GI surgery Flashcards
discuss abdominal trauma
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.
discuss anal fissure
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.
discuss haemorrhoids
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
discuss hernias- inguinal
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.
perianal fistula/ abscess
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.
how to tell the path of the perianal fistulae
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.
