Surgery Flashcards
What are the “3 I’s” of “Thumbprinting” ?
Infection (C.diff or salmonella colitis) / Inflammation (UC or Crohn’s) / Ischaemia (Ischaemic colitis)
Surgical Sieve “TIN CAN BEDs”
Trauma Infection Neoplasm Congenital Acquired Neuro Blood Endocrine Drugs Syphilis
List Dysphagia (difficulty swallowing) differentials
Oesophageal carcinoma (Squamous/ adenocarcinoma)
Achalasia (LES dysfunction)
Oesophageal / peptic stricture
Hyperthyroidism
Oesophageal candidiasis (immunosuppressed patients)
Bulbar Palsy (CN IX - XII)
Trypanosomiasis (Chagas’ disease) tropical disease
GORD
Extrinsic Malignancies (lung/lymph node) can externally compress oesophagus)
Name the 3 Bacteria that can cause life threatening infections in patients with splenectomy.
Neisseria Meningitidis (aka Menigococcus) Streptococcus Pneumonia (aka Streptococcus) Haemophilus Influenza
Most common places for oesophageal metastases
The 2 L’s - Liver and Lungs
List differentials for a RIF mass
Appendix abscess / Mass (omentum envelopes inflammed appendix giving a mass like feeling on palpation)
Hepatomegaly
Crohn’s
Caecal carcinoma
Meckels diverticulum (paeds)
Ileo-ceacal stricture (Yersinia and TB - 2 rare but important differentials to be excluded with CXR)
List the criteria that make a UTI complicated
> 2 in 6 months / > 3 in 1 Year
Pyelonephritis (i.e loin pain and upper UTI)
Men
Anatomical disruption (stent/catheter/stricture)
List the causes of Pancreatitis
I GET SMASHED
Iatrogenic Gall stones Ethanol (alcohol) Trauma Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP Drugs (Azothioprine/ Anticonvulsants (ex. sodium valproate) / Antimicrobials (metronidazole) / Diuretics (ex. Thiazides and Furosemide)
Name the two strains of bacteria and the toxin that causes Haemolytic Uraemic Syndrome (HUS). List the classic pathological triad associated with HUS.
E.Coli (0157:H7) and Shigella - Shiga toxin
Anaemia
AKI
Thrombocytopaenia (Low platelets)
List post surgical complications of GI surgery
Infection (Suture site/from laporotomy/UTI/ Hospital acquired pneumonia) DVT/PE Haemorrhage Obstruction Paralytic ileus (bowel goes to sleep) Anastomotic leak
Name the 3 Features of Charcot’s Triad and which condition this indicates.
Fever (usually with rigors)
Jaundice
RUQ pain
Ascending Cholangitis (infection of the biliary tree)
5 risk factors for acute cholecystitis
5F's Female Forty Fat Fertile Family History
Pregnancy / oral contraceptives (oestrogen causes more bile to be secreted into bile duct) / any condition that causes haemolysis (sickle cell disease etc) / Malabsorption (ileal resection / crohns)
What is the normal diameters of the Small bowel / Large bowel / Appendix / Caecum ?
3-6-9 rule
Small bowel <3cm
Large bowel <6cm
Appendix <6mm
Caecum <9cm
What is Murphy’s sign?
Apply pressure to RUQ and ask patient to inhale. Cessation of inspiratory effort due to pain in RUQ is indicative of Gall bladder Inflammation (i.e cholecystitis and not biliary colic).
Name 6 complications of gall stones
Acute Pancreatitis
Gall bladder mucocoele (mucous filled overdistended gall bladder - can become infected and lead to empyema)
Porcelain gall bladder (calcified gall bladder wall)
Small bowel obstruction (lodge at ileo-coecal valve)
Ascending cholangitis (infection of biliary tree)
List the Glasgow-Imrie score criteria that determines the severity of Pancreatitis?
Remember Mnemonic PANCREAS
PaO2 (<60 mmHg) Age (> 55 y/o) Neutrophilia (>15) Calcium (<2) uRea (>16) Enzymes (LDH > 600 AST/ALT > 200) Albumin (<32) Sugar (glucose >10)
Name the synonym for ovulation pain, and the causes.
Mittelschmertz - Endometriosis / Adhesions/ Surgical Scarring/ Scarring from STI’s (ex. Chlamydia).
Mesenteric Adenitis is typically precipitated by which type of infection? It is thus important to perform which examination to rule out mesenteric adenitis as the cause of GI pain.
Respiratory Tract Infection
Ear and Throat examination (sore ears/throat and symptoms of cold predate mesenteric adenitis)