Surgery Flashcards
Causes of acute abdominal pain and %
Unknown/non-specific 43%
Appendicitis 4-20%
Cholecystitis 3-9%
SBO 4%
Kidney stones 4%
Appendicitis lifetime risk
8% males
6.7% females
Perforation 17-32%
Causes of acute pancreatitis
GET SMASHHED
Gallstones (40%)
ERCP (4%)
Idiopathic
Trauma
Scorpions
Drugs
Mumps
Auto-immune
Hypercalcaemia
Hyperlipidaemia
Ethanol (35%)
Drugs - 2%
(azathioprine, frusemide, oestrogen’s, sulphonamides, sodium valproate, tetracyclines)
Pancreatic abnormalities eg Sphincter of Oddi dysfunction
Vascular
AAA statistics - mortality and risk of rupture
Pre-hospital rupture 60-80%
Emergency repair 40%
Elective repair 4-6%
Lifetime risk of rupture by size:
5cm 20% 6cm 40% 7cm 50%
Diverticular disease stats
75% asymptomatic
65% of people aged 85 and over
Renal colic stats
10% of population
30-40% recurrence in 5 years rate
Renal colic risk factors
Chronic dehydration
FHx nephrolithiasis
Abnormal anatomy of GU tract
Hypercalcaemia
Hx renal stones
Gout
Obesity
Hyperparathyroidism
Causes of urinary obstruction by gender
Obstruction
M - BPH, prostatic cancer, phimosis
F - pelvic organ prolapse
Both - neoplasm, blood clots, faecal impaction/constipation, stricture
Infection/inflammation
M - prostatitis, balanitis
F - lichen sclerosis
Both HSV, cystitis
Neuro
Both - diabetic cystopathy, GB syndrome, caudal equine, spinal disease/abscess, CVA, MS
Medications
Antihistamines - scopaderm
Antipsychotics - haloperidol
Anticholinergics - oxybutynin
Muscle relaxants - diazepam
Sympathomimetics - pseudoephedrine
Gallstone stats
15% of people have gallstones
15-25% of these are symptomatic
Haemorrhoid facts
25-50% of population
Can be internal or external
Internal are viscerally innervated (painless) and above the dentate line.
External are somatically innervated (painful)
Haemorrhoid grading
(internal haemorrhoids only, there is no grading system for external haemorrhoids)
Grade 1 - internal haemorrhoid prolapses past dentate line but not externally
Grade 2 - prolapses externally with straining but spontaneously reduced
Grade 3 - prolapses with straining and requires manual reduction
Grade 4 - unable to reduce
Ischaemic bowel risk factors
Can be small bowel (mesenteric ischaemia) or large (colonic ischaemia)
Mesenteric ischaemia appears more unwell
Age >60
Vasculopaths
AF
AAA/aortic atherosclerosis
Valvular disease
Smokers
Recent MI
Can occur due to venous thrombosis which is rare and occurs in younger patients. RF for this are:
-blunt abdominal trauma
-hypercoaguable state
-pancreatitis
-abdo infections
-portal hypertension
-dehydration
-portal malignancy
Anal fissure
Causes:
Slight ischaemia due to blood supply in posterior midline being lowest point, increased anal sphincter pressure, trauma/microtrauma, constipation
If not posterior midline consider Crohn’s disease, HIV, malignancy, TB
RF:
IBD
HIV/STI
Constipation
Anal cancer
Childbirth
Trauma eg FB or excessive wiping/constipation
Perianal abscess types and RF
Simple - arises from glandular crypts in anus or rectum. Infected anorectal gland
Complex - involves different planes eg ishiorectal, intersphincteric (between internal and external sphincters)
RF:
M:F 2:1
Receptive anal intercourse
Anal STI
Anal fissure
Smokers
DM/immunocompromise
Crohn’s disease
Perianal fistula - causes
Anorectal abscess #1
Crohn’s disease
Malignancy
Radiation
HIV/TB
Prior surgery
FB
Breast abscesses by location
Lactational - peripheral
Non-lactational - peri-areolar, sub-areolar
Breast abscess treatment
Lactating - fluclox, aspiration
Non-lactating - augmenting, aspiration, FU
6 Ps of limb ischaemia
Pain (POOP)
Pallor
Pulselessness
Paraesthesia
Poikilothermia (perishingly cold)
Paralysis
Scrotal masses - causes
Cancer
Hydrocoele
Varicocoele
Hernia
Spermatocoele
Priapism causes and treatment
Intracavernous injections
Medications eg psychiatric, ED, anticoagulants, recreational drugs
Unknown cause
Trauma
Sickle cell disease
Tx
Ice
Analgesia
Walk up stairs
Refer urology emergently
Paraphimosis risk factors and treatment
Older men
Partial phimosis
Poor hygiene
Balanitis
Tx:
Use topical analgesia
Ice
Sugar
Manual reduction
Causes of macroscopic haematuria
50% unknown, 30-40% malignancy
Benign masses eg BPH, renal
Stones
Infective
Nephropathy
Malignant
Traumatic
Iatrogenic - TRUS/TURP/ECSWL/renal biopsy/ureteric stents/catheter/radiation
Higher risk for bladder/urinary tract cancer
Age >40
Smoking hx
Chronic cystitis
Gross haematuria
Irradiation
Occupational chemical/dyes or cyclophosphamide exposure
Causes of microscopic haematuria
70% unknown, 5% malignancy
UTI 4-20%
BPH 10%
Stones 5%
Bladder cancer 3%
Renal cystic disease 2%
Renal disease 2%
Kidney cancer <1%
Prostate cancer <1%
Urethral stricture <1%
Microscopic haematuria definition
> 20x10 to the 6/L RBCs on 2 out of 3 samples collected at least 7 days apart, confirmed with microscopy, without infection
