surgery Flashcards
difference between femoral and inguinal hernias
femoral = INFEROLATERAL to pubic tubercle
usually not reducible
inguinal = SUPRAMEDIAL to pubic tubercle
more commonly reducible
BPH mgt:
- watchful waiting
- alpha-1 antagonists
- 5 alpha reductase inhibitors
- combination of 2&3
- TURP
alpha-1 antagonists examples
tamsulosin
alfuzosin
alpha-1 antagonists
mechanism:
reduce smooth muscle tone of prostate and bladder
alpha-1 antagonists adverse effects (4)
dizziness
postural hypotension
dry mouth
depression
5 alpha-reductase inhibitors
examples:
finasteride
5 alpha-reductase inhibitors
mechanism:
block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
indicated if severely enlarged prostate
note causes reduction in prostate volume and so slows disease progression – however takes time and sx may not improve for 6 months
5 alpha-reductase inhibitors SE:
decrease PSA concentrations by up to 50%
erectile dysfunction
reduced libido
ejaculation problems gynaecomastia
prostate ca ix:
1st line = multiparametric MRI
then TRUS guided biopsy
cancer of:
caecum/ ascending/ proximal transverse colon
i. type of resection
ii. anastomosis
i. R hemicolectomy
ii. ileo-colic
cancer of:
distal transverse/ descending colon
i. type of resection
ii. anastomosis
i. L hemicolectomy
ii. colo-colon
cancer of:
sigmoid colon
i. type of resection
ii. anastomosis
i. high anterior resection
ii. colo-rectal
cancer of:
upper rectum
i. type of resection
ii. anastomosis
i. anterior resection (TME)
ii. colo-rectal
cancer of:
low rectum
i. type of resection
ii. anastomosis
i. anterior resection (low TME)
ii. colo-rectal (+/- defunctioning stoma)
cancer of:
anal verge
i. type of resection
ii. anastomosis
i. Abdomino-perineal excision of rectum
ii. none
sigmoid volvulus associations
older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia
sigmoid volvulus on AXR
large bowel obstruction (large, dilated loop of colon, often with air-fluid levels)
coffee bean sign
sigmoid volvulus mgt
rigid sigmoidoscopy + rectal tube insertion
caecal volvulus associations:
adhesions
pregnancy
caecal volvulus AXR findings
small bowel obstruction
caecal volvulus mgt
operative - often needs R hemicolectomy
nerve injured in carotid endartectomy
IPSILATERAL hypoglossal nerve CN XII
acute anal fissure mgt:
- soften stool
- lubricants
- topical anaesthetics
- analgesia
chronic anal fissure mgt:
topical GTN
refer to secondary care for sphincterotomy or botox if no effect from GTN in 8 weeks
SERM (selective oestrogen receptor modulators)
type of breast cancer it is used to treat?
example?
oestrogen-receptor +ve
e.g. tamoxifen
SERM adverse effects:
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
aromatase inhibitors
type of breast cancer it is used to treat?
example?
ER +ve in post menopausal women
(as it reduces peripheral oestrogen synthesis)
e.g. anastrazole
letrozole
aromatase inhibitors adverse effects:
osteoporosis (do DEXA when initiating)
hot flushes
arthralgia, myalgia
insomnia
biological therapy
i. type of breast cancer it is used to treat
HER2 +ve
biologics for breast cancer:
i. most common
ii. CI
i. trastuzumab (Herceptin)
ii. cardiac disease
drug for vasospasm prevention in SAH
nimodipine
Charcot’s triad
what condition do we see it in?
- fever
- jaundice
- RUQ pain
ascending cholangitis (bacterial infection of biliary tree, most commonly e. coli)
epidydimal cyst features
separate from body of testicle
posterior to testicle
epidydimal cyst associations (3)
PCKD
CF
von Hippel Lindau
hydrocele definition
accumulation of fluid within tunica vaginalis
can be communicating communicating: due to patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum. common in newborn males, usually resolve within first months of life
non-communicating: caused by excessive fluid production within the tunica vaginalis
hydroceles may develop secondary to:
epididymo-orchitis
testicular torsion
testicular tumours
hydrocele features:
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates
the testis may be difficult to palpate if hydrocele is large
suspected epididymo-orchitis
ceftriaxone 500mg im stat + PO doxycycline 100mg BD for 10-14 days
epididymo-orchitis most common cause
chlamydia
biliary colic cx (5)
acute cholecystitis (most common)
ascending cholangitis
acute pancreatitis
gallstone ileus
gallbladder cancer
mammary duct ectasia
Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
Duct papilloma
Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge
fat necrosis
More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted
criteria for brain stem death testing (4)
Deep coma of known aetiology
Reversible causes excluded
No sedation
Normal electrolytes
Hartmann’s procedure
what is it?
resection of the relevant portion of bowel + formation of end colostomy/ileostomy.
can be reversed - end colostomy is closed following the formation of a colorectal anastomosis, restoring continuity of the bowel
supplementation of prednisolone prior to:
i. minor surgery
ii. moderate procedure
iii. major procedure
i. nil
ii. 50mg hydrocortisone prior to induction, 25mg every 8 hrs for 24 hours
iii. 100mg hydrocortisone before induction, 50mg every 8h for 24h, thereafter halving dose every 24h until maintenance dose reached.
varicocele
i. what is it?
ii. association
i. abnormal enlargement of testicular veins (“bag of worms”)
ii. infertility
bladder cancer RF
urothelial (transitional cell) carcinoma
smoking
exposure to alanine dyes
rubber manufacture
cyclophosphamide
bladder ca RF SCC
schistosomiasis
smoking
gastric vs duodenal ulcers
i. which is more common
ii. pain WORSE on eating
i. duodenal ulcers
ii. gastric
duodenal atresia
i. age at presentation
ii. dx
iii. rx
i. few hours PN
ii. double bubble sign on AXR, sometimes with xontrast study
iii. Duodenoduodenostomy
malrotation + volulus
i. age at presentation
ii. dx
iii. rx
i. 3-7 days PN
ii. Upper GI contrast study may show DJ flexure is more medially placed, USS may show abnormal orientation of SMA and SMV
iii. LAdd’s procedure
Jejunal/ ileal atresia
i. age at presentation
ii. dx
iii. rx
i. within 24hrs PN
ii. air fluid levels on AXR
iii. laparotomy with primary resection and anastomosis
meconium ileus
i. age at presentation
ii. dx
iii. rx
more common in cystic fibrosis
i. 24-28hrs PN
ii. air-fluid levels on AXR, sweat test to confirm CF
iii. surgical decompression
NEC
i. age at presentation
ii. dx
iii. rx
i. week 2 PN
ii. Dilated bowel loops on AXR, pneumatosis and portal venous air
iii. conservative
AAA screening:
i. small aneurysm
ii. medium aneurysm
iii. large aneurysm
i. 3-4.4cm
rescan in 12 months
ii. 4.5-5.4cm
rescan in 3 months
iii. >5.5cm
2 week referral to vascular for probable intervention
AAA screening - what is offered?
single USS abdomen to males aged 65
non-malignant causes of elevated PSA
BPH
prostatitis/ UTO
ejaculation
vigorous exercise
urinary retention
instrumentation of urinary tract
PSA testing should not be done within:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
drug class used to manage over-active bladder
anti-muscarinics
renal stones mgt
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
ureteric stones mgt
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
what % of people with +ve FIT test have colorectal cancer?
5-15%
CRC screening - what is offered?
FIT test every 2 years to pts aged:
60-74 in England
50-74 in Scotland
