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Surgery State exam > Part 2 > Flashcards

Part 2 Flashcards

1
Q

Q101 Colon cancer: clinical forms (symptomatics, diagnostics)

A

Symptoms according to location
-Right sided carcinomas (10%) ascending colon and cecum
Iron deficiency anaemic and melena/diarrhea

Left sided carcinomas (10%) transverse and descending colon
Changes in blood habits, blood streaked stool and colicky abdominal pain due to obstruction

Rectum and sigmoid (30%)
Changes in stool structure (pencil), hematoscheiza, tenesmus, rectal pain

Advanced disease-palpable abdominal mass, intestinal obstruction or perforation)
Metastases: liver, lung, lymph nodes symptoms

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2
Q

Q102 Colon cancer complications

A

-Right side lesion: bleeding and diarrhoea; anaemia and electrolyte loss, malnourishment and weight loss
Left sided lesion: obstructions and perforation
-Small bowel obstruction and ileocecal fistulas
-Sigmoid tumors; colovesical fistula-> UTIs, faecaluria, pneumatoria, haematuria
-Uterostasis
Distant mts: lung, liver, bone and brain

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3
Q

Q102 Surgery for colon cancer

A
  • right side hemicolectomy - resect right side colon including hepatic flexure, ileocaecal valve, part of distal ileum with end to end, ileocolonic anastasmosis
  • extended right side hemicolectomy if tumour is in proximal or middle transverse colon
  • left side hemicolectomy - resection of descending colon including left flexure and sigmoid colon
  • sigmoid colectomy
  • total abdominal colectomy (hereditary and multifocal)
  • regional lymph node dissection
  • resection of mts in liver, lung
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4
Q

103 Stomach cancer Clinical features

A

Unspecific eg dyspepsia
Early satiety, anorexia, weight loss
Chronic iron deficiency anaemia
GI signs abdominal pain, nausea, vomiting, dysphagia
Acute GI bleeding haememesis and melena
Late stages; palpable tumour, gastric outlet obstruction, then mts in liver, bone
MALIGNANT ACANTHOSIS NIGRICANS GASTRIC ADENOMA
enlarged lymph nodes

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5
Q

104 Stomach cancer diagnostics and surgical treatment

A

Dgs
Lab CBC (iron deficiency anaemia), electrolytes, liver function tests, tumor markers (CEA, CA19.9)
Upper endoscopy with biopsy
barium swallow
+ staging through US, CT, Endoscopy, Endo US, dg laparoscopy

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6
Q

104 stomach cancer surgical treatment

A

Endoscopic resection- early stage or localised
Radical gastrectomy and lymahdenectomy
Roux en y gastric bypass; end to end anastomosis - esophagojejunostomy (remaining stomach) or gastrojejunostomy (remaining stomach)
Alternative subtotal gastrectomy

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7
Q

105 intestinal polyps classification

A

Low malignant potential
o Hamartomatous polyps – seen in inherited syndromes e.g. juvenile polyposis o Inflammatory polyps (pseudopolyps) – seen in ulcerative colitis
o Mucosal polyps – benign, usually < 5 mmo Submucosal polyps – benign, most common submucosal lipoma - Moderate malignant potential – serrated polyps
o Hyperplastic polyps – minimal risk of malignancy, small (< 5 mm) o Sessile serrated polyps – risk of malignancy ∼ 5%, > 5 mm in size o Traditional serrated adenoma – risk of malignancy ∼ 5%
- High malignant potential – adenomatous polyps
o Tubular adenoma – risk of malignancy < 5%, can be anywhere in colon
o Tubulovillous adenoma – risk of malignancy ∼ 20%
o Villous adenoma – risk of malignancy ∼ 50% (large adenomas), common in rectum

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8
Q

105 intestinal polyps clinics

A
  • can be asymptomatic
  • blood in stool
  • constipation/diarrhea
  • mucus in stool
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9
Q

105 intestinal polyps treatment

A

snare polypectomy - ped polyps if <2cm
endoscopic mucosal resection for large sessile polyps
surgical resection if >2cm, if malignant, if hereditary

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10
Q

106 intestinal polyps diffuse polyposis syndromes

A
  • familial adenomatous polyps
  • peutz jeghers
  • juvenile polyposis syndrome
  • cowden syndrome
  • cronkhite canada syndrome
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11
Q

110 inguinal hernia treatment possibilties

A

Open hernia repair
a) Indications
- Complicated hernias
- Previous preperitoneal surgeries (e.g. hysterectomy, cesarean section)
- Presence of ascites
- Inability to undergo surgery under general anesthesia
- Recurrent hernia – if patient initially had a laparoscopic hernia repair
b) Procedure
- Lichtenstein repair – reinforcement by implementation of a synthetic mesh between the
abdominal internal oblique muscle and the aponeurosis of the abdominal external oblique
muscle
- Shouldice repair – doubling of the transverse fascia and fixation of the abdominal internal
oblique muscle and transverse muscle at the inguinal ligament by suture (non-mesh repair)
II. Laparoscopic hernia repair
a) Indications
- Bilateral hernia
- Recurrent hernia – if patient initially had an open hernia repair
b) Procedure
- Transabdominal preperitoneal repair (TAPP) – laparoscopic, preperitoneal mesh
implementation between the parietal peritoneum and transverse fascia
- Total extraperitoneal repair (TEP) – laparoscopic, extraperitoneal mesh implementation
between parietal peritoneum and transverse fascia

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12
Q

108 complications of diverticulosis of large bowel, diagnostics

A
  • divirticulitis
  • diverticular bleeding
  • perforation
  • fistula
  • intestinal obstruction
  • ileus

DG; abdominal ct with oral and iv contrast
Abdominal US
Colonoscopy

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13
Q

109 classifications inguinal hernia

A

direct inguinal hernia : funicular, dual hernia

indirect inguinal hernia: bubunocele, funicular, complete scrotal

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14
Q

117 drug treatment of BPH

A

Indications -mild bph, uncomplicated moderate bph with minimal discomfort due to symptoms

Alpha blockers
eg tamsulosin, doxazosin, alfuzosin, inhibiting a1 receptor in prostate urethra or bladder neck–> smooth muscle relaxation, decreased resistance to urinary outflow, symptom improvement
SE headache, ED, dizzy, orthostatic hypotension

5 alpha reductase inhibitors
eg finasteride, dutasteride
prevent conversion of testosterone to DHT,lower DHT in prostate, decrease prostate growth and increased apoptosis
SE gynacomastia, SD, decreased libido

Parasympatholytic/anticholinergic- oxybutynin, darifenacin etc for pt with irrititative symptoms with no post void

Phosphodiesterase type 5 inhibitors, tadafil smooth muscle relaxation, for pt with mild/mod symptoms and erectile dysfunction

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15
Q

118 surgical treatment of BPH

A

Indications- SEVERE BPH with or without complications, moderate BPH with complications

Types:
1. TURP; transurethral resection of the prostate (resection of hyper plastic prostate tissue under cystoscopic guidance with a cautery resectoscope), remove tissue in layers, leaves the capsule intact. Peripheral zone left intact (ca risk after turp same as for rest of pop)

2 TUIP transurethral incision of prostate; deep incision through the prostate urethra into prostate; widens bladder neck no removal of tissue

Laser/radiofrequency/microwave ablation

Open/laporoscopic prostatectomy

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16
Q

119 prostate cancer symptoms and diagnostics

A 
usually adenocarcinoma 
early stage: usually asymptomatic 
-fatigue, weight loss, loss of appetite
-hematuria 
-urinary retention, hydronephrosis
-incontinence 
-erectile dysfunction
mts 
DG, Digital rectal exam 
PSA >4ng/ml indicates malignancy, alkaline phosphatase, prostate acid phosphatase 
urine culture
biopsy 
Staging - ct, X-ray us scintography
17
Q

120 treatment methods of prostate cancer

A
  1. watchful waiting; regular follow ups with restaging
  2. definitive treatment radiation therapy with or without prostatectomy
    - radiation therapy localised disease, using external beam therapy, brachytherapy
    - radical prostatectomy for localised disease, with lymphadenectomy
    - anti androgen therapy- androgen sensitive localised high grade or metastatic prostate cancer
    - medical castration GnRH agonists leprolide or antagonist degarelix
    - surgical castration bilateral orchiectomy

Disseminated disease; chemo with docetaxel, antindrogen therapy, osteoclast inhibitor in bone mts

management of castration resistant prostate ca
-continue ADT and chemo docetaxel/immunotherapy
+
-asymptomatic bone mts- zolendronic acid each 3-4 weeks/denosumab
or +
symptomatic bone mts
-single: palliative external beam radiotherapy or multifocal: iv radoopharmaceuticals

18
Q

121 hydrocele: what is it?

A

painless accumulation of fluid within tunica vaginalis of scrotum surrounding one or two testicles

19
Q

121 hydrocele aetiology

A
  1. Idiopathic (most common)
    - failed closure of processus vaginalis during development, peritoneal fluid flows into scrotum, or if theres no connection to peritoneal cavity could be due to increased secretion or decreased resorption by tunic vaginalis
  2. secondary (due to underlying pathology) Trauma, tumour, torsion e.g. lymphatic filiarias
20
Q

121 hydrocele diagnostics

A
  • physical exam
  • communicating hydrocele will increase in size with valsava maneuver and are reducible
  • noncommunicating hydrocele no affected with valsalva and are not reducible
  • positive translumination

-ultrasound; hypo echoic fluid

21
Q

121 hydrocele treatment

A

-usually resolve spontaneously within 6 months of birth

indications for surgery:

  • no resolution by 1 year of age
  • excessive discomfort
  • underlying pathology
  • testicle not palpable
  • risk of infertility

-procedure; surgical excision or percutaneous aspiration

22
Q

122 testicular torsion diagnostics

A

Clinical picture; sudden pain, swelling, nausea and vomiting, tender testicle
Physical exam; absent cremasteric reflex, no relief of pain on elevation of testes
Lab- urine dipstick and inflammatory markers to exclude epididymitis
US of scrotum
Doppler US

23
Q

122 testicular torsion treatment

A

URGENT TREATMENT!!
–> MEDICAL EMERGENCY…. within 6 hours of onset
Manual detorsion - buy time and relieve symptoms
immediate surgical exploration with reduction and orchidopexy
to CL side
Removal of necrotic testes

24
Q

123 Urinary tract stones : aetiology and types

A

Calcium 80% (phosphate -hyperparathyroidism and hypercitraturia.)

and oxalate-hyperparathyroidism, hyperoxaluria, hypercitraturia)

Struvite 10% -upper UTI with urease prod bacteria

Uric acid 10% - persistent acidic urine, gout, hyperuricemia/uricosuria

Cysteine 1%; cystinuria AR disorder

25
Q

124 Renal colic symptoms

A 
Nausea and vomiting 
Reduced bowel sounds 
Dysuria, frequency, urgency 
Severe LQ pain- colicky flank pain, unilateral, radiates downwards to groin, progressive
Hematuria
26
Q

124 renal colic diagnostics

A

Physical
CBC , increased Serum urea nitrogen and creatine if AKI
Urinanalysis-hematuria , WBC

US
KUB CT- kidney ureter and bladder - calcium stones are radiopaque and uric acid are radiolucent
Intravenous pyelogram

27
Q

124 renal colic treatment

A

Conservative treatment
Analgesics: diclofenac PR
I/v fluids
Antimimetics if n and v, antibiotics if UTI
Alpha blockers: tamsulin or CCB nifedipine

Surgical treatment 
Extracorporeal Shock Wave Lithotripsy
Ureteroscopy and Laser Lithotripsy 
Percutaneous Nephrolithotomy
Laparoscopy or open
28
Q

127 penile cancer symptoms

A

95% are SCC , glans and foreskin commonly

  • palpable painless lesions
  • chronic penile rash or burning sensation
  • swollen inguinal lymph nodes
29
Q

127 penile cancer diagnostics

A
  • excisional biopsy
  • tumor staging; FNA, biopsy or dissection of LN
  • imaging US/CT/MRI
30
Q

127 penile cancer treatment

A

small - <3cm
-limited local excision, laser ablation and radiation therapy

invasive or bulky primary tutors

  • partial penectomy (2cm resection margin)
  • total penectomy and perineal urethrostomy
  • regional IL LN dissection
  • adjuvant chemo
  • recurrent or metastatic penectomy or palliative chemo
31
Q

126 Phimosis, paraphimosis aetiology

A

Phimosis refers to an inability to retract the foreskin after it was previously retractable or after puberty due to scarring of distal penis. Physiological and pathological.

  • recurrent infections
  • congenital
  • trauma

Paraphimosis - disease of uncircumcised male, or partly circumcised- entrapment of foreskin behind to coronal sulcus, for a prolonged time.

  • complication of phimosis
  • elderly
32
Q

126 phimosis paraphimosis, treatment

A

Phimosis- CS cream and then vertical incision or cicumsion

Paraphimosis- manual reduction then dorsal slit reduction then circumcision

33
Q

128 Kidney trauma stages

A
  1. Renal contusion and or non expanding sub capsular hematoma
  2. laceration <1cm spares renal medulla and collecting system and or non expanding retroperitoneal hematoma
  3. laceration >1cm sparing collecting system

4 laceration >1cm involving the collecting system and or renal vessel injury with a contained haemorrhage

5- shattered kidney and or renal artery thrombosis, avulsed renal vessels

34
Q

Budd chiari syndrome

A

liver dysfunction edema and ascites

35
Q

129 kidney tumor treatment

A

Chemotherapy not used at all- RCC highly resistant

Stage 1 cryoblation, thermal ablation, partial nephrectomy, simple nephrectomy

Stage 2-4 radical nephrectomy

Patients unfit for surgery

  • arterial embolisation
  • external beam radiotherapy

Immunomodulatory or targeted therapy; interferon a/recombinant cytokines(il-2), TK inhibitors (sorafenib)

Surgery State exam (2 decks)

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