)
GTN cream or diltiazem cream - inc blood and reduce tone.

chronic- surgical management.
try botox injections first
then lateralsphincterectomy.

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3
Q

discuss haemorrhoids

A

3 vascular cushions in the anus
3,7,11 o’clock.

haemorrhoids are enlargements of these.

1st degree- remain in rectum
2nd degree- prolapse on defacation but spont reduce
3rd- reduce with digital relocation
4th- presistently prolapsed.

RF: excesssive straining (constipation), age, raised intraabdo pressure.

S+S: painless bright red bleeding, not mixed in.
pruritis, rectal fullness, lump, soiling.

Ix: proctoscopy, colonoscopy.

Rx: conservative
inc fibre, fluid, laxatives, lignocane gel,
sit on ice pack,
1st and 2nd degree- rubber band ligation.
3st and 4st- ectomy, or artery ligation

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4
Q

discuss hernias- inguinal

A

inguinal hernias– most common type, more frequent in men. lump in the groin 2cm above + 2cm medial to pubic tubercle.
present as a lump in the groin.

indirect- goes through the whole canal- i.e the deep ring also
direct- pushed straight through the superficial ring

how to tell- reduce it, then firmly press the deep inguinal ring, if it still comes out then its direct

clinical diagnosis
Rx: mesh repair, open if first and uni, lap otherwise.

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5
Q

perianal fistula/ abscess

A

collections of pus in perianal glands following blockage of anal duct

these normally secrete mucous to help with defecation, but blockage–> infection

the inc pressure can cause fistulae to form if left for long enough

S+S: severe pain, worse with pressue (sitting) – discharge, bleeding.

erythermaous, fluctuant, tender, v painful on DRE

Ix: abcess is clnical
fistulae is MRI

Rx:abx whilst awaiting surgery- abcess- drainage, leave open– dress for 1 day. then leave alone.

fistulae- sphincterotomy (cut open and allow to heal)
seaton- keep open and allow to heal
can close if needed.

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6
Q

how to tell the path of the perianal fistulae

A

if posterior to mid anal line- will be curved and funky- but will open into the middle posterior aspect of the anal canal

if within 3cm and anterior- will be a straight path to the anterior anal canal.

if more than 3cm and anterior- will probably go to the posterior canal in a funky way.

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