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Surgery Flashcards

1
Q

What type of pain is colicky?

A

A squeezing pain which sometimes comes and goes

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2
Q

When suspecting peritonitis, you should ask if it hurts when?

A

Laughing, coughing or going over speedbumps

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3
Q

What will be the difference in movement of patients with peritonitis or colicky pain?

A

Peritonitis- completely still

Colicky- move about, can’t be comfortable

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4
Q

Where does gallbladder pain radiate?

A

Round to back

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5
Q

Where does pancreas pain radiate?

A

Through to back

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6
Q

The appendix is what kind of structure?

A

Midgut

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7
Q

Describe pain of appendicitis?

A

Starts in umbilical region and then shifts to RIF

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8
Q

What is spread pain?

A

When it starts localised and then spreads all over- different to shift!!

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9
Q

What causes somatic pain?

A

Area of inflammation

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10
Q

Inflammation from only one structure causes pain where? What is this known as?

A

In its corresponding area (foregut, midgut, hindgut)- local peritonism

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11
Q

Where is sore to touch in peritonitis?

A

Everywhere

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12
Q

What is a really important thing to know about the onset of pain?

A

If it came on suddenly or gradually

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13
Q

What type of pain will inflammation give you?

A

Throbbing

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14
Q

What kind of pain will an obstruction give you?

A

Colicky

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15
Q

When does pain make patients unable to breathe?

A

Peritonitis

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16
Q

What can cause shoulder tip pain?

A

Gallbladder or liver pain from aggravation of the diaphragm

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17
Q

What is the best pain relief but what is its downside?

A

IV morphine- all patients who have had this must be admitted

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18
Q

What cases don’t get IV morphine, what do they get instead?

A

Colic- anti-inflammatory

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19
Q

What causes tenderness to percussion?

A

Peritonism

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20
Q

What is voluntary guarding?

A

Patients tense up for first/second exam but this will go away

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21
Q

What is involuntary guarding?

A

Physiological response to peritonitis- will not go away

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22
Q

What type of pain does cholecystitis cause?

A

Biliary colic

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23
Q

What type of pain does diverticulitis cause?

A

LIF pain

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24
Q

What type of pain does an intestinal obstruction cause, what are some associated symptoms?

A

Colic- nausea and vomiting

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25
Q

What age are people with appendicitis?

A

Either young or old

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26
Q

What are some other symptoms of appendicitis?

A

Sick maybe once, fever

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27
Q

What will the CRP on day 1 of appendicitis be?

A

Normal usually

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28
Q

What should you find out about abdominal masses during a history?

A

Size (changes), tender, duration, associated symptoms

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29
Q

What are important investigations to do for an abdominal mass?

A

CXR, AXR, ultrasound, CT, sigmoid/colon/endoscopy + biopsy, ERCP, laparoscopy and biopsy

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30
Q

What is abdominal mass with a history of collapse and pain radiating to the back likely to be? What would be the investigation of choice to confirm?

A

AAA- CT

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31
Q

What is abdominal mass with a history of weight loss, jaundice and hepatomegaly to the back likely to be? What would be the investigation of choice to confirm?

A

Hepatic mass- US, CT liver biopsy

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32
Q

What is abdominal mass with a history of trauma and weight loss with splenomegaly likely to be? What would be the investigation of choice to confirm?

A

Splenic mass- CT, MRI, PET

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33
Q

What is abdominal mass with a history of renal failure and weight loss likely to be? What would be the investigation of choice to confirm?

A

Renal mass- US, CT

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34
Q

What is abdominal mass with a history of weight loss, alcohol and non-tenderness likely to be? What would be the investigation of choice to confirm?

A

Pancreatic mass- ERCP, CT, biopsy

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35
Q

What is abdominal mass with a history of weight loss, altered bowel habit and PR bleeding likely to be? What would be the investigation of choice to confirm?

A

Colorectal cancer- CT, colonoscopy

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36
Q

What is another really important cause of abdominal masses?

A

Hernias

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37
Q

What type of hernia is caused by an insufficiently healed wound?

A

Incisional

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38
Q

Where do midline hernias come out between?

A

The two rectus muscles

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39
Q

What is more sinister than bleeding while defecating?

A

Bleeding into pants

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40
Q

What is absolute constipation?

A

No flatus or faeces

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41
Q

What does a tinkling bowel sound mean?

A

Obstruction

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42
Q

When can bowel sounds be absent?

A

Very obese people

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43
Q

What are Cullen’s and Grey Turner’s signs suggestive of?

A

Acute pancreatitis

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44
Q

What is a really important investigation to do for acute pancreatitis?

A

Amylase

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45
Q

What are cases of people who would not go to theatre immediately?

A

Pancreatitis or diabetic ketoacidosis

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46
Q

What are examples of patients who would go to theatre immediately?

A

Faecal peritonitis, ischaemic gut

47
Q

What can free air under the diaphragm be suggestive of?

A

Perforated ulcer

48
Q

What determines if an obstruction is an emergency or not?

A

Competent ileocaecal valve- emergency

Not competent- not emergency

49
Q

Incisional and midline hernias will do what on coughing and lying flat?

A

Coughing- bulge

Lying flat- disappears

50
Q

Why is there more pain below the pectinate line than above?

A

That is skin, not mucosa

51
Q

What are haemorrhoids?

A

Enlarged vascular cushions in the lower rectum and anal canal

52
Q

What are symptoms of haemorrhoids?

A

Painless bleeding, fresh red blood not mixed with the stool

53
Q

What are common symptoms of bowel problems which are NOT the case in haemorrhoids?

A

Change in bowel habit and weight loss

54
Q

Where do the positions of haemorrhoids relate to?

A

Branches of the superior haemorrhoidal artery occurring at 3, 7 and 11 o clock

55
Q

What position should the patient be in when looking for haemorrhoids?

A

Lithotomy

56
Q

What exams should be done for haemorrhoids?

A

PR exam, rigid sigmoidoscopy, proctoscopy

57
Q

What test should be done for >50 with suspected haemorrhoids?

A

Flexible sigmoidoscopy

58
Q

When should haemorrhoids be managed?

A

When symptomatic (normally constipation)

59
Q

What are different ways of surgically treating haemorrhoids?

A

Rubber band ligation
Open/stapled haemorrhoidectomy
HALO/THD procedure

60
Q

What is the HALO procedure?

A

Use a Doppler to find vessel, tie off the vessel and the haemorrhoid shrinks

61
Q

What happens to cause partial rectal prolapse?

A

Prolapse of anterior muscle

62
Q

What is a rectal prolapse?

A

Protruding mass from the anus, especially during defaecation

63
Q

What is it common to pass with a rectal prolapse?

A

Blood or mucus

64
Q

How do you treat complete rectal prolapse?

A

Perianal/abdominal rectopexy

65
Q

How is an incomplete prolapse treated in children?

A

Diet advice and treat constipation

66
Q

How is an incomplete prolapse treated in adults?

A

Similarly to haemorrhoids

67
Q

What is an anal fissure?

A

A tear in the anal margin due to passage of a constipated stool

68
Q

How is an anal fissure differentiated from haemorrhoids?

A

Fissure is painful

69
Q

What could multiple anal fissures suggest?

A

Crohn’s

70
Q

Who are anal fissures more common in?

A

Younger people, particularly women

71
Q

How long does the pain of an anal fissure last after defaecation?

A

Half an hour

72
Q

What type of PR bleeding will anal fissures cause?

A

Bright red

73
Q

What is the non surgical treatment for an anal fissure?

A

Dietary advice and stool softeners

74
Q

Ointments containing what drugs can be used for anal fissures?

A

GTN and diltiazem

75
Q

What is a treatment used to paralyse the internal anal sphincter?

A

Botox

76
Q

What is an anal fistula?

A

Internal opening in the anal canal and one or more on peri-anal skin

77
Q

What are rare causes of anal fistulae?

A

Crohn’s, TB and carcinoma

78
Q

What are treatments for anal fistulae?

A

Laying open, setons

79
Q

What are complications of anal fisulae?

A

Pain, bleeding, incontinence, recurrence

80
Q

What are cardiovascular surgery complications?

A

Haemorrhage, MI, DVT

81
Q

What two types of haemorrhage can occur as a complication of surgery?

A

Reactionary (during) or secondary (infection- later)

82
Q

What are some presentations of haemorrhage?

A

Tachycardia, hypotension, oliguria (low urine output)

83
Q

How can haemorrhage in surgery be prevented?

A

Good technique, avoiding sepsis, correction of coagulation disorders

84
Q

What increases risk of MI in surgery?

A

Severe angina, previous MI

85
Q

What is the rule on operating on patients with MI?

A

Try to avoid 6 months following

86
Q

How can an MI following surgery present?

A

Often silent, can be cardiac failure or arrhythmias

87
Q

What increases risk of DVT?

A

Age > 40, previous DVT, major surgery, obesity, malignancy

88
Q

What causes DVT as a complication?

A

Immobility during surgery and hypercoagulable state

89
Q

How can a DVT present?

A

Low grade fever, unilateral ankle swelling, calf/thigh tenderness, shiny skin, pitting oedema

90
Q

What is a first line rule out test for DVT?

A

D-dimers (degradation product of fibrin)

91
Q

What are other tests for DVT?

A

Doppler ultrasound, venography

92
Q

How can DVT be prevented?

A

Compression stockings, low dose subcutaneous heparin, early mobilisation

93
Q

What are respiratory complications of surgery?

A

Lung collapse, pneumonia, PE

94
Q

What does atelectasis/lung collapse during surgery lead to?

A

Pneumonia

95
Q

How is there an increased risk of pneumonia in surgery?

A

Anaesthetic inhibits cilia,, postoperative pain inhibits coughing, aspiration

96
Q

What is the presentation of a chest infection?

A

Fever, dyspnoea, productive cough, confusion

97
Q

How can a chest infection be prevented?

A

Stop smoking, adequate analgesia, physiotherapy

98
Q

What causes a PE?

A

DVT

99
Q

How does a PE present?

A

Tachypnoea, dyspnoea, confusion, pleuritic pain, haemoptysis

100
Q

What is a good test for PE?

A

V/Q scan or CTPA

101
Q

What are GI complications of surgery?

A

Ileus, anastomosis, adhesions

102
Q

What does ileus mean?

A

Paralysis of intestinal motility

103
Q

How does an ileus present?

A

Vomiting, abdominal distension, dehydration, silent abdomen

104
Q

How can an ileus be prevented?

A

Minimal operative trauma, laparoscopy, avoidance of sepsis

105
Q

What is an adhesion?

A

Fibrin to fibrous tissue

106
Q

Where are common adhesions?

A

Bowel to abdominal wall, lung to chest wall

107
Q

What can cause adhesions?

A

Inflammatory response, ischaemia

108
Q

What can adhesions present as?

A

An intestinal obstruction

109
Q

What complications can arise with a wound?

A

Infection, splitting, hernia

110
Q

How does a wound infection present?

A

Pyrexia, redness, pain, swelling, discharge

111
Q

What are urinary surgical complications?

A

Acute retention of urine, UTI, urethral stricture, acute renal failure

112
Q

What are neurological surgical complications?

A

Confusion, stroke, peripheral nerve lesions

113
Q

What does confusion occur as a result of?

A

Hypoxia

GI (17 decks)

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