Surgery Flashcards
tx of rectal cancer (especially anal verge)
abdomino-perineal excision of rectum
high VS low anterior resection
high: excise upper rectal tumours, remove proximal rectum, sigmoid colon but the ana sphincter is intact. loop ileostomy is performed to defunction the colon for healing
low: for low rectal tumours but not anal verge tumours. excise the distal colon, rectum and anal sphincters. does not result in permanent colostomy.
fibroadenoma - management plan
if <3cm - watch and observe
if >3cm, excise
causes of small bowel obstruction
adhesions
hernias
causes of large bowel obstruction
cancer
management of SAH
non-contrast CT-Head
(if done within 6 hours and negative) -> no LP & consider other causes
(if done out of 6 hours and negative) -> LP
(if positive) -> do CT-angiography of head
(if show aneurysm) -> aneurysm causes
(if not show aneurysm) -> MRA/digital subtraction angiography
difference between inguinal and femoral hernia
inguinal: above & medial to pubic tubercle, can be reduced completely, common in male
-DIRECT: above the opening of inguinal canal
- INDIRECT: at the opening of inguinal canal
femoral: below & lateral to pubic tubercle, cannot be reduced completely, common in female, needs surgery as HIGH risk of strangulation/obstruction
what to do on day of surgery if still using diabetic medications?
metformin: continue does (unless taking TDS, then omit one dose)
sulphonylureas: omit one dose (unless the procedure is in the afternoon, then omit both BD doses)
DPP IV inhibitors: no change
GLP-1 analogues: no change
SGLT2 inhibitors: omit on the day
long0acting insulin OD (lantus, levemir): reduce dose by 20%
twice daily biphasic or ultra long acting insulin (novomix 30 or humulin M3): halve the morning dose and continue eveningdose.
spigelian hernia
richter hernia
what are these??
spigelian: lateral ventral hernia. rare and seen in elderly patients. hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and semilunar line laterally)
richter: rare, only the anti-mesenteric border of the bowel herniates through the fascial defect. can present with strangulation without symptoms of obstruction
what is Hartmann’s procedure?
done in emergencies - bowel obstruction/perforation
complete resection of rectum and sigmoid colon with formation of end colostomy and closure of rectal stump
grading of internal haemorrhoids
1 - do not prolapse out of anal canal
2 - can reduce spontaneously
3 - manual reduction
4 - cannot be reduced
treatment of renal stones
if <5mm - watch and wait
5-10mm - shockwave lithotripsy
10-20mm - shockwave lithotripsy or ureteroscopy
>20mm - percutaneous nephrolithotomy
treatment of ureteric stones
<10mm - shockwave lithotripsy +/- alpha blockers
10-20mm - uretersocopy
difference between strangulated and incarcerated?
strangulated: ischaemia due to blockage of blood vessels
incarcerated: stuck and cannot be reduced
surveillance for aortic aneurysm
single abdo USS at 65yo
fibroadenoma VS fibroadenosis
fibroadenoma: ‘breast mice’, discrete non-tender, highly mobile lumps
fibroadenosis: aka fibrocystic disease, benign mammary dysplasia. lumpy breast which may be helpful, symptoms worse on menstruation
what to do about COCP when patient is due to go for laparoscopic procedures?
stop COCP 1 month (28 days) before procedure
treatment of anal fissure
Acute (<1 week): high fibre, bulk-forming laxative, lubricants, topical anaesthetics, analgesia
Chronic: topical GTN, shincterotomy, botulinum toxin
bilateral hydocele in infants - ?worried or not
No worries! Will resolve spontaneously
priapism - what is it?
does it occur in children? what is the investigation for this?
prolonged erection of penis
yes, it does.
Ix: cavernosal blood gas analysis to find out if it is ischaemic (pO2 and pH reduced and pCO2 increased) or non-ischaemic
Ischaemic: impaired vasorelaxation, reduced vascular outflow resulting in congestion ad trapping deoxygenated blood in corpus cavernosum
Non-ischaemic: high arterial inflow (usually due to fistula formation either due to congenital or traumatic mechanisms)
Phimosis VS Paraphimosis ?difference
phimosis: unable to retract foreskin back
paraphimosis: retracted foreskin + not able to be pulled back + blockage of blood supply
