surgery?

Question 1

what are risk factors for abdominal hernias

Answer 1

obesity // ascites // age // surgery

Question 2

features of abdo hernias

Answer 2

lump // cough impluse // pain // obstruction // strangulation

Question 3

what is the most common abdo wall hernia

Answer 3

inguinal

Question 4

who usually gets inguinal hernias

Answer 4

men

Question 5

where do inguinal hernias usually occur + what are symptoms

Answer 5

superior and medial to pubic tubercle // discomfort worse on activity

Question 6

when is surgery indicated for inguinal hernias

Answer 6

all patients even if asymptomatic

Question 7

surgery for inguinal hernias

Answer 7

unilteral = open // bilateral or recurring = lap

Question 8

when can you return to work after inguinal hernias

Answer 8

open repair (2-3 weeks) // lap (1-2) weeks

Question 9

what is a direct vs indirect inguinal hernia

Answer 9

direct is a bulge in posterior wall of bowel that protrudes into the superficial ring // indirect is herniation down the deep inguinal ring

Question 10

what is an incarcerated hernia and what does it increase risk of

Answer 10

non-reducible // risk of strangulation

Question 11

what is a strangulated inguinal hernia

Answer 11

blood supply to tissue cut off –> ischaemia –> bowel perforation

Question 12

symptoms strangulated inguinal hernia

Answer 12

pain in perviously aysmptomatic hernia // fever // increased size // peritonitis // bowel obstuction // bloody stool

Question 13

bloods in strangulated hernia

Answer 13

raised lactate // raised WCC (leukocytosis)

Question 14

should you reduce a strangulated inguinal hernia

Answer 14

no –> can increase peritonitis

Question 15

what hernia is common in children

Answer 15

inguinal hernias (males)

Question 16

what passage to femoral hernias form

Answer 16

through femoral ring –> femoral canal

Question 17

anatomy of femoral hernia

Answer 17

inferolateral to pubic tubercle

Question 18

symptoms femoral hernia

Answer 18

mildy painful // non reducable // no cough impulse // multiparous women

Question 19

complications femoral hernia

Answer 19

straungulation // bowel obstruction// bowel ischaemia

Question 20

mx femoral hernia

Answer 20

surgery - lapaopscopically or open

Question 21

how do direct inguinal hernias form

Answer 21

weakness in hesselbach traingle

Question 22

how do indirect hernias form

Answer 22

failure of processus vaginalis to close

Question 23

o/e how would you differentiate direct vs indirect hernia

Answer 23

reduce –> cover deep inguinal canal –> cough –> reappears = direct // does not reappear = indirect

Question 24

where do epigastric hernias form

Answer 24

midline between umbilicus and xiphisternum

Question 25

rf for epigastric hernias

Answer 25

teenage boys // exercise // coughing

Question 26

where do umbilical hernias appear and who gets them

Answer 26

symmetrically under umbilicus - newborns

Question 27

where do para-umbilical hernias appear and who gets them

Answer 27

asymmetric above or below umbilicus - obesity and ascites

Question 28

when would Hartmann's procedure be indictaed

Answer 28

emergency eg bowel obstruction or perforation

Question 29

indication proctocolectomy UC

Answer 29

dysplastic transformation

Question 30

mx emergency colitis

Answer 30

sub total colectomy + end ileostomy

Question 31

restorative option UC

Answer 31

ileoanal pouch (only if rectim in situ)

Question 32

surgical mx chrons

Answer 32

small bowe; resections // ileocacel resection

Question 33

4 types of fistulas

Answer 33

Enterocutaneous (skin to intestine) // enter colic (large or small intestine) // enterovaginal // enterovesicular (to bladder)

Question 34

invx fistulas

Answer 34

barium + CT

Question 35

location + appearance ileostomy

Answer 35

RIF, spouted, liquids

Question 36

location + appearance colostomy

Answer 36

usually left side, flushed, solids

Question 37

indication loop ileostomy

Answer 37

definitioning colon eg rectal cancer to PROTECT for an anastomosis

Question 38

function end ileostomy

Answer 38

following complete colon excision with NO plan for anastomosis

Question 39

indication loop colostomy

Answer 39

definition single section of colon in obstructing cancer // may be anastomosed later

Question 40

what is abdominal wound dehiscence

Answer 40

all layers of abdo closure fail and viscera protrudes externally

Question 41

superficial vs compelete abdominal wound dehiscence

Answer 41

superficial = skin // complete = all layers

Question 42

RF abdominal wound dehiscence

Answer 42

malnutrition // jaundice // steroids // wound contamination

Question 43

mx abdominal wound dehiscence

Answer 43

cover wound with saline gauze, IV broad spec abx, analgesia, IV fluids

Question 44

absolute contraindications laparoscopic surgery

Answer 44

haeodynamically unstable // raised ICP // acute intestinal obstruction, bowel loops >4cm // coagulopathy

Question 45

complications lap surgery

Answer 45

anaesthetic // bradycardia // surgical emphysema // GI tract or vessel injury

Question 46

common hormone imbalance after brain surgery

Answer 46

SIADH --> hypoNa

Question 47

common complication + mx following GI surgery

Answer 47

ileus --> NG tube

Question 48

what is a anastaotpic leak

Answer 48

sepsis --> mediastinitis or peritonitis