Surgery Flashcards
Management of testicular cancer
sperm bank orchidectomy can insert prosthesis CT TAP for mets chemo for mets LN dissection
Management of kidney stones with no obstruction
Hydration and NSAIDs (diclofenac PR)
<5mm or <10mm and pt agrees: expectant management +/- alpha blocker/CCB
<10mm: SWLT +/ alpha blockers
10-20mm: SWL OR uroscopy
2nd: percutaneous nephrolithotomy
> 20mm: percutaneous nephrolithotomy
post: increase fluids, lemon juice, avoid fizzy drinks, decrease salt
consider metabolic testing
Management of kidney obstruction
Ureteric stent past obstruction
OR
percutaneous nephrostomy tube via interventional radiology
BPH management
Alpha blockers (tamsulosin) 5-alpha inhibitors (finasteride)
Surgery: TURP
REZUM
HoLEP
Urolift
Difference between stomas
ileostomy: spouted, right side, corrosive paste-like stools
colostomy: flush, left side, poo stools
urostomy: spouted, lower right side, mucus and urine
Indications for Hartmann’s procedure
obstruction/perforation secondary to sigmoid tumour or diverticulitis
colostomy stoma
Management of colorectal cancer
Sigmoidoscopy -> colonoscopy
Contrast CT
Check for spread (liver)
resection
(anterior and abdomino-perineal = rectum to sigmoid, left and right hemicolectomy for colon, hartmann = emergency sigmoid)
High rectal cancer = Anterior
Middle rectal = Anterior
Low = AP
+/- neoadjuvant chemoradiotherapy
complications post-operatively abdominal surgery
ileus: peristalsis halted, low electrolytes and dehydration but positive fluid balance (NG + fluids)
dehiscence: day 6 fever and sepsis
why is splenic flexure vulnerable to ischaema
marginal artery of Drummond is tenuous here and absent in 5% of pt
Management of duct ectasia
conservative management
consider microdochetomy if young
consider total duct excision if old
management of breast fat necrosis
triple assessment
conservative
management of acute mastitis
conservative: analgesia, warm compresses, continue breastfeeding
Abx: fluclox
2nd: amoxi
MRSA: trimethoprim
management of breast abscess
USS only as MMG untolerated
analgesia, warm compresses, continue breastfeeding if possible
USS guided aspiration (consider I+D if necrotic)
culture fluid
abx
management of fibroadenoma
rescan in 3-6m of first instance for rapid enlargement
<4cm conservative
>4cm or quickly enlarging consider excision
biopsy if over 25/large conscerns regarding phyllodes tumor
management of fibroadenosis
conservative
management of intraductal papilloma
microdochetomy (excision of single duct behind nipple)
if older/finished family, remove all ducts behind nipple (but not the nipple)
management of Phyllodes tumour
consider surgery
Types of breast cancer
invasive ductal most common
invasive lobular 2nd most common
DCIS
LCIS
What is the triple assessment
history and exam
imaging: USS <40, mammogram and USS >40, MRI if implants
FNA/biopsy
Management of breast cyst
USS aspiration if large and painful
Nipple discharge colour diagnoses: green yellow milky Blood
Green: multi-duct discharge (smokers)
Yellow: ectasia
Milky: prolactinoma
Blood: cancer, DCIS, papilloma
management of cancer with blood nipple discharge
removal of nipple-areolar complex
treat cancer
management of breast cancer
USS +/- biopsy of abnormal axillary lymph nodes
triple assessment
MRI if lobular cancer suspected
CT for staging
consider bone scan if >3cm/LN+
Surgery: mastectomy or WLE
removal of lymph nodes
Chemo: if LN+, triple negative disease OR HER2+ve
Radiotherapy: >4cm, LN+, skin/muscle involvement
Tamoxifen if ER+: tamox if premenopausal, letrozole if post-menopausal
management of prostate cancer
most conservative + follow-up
consider surgery, radiotherapy, hormonal therapy
Investigations for RCC
cystoscopy, renal USS, CT urogram
management of stress incontinence
referral to specialist
lifestyle advice: WL, pelvic floor exercises 3m
duloxetine
consider surgery
management of urge incontinence
lifestyle advice: bladder retraining for 6w, avoid triggers
oxybutinin, tolterodine
mirabegron
Sacral nerve stimulation
surgery: botox injection
Difference between testicular lumps
hydrocele varicocele epididymal cyst spermatocele cancer
hydrocele: painless, transillumination, testicle palpable within cyst
varicocele: bag of worms, worse standing up, post-sex
epididymal cyst: smooth cyst in head of epididymis, fluctuant, separate from testicle, transilluminates
spermatocele: exactly same as epididymal cyst, just full of sperm
cancer: craggy, hard, solid mass
management of PAD
conservative: no smoking, WL, foot care, 12w supervied exercise programme
medical: statin, anti-platelet, management of risk factors
Intermittent claudication: naftidrofuryl, cilostazol, pentoxifylline
surgical: bypass, embolectomy
Management of chronic venous insufficiency
compression bandanges if ABPI >0.8
moisturising cream
Medical: pentoxifylline, consider abx, NOT nsaids
ulcer: dress ulcer
varicose: sclerotherapy, ablation, ligation
management of Raynaud’s
smoking cessation
avoid cold
nifedipine
management of venous thrombophlebitis
compression stockings
NSAIDS if <5cm
DOAC if >5cm
surgery +/- LMWH
major haemorrhage protocol
baseline bloods inc fibrinogen
if trauma and <3h from injury, tranexamic acid 1g 10 mins
IV infusion of 1g over 8h
warm fluids
specific blood products ASAP low hb -> red cells PT >1.5 -> FFP fibrinogen <1.5 -> cryo platelets <75 -> platelets
indications for amputation
Dead: gangrene
Deadly: Wet gangrene, AV fistula, spreading cellulitis
Dead useless: severe intractible pain with CLI, paralysis, trauma
Types of amputations
Above knee: easiest to do, may not be able to walk with prosthesis
Below knee: harder, heal less reliably, may be more mobile
Transmetatarsal: Diabetes mellitus
Also through knee, ankle
Below knee amputation flaps
AP (Fish mouth)
Lateral-medial
Two forms of AAA
Fusiform (aneurysm everywhere)
Sacular (bulb)
Location of most AAA
infrarenal
Buzzwords for Fibroadenoma Phyllodes tumour Duct ectasia Fibroadenosis Intraductal papilloma Breast cyst Paget's disease of nipple
Fibroadenoma: young, breast mouse
Phyllodes tumour: similar to fibroadenoma, bigger/grows faster, 40s
Duct ectasia: menopause, green discharge, tender lump around areola
Fibroadenosis: middle aged women, lumpy tender breasts, worse before period
Intraductal papilloma: blood stained discharge, 40-60s, local areas of hyperplasia
Cyst: sudden tender tense lump
Pagets: eczematoid change, may be bloody discharge, nipple inversion
What does breast screening involve
3yearly national screening, 2 mammograms
between ages 50-71
Colorectal cancer screening
56, 60-74: FIT testing every 2y.
If +ve, colonoscopy
describe Gleason scale
Made of two numbers e.g. 2+2
Made of grading of cells of largest area of tumour + cells of 2nd largest
6 or less = slow growing, watchful waiting
8 or more = aggressive
