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NMF: General Surgery > Surgery > Flashcards

Surgery Flashcards

1
Q

Name some types of external hernia

A 
inguinal
femoral
incisional
umbilical
epigastric
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2
Q

What are the 2 types of groin hernia?

A

femoral

inguinal

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3
Q

what type makes up around 80% of hernias?

A

inguinal

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4
Q

What are the signs and symptoms of inguinal hernia

A

visible lump that enlarges when coughing
heavy feeling/discomfort
pain/ache on exertion
constipation

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5
Q

What are the risk factors for hernia?

A 
personal hx
increasing age
male
white
chronic cough/ chronic constipation due to raised intraabdominal hernia
smoking
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6
Q

What anatomical landmark separates indirect and direct inguinal hernia?

A

inferior epigastric artery

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7
Q

Where is the inferior epigastric artery in relation to the spermatic cord?

A

medial

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8
Q

Where is an indirect inguinal hernia?

A

bowel enters inguinal canal through deep inguinal ring lateral to inferior epigastric artery

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9
Q

Where is a direct inguinal hernia?

A

Bowel enters the inguinal canal “directly” through a weakness in the posterior wall of the canal, termed Hesselbach’s triangle

medial to the inferior epigastric artery

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10
Q

What is the purpose of the inguinal canal embryologically?

A

testes descend from posterior abdomen to scrotum through the canal

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11
Q

Where is the femoral pulse palpated?

A

mid-inguinal point

halfway between pubic symphysis and ASIS

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12
Q

Where is the deep inguinal ring palpated?

A

just above halfway between pubic tubercle and ASIS

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13
Q

What are the contents of the inguinal canal?

A

spermatic cord in males
round ligament in females
part of the ilioinguinal nerve
genital branch of genitofemoral nerve

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14
Q

WHat nerve is most at risk during inguinal hernia repair?

A

ilioinguinal which supplies sensory innervation to genitals

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15
Q

What can cause an indirect inguinal hernia?

A

failure of processus vaginalis to regress

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16
Q

What can cause a direct inguinal hernia?

A

They occur more commonly in older patients, often secondary to abdominal wall laxity or a significant increase in intra-abdominal pressure

17
Q

How does a strangulated hernia present?

A

irreducible, tender, tense lump
pain out of proportion
bowel obstruction

18
Q

What are the two types of hernia repair surgery?

A

open repair (lichtenstein) or laparascopic (tep or TAPP)

19
Q

What method of repair is preferred for a primary hernia?

A

open mesh repair

20
Q

What method of repair is preferred for bilateral or recurrent hernia?

A

laparoscopy

21
Q

How does laparascopic hernia repair compare to open repair?

A

longer operating times but quicker post-operative recovery, fewer complications, and less post-operative pain

22
Q

When should bowel obstruction be managed surgically?

A

ischaemia
caused by strangulation/ tumour
not settled in 48hrs conservatively

23
Q

Which cases of bowel obstruction rarely settle without surgery?

A

large bowel obstruction or virgin small bowel obstruction (ie no prev surgery)

24
Q

What surgery is usually performed for bowel obstruction?

A

laparotomy

25
Q

What are the 3 aspects of surgical repair of a perforation?

A
  1. washout
  2. identify lesion + what caused it
  3. repair w omental patch or using hartmanns
26
Q

What is hartmanns procedure?

A

surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

27
Q

Which vessel is vulnerable during pfannsteil incision or laparascopic surgery?

A

inferior epigastric artery

28
Q

Which type of procedure can cause retroperitoneal bleeding?

A

angiography via the external iliac artery

29
Q

What is the dentate line?

A

divides lower 1/3rd of anal canal from the hindgut

30
Q

How does left sided colon cancer present?

A

rectal bleeding, altered bowel habits, tenesmus

31
Q

How does right sided colon cancer present?

A

anaemia

32
Q

What is the gold standard investigation for colon cancer?

A

colonoscopy

alternative is CT colonography

33
Q

How are colon cancers staged?

A 
Dukes
A = beneath MP
B = extend past MP
C = lymph
D = distant mets
34
Q

How can an ileostomy be differentiated from a colostomy?

A

ileostomy has a spout and is on the right

colostomy is flush with the skin and on the left

NMF: General Surgery (8 decks)

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