surgery Flashcards
where are ileostomy
right iliac fossa
are ileostomy sprouted or flushed
sprouted
what is the output of ileostomy
liquid
where are colostomy more likely
left side
are colostomy flushed or sprouted
flushed
what is output of colostomy
solid
acute mesenteric ischaemia what PMH is patient likely to have
AF
management of acute mesenteric ischaemia
immediate laparotomy
what are most anal cancers
squamous cell carcinomas
why is anal cancer incidence rising
amongst men who have sex with men due to HPV
aorta width <3cm what is the action
no further action
aorta width 3-4.4cm what is the action
rescan every 12 months
aorta width 4.5-5.4cm what is the action
rescan every 3 months
aorta width >5.5cm what is the action
refer within 2 weeks to vascular surgery
risk factors for abdominal aortic aneurysms
smoking
hypertension
syphilis
Ehler Danlos
Marfan
ABPI < 1 is indicator of
peripheral arterial disease
ABPI >1.2 indicates
calcified, stiff arteries
advanced again
what is a normal ABPI
1-1.2
what ABPI is compression bandaging acceptable
> 0.8
what is marjolin ulcer
squamous cell carcinoma
where do marlin ulcer occur
sites of chronic inflammation
e.g. burns, osteomyelitis
what are features of acute limb threatening Ischaemia
6P’s
- pale
- pulseless
- painful
- paralysed
- paraesthetic
- perishing with cold
initial investigation in acute limb threatening ischaemia
handheld arterial Doppler examination
factors suggestive ischaemia due to thrombus
- pre existing claudication
- no obvious emboli source
- reduced or absent pulses in contralateral limb
- widespread vascular disease e.g. MI, stroke
factors that suggest Ischaemia due to embolus
- sudden onset painful leg <24 hour
- no history claudication
- clinic source of emboli AF, MI,
- proximal aneurysm
initial management of acute limb ischaemia
- ABC approach
- IV opioids
- IV unfractionated heparin
definitive management of acute limb ischaemia
- intra-arterial thrombolysis
- surgical embolectomy
- angioplasty
- bypass surgery
- amputation
features of critical limb ischaemia
- rest pain in foot for more than 2 weeks
- ulceration
- gangrene
- patient hangs leg out of bed at night to ease pain
ABPI in critical limb ischaemia
< 0.5
features of intermittent claudication
- aching or burning in leg muscles following walking
- relived within minutes of stopping
- not present at rest
first line investigation for intermittent claudication
duplex ultrasound
what should be performed before any intervention in intermittent claudication
magnetic resonance angiography
what is a strong link for peripheral arterial disease
smoking
what should all patients be on with intermittent claudication
statin - atorvastatin 80mg
what is first line management for peripheral arterial disease
clopidogrel
definitive management of peripheral arterial disease
endovascular revascularisation
surgical revascularisation - for long segment lesion >10cm
features of ruptured abdominal aortic aneurysm
- severe, central abodminla pain radiating to the back
- pulsatile, expansile mass in abdomen
- patient may be shocked (hypotension, tachycardia) or collapse
investigation for ruptured abdominal aortic aneurysm if stable
CT angiogram - if diagnosis in doubt
what is thrombophlebitis
inflammation associated with thrombosis of one of the superficial veins
what vein is usually affected in superficial thrombophlebitis
long saphenous vein
1st line management of superficial thrombophlebitis
NSAIDs
- oral if severe
compression stockings
LMWH
investigation for superficial thrombophlebitis
ultrasound
risk factor for varicose veins
- ageing
- female gender
- pregnancy
- obesity
features of varicose veins
- appearance
- aching, throbbing
- itching
- bleeding
- venous ulceration
investigation for varicose vein
venous duplex ultrasound - retrograde venous flow
conservative management for varicose vein
- leg elevation
- weight loss
- regular exercise
- graduated compression stockings
severe varicose vein management
- endothermal ablation - radio frequency
- foam sclerotherapy
- surgery
what is coning
brainstem compression
unilaterally dilated pupil what nerve
3rd nerve compression secondary to tectorial herniation
bilaterally dilated pupil
bilateral 3rd nerve palsy
poor CNS perfusion
bilaterally constricted pupil what is the cause
- opiates
- pontine lesion
- metabolic encephalopathy
features of hydrocephalus
- headache (worse in morning, when lying down)
- nausea and vomiting
- papilloedema
- coma
child features of hydrocephalus
- bulging anterior fontanelle
- failure of upward gaze (sunsetting eyes)
dementia, incontinence and disturbed gait =
normal pressure hydrocephalus
1st line investigation in hydrocephalus
CT head
what is gold investigation for hydrocephalus
lumbar puncture
- diagnostic and therapeutic
management of severe hydrocephalus
external ventricular drain
management for long term CSF diversion
ventriculoperitoneal shunt
hepatocellular carcinoma tumour marker
serum AFP
altered sensation in arm and discomfit when using his hands above their head
cervical rib
gold investigation for intracranial haemorrhage
non contrast CT head
GCS limits for CT head within 1 hour
GCS <13 on initial assessment
GCS <15 at 2 hours post injury
jaundice and RUQ pain suggestive of
biliary obstruction
when can patient shower after surgery
48 hours
what is used for cleaning the wound up to 48 hours after surgery
sterile saline
what does an uncle herniation cause
ipsilateral fixed, dilated pupil (due to compression of 3rd cranial nerve)
contralateral paralysis
management of intracranial aneurysm following a SAH
coiling by an interventional neuroradiologist
what is given to reduce vasospasm following SAH
nimodipine
Charcot triad
fever
jaundice
RUQ pain
what is Charcot triad a sign of
ascending cholangitis
investigation for ascending cholangitis
ultrasound
management of ascending cholangitis
antibiotics
ERCP - remove obstruction
what is a complication of SAH
SIADH
long term mechanical ventilation in trauma patients can result in
trachea-oesophageal fistula formation
