Surgery Flashcards
Colovesical fistula Px and Rx
Px:
Background of diverticular disease
Dark sediment in urine
Recurrent UTIs
Rx:
Resection of involved bowel + primary anastomosis
Ix of choice for haemorrhoids
PROCTOSCOPY + rigid sigmoidoscopy
- Flexi sig if nothing found
(If dark red blood or CIBH, consider colonoscopy as first choice)
Causes of haemorrhoids
Treatment options
Idiopathic (most common) Pregnancy Heart failure Chronic constipation Pelvic mass Portal hypertension
Rx options:
sclerotherapy
banding
haemorrhoidectomy
Surgical treatment for localised Paget’s disease fo the nipple
Breast conserving surgery
Surgical treatment for DCIS
Breast conserving surgery
Electrolyte changes in referring syndrome
hypoK
hypoMg
hypoPO4
Patient on PN has deranged LFTs. What complication of PN is this?
What is the Rx?
Cholestasis
Rx: Increase amount of enteral feed
Options for debridement of necrotic ulcer
Surgical or maggot therapy
Pain and reduced ileostomy output
Dx and Rx?
Constipation
Rx: MgSO4 (osmotic laxative) - best in context of ileostomy
Gaucher’s disease presentation and pathology
Lysosomal storage disease prevalent in Ashkenazi Jews
Px: bleeding, bruising, hepatosplenomegaly, deranged LFTs, pancytopenia
Lipid accumulates in organs causing pancytopenia, hepatosplenomeg etc.
BM aspirate: lipid laden macrophages
14yo with long term exertion knee pain now has bone pain worse at night
o/e: swelling medial aspect of knee
Knee XR: Codman triangle and fir tree like appearance
Osteosarcoma
Mammograms not suitable for assessment for breast lump if patient young or old?
Young - makes image difficult to interpret
Intussecuption Px and Ix
Bowel obstruction from 5mo-3yo
“Redcurrant jelly” stools
USS: bullseye
Neonate can’t feed + mucus filled vomit + can’t pass NG
?cause
trachea-oesophageal fistula
Grading and Staging of a tumour definitions
Grade: histopathological cell differentiation
Stage: extend of local and distant spread
ie. high grade tumours can still be resectable if stage low
Area of red/white discolouration in a alcohol heavy smoker
Squamous cell ca
(alcohol and smoking both RFs)
Can also present as a non-healing ulcer
Slow growing left sided facial mass inferior to angle of mandible. Dx and Rx?
Pleomorphic adenoma (benign) Parotidectomy
Can involve facial nerve but be suspicious of malignancy if present
Fast growing and spreading thyroid cancer occurring in older patients with poor prognosis
Anaplastic
Thyroid cancer in younger patients with good prognosis
Papillary
Thyroid cancer that can cause hypocalcaemia due to calcitonin production
Medullary
IV Trastuzumab (Herceptin) indication + MoA
Indication: HER2 +ve breast cancer
MoA: Binds HER2 to reduce cell division
Tamoxifen indication + MoA
Indication: Oestrogen receptor positive breast cancer
MoA: SERM antagonises oestrogen receptors in breast tissue
NB. BUT agonises oestrogen in endometrium ie. increased ca risk
Anastrazole indication + MoA
Indication: Oestrogen receptor positive breast cancer
MoA: aromatase inhibitor ie. reduce production of oestrogen
NB. reduces bone density ie. co-prescribe bisphosphonate
Associated risks of undescended testis
Inguinal hernia
Testicular torsion
Testicular cancer
Infertility
NB. not epididymo-orchitis
Smooth superficial mass immediately below and lateral to umbilicus. Dx and Rx?
Spigelian hernia
Rx: Surgical repair - high risk of strangulation
Colorectal screening programme: what test? who gets it? how often?
Faecal occult blood test
OR
Faecal immunochemical test
(FIT or FOB)
Every 2 years 60-74 in England
Every 2 years 50-74 in Scotland
Acute anal fissure Rx
o Dietary advice o Bulk forming laxatives (first line) -> then try lactulose o Topical anaesthetics o Lubricants o Analgesia o (NOT top steroids)
Chronic anal fissure Rx
o Above acute measures
o Topical GTN
o If persists after 8/52 -> refer 2ndary care for consideration of botulinum toxin
What is tylosis
AD syndrome ~:
- oesophageal SCC
- hyperkeratosis of palmoplantar aspect of palms/soles
Breast cancer urgent referral indication
Breast cancer routine referral indication
Cancer pathway:
30+ and unexplained breast lump
50+ with unilateral nipple Sx
Skin changes that suggest ca (consider)
30+ with unexplained lump in axilla (consider)
o Non-urgent referral:
<30 + unexplained breast lump
Undescended testicle complications
Infertlity Cancer Inguinal hernia Torsion (NOT infection)
Longstanding venous ulcer. Now sloughy, tender and edges raised.
Marjolin’s ulcer: malignant transformation of chronically inflamed skin
Scoring criteria for acute pancreatitis
Ranson - only useful for alcoholic pancreatitis
Glasgow
