Surgery Flashcards
AAA screening:
When does this occur?
What is the sequelae of follow-up dependent on findings:
High rupture risk findings:
Single screening abdominal ultrasound at the age of 65
<3cm normal
3-4.5cm small -> Re-scan every 12 months
4.5-5.4 medium aneurysm - rescan every 3 months
>5.5cm Large - refer within 2 weeks for probably intervention
symptomatic, >5.5cm, rapidly evolving (>1cm/year)
Which GI ulcer improves after eating:
Duodenal ulcer (these are more common than gastric ulcers)
Stoma types:
Ileostomy vs colostomy
Location:
Appearance:
Output:
Ileostomy -> RIFm spouted and liquid output
Colostomy -> more likely on Left side of abdomen, flushed, solid
Which hernia is obstruction/strangulation more common in:
Most common hernia:
Femoral hernias
inguinal hernia (75%)
congenital inguinal hernia vs infantile umbilical hernia -> which one needs fixed
congenital inguinal hernia -> should be repaired soon after diagnosis due to risk of incarceration
Pancreatitis: GETSMASHED mnemonic
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hypercalcaemia,
Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
Anal fissure: defined as acute if less than how many weeks?
Management:
6
Management of an acute anal fissure (< 1 week)
soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives
topical anaesthetics
analgesia
Management of a chronic anal fissure
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
Adverse effects of tamoxifen
Adverse effects of aromatase inhibitor
Adverse effects
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer -> menopausal type symptoms
Adverse effects
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
Features of chronic pancreatitis:
Test to assess exocrine function:
pain worse 30 minutes following a meal
steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain.
diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin.
Faecal elastase
Location of epididymal cysts relative to testicles
Posterior
Operation for sigmoid cancer
Upper rectum:
Lower rectum:
Anal verge:
High anterior resection
Anterior resection
Anterior resection with low TME
Abdomino-perineal excision of rectum
Imaging modalities for investigating hydatid cysts:
Hypersensitivity reaction which results from daughter cysts:
Usually US first
Then CT -> best to differentiate between different types of cyst.
Type 1 HS
Operations and their associated nerve lesions:
Posterior triangle lymph node biopsy
Lloyd Davies stirrups
Thyroidectomy
Anterior resection of rectum
accessory nerve lesion
common peroneal nerve
laryngeal nerve
hypogastric autonomic nerves
Operations and their associated nerve lesions:
Axillary node clearance
Inguinal hernia surgery
Varicose vein surgery
Posterior approach to the hip
Carotid endarterectomy
Axillary node clearance; long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve
Inguinal hernia surgery and ilioinguinal nerve
Varicose vein surgery- sural and saphenous nerves
Posterior approach to the hip: sciatic nerve
Carotid endarterectomy and hypoglossal nerve
TPN can cause which blood test derangement
LFTs -> causes fatty liver
