surgery Flashcards
which hernia is superior and medial to pubic tubercle
inguinal hernia
which hernia is below and lateral to the pubic tubercle
femoral hernia
mx of neurogenic shock
vasopressors
what does double wall sign on AXR mean
free air in abdomen
thrombosed haemorrhoid vs external haemorrhoid
thrombosed - anorectal pain and tender lump
external haemorrhoids do not tend to be painful
cholecystitis vs cholangitis
cholecystitis = RUQ pain and fever cholangitis = RUQ pain + fever + jaundice
first line mx of haemorrhoids
increase dietary fibre and fluid intake
is there jaundice in pancreatitis
no
Grey-Turner’s sign vs Cullen’s sign
Grey Turner’s - bruising of flanks
Cullen’s - peri-umbilical bruising
what anatomical landmark defines an upper vs a lower GI bleed
ligament of Treitz
when should congenital inguinal hernias be operated on
refer immediately
<6 weeks - within 2 days
<6 months - within 2 weeks
<6 years - within 2 months
operation for carcinoma of caecum
right hemicolectomy
what is the Parkland formula for fluid resus in burns
volume of fluid = total body surface area of burn (%) x weight (kg) x 4 ml
best long term enteral feeding route
PEG tube
mx of sigmoid volvulus
unruptured - rigid sigmoidoscopy with rectal tube insertion
signs of peritonitis - urgent laparotomy
factors indicating severe pancreatitis
age >55 hypocalcaemia hyperglycaemia hypoxia neutrophilia elevated LDH and AST
features of anal fissure
painful, bright red, rectal bleeding
when is anterior resection used
upper and mid-rectal tumours
involves removal of the rectum
when is abdomino-perineal resection used
removal of cancer at lower one-third of rectum, near anal margin
features that point to wards ureteric calculus over pyelonephritis
possibility of dehydration, e.g. D&V before loin to groin pain
hydatid cysts found on USS, next ix
CT abdo
mx of diverticulitis flares
mild cases - oral ABX at home
if symptoms do not settle within 72h, or severe case, admit to hospital for IV ABX
ix for chronic pancreatitis
CT pancreas with IV contrast
how to differentiate between Crohn’s and UC on first presentation
Crohn’s - more common at ileocaecal junction and terminal ileum (RIF pain)
UC - starts distally and moves proximally (LIF first), also has bloody diarrhoea
mx of acute pancreatitis
fluids and analgesia
how to determine between direct and indirect inguinal hernia
after reducing, an indirect inguinal hernia can be controlled by putting pressure over the DEEP inguinal ring
biliary complications of IBD
Crohn’s - stones
UC - PSC
features of proctitis
nocturnal diarrhoea
incontinence
bright red rectal bleeding
it is a finding in UC
mx of acute anal fissure
medically first with bulk-forming laxatives and dietary advice
topical lubricants, anaesthetics and analgesia should be tried
strongest risk factor for anal cancer
HPV infection
surgical mx of anal fissues, when is it used
sphincterotomy
used when conservative mx has not worked
mx of acute cholecystitis
analgesia
IV fluids
IV ABX
lap chole within 1 week
ix for acute pancreatitis
- serum amylase and lipase
- USS
lipase will confirm dx of acute pancreatitis, US will confirm cause of pancreatitis - CT abdomen
gallstones no jaundice, where is the stone
cystic duct
cannot be anywhere that would cause a back up of bile towards the liver
which bladder cancer has painless haematuria
transitional cell carcinoma of bladder
define isograft, autograft, allograft, xenograft
isograft - identical twin donation
autograft - self-donation (e.g. long saphenous vein to be used for CABG)
allograft - genetically non-identical donation
xenograft - different species donation
definitive ix for SBO
abdominal CT
AXR is first line
which oesophageal cancer does Barrett’s increase risk of
adenocarcinoma
hyperechoic liver lesion on USS
haemangioma
what are calcium levels in osteomalacia vs osteoporosis
osteomalacia - low
osteoporosis - normal
what type of cancer is RCC
adenocarcinoma
which inguinal hernia is more common in children
indirect inguinal hernia
initial mx of suspected ruptured AAA
immediate vascular review before any imaging, etc.
indications for thoracotomy
loss of >1.5 litres blood initially or ongoing losses of >200ml/h for >2h
best diagnostic investigation for acute abdominal pain
CT abdomen
indications for splenectomy
haemodynamic instability
uncontrollable splenic bleeding
devascularised spleen
sepsis following splenectomy is typically caused by which organism
pneumococcus (encapsulated organisms)
ix for acute mesenteric ischaemic
lactate
when can sutures or staples on the chest, stomach or back be removed
10-14 days post-op
mx ascending cholangitis
emergency decompression of CBD w ERCP then elective cholecystectomy
which analgesia is best for post-op analgesia in respiratory disease
epidural because opioids are contraindicated
initial ix for acute limb ischaemia
ultrasound doppler
complication of giving too much sodium chloride
hyperchloraemiac acidosis
indications of poor prognosis in pancreatitis
age > 55 years **hypocalcaemia** hyperglycaemia hypoxia neutrophilia elevated LDH and AST
what may balanitis xerotica obliterates cause
phimosis
criteria for AAA surgery
asymptomatic but >5.5cm in diameter - elective surgery
asymptomatic but enlarging by >1cm/year - elective surgery
symptomatic - urgent surgery
mx of symptomatic gallstone disease
laparoscopic cholecystectomy
what is Boerhaave’s syndrome
spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting
ix for Boerhaave’s syndrome
CT contrast swallow
steps after insertion of NG tube
aspirate before administering any feed or medication
if aspirate pH <5.5, safe to use
if aspirate pH >5.5, CXR to determine position
features of acute cholecystitis
constant RUQ pain fever positive Murphey's sign raised inflammatory markers NORMAL LFTs
