PassMed Flashcards
most likely explanation for ongoing pain + jaundice after cholecystectomy?
Gallstones in the common bile duct
Most common type of colorectal cancer?
adenocarcinoma
Caecol volvulus is associated with…
Toxic megacolon is associated with…
1) previous surgery, Crohn’s
2) UC
T or F, amylase level correlates with severity of pancreatitis?
False
though calcium does!
Compare an end vs loop stoma?
Loop can be reversed
What type of bowel surgery is indicated if there is a malignancy in the ascending colon?
Loop ileostomy
What bowel resection in a splenic fixture or descending colon cancer?
Left hemicolectomy
hyper vs hypo kalemia on ECG
hyper –> peaked T waves, wide QRS
hypo –> prominent U waves
Airway management in followin scenarios:
1) long-term weaning in ICU
2) inguinal repair, day case
3) laparotomy SBO
1) tracheostomy
2) laryngeal mask (don’t need muscle paralysis for this surgery, quick recovery)
3) endotracheal (due to high risk of regurg/vomit)
Diabetic preparing for surgery, well-controlled with sulphonylurea (gliclizide). What to do re: diabetic control for surgery?
Withhold morning dose.
If they had poorly controlled diabetes/long as fuck fasting periods, would withhold and change to a variable rate insulin infusion
HER-2 positive biologic treatment
Trastuzumab/Herceptin
Biologic in peri-anal Crohn’s disease w/ multiple fistalue?
Infliximab
T or F Crohn’s patients are susceptiable to haemorrhoids?
No, susceptible to fissures!!!
Steatorrhoea in chronic pancreatitis medical management
Pancreatic enzyme supplement to aid with digestion
What tumour location –> right hemicolectomy?
Cacum, ascending or hepatic flexure
What surgery for tumour in sigmoid colon?
High anterior resection
What are the two types of hitaus hernia?
Sliding (95%), the esophagus-stomach junction literally moves up above the diaphragm into thorax
Rolling - a diff part of the stomach goes up
What does time out mean in the WHO checklist?
when the patient is anaesthetised before first skin incision, where the team talks about cool secret information
What 7 things need to be checked before preceding with operation on the WHO safety checklist?
1) Patient confirms identity, site, procedure and consent
2) Site marked
3) Anaesthesia safety check
4) Pulse oximeter on patient and functioning
5) Known allergies
6) Difficult airway/aspiration risk?
7) Risk of blood loss?
Jaundice but normal liver + cholestatic results…
Do a FBC! Could be haemolysis or Giberts syndrome (liver doesn’t process bilirubin)
Gold standard for confirming SBO?
CT abdomen
XRAY usually first line - shows dilatation and perforation
What is rosvings sign?
pain felt R) when push on L), indicative of appendicitis
Script: severe epigastric pain worse leaning forward, vomiting,
pancreatitis
T or F: amylase is specific to pancreatitis
False, can rise in small bowel obstruction
Treatment for low grade gastric MALT lymphoma
Eradicate H Pylori
How do we eradicate H pylori?
Omeprazole, amoxicillin and clarithromycin
Critieria for 2 week referral for ?CRC
> 40 with weight loss + abdo pain
50 with bleed
60 Fe+ anaemia or change bowel habit
All occult blood tests.
CONSIDER it in other circumstances (e.g. <50 bleed and weight loss)
FIT test if symptoms and don’t reach the criteria
Blood features post-splenectomy?
Howell-Jolly bodies
inclusions of DNA remants in RBCs usually removed by spleen as ‘quality control’. tiny little dots inside cells.
Not pathological
How to treat local anaesthetic toxicity? e.g. accidentally put lignocaine in a vessel
20% lipid emulsion
How to treat benzo overdose?
Flumazenil
competitive antagonist
TAC overdose?
sodium bicarbonate
What is a Hartmann’s procedure, why is it preferred over a hemicolectomy in an emergency?
Hartmann’s involves removing bad bowel and forming a stoma, stitch the rectum shut totally. Can be reversed later by stitching them back together.
Better in an emergency due to not needing an anastomosis
Where are diverticula most common?
Sigmoid colon
How does diverticular disease present?
change in bowel habit, rectal bleeding, abdo pain.
mimics malignancy! –> colonoscopy
What common medication can cause slower fracture healing?
NSAIDs
Risk factors for pigment gallstones?
Cirrhosis, haemolysis (e.g. sickle cell anaemia), biliary stasis
What medication must be given before an appendicectomy?
Prophylactic antibiotics
What does diverticulitis look like on a CT?
mural thickening of the colon and presence of pericolon fat stranding
e.g. bleed, low grade fever, pain
lifestyle - How to treat diverticular disease?
Increase fruit + vege (fibre)!
Where does UC begin?
the rectum
Where is Crohn’s most commonly found?
terminal ileum
Chronic pancreatitis is associated with ____ and should be monitored _______
diabetes!
annual Hba1c
What is the general advice around COCP for surgery?
Stop taking 4 weeks in advance due to thromboembolism risk
Are the following safe for surgery:
1) beta blockers
2) amlodipine
3) levothyroxine
Yes all are safe to take on the day of surgery.
What is the difference between a strangulated and incarcerated hernia?
Incarcerated = cant reduce, but not painful
Strangulated = cant reduce + very painful
How to differentiate between acute cholecystitis and ascending cholangitis?
Very similar presentation - both have RUQ pain, fever, raised inflammatory markers. HOWEVER, ascending cholangitis more likely to have ABNORMAL LIVER TESTS. - think about the anatomy :)
Abdominal pain, bloating and vomiting following bowel surgery?
Post op ileus
+ presents with electrolytes
