Surgery (2)

Question 1

Complications of breast surgery

Answer 1

• Haematoma
• Frozen Shoulder
• Long thoracic nerve palsy
• Lymphoedema

Question 2

Match these

Answer 2

Question 3

How can be breast ca describe (2 simple types)

Answer 3

• carcinoma in situ
• invasive

Question 4

The most common type of breast cancer

Answer 4

Invasive ductal carcinoma

Question 5

Risk factors for breast cancer

Answer 5

• BRCA
• Family history
• obesity
• hormone use (HRT/COCP)
• nulliparity

Question 6

What are these?

Answer 6

1- Cullens

2 - Grey- Turners

Question 7

Ix for suspected pancreatitis

Answer 7

• Bedside → urine dip, ECG
• Bloods → FBC, U&Es, LFTs, albumin, amylase/lipase, bone profile, blood glucose, ABG, inflammatory markers
• Imaging → USS Abdomen, Erect CXR/AXR
• Invasive → if gallstones suspected → MRCP

Question 8

Causes of pancreatitis

Answer 8

Question 9

Scoring systems for pancreatitis - describe

Answer 9

Question 10

Management of pancreatitis

Answer 10

• ABCDE
• Fluid resuscitation
• Adequate analgesia → opioids
• antibiotics (although conflicting evidence)→ IV Cefuroxime
• Urgent therapeutic ERCP → if suspected gallstones or if fulfil criteria for severe pancreatitis with either cholangitis, jaundice or dilated common bile duct

Question 11

Early and late complications of acute pancreatitis

Answer 11

Early

• Shock
• Renal Failure
• ARDS
• Hypocalcaemia
• Hyperglycaemia

Late

• Pancreatic pseudocyst
• Pancreatic necrosis
• T1DM
• Chronic pancreatitis

Question 12

Possible ways (conditions) of gallstone presentation

Answer 12

• Biliary Colic
• Acute cholecystitis
• Ascending cholangitis
• Mucocoele
• Pancreatitis
• Gallstone ileus
• Mirrizi syndrome

Question 13

Pre - hepatic causes of jaundice

Answer 13

Question 14

Intra-hepatic causes of jaundice

Answer 14

Question 15

Post-hepatic causes of jaundice

Answer 15

Question 16

Courvoisier’s law

Answer 16

Courvoisier’s law

Presence of a palpably enlarged gallbladder which is non-tender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones

Question 17

Most common type of pancreatic cancer

Answer 17

80% of pancreatic ca is adenocarcinoma

Question 18

Associations with pancreatic cancer

Answer 18

• ↑age
• smoking
• diabetes
• HNPCC
• MEN
• BRCA2
• chronic pancreatitis

Question 19

Features of pancreatic cancer

Answer 19

• Painless jaundice
• loss of exocrine function (steatorrhoea)
• Migratory thrombophlebitis (Trousseau sign) is more common than other cancers

Question 20

Treatment of pancreatic cancer

Answer 20

• Less than 20% suitable for surgery at diagnosis
• If surgery possible → Whipple’s resection for resectable lesions + chemotherapy

Question 21

Match the following

Answer 21

Question 23

Ix for possible bowel obstruction

Answer 23

History, Abdo exam, PR exam

• Bedside → urine dip, ECG
• Bloods → FBC, U&Es, LFTs, albumin, amylase/lipase, ABG, CRP
• Imaging →USS Abdomen, Erect CXR/AXR, ?CT

Question 24

What’s that? (spot diagnosis)

Answer 24

Small bowel obstruction

Question 25

Causes of small bowel obstruction

Answer 25

• Adhesions (60%)
• Strangulated hernia (20%)
• Malignancy (5%)
• Volvulus (5%)

Question 26

(4) features of intestinal obstruction

Answer 26

1. Pain
2. Vomiting
3. Distension
4. Absolute constipation

Question 27

Management of small bowel obstruction

Answer 27

• ABCDE
• Fluid resuscitation
• NG tube in all patients

If presumed to be due to adhesions and no features of peritonism:

• Conservative management (drip and suck) for up to 48 hours

If features of peritonism or systemic toxicity present:

• Consider early operation

Question 28

Absolute and relative indications for surgery in small bowel obstruction

Answer 28

Absolute

• Peritonitis
• Visceral perforation
• Irreducible hernia

Relative

• Palpable mass lesion
• Failure to improve

Question 29

Small bowel obstruction vs Large bowel obstruction

• common causes
• symptoms
• X-ray findings
• management

Answer 29