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SURGERY Flashcards

1
Q

What most commonly causes acute pancreatitis?

A

Gallstones - 50% of cases
Alcohol - 25% of cases

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2
Q

Investigations for diagnosing pancreatitis?

A

Serum amylase is usually >3 times the upper limit of normal. Serum lipase may be used if late presentation
Liver, renal function and CRP may be done

Pancreatitis can be diagnosed without imaging if characteristic pain and amylase/lipase is >3 times the normal limit

Early USS to assess aetiology as this can affect management. CT or MRI can be used.
Additional imaging e.g. MRCP or endoscopic US may be needed if underlying cause is not known

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3
Q

Scoring systems used to identify severe pancreatitis?

A

Ranson score
Glasgow score
APACHE II

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4
Q

Which investigation for pancreatitis is most sensitive and specific?

A

Serum lipase

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5
Q

Causes of raised amylase?

A

Pancreatitis
Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
DKA

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6
Q

What are some prognostic factors indicating severe pancreatitis?

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

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7
Q

What most commonly causes chronic pancreatitis?

A

Alcohol excess - 80%

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8
Q

Features of chronic pancreatitis?

A

Pain 15-30 mins after a meal
Steatorrhoea 5-25 years after pain onset
Diabetes mellitus >20 years after symptoms

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9
Q

Investigations for chronic pancreatitis?

A

CT is most sensitive but abdominal XR can be done
If imaging is inconclusive then faecal elastase can be done to assess exocrine function

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10
Q

According to NICE guidance for CT head scans… what is “a dangerous mechanism of injury” that necessitates a CT head scan within 8 hours of the injury?

A

a pedestrian or cyclist struck by a motor vehicle
an occupant ejected from a motor vehicle
a fall from a height of greater than 1 metre
A fall from more than 5 stairs

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11
Q

What usually causes neurogenic shock? outline the pathophysiology?

A

Spinal cord transection = interruption of autonomic nervous system = decreased sympathetic tone or increased parasympathetic tone = decrease in peripheral vascular resistance mediated by marked vasodilation = decreased preload = decreased CO = decreased tissue perfusion = shock

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12
Q

What does it suggest if a person is in shock but has warm peripheries?

A

It suggests vasodilation as a cause of shock e.g. sepsis, anaphylaxis, neurogenic

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13
Q

What is the difference between an incarcerated and a strangulated hernia?

A

Incarcerated - a hernia cannot be reduced
Strangulated - were blood supply to the hernia is compromised leading to ischaemia or necrosis

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14
Q

Inguinal vs femoral hernia location?

A

Inguinal - above and medial to pubic tubercle
Femoral - below and lateral to the pubic tubercle

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15
Q

Cause of congenital inguinal hernia? How should they be repaired?

A

Indirect hernias resulting from a patent processus vaginalis
Should be surgically repaired soon after diagnosis as at risk of incarceration

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16
Q

What % of superficial thrombophlebitis cases will have an underlying DVT at presentation?

A

20%

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17
Q

What is superficial thrombophlebitis?

A

Thrombus formation in a superficial vein with associated inflammation in the tissue surrounding the vein

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18
Q

What is migratory thrombophlebitis? what is it commonly associated with?

A

Thrombophlebitis that recurs at varying sites but most commonly in the leg
It is often associated with a serious underlying cause such as cancer

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19
Q

Symptoms of superficial thrombophlebitis?

A

Pain, tenderness, itching, reddening of the skin
Hardening of surrounding tissue
Pigmentation changes of overlying skin

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20
Q

What is the 2 most common cause of small bowel obsictions?

A
  1. Adhesions
  2. Hernias
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21
Q

Definitive investigation for small bowel obstruction?

A

CT
(AXR is commonly used first line still)

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22
Q

Most commmn 3 causes of large bowel obstruction?

A

Tumours 60%
Volvulus
Diverticular disease

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23
Q

Small vs large bowel obstruction imaging findings?

A

Small bowel - valvulae conniventes extend all the way across (plicae circulares)
Large bowel - haustra extend about 1/3rd the way across

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24
Q

What is spina bifida occult?

A

the skin and tissues (but not not bones) may develop over the distal cord. The site may be identifiable by a birth mark or hair patch
Up to 10% of the population may have this

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25
What is scheuermann’s disease?
Rigid form of spinal kyphosis caused by anterior wedging of >5 degrees across 3 consecutive vertebrae, most commonly in the thoracic spine in adolescents causing back pain, stiffness and kyphosis
26
What is stauffer syndrome?
a paraneoplastic disorder associated with renal cell cancer typically presents as cholestasis/hepatosplenomegaly
27
Why might you monitor U&Es after a SAH?
As it can cause hyponatraemia secondary to SIADH
28
What are the most common cause of scrotal swellings?
Epididymal cyst
29
How does epididyml cysts present? what age is most common?
The cyst is separate from the body of the testicle And found posterior to the testicle Painless Not possible to get above the lump Usually in pts over 40
30
What conditions are epididymal cysts associated with?
polycystic kidney disease cystic fibrosis von Hippel-Lindau syndrome
31
What may hydroceles develop secondary to?
epididymo-orchitis testicular torsion testicular tumours
32
Presentation of hydroceles?
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle the swelling is confined to the scrotum, you can get 'above' the mass on examination transilluminates with a pen torch the testis may be difficult to palpate if the hydrocele is large
33
What is a varicocele?
An abnormal enlargement of the testicular veins Can be associated with infertility
34
why do varicoceles typically occur on the left?
As the testicular vein drains into the renal vein on the left
35
What do you do if AAA screening reveals an aorta width of <3cm?
No further action
36
What do you do if AAA screening reveals an aorta width of 3-4.4cm?
This is a small aneurysm so rescan every 12 months
37
What do you do if AAA screening reveals an aorta width of 4.5-5.4cm?
Medium aneurysm so rescan every 3 months
38
What do you do if AAA screening reveals an aorta width of >=5.5cm?
Large aneurysm so refer within 2 weeks to vascular surgery for probable intervention
39
What do you do if AAA screening reveals an aorta width of any size but has grown >1cm in a year?
High rupture risk so refer within 2 weeks to vascular surgery for probable intervention
40
What is a high anterior resection?
Used for cancers of the sigmoid colon Removes sigmoid colon
41
What is an anterior resection?
Used for cancers of the rectum i..e within 5cm of the anal verge Removes the lower part of the rectum whilst preserving the sphincter musces at the anus to maintain continence
42
What is an abdominoperineal resection?
Used for cancers of the anal verge (i.e. low rectum or in the anus) Extensive surgery removing the anus,m rectum and part of the sigmoid colon resulting in permenant colostmy as entire anal opening is removed
43
Where is the most common location for colorectal cancer?
Rectum - 40% of cases (Sigmoid at 30%, ascending colon and caecum 15%, transverse colon 10% and descending colon 5%)
44
Screening for colorectal cancer?
Men and women 60-74 every 2 years get a FIT test Pts over 74 can request screening
45
If a pt is positive in the screening for colorectal cancer via a FIT test, what are the chances of them finding cancer at colonoscopy?
1 in 10 5 in 10 normal and 4 in 10 will be found to have polyps
46
Referral criteria for colorectal cancer at any age?
Abdominal mass Change inn bowel habit IDA
47
Referral criteria for colorectal cancer for pts aged 40 and over?
Unexplained weight loss and abdominal pain
48
Referral criteria for colorectal cancer for pts aged under 50?
aged under 50 with rectal bleeding and either of the following unexplained symptoms: abdominal pain weight loss
49
Referral criteria for colorectal cancer for pts aged 60 and over?
Anaemia even in the absence of iron deficiency
50
What are the 3 types of colon cancer? And how common is each one?
sporadic (95%) hereditary non-polyposis colorectal carcinoma (HNPCC, 5%) familial adenomatous polyposis (FAP, <1%)
51
Mutations seen in colon cancer?
APC gene K-ras oncogene Deletion of p53 DCC tumour suppressor genes
52
What % of pts with HNPCC develop cancers?
90
53
Most common genes involved with HNPCC colon cancer?
MSH2 MLH1
54
Which cancers are pts with HNPCC at risk of?
Colon cancer Endometrial cancer Ovarian cancer
55
What criteria is used to aid diagnosis of lynch syndrome?
The Amsterdam criteria: at least 3 family members with colon cancer the cases span at least two generations at least one case diagnosed before the age of 50 years
56
What is FAP?
a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years. Patients inevitably develop carcinoma. Also at risk of duodenal tumours
57
What causes FAP?
It is due to a mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.
58
What is Gardner’s syndrome?
A variant of FAP where there are osteomas of the skull/mandible, retinal pigmentation, thyroid carcinomas and epidermoid cysts on the skin
59
What age are fibroadenomas common?
15-35
60
Who does fibroadenosis/fibrocystic breast disease most commonly affect?
Middle-aged women 30-50
61
How does fibroadenosis present?
Lumpy breasts which may be generally painful Symptoms may worsen prior to menstruation
62
What age is mammary duct ectasia most common?
Around menopause 45-55
63
How does mammary duct ectasia present?
Tender lump around the areola Nipple may be red, tender or inverted thick green nipple discharge from single or multiple ducts (can also be brown, watery or bloodstained)
64
How does intraductal papilloma present?
Clear or blood stained discharge from a single duct If large is can present with a mass Usually painless
65
How does fat necrosis present?
May follow trauma Firm and round lump but may develop into a hard, irregular breast lump Mass may increase in size initially
66
How does a fibrodenoma present?
Mobile, firm breast lump
67
How do breast cysts present?
Smooth discrete lump which may be fluctuant Can be any size Common to have more than 1 Size or tdenderness changes may occur around periods of
68
What age does periductal mastitis present?
Younger age than duct ectasia - early 30s
69
How does periductal mastitis present?
Tender, hot, red breast Discharge from the nipple that may be bloody Mass felt behind the nipple Nipple may be inverted Fever
70
What is periductal mastitis strongly associated with?
Smoking
71
Screening for breast cancer?
Women 50-70 offered a mammogra every 3 years After 70 they can request this
72
Which pts should be screened for familial breast cancer?
1 first-degree female relative diagnosed with breast cancer at <40 years 1 first-degree male relative diagnosed with breast cancer at any age 1 first-degree relative with B/L breast cancer where the first primary was diagnosed at <50 years 2 first-degree relatives, or 1 first-degree and 1 second-degree relative, diagnosed with breast cancer at any age 1 first-degree or second-degree relative diagnosed with breast cancer at any age and 1 first-degree or second-degree relative diagnosed with ovarian cancer at any age 3 first-degree or second-degree relatives diagnosed with breast cancer at any age
73
What is he most common type of breast cancer?
Invasive ductal carcinomas
74
Lifetime risk of breast or ovarian cancer if a pt has BRCA1 or BRCA2 gene positives?
40%
75
What prognostic tool can be used to indicate survival for surgical management of breast cancer?
Nottingham prognostic index
76
When should you refer a pt for suspected breast cancer?
Aged 30 or older with an unexplained breast lump Aged 50 or over with any symptoms in 1 nipple only: discharge, retraction or other changes of concern
77
What is a phyllodes tumour?
Rare type of breast cancer of fibroepithelial origin that affects women in their 40-50s most commonly
78
Presentation of phyllodes breast tumour?
Rapidly enlarging, smooth, hard palpable breast mass In advanced stages an ulcer may form in the breast
79
What is intraductal papilloma?
Local areas of epithelial proliferation in large mammary ducts forming a benign tumour
80
What is mammary duct ectasia?
Dilatation and shortening of large breast ducts which become inflamed Seen in yp to 25% of normal female breasts

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