surgergy Flashcards
3 causes of early post op pyrexia (0-5 days)
- Physiological systemic inflammatory reaction
- pneumonia/atelectasis
- UTI?IV line infection
3 causes of late causes of post op pyrexia
- surgical site/wound infection
- PE/DVT
- anastamotic leak
what is an anastomotic leak?
leak of bowel contents at surgical site
presentation of anastomotic leak?
- abdo pain
- pyrexia
- tachycardia
- more than 5 days post op
what is post op ileus
pseudo-obstruction of the bowel due to a loss of peristalsis post op
when does post op ileus present?
within few days
presentation of post op ileus?
- N & V
- abdominal distension
- abdominal pain
- failure to open bowels
- hiccups
management of post op ileus
- NG tube: drip & suck
- IV electrolyte replacement
- NBM
- IV fluid/nutrition
- mobilise to encourage peristalsis
triad of mesenteric ischaemia?
- high lactate
- soft & non tender abdomen
- Cardiovascular disease
what bowel does mesenteric ischaemia typically affect
small bowel
2 conditions that involve ischaemia to lowe GI tract?
- mesenteric ischaemia
- ischaemic colitis
what part of bowel does ischaemic colitis affect?
large bowel
presentation of ischaemic colitis
bloody diarrhoea
markings visible on small bowel and describe them?
valvulae conniventes - cross entire width of bowel
name 3 causes of bowel obstruction
- hernias
- cancer
- adhesions
what are Valvulae conniventes
mucosal folds that form lines that extend the full width of the small bowel
name or markings seen on large bowel?
haustra
Abdominal xray – coffee bean sign
sigmoid volvulus
air under diaphragm
pneumoperitoneum
blood supply to the ascending colon?
2 branches of the superior mesenteric artery (ileocolic & right colic arteries)
3 branches of the ileocolic artery
- colic
- anterior caecal
- posterior caecal
3 branches that supply the transverse colon and what do they branch from?
left, middle & right colic artery
right & middle colic arise from the superior mesenteric
left colic arise from the inferior mesenteric
blood supply to the descending colon?
left colic artery (branches off from the inferior mesenteric)
arterial supply of the sigmoid colon?
sigmoid arteries - branches of the inferior mesenteric artery
symptoms of haemorrhoids
- constipation
- painless bright red bleeding
- sore/itchy anus
- feeling a lump around or in anus
what causes a thrombosed haemorrhoid
strangulation at base of haemorrhoid causing thrombosis in the haemorrhoid - can be extremely painful
appears as purple, very tender swollen lumps around anus
what are diverticula?
pouches in bowel wall
what is diverticulosis?
the presence of diverticula without symptoms
risk factors for diverticulosis
- age
- low fibre diet
- obesity
signs & symptoms of diverticulitis
- fever
- LIF pain
- diarrrhoea
- PR blood/mucus
- N&V
complications of diverticulitis?
- haemorrhage
- perforation
- abscess
- fistula
- ileus/obstruction
diagnostic investigation for AAA
CT angiogram
3 most common causes of acute pancreatitis
- post ERCP
- Alcohol
- Gall stones
score used to assess severity of acute pancreatis
Glasgow score
outline the glasgow score
- PaO2 < 8kPa
- Age > 55 years
- Neutrophils: WCC > 15
- Calcium < 2
- Renal function: Urea > 16
- Enzymes (LDH > 600 or AST/ALT>200)
- Albumin <32
- Sugar: Glucose > 10
management of sigmoid volvulus
decompression via rigid sigmoidoscopy & flatus tube insertion
anorectal pain and a tender lump on the anal margin
thrombosed haemorrhoid
Dukes classifcation __ if involves lymph nodes?
C
dukes __ if invading bowel wall
B
when is a one off flexy sigmoidoscopy done & why?
at age 55: to detect & treat polyps to reduce future risk of colorectal cancer
