Surgery Flashcards
Appendix abscess
What antibiotic to use? Why (2)
Broad spectrum
- Cefuroxime (aerobic)
- Metronidazole (anaerobic)
What is McBurney point? How to find?
Appendicitis
tenderness
Lateral 1/3 of the line btw ASIS and umbilicus
What is ileus? Why does it occur?
Inhibition of peristalsis
Peritonitis/ neurogenic causes
Appendicitis common presentation (6)
- Vomiting
- Diarrhoea
- Anorexia
- Generalised pain -> RIF pain
- Guarding
- Fever
Peritonitis symptoms?(4)
- Fever
- Generalised pain radiate to shoulder and back
- Pain worsen @move
- Guarding
Possible causes of peritonitis?(4)
- perforated (4)
- Perforated: appendicitis, diverticulitis, tumour, upper GI
- Acute pancreatitis
- Peritoneal-dialysis related
- Post-surgery
Suspect Pancreatitis, lab invxs?
Amylase (increase)
What is the risk factor for cholelithiasis? (4+1)
Fat, forty, female, fertile
Fasting/ total parental nutrition
3 common symptoms of GB stones?
(Cholelithiasis, choledocholithiasis)
Colicky pain
Epigastric/ RUQ
N/V
What is the symptoms of cholecystitis? (4)
Fever
Constant Epigastric/ RUQ pain
Pain radiate to flank/ back
Murphy sign
What is Murphy sign? What condition have it?
Cholecystitis
Tenderness elicited when GB is palpated
Complications of cholecystitis? (5)
Empyema/ abscess
Choleduodenal fissures
Mirizzi syndrome
Perforation-> peritonitis
GB cancer
What is Charcot triad ? In what condition?
Ascending cholangitis
- fever, RUQ pain, jaundice
Common cause of acute pancreatitis? (2)
Stones
Alcohol
- ERCP, steroid, drugs
Acute pancreatitis presentation? (5)
Epigastric pain (chronic/ recurrent)
Radiates to back/ tip of scapula
Fever
Steatorrhea (oily stools)
Jaundice, pale stool, dark urine
Peritonitis. Broad spectrum Abx used is Augmentin, why?
Augmentin = amoxicillin + clavulanic acid
Clavulanic acid inhibits B-lactamase enzyme, allow amoxicillin to destroy the bacteria
Peritonitis the antibiotics used is Augmentin, why?
Amoxicillin + clavulanic acid
Clavulanic acid inhibits B-lactamase enzyme, allow amoxicillin to work on bacteria
Apart from Augmentin as broad spectrum Abx, what other combinations can use?
Cephalosporin (Cefuroxime) or
Quinolone (Ciprofloxacin)
And
Metronidazole
Best imaging modalities to view gallstones?
What do we look for? (3)
Ultrasound
- identify stones
- wall thickening
- dilation of duct
Pain worsen with food= ?
Aggravated by fatty food= ?
Pain relieved with food= ?
- Gastric ulcer
- Gallstones
- Duodenal ulcer
What is Couvoisier’s Law?
If Jaundice + palpable GB, unlikely gallstones
