Surgery Flashcards
What is the triad of anaesthesia
Hypnosis, muscle relaxation, analgesia
What are some complications of anaesthesia?
Respiratory depression
Nausea
What are some general complications of surgery?
Infection
Haemorrhage
What are some patient risk factors for surgery?
CAD
DM
Haemophilia
What are some criteria for Well’s scoring?
Active cancer Paralysis Major surgery within 2 weeks Local tenderness Entire leg swollen Calf swelling >3cm Pitting oedema Collateral superficial veins Previous DVT (Alternative diagnosis more likely = -2)
What Well’s score makes DVT unlikely?
Less than 1 - do D dimer
What are some causes of bilateral leg swelling?
Right heart failure
Renal or liver failure - decreased albumin
Venous insufficiency
Pregnancy
What are some complications of biliary surgery?
Cholangitis, pancreatitis
Bile duct stricture
Where are colostomies usually situated?
Left iliac fossa
What are the different types of colostomy?
Loop - temporary, protects distal anastomosis, 2 lumens
End - usually permanent
Where are ileostomies usually situated?
Right iliac fossa, spouted
Where are urostomies usually situated?
Right iliac fossa, 2 ureters attached to piece of small bowel
What are some stoma complications?
Infection Not draining High output Hernia Retraction Ischaemia Bleeding
What are some causes of acute abdomen?
Peritonitis Ruptured AAA Appendicitis Pancreatitis Diverticulitis Ruptured ulcer
What are the boundaries of the inguinal canal?
Muscle - internal oblique
Aponeurosis - external oblique
Ligament - inguinal
Tendon - transversals fascia
Where is the deep ring of the inguinal canal?
Halfway along the inguinal ligament
Where is the superficial ring of the inguinal canal?
Superior and medial to the pubic tubercle
What are the features of a direct inguinal hernia?
Passes through posterior wall of the inguinal canal
What are the features of HNPCC?
Autosomal dominant
Risk 80%
Biennial colonoscopy 25-75 years
What are the features of FAP?
Mutation in APC suppressor gene Multiple colorectal adenomas - malignant transformation Risk 100% by age 50 Sigmoidoscopy from 12 years Prophylactic surgery by age 25
What are the red flags for bowel cancer?
Positive faecal occult blood
Over 40 + abdo pain + weight loss
Over 50 + rectal bleeding
Over 60 + IDA or change in bowel habit
Where does bowel cancer spread to?
Liver, lung, bone
What type of surgery is done for caecal/ascending bowel tumours?
Right hemicolectomy
What type of surgery is done for transverse/descending bowel tumours?
Left hemicolectomy
What type of surgery is done for sigmoid bowel tumours?
Sigmoid colectomy
What type of surgery is done for low rectal tumours?
AP resection
What type of surgery is done for emergency/palliative bowel tumours?
Hartmann’s procedure
When is bowel screening done?
60-75 years with faecal occult blood test
What are the red flags for oesophageal cancer?
Dysphagia, weight loss, hoarseness, retrosternal chest pain
What are the risk factors for gastric cancer?
Pernicious anaemia, h pylori, smoking
What are the signs of chronic mesenteric ischaemia?
Severe colicky post-prandial pain
Weight loss
Upper abdominal bruit
What are the criteria for obesity surgery?
BMI over 40 Failure of non-surgical options for 6 months Fit for surgery Intensive management Well motivated patient
What are the treatment options for haemorrhoids?
Increase fluid and fibre Stool softener Rubber band ligation Diathermy Excisional haemorrhoidectomy
What are some complications of diverticular disease?
Perforation Haemorrhage Fistulae Abscesses Post-infective strictures
What are the symptoms of biliary colic?
RUQ -> back pain
What are the symptoms of acute cholecystitis?
Continuous RUQ or epigastric pain
Vomiting, fever, local peritonism
Murphy’s sign
What are the symptoms of cholangitis?
Charcot’s triad - RUQ pain, jaundice, rigors
What are the causes of pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Hyperlipidaemia ERCP Drugs
What are the symptoms and signs of pancreatitis?
Severe epigastric to back pain relieved by sitting forwards
Vomiting
Cullen’s - periumbilical bruising
Grey Turner’s - flank bruising
What tests should be done for pancreatitis?
FBC, LFTs, UEs, blood sugar
Amylase, lipase, ABG
CT
What are the symptoms and signs of kidney stones?
Spasms of loin to groin pain
Nausea and vomiting
Pelvic pain, dysuria, interrupted flow
Renal angle tenderness
What investigations should be done for renal stones?
FBC, UE
Urine dip
Non-contrast CT
What are the treatment options for renal stones?
Pass spontaneously
>5mm medical expulsive - nifedipine/tamsulosin
>48 hours extracorporeal shockwave lithotripsy
What are some causes of urinary tract obstruction?
Stones, clot, tumour
Stricture, neuromuscular dysfunction
Abdominal/pelvic mass
What are the symptoms and signs of acute lower urinary tract obstruction?
Severe suprapubic pain and acute confusion
Distended, palpable bladder
What are some causes of haematuria?
RCC Glomerulonephritis HSP UTI Menstrual Rifampicin Rhabdomyolysis
