MD2 Surgical Flashcards
What is Meckel’s diverticulitis?
Congenital outpouching of tissue, can be tissue from anywhere in GIT tract. i.e outpouching in intestine of stomach tissue releasing HCl.
What would you look for on exam to assess peritonitis?
- Willingness/ability to cough
- Mobility
- Rebound tenderness
- Involuntary guarding
Why does sepsis often lead to lactate rise?
Systemic hypoxia leading to lactate release
Does sepsis always have raised WCC?
No.
What is the difference between biliary colic vs cholecystitis?
Simple biliary colic is gallbladder pain that lasts just a few hours.
Cholecystitis is prolonged pain, often radiating.
Both are associated with food.
What is bile made of and how does this relate to risk of gallstones?
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.
Which gut molecule id made to promote gallbladder contraction?
CCK
Is the treatment for gallstones always surgery?
No, conservative medical management is possible with antibiotics.
What is a volvulus and how to treat it?
Twisting of the bowel (usually colon) (coffee bean shape), try to untwist it by using a scope (colonoscopy).
What are some potential causes of midgut pain?
Ischemic bowel, volvulus, pancreatitis, gastro, AAA.
What are 3 causes of ischemic bowel?
Hypoperfusion, embolus or thrombosis.
What does it mean if APTT/INR are high?
High means time taken to clot is too slow - likely to bleed. Vice Versa also true.
What is the difference between ischemic bowel and ishcemic colitis?
Ischemia bowel is small intestine, ischemic colitis is for bowel.
How can a peptic ulcer cause generalised (rather than local) abdominal pain?
If the ulcer perforates, can get chemical/bacterial peritonitis.
What are some causes for Epigastric pain?
MI, AAA, perforated ulcer (red flags)
Also biliary and pancreatic issues
What are Grey Turner’s Sign and Cullin’s sign - what do they indicate?
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.
Biliary tree obstruction can be identified by which biochemical marker?
Bilirubin level.
Why does pancreatitis cause a rise in Hb level?
Dehydration due to fluid sequestration common in pancreatitis ( eg. due to pseudocysts - collection of pancreatic fluid around pancreas).
List 4 causes of pancreatitis (2 main ones).
Gallstones and alcohol are the main 2.
Other two: viral illness, tumours.
How does pancreatitis impact clot formation?
Pancreatitis is pro-thrombotic
Management of Toxic Megacolon?
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.
An abdo pain presentation that is worse on cough but with fine movement is indicative of what?
Local peritonitis - hasn’t gone general yet. Just irritation, not perforation.
What is the typical time course of appendicitis?
Tends to degrade into local pain stage after 24-36 hours of pain unless super severe.
What lower abdo pain red flag what would you always check for in females?
Ectopic pregnancy
Which extra biochem marker would you test if you suspected ectopic pregnancy?
Beta HCG
What is TPN?
All nutrients through IV.
What is the normal urine output per hour?
ideally 1-1.5ml per kg per hour, should at least be 0.5 and over.
Why is fever time course relevant post-op?
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
Name 4 causes of post-op confusion:
Hypoxia (due to atelectasis usually), sepsis, meds (opiods), metabolic (low sugar, high urea, high electrolytes).
How does an epidural impact blood vessels?
Loss of tone below epidural point - vasodilation - can cause hypotension.
What should the large bowel look like grossly?
Bright pink/red, shiny, warm.
What is the volume considered a high output stoma?
1500 ml a day for 2 days
Why should IV Potassium (in Hartman’s etc) be given to fasted patients?
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.
How do you differentiate the large and small bowel on imaging?
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)
What is Lopiramide?
Opioid used to slow bowel
What is octreotide?
Somatostatin analogue
What is the mnemonic for causes of post-op fever?
The 5 W’s
Water - UTI
Walking - DVT
Wind - pneumonia
Wound
Wonder drugs