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MD > MD2 Surgical > Flashcards

MD2 Surgical Flashcards

1
Q

What is Meckel’s diverticulitis?

A

Congenital outpouching of tissue, can be tissue from anywhere in GIT tract. i.e outpouching in intestine of stomach tissue releasing HCl.

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2
Q

What would you look for on exam to assess peritonitis?

A
  • Willingness/ability to cough
  • Mobility
  • Rebound tenderness
  • Involuntary guarding
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3
Q

Why does sepsis often lead to lactate rise?

A

Systemic hypoxia leading to lactate release

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4
Q

Does sepsis always have raised WCC?

A

No.

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5
Q

What is the difference between biliary colic vs cholecystitis?

A

Simple biliary colic is gallbladder pain that lasts just a few hours.
Cholecystitis is prolonged pain, often radiating.
Both are associated with food.

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6
Q

What is bile made of and how does this relate to risk of gallstones?

A

Bile is made of cholesterol, bile pigment (bilirubin) and bile salts.
A rise in any one of these promotes gallstones, as gallstones form due to an imbalance of these 3 components.

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7
Q

Which gut molecule id made to promote gallbladder contraction?

A

CCK

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8
Q

Is the treatment for gallstones always surgery?

A

No, conservative medical management is possible with antibiotics.

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9
Q

What is a volvulus and how to treat it?

A

Twisting of the bowel (usually colon) (coffee bean shape), try to untwist it by using a scope (colonoscopy).

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10
Q

What are some potential causes of midgut pain?

A

Ischemic bowel, volvulus, pancreatitis, gastro, AAA.

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11
Q

What are 3 causes of ischemic bowel?

A

Hypoperfusion, embolus or thrombosis.

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12
Q

What does it mean if APTT/INR are high?

A

High means time taken to clot is too slow - likely to bleed. Vice Versa also true.

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13
Q

What is the difference between ischemic bowel and ishcemic colitis?

A

Ischemia bowel is small intestine, ischemic colitis is for bowel.

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14
Q

How can a peptic ulcer cause generalised (rather than local) abdominal pain?

A

If the ulcer perforates, can get chemical/bacterial peritonitis.

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15
Q

What are some causes for Epigastric pain?

A

MI, AAA, perforated ulcer (red flags)
Also biliary and pancreatic issues

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16
Q

What are Grey Turner’s Sign and Cullin’s sign - what do they indicate?

A

Grey Turners - bruising on flanks (think turning body - bruising on flank).

Cullins sign - bruising around umbilicus

Both signs of abdominal haemorrhage, typically mediating by pancreatic issue.

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17
Q

Biliary tree obstruction can be identified by which biochemical marker?

A

Bilirubin level.

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18
Q

Why does pancreatitis cause a rise in Hb level?

A

Dehydration due to fluid sequestration common in pancreatitis ( eg. due to pseudocysts - collection of pancreatic fluid around pancreas).

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19
Q

List 4 causes of pancreatitis (2 main ones).

A

Gallstones and alcohol are the main 2.
Other two: viral illness, tumours.

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20
Q

How does pancreatitis impact clot formation?

A

Pancreatitis is pro-thrombotic

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21
Q

Management of Toxic Megacolon?

A

Can either do medical or surgical management. Medical is high dose steroids trial (a few hours) and check progress, often ends in surgical management anyway - total colectomy (with stoma).
After 6 months - ileorectal join made with J pouch.

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22
Q

An abdo pain presentation that is worse on cough but with fine movement is indicative of what?

A

Local peritonitis - hasn’t gone general yet. Just irritation, not perforation.

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23
Q

What is the typical time course of appendicitis?

A

Tends to degrade into local pain stage after 24-36 hours of pain unless super severe.

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24
Q

What lower abdo pain red flag what would you always check for in females?

A

Ectopic pregnancy

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25
Q

Which extra biochem marker would you test if you suspected ectopic pregnancy?

A

Beta HCG

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26
Q

What is TPN?

A

All nutrients through IV.

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27
Q

What is the normal urine output per hour?

A

ideally 1-1.5ml per kg per hour, should at least be 0.5 and over.

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28
Q

Why is fever time course relevant post-op?

A

Day 1 fever - non-specific fever eg. drug fever

Day 3 - lung infection
Day 5 - all the other infections, UTI, surgical site, leaks, PE/DVT

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29
Q

Name 4 causes of post-op confusion:

A

Hypoxia (due to atelectasis usually), sepsis, meds (opiods), metabolic (low sugar, high urea, high electrolytes).

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30
Q

How does an epidural impact blood vessels?

A

Loss of tone below epidural point - vasodilation - can cause hypotension.

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31
Q

What should the large bowel look like grossly?

A

Bright pink/red, shiny, warm.

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32
Q

What is the volume considered a high output stoma?

A

1500 ml a day for 2 days

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33
Q

Why should IV Potassium (in Hartman’s etc) be given to fasted patients?

A

Not eating will deplete potassium but it won’t show up on bloods until it is a real issue as cells will exchange their ions to externalise their potassium. It will look normal even though they’re potassium deficient. Until it suddenly drops leading to ileus/heart issue.

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34
Q

How do you differentiate the large and small bowel on imaging?

A

Small bowel has one line across entire diameter of bowel (plicae circulares) vs large bowel that has w arched lines across diameter (haustra). Think small bowel is small number (1) and large bowel is larger number (2)

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35
Q

What is Lopiramide?

A

Opioid used to slow bowel

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36
Q

What is octreotide?

A

Somatostatin analogue

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37
Q

What is the mnemonic for causes of post-op fever?

A

The 5 W’s
Water - UTI
Walking - DVT
Wind - pneumonia
Wound
Wonder drugs

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38
Q

What colour is gas on imaging?

A

Black

39
Q

Gas inside the abdomen is evidence of what? How would this gas appear on scans taken in different positions?

A

Gas in the abdomen means the GIT system has perforated somewhere.
If the patient is lying down the has will be seen anteriorly at the top. If the patient is standing, the gas will rise and fluids will fall, so the gas will be up top.

40
Q

What does an AAA look like on scans (unburst).

A

Bright white aorta (contrast) with a bulge.

41
Q

What is the best imaging for ovarian pathologies?

A

Ultrasound

42
Q

What would a CT show in cholecystitis?

A

Thickened gallbladder wall, organ can be fkn huge, like 1/3 size of the liver. May show stones if they’re there.

43
Q

How would you spot calcifications on imaging?

A

They are bright white like bone.

44
Q

How can kidney stones affect the kidney?

A

Cause a backup of fluid leading to renal pelvis dilation and hydronephrosis.

45
Q

How could you identify a cancer’s sentinel lymph node?

A

Inject dye into the site and see which lymph node changes colour

46
Q

What is a vulvulus? How does a vulvulus look on a scan? What are the types of vulvulus and how would you differentiate them?

A

A vulvulus is a twisted large bowel. It is a coffee bean shape on a scan. They are either sigmoid or ceacal, the line of the ‘bean’ point towards the area which identifies the vulvulus. Eg. if the line points to the right it’s pointing towards the sigmoid colon so it’s a sigmoid vulvulus and voice versa.

47
Q

Black bubbles on imaging of a leg would indicate what?

A

Black = gas. The only way free gas could be in the leg is if bacteria were creating the gas = Necrotizing fascitis

48
Q

What is a mucus fistula?

A

A mucus fistula is a type of stoma that is used by a defunctioned area of bowel. It will only be expelling mucus, not stool.
For example - after a sigmoidectomy, a surgeon may choose to create a mucus fistula of the distal loose end (rectal stump) instead of stapling it shut to make future anastamoses easier and less likely to make adhesions.

49
Q

Is the ileum happy to join the colon in an anastamoses?

A

Yes, they join together naturally at the ileo-caecal valve and can be joined together happily.

50
Q

What is the worry with an anastamoses of colon and rectum? How can you solve this?

A

The worry is that the join will fall apart before it heals (largely due to stool being more solid by that point) - can solve this by defunctioning the gut by creating a stoma upstream of the new join and reconnecting the gut when the join has had time to heal.

51
Q

What is the treatment for an ileus?

A

An ileus should resolve with fluids and supportive treatment, if it doesn’t you probably have the wrong diagnosis.

52
Q

A proper functioning ileostomy should produce which colour fluid?

A

Brown.
Will make green fluid at first while still healing.

53
Q

A proper functioning ileostomy should produce which colour fluid?

A

Brown.
Will make green fluid at first while still healing.

54
Q

What is a pseudo-obstruction?

A

Essentially an ileus of the colon

55
Q

What is the relationship between COPD and cachexia? What is the prognosis?

A

COPD can cause extreme weight loss due to increased work of breathing and recruitment of accessory muscles. Metabolic demand is increased due to hypoxia. This all chews up energy.
Once you get a lot BMI with COPD, that’s basically the end of the line. Virtually palliative, 12 months.

56
Q

How could you tell if you had an overexposed X-ray?

A

Can’t see vertebral bodies throughout the thorax

57
Q

When do most post-op complications occur?

A

Day 3 or 4 after surgery

58
Q

Why are both Hb and iron/ferritin levels important peri-op?

A

Hb to check they’re not anemic (worse health outcomes) but also check iron stores to make sure they make enough RBC post surgery bleeding to recover

59
Q

How long can a central line be in for?

A

Around 7 days

60
Q

How can a DVT be identified on Doppler ultrasound?

A

the DVT cannot be compressed like the rest of the vein

61
Q

At what point should you start thinking about adding a colloid fluid to raise oncotic pressure in a patient receiving fluids?

A

When you’ve given 2L of crystalloid it’s time to consider colloids.

62
Q

Explain chest drain ‘swing’

A

With a chest drain in (eg. into pleura post Ivor Lewis) a patient may be asked to take a deep breath or to cough - if the fluid in the tube moves (swings) with the cough, the tube is in the right place.
Bubbling also assessed for air being drained.

63
Q

Distension without pain or with discomfort (but not pain) is more likely to be due to a ________ obstruction.
Distension with colic type pain is more likely to be due to a _________ obstruction.

A

Non-mechanical (asleep bowel).
Mechanical (true block, peristalsis of gut against block causes pain).

64
Q

Pain below the umbilicus is associated with structures liked to the embryonic ______.
Midgut structures will cause pain in the __________ region.

A

Hindgut.
Periumbilical

65
Q

In contrast to a large bowel obstruction, a small bowel obstruction will almost certainly cause _____ alongside the typical nausea.

A

Vomiting.

66
Q

What are the most common causes of mechanical obstructions in the small versus large bowel?

A

Small: ABC
Adhesions, bulges (herniae), cancer

Large: CDV
Cancer, diverticulitis, vulvulus.

67
Q

In a complete bowel obstruction, _________ is a drug that should be avoided.

A

Metaclopramide

68
Q

A long INR time may indicate which deficiency? How could you treat it?

A

Vitamin K, give Vitamin K.

69
Q

What is refeeding syndrome?

A

Electrolyte imbalance caused by quickly introducing a full diet to a malnourished patient.

70
Q

What is a protectomy?

A

Remove of rectum

71
Q

Compare:
Low Anterior Resection
High Anterior Resection
Sigmoid colectomy
Total protocolectomy
Total abdominal colectomy

A

Low Ant resection - sigmoid and rectum but leave anus
High Ant resection - sigmoid and top of rectum
Sigmoid colectomy - just sigmoid
Total protocolectomy - entire colon AND rectum
Total abdominal coloectomy - entire colon but not rectum

72
Q

What is a hiatus hernia?

A

Stomach herniating up towards esophagus through hiatus in diaphragm at T10.

73
Q

What is Zenker’s diverticulum?

A

Pharyngeal pouch - due to weakness in Killian’s triangle posterior to cricoid cartilage.

74
Q

What is achalasia?

A

Esophageal smooth muscle not relaxing, leading to either a closed sphincter or shitty peristalsis or both.

75
Q

What is a succussion splash?

A

Slosh heard on auscultation of stomach (long after food) which indicates obstruction leading to stomach fullness.

76
Q

List 3 causes of acute gastric dilation?

A
  • Physical block - shit pyloric sphincter or hiatus hernia volvulus
  • non-mechanical ‘block’ - gastroparesis/anorexia
  • diabetic ketoacidosis
77
Q

A mass in the RUQ that you cannot get above is likely to be:

A

Inflammed gallbladder

78
Q

What is the double duct sign and what does it indicate?

A

Can see both the pancreatic duct and biliary tree on imaging - indicates pancreatic cancer

79
Q

If someone’s INR was slow but their albumin was fine, what would this indicate?

A

Albumin being fine shows liver is not damaged, so more likely it is due to poor vit K absorption in the gut. Perhaps an issue with bile as ADEK vitamins need bile to be absorbed.

80
Q

What is the specific cancer marker for pancreatic cancer?

A

CA 19-9.

81
Q

How can distension lead to hypoxia?

A

Gas/fluid pushing up on diaphragm limiting expansion.

82
Q

Which anti-emetic would you NOT give for a bowel obstruction?

A

Metaclopramide - don’t want things moving

83
Q

Which cancer types are most common in different areas of the esophagus?

A

Dital 1/3 - adenocarcinoma - barret’s esophagus
Proximal 2/3 - squamous cell carcinoma

84
Q

What is Dupuytren’s contracture?

A

Firm band in palm of hand, indicative of chronic liver disease.

85
Q

Which random medication causes constriction of vessels in the esophagus and can be a treatment for burst varices?

A

Octreotide

86
Q

What are some surgical options for esophageal varices?

A

Endoscopic variceal band ligation is common, like haemorroids.
TIPS is also done - transjugular intrahepatic portosystemic shunt - to bypass liver and allow portal system to drain (encephalopathy risk).

87
Q

Bleeding in each section of the gut will give rise to which colour stools?

A

Foregut - black
Midgut - purple
Hindgut - red

88
Q

How does tenesmus relate to rectal cancer?

A

The body tells the patient they still need to poo even after they’ve pooed because the body detects matter (a tumour) in the rectum/anus.

89
Q

What is the normal female Hb range?

A

110-130

90
Q

Does an empty drain mean the patient is not bleeding?

A

NO - bleeding may be elsewhere or drain may be clotted off

91
Q

Colorectal cancers tend to be what broad type of cancer? Gastric cancers?

A

Adenocarcinoma for both

92
Q

What are the treatment options for a slow INR?

A

3 things:
1. vit K to reverse warfarin etc
2. prothrombin
3. FFP - fresh frozen plasma

93
Q

What is thrombocytopenia?

A

Low platelets

MD (18 decks)

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