Surgery -common Flashcards
What is appendicitis?
Acute inflammation of the appendix most likely due to obstruction of the lumben
What is the presentation of appendicitis?
*Abdominal pain mid abdomen to RIF
*Anorexia
*Nausea and vomiting
*RLQ tenderness - McBurney’s point
*Low grade pyrexia
Examination in appendicits
*Rovsing’s sign: palpation of LIF causes pain in the right
*Guarding
*Rebound tenderness in RIF
*Percussion tenderness
What does rebound tenderness suggest in the case of appendicitis?
That there is peritonitis due to rupture
What investigations should be carried out in appendicitis?
*FBC
*CRP
*Ultrasound scan if imaging is required, or CT
*Urinalysis to rule out a UTI
*Pregnancy test in women
What are the differentials for appendicitis?
*UTI
*Ectopic pregnancy
*Ovarian cysts
*Meckel’s diverticulum
What is the management of appendicitis?
Supportive care and appendectomy
What are the complications of appendicitis?
*Gangrene
*Rupture leading to peritonitis
What are the complications of an appendectomy?
- Bleeding
*Infection
*Scar
*Thromboembolic event
*Damage to the bowel or bladder
*Complciations relating to anaesthesia
What is Cholecystitis?
Inflammation of the gallbladder caused by blockage of the cystic duct
What is the presentation of cholecystitis?
*RUQ pain which may radiate to the shoulder
*Nausea and vomiting
*tachycardia and tachypnoea
*raised inflammatory markers
Murphy’s sign
Palpation of the RUQ causes arrest of inspiration - cholecystitis
What investigations should be carried out in cholecystitis?
*FBC
*CRP
*Abdominal USS - thick gallbladder Wal, stones/sludge, fluid around the gallbladder
What are the complications of cholecystitis?
*Sepsis
*Gallbladder empyema
*Gangrenous gallbladder
*Perforation
What is the management of cholecystitis?
*Conservative: will by mouth, IV fluids, antibiotics, NG tube if vomiting
*ERCP can be used to remove the stones in the common bile duct
*Cholecystectomy within 72 hours of symptoms onset or if inflamed then can wait 6-8 weeks for the infection to settle
What are the causes of acute pancreatitis?
*Idiopathic
*Gallstone
*Alcohol
*Trauma
* Steroids
*Mumps
*Autoimmune
* Scorpion bite
*Hyperlipidaemia
*ERCP
*Drugs (furosemide, thiazide like diuretics, azathioprine)
What is the presentation of acute pancreatitis?
*Severe epigastric pain which may radiate to the back
*Nausea and vomiting
*Systemically unwell (tachycardia, hypotension, hypovolaemia, low grade fever)
*Dyspnoea (due to diaphragmatic splinting)
*Jaundice may present if gallstones
What investigations should be carried out for acute pancreatitis?
*Lipase or amylase
*FBC
*CRP
*U+Es
*LFTs: if ALT >3x normal then suggests gallstones
*Calcium: hypercalcaemia is a rare cause
*Consider a transabdominal USS to look for biliary pathology
What is the management of acute pancreatitis?
*Glasgow score to assess severity: 0/1 is mild, 2 is moderate, 3+ is severe
*ABCDE and resuscitation and IV fluids
*Nil by mouth in severe pancreatitis
*Analgesia
*ERCP or cholecystectomy if gallstone pancreatitis
* Treatment of complications
What are the complications of acute pancreatitis?
*Necrosis
*Infection in necrotic area
*Abscess Formation
*Acute peripancreatic fluid collections
*Pseudocysts
*Chronic pancreatitis
*Sepsis
What is the prognosis of pancreatitis?
*80% mild and will resolve in 3-7 days
*mortality overall is around 5% but rises to 25-30% in severe cases
What is the presentation of peritonitis?
*Abdominal pain/tenderness
*Signs of ascites
*Fever
*nausea and vomiting
*Diarrhoea
*Altered mental status
What investigations should be carried out in peritonitis?
*FBC
*Serum creatinine
*Ascitic fluid: check appearance, neutrophil count, culture
*Blood cultures
*LFTs: raised bilirubin and liver enzymes, low albumin
What is the management of peritonitis?
*IV cefotaxime
What is diverticulitis?
Inflammation and infection of the diverticula
What is the presentation of diverticulitis?
*Pain and tenderness in the LIF
*Fever
*Diarrhoea
*Nausea and vomiting
*Rectal bleeding
*Palpable abdominal mass
*Raised inflammatory markers and white blood cells
What is the management of diverticulitis?
*At least 5 days oral co-amoxiclav
*Analgeisia (avoid NSAIDs and opiates)
*Clear liquids only - no solid food until symptoms improve
What are the complications of diverticulitis
*Perforation
*Peritonitis
*Peridiverticular abscess
*large haemorrhage
*Fistula e.g. between colon and bladder
*Ileus/obstruction
What are the risk factors of an aortic aneurysm?
*Smoking
*Sedentery lifestyle
*Hypertension
*Diabetes
*Hyperlipidaemia
What is the presentaiton of a ruptured aortic aneurysm?
*Severe abdominal pain radiating to the back
*Haemodynamic instability
*Pulsatile and expansile mass in the abdomen
*Collpase
*Loss of consciousness
What is the management of ruptured aortic aneurysm?
*Surgical emergency
*If haemodynamically stable, CT angiogrpahy can be used to diagnose or exclude
What are the features of acute limb ischaemia?
*Pallor
*Pulselessness
*Perishingly cold
*Paraesthesia
*Painful
*Paralysed
What investigations should be carried out in acute limb ischaemia
*Doppler
*ABPI
*Investigate to determine thrombus or embolus
What is the management of acute limb ischaemia?
*Endovascular thrombolysis
*Endovascular thrombectomy
*Bypass surgery
*Amputaiton if unable to restore blood flow
*surgical embolectomy
*ABCDE approach, IV opioids, vascualr review, unfractionated heparin
