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Semester 1 > Surgery > Flashcards

Surgery Flashcards

1
Q

Cystitis

A

lower ab pressure
dysuria, pyuria, hematuria, frequency

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2
Q

Pyelonephritis

A

UTI and systemic features- fevers, rigors, nausea, vomiting

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3
Q

MSK

A

sciatica, lumbar disc, bony mets

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4
Q

gastroenteritis

A
  • abdo pain
  • diarrhea + blood.mucus
    vomit
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5
Q

acute mesenteric ischemia

A

risk - elderly, afib, cardiac disease
vomiting, diarrhea, ileus
very severe pain unrelieved by analgesia

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6
Q

chronic mesenteric ischemia

A

post prandial pain
weight loss
change in bowel habit

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7
Q

bowel obstruction

A

vomit - green (bilious or brown (faeculent)
constipation/obstipation
(no flatus in complete obstruction)
Distension
perforation (sudden)
- decreased resonance on percussion
SBO (high) - first bilious vomit, then constipation
LBO (low) - first constipation then faeculent vomit - on exam distension, tympanic abdomen and high pitched bowel sounds

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8
Q

appendicitis

A

migratory umbilical pain to rif pain
worse on movement and coughing (inflammatory)
fevers, chills, rigors
nausea/vomiting
anorexia -> lack of appetite
deep tenderness at mcburney’s point 1/3 distance from asis to umbilicus
and rebound tenderness (peritonitis)
rovsing’s sign -> lif palpation inc rif pain
obturator sign -> retrocaecal appendicitis - inflame obturator internus
psoas sign -> ilieo psoas

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9
Q

inguinal hernia

A

lump
incarcerated or not
strangulation - constant pain.
exam - fever, tachycardia, localized tenderness, irreducible hernia

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10
Q

ureteric stone

A

severe pain
loin to groin
restless with pain
hematuria
dysuria, urgency
vomiting

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11
Q

inflammatory bowel disease (IBD)

A

changes in bowel motion (what’s normal?)
hematochezia/ bloody diarrhea
systemic symptoms:
- weight loss
- joint pain
- eye trouble
- skin rash

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12
Q

Diverticulitis

A

Left iliac fossa pain (LIF)
change in bowel motion
hematochezia , bloody diarrhea
fever, chills, rigors, anorexia
prior colonoscopy?

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13
Q

Suprapubic pain

A

urine retention, uti, prostitis, PID, IBD

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14
Q

NGT

A

wide bore to decompress obstruction/relieve vomiting

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15
Q

LFTs

A

PTT - coag screen
albumin - malnutrition, pancreatitis

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16
Q

Analgesia contraindications

A

opioids in SBO (constipation)
NSAIDs in PUD, AKI, asthma

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17
Q

rutherford morrison incision

A

renal transplant

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18
Q

Drains

A

they remove collections of blood (hemothorax) ,
fluid (ascitic drain),
pus (empyema or subphrenic abscess)
air (pneumothorax)
prevent accumulation of fluid around operative site (bile after biliary surgery)
drains removed when nothing comes out, or when they fall below 30-50ml in 24 hrs
may damage underlying structures due to migration/miscplacement
and route for infection

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19
Q

Poor nutrition leads to

A

impaired albumin production
impaired wound healing and collagen deposition
ICU myopathy (skeletal muscle weakness)
reduced neutrophil and lymphocyte function

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20
Q

central venous cathereisation

A

damage to surrounding structures ->
pneumothorax, air embolism, cardiac dysrhythmias , carotid artery dissection

hematoma

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21
Q

Medications in surgery

A

CCBs and BBs must be continued
patients on long-term steroids - risk of adrenal atrophy - unable to mount a physisiological stress response to surgery - severe hypotension can occur if steroids are discontinued.
Steroid dose is doubled to counter inc steroid requirement

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22
Q

Cyclizine

A

avoid in fluid retention (heart failure)

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23
Q

Metoclopramide

A

dopamine antagonist
avoid in patients with parkinson’s

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24
Q

TED stockings

A

contraindicated in peripheral arterial disease

25
Hypovolaemic signs
reduced urine output, tachycardia, postural hypotension, low bP, reduced cap refill, cool peripheries, reduced skin turgor, sunken eyes, higehr urea and creatinine, higher Na
26
Hypervolemic signs
inc resp rate, hypertension, circ overload, jugular venous pulse, bibasal creps, low hematocrit , low hb, low urea, creat, cxr = pul oedema
27
Fluid requirements
fluid intake - 2.5 L losses = 2.5 1.5 L urine 0.8 insensible (skin, lungs) 0.2 l stool elec 120-140 sodium K 70 mmol h20 - 2/3 of body mass thirds ECF = 1/3 intravasc = 1/3 intersitial = 2/3 ICF = 2/3
28
IV fluid prescription
Resuscitation hypotensive/techycardic 500ml bolus over 10-15 mins or 250 ml in heart failure reassess - heart rate, blood pressure, and urine output - hypovolemic 1 L 4-6 H - maintenance 1 L 9-10 hrs elderly 1L 10-18 hrs fluid challenge shock, low urine output 500 ml normla saline /30 min 250 if frail/overload risk if output improves, then hypovoelemia was the cause - GI loss - replace K if vomiting or diarrhea or high output stoma -
29
Sepsis
take 3, give 3
30
Direct inguinal Hernia
acquired, most common in older pts, medial to epigastric vessels
31
femoral hernia
most likely to incarcerate
32
intusscepsion
telescoping
33
Retroperitoneal structure
suprarenal (Adrenal), aorta/ivc, duodenum, pancreas, ureters, colon (ascending/descending), kidneys, esophagus, rectum
34
intraperitoneal structures
stomach, spleen, liver, jejunum, ileum, transverse colon, sigmoid colon
35
transition between small intestine to colon
ileocecal valve
36
hypovolemia -> where do they get ischemia?
watershed era is splenic flexure and rectosigmoid junction
37
risk factors for biliary colic
female, forty, fat, familial, fertile, tpn, rapid weight loss
38
pathophys of biliary colic
fatty food -> cck release -> gallblader contraction - obstructed cystic duct
39
same symptoms with temp, and murphy's sign
acute cholecystitis
40
findings on U/S
gallstones, gallbladder wall thickening, pericholcystic fluid, sonographic murphy's sign
41
subtypes
air in gallbladder wall -> emphysematous cholecystitis = immunocomprimised (diabetic) gastric forming bacteria (clostridium) - is life threatening
42
acalculous cholecystitis
severly ill patients -> sepsis, organ failure, burns cholecystectomy, percutanoues cholestotomy
43
hesselbach's triangle
inferior epigastric artery rectus abdominus inguinal ligament direct inguinal hernia - defect in abdominal wall medially to inferior epigastric vessels
44
midpoint of inguinal ligament
femoral nerve (to tubercle)
45
midinguinal point
asis to symphysis femoral artery (pulsates)
46
indirect inguinal hernia
laterally to triangle
47
gastric ulcers
should always be biopsied (ogd) to rule out malignancy, and repeat to confirm healing
48
triple therapy for h. pylori
1-2 weeks two antibiotics = amoxicillin 1g BD clarithromycin 500 mg BD PPI BD 1-2 weeks, then OD 4-6 weeks
49
complications in achalasia
nocturnal aspiration bronchiectasis lung abscess carcinoma (scc) of esophagus
50
chagas disease
chronic infection with parasite tyrpanosoma cruzi intramuscular ganglion cells destruction - cardiomyopathy and megacolon etc.
51
scleroderma
80% have oesophageal involvement seen in CREST
52
CREST
Calcinosis Raynaud's Oesophagitis Scleroderma Telengiectasia
53
Oesophageal cancer - SCC
SCC most common globally associated with mucosal damage from alcohol, smoking, and poor diet also from achalasia and strictures nitrosamines, ac def, coeliac disease, PUD, strictures
54
Adenocarcinoma
acid and bile reflux leading to metaplasia and dysplasia lower third of oesophagus risk is barrets oesophagus Gord, obesity, high fat,
55
disseminated disease of oesophageal cancer
cervical lymphadenopathy (virchow's node) hepatomegaly due to metastasis epigastric mass due to para aortic lymphadenotpathy local invasion - hoarseness, cough and haemoptysis, neck sweilling in svc obstruction, horners syndrome if sympathetic chain invasion
56
investigations for oesophageal cancer
local stationg, regional staging and disseminated disease
57
gastric cancer
adenocarcinoma most common (mucosa) >50 yrs neuroendorine -> carcinoid lymphoma -> h pylori risk factors family history , blood type A, chronic gastric ulceration due to H PYLORI , NITROSAMINES, ebv
58
gastrectomy complications
dumping syndrome
59

Semester 1 (13 decks)

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