Surgery Flashcards
What is a direct inguinal hernia?
Hernia pushes its way directly through Hasselback’s triangle, an area of weakness in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels.
What is an indirect inguinal hernia?
Hernia passes through the internal inguinal ring and possibly back out through the external inguinal ring
What conservative measures may be recommended to patients with direct inguinal hernias?
Lose weight and stop smoking
What are the contents of the inguinal canal?
External spermatic fascia, cremasteric fascia, internal spermatic fascia, Vas deferens, obliterated processus vaginalis, gonadal vessels, genital branch of the genitofemoral serve, ilioinguinal nerve
In females - the round ligament of the uterus.
What is the management of acute mesenteric ischaemia?
IV fluid, IV analgesia, IV antibiotics, heparin.
Consider catheter thrombolysis if arteriography is taking place.
Laparotomy is required to remove dead bowel
What is the management of chronic mesenteric ischaemia?
Percutaneous transluminal angioplasty and stenting
How does chronic mesenteric ischaemia present?
Severe, coliky, post-prandial pain.
Weight loss - due to anorexia
PR bleeding
N/V
How should triple-negative breast cancer be managed?
Surgery - Breast-conserving vs Mastectomy + SNB
Radiotherapy
+/- Chemotherapy if stage indicates this is necessary
What drug is available for ER+ve breast cancer in postmenopausal women?
Aromatase inhibitors
What drug is available for ER+ve breast cancer in premenopausal women?
Tamoxifen
What is the mechanism of action of tamoxifen and explain how this is associated with the potential risks of treatment?
SERM - acts as an oestrogen agonist in endometrial tissue so it increases proliferation and therefore risk of cancer
What drug therapy is available for HER2+ve breast cancer?
Trastuzumab
What procedure may be indicated in a woman with a positive sentinel node biopsy during breast cancer surgery?
Axillary node clearance?
What is the major risk associated with axillary node clearance?
Lymphoedema
What are the causes of small bowel obstruction?
Adhesions, hernias, gallstone ileus, foreign body, intussusception
What are the causes of large bowel obstruction?
Colon cancer, constipation, diverticular stricture, volvulus,
What is the immediate management of bowel obstruction?
NBM
Analgesia
NG tube aspiration and free drainage
IV fluids
What is the first-line drug therapy for BPH?
Tamsulosin (alpha-blocker) or Finasteride (5alpha reductase inhibitor)
What are the common clinical features of BPH?
Nocturia, frequency, urgency, dribbling, poor flow, hesitancy, overflow incontinence, haematuria.
What is the initial management for a ruptured AAA?
Page vascular surgery and anaesthetics
Bloods: Amylase, FBC, VBG
Actions: IV access, crossmatch and transfuse with O neg, permissive hypotension, catheterise, give IV co-amoxiclav
Theatre
What are the 6 P’s of acute limb ischaemia?
Pulseless, perishingly cold, pallor, paraesthesia, paralysis, pain
What is chronic critical limb ischaemia
more than 2 weeks of rest pain, gangrene, or ulceration?
What would a patient with iliac stenosis complain of?
Buttocks claudication
How should peripheral arterial disease be investigated?
Bloods: FBC, U/Es, Lipids, HbA1C, ESR/CRP, ECG Consider thrombophilia screen ABPI Colour duplex US leg MR/CT angiography to plan intervention
