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Year 6 > Surgery Conditions > Flashcards

Surgery Conditions Flashcards

1
Q

what are the main signs and symptoms of acute appendicitis?

A

symptoms:
- peri-umbilical abdo pain radiating to RIF
- pain worse on coughing
- vomiting once or twice
- mild fever
- anorexia

signs:
- rebound tenderness
- right-sided tenderness with pelvic appendix
- Rovsing’s sign
- Psoa’s sign

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2
Q

Diagnosis for acute appendicitis

A

increased ESR CRP
neutrophil leucocytosis
urine analysis: exclude pregnancy, renal colic and UTI
USS if female
CT if needed

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3
Q

what is the management for acute appendicitis?

A
  • lap appendicectomy
  • prophylactic ABx
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4
Q

what is the pathophysiology of acute pancreatitis?

A

auto digestion of pancreatic tissue by the pancreatic enzymes leading to necrosis

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5
Q

what are the signs and symptoms of acute pancreatitis?

A
  • severe epigastric pain radiating to back
  • vomiting
  • epigastric tenderness
  • low grade fever
  • Cullen sign: periumbilical discolouration
  • Grey-Turner sign: flank discolouration
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6
Q

what rare feature is associated with pancreatitis?

A

ishcaemic retinopathy

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7
Q

what are the investigations for acute pancreatitis?

A
  • increased serum amylase
  • increased serum lipase
    imaging
  • USS
  • contrast enhanced CT

bloods:
- hypocalcaemia
- hyperglycaemia
- elevated LDH
- elevated AST

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8
Q

what scoring systems are used for acute pancreatitis?

A

ranson score
glasgow score

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9
Q

what are the causes of acute pancreatitis?

A

GET SMASHED
gallstones
ethanol
steroids
mumps
autoimmune
scorpion venom
hyeprtryglyceridaemia
hypercalcaemia
hypothermia
ERCP
Drugs e.g. azathioprine, furosemide, pentamidine, steroids

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10
Q

what are the complications of acute pancreatitis?

A
  • peripancreatic fluid collections
  • pseudocysts
  • pancreatic necrosis
  • pancreatic abscess
  • haemorrhage
  • ARDS
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11
Q

what is the management of acute pancreatitis?

A

fluid resus:
- crystalloids
- aim for >0.5ml/kg/hr urine output
analgesia:
- IV opioids
nutrition:
- NBM
- enteral nutrition
surgery:
- if due to gallstones
- obstructed biliary system -> ERCP
- if necroses -> necrosectomy

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12
Q

what is the difference between acute and chronic anal fissures?

A

acute: less than 6 weeks
chronic: more than 6 weeks

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13
Q

what are the risk factors for anal fissure?>

A
  • constipation
  • IBD
  • STIs
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14
Q

what are the signs and symptoms of anal fissures?

A
  • painful bright red rectal bleeding
  • fissures seen posterior midline
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15
Q

what is the management of anal fissures?

A

acute:
- high fibre diet
- bulk forming laxatives
- lubricants
- topical anaesthetics
analgesia

chronic:
- topical GTN
- surgery e.g. sphincterectomy

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16
Q

what is the pathophysiology of aortic dissection?

A

tear in the tunica intimate of wall of aorta

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17
Q

what are the risk factors of aortic dissection?

A
  • hypertension
  • trauma
  • bicuspid aortic valve
  • marfans
  • Ehlers danlos
  • pregnancy
  • syphilis
  • turner’s
  • noonan’s
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18
Q

what are the signs and symptoms of aortic dissection?

A
  • sharp and severe chest and back pain
  • chest pain = type A
  • upper back pain = type B
  • weak carotid, brachial or femoral pulse
  • aortic regurgitation
  • hypertension
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19
Q

what is the classification of aortic dissection?

A

Stanford:
- type A: ascending aorta
- type B: descending aorta

DeBakey

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20
Q
A
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21
Q

what is the management of aortic dissection?

A

type A:
- surgical management
- control BP

type B:
- conservative management
- bed rest
- labetalol to reduce BP

22
Q

what are the complications of aortic dissection?

A

backward tear:
- aortic regurgitation

forward tear:
- unequal pulses and BP
- stroke
- renal failure

23
Q

what is aortic regurgitation?

A

leaking of aortic valves that causes blood to flow in the reverse direction during ventricular systole

24
Q

what are the chronic causes of aortic regurgitation?

A

valve disease:
- rheumatic fever
- calcific valve disease
- RA or SLE
- bicuspid aortic valve

aortic root disease:
- bicuspid aortic valve
- Ankylosing spondyl
- hypertension
- Marfan’sw

25
Q

what are the acute causes of aortic regurgitation?

A

valve disease:
- infective endocarditis

aortic root disease:
- aortic dissection

26
Q

what are the signs and symptoms of aortic dissection?

A
  • early diastolic murmur
  • collapsing pulse
  • wide pulse pressure
  • quincke’s sign
  • de musset’s sign
27
Q

what are the investigations for aortic regurgitation?

A

echocardiography

28
Q
A
29
Q

What is the management of aortic regurgitation?

A

medical management of any associated heart failure
surgery: aortic valve indications include
symptomatic patients with severe AR
asymptomatic patients with severe AR who have LV systolic dysfunction

30
Q

What are the clinical features of aortic stenosis?

A

chest pain
dyspnoea
syncope / presyncope (e.g. exertional dizziness)
murmur
an ejection systolic murmur (ESM) is classically seen in aortic stenosis
classically radiates to the carotids
this is decreased following the Valsalva manoeuvre

31
Q

What are the severe features of aortic stenosis?

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

32
Q

What are the causes of aortic stenosis?

A

degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

33
Q

What is the management of aortic stenosis?

A

if asymptomatic then observe the patient is a general rule
if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
options for aortic valve replacement (AVR) include:
- surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
- transcatheter AVR (TAVR) is used for patients with a high operative risk
balloon valvuloplasty
- may be used in children with no aortic valve calcification
- in adults limited to patients with critical aortic stenosis who are not fit for valve replacement

34
Q

What is bicuspid aortic valve asssociated with?

A

Left dominantly coronary circulation and Turner’s syndrome

35
Q

What are the complications of bicuspid aortic valve?

A
  • Aortic stenosis and regurgitation
  • aortic dissection and aneurysm of ascending aorta
36
Q

What are the most common valves need replacing?

A

Aortic and mitral valve

37
Q

Describe the use of bio prosthetic valves

A
  • deteriorates over time
  • warfarin given for first 3 months
38
Q

Describe the use of mechanical valves

A
  • most common is bileaflet valve
  • increased risk of thrombosis so you need long term anticoagulation -> use warfarin
39
Q

What are the causes of ascites with SAAG >11g/L?

A

Liver disorders:
- cirrhosis
- acute liver failure
- metastases

Cardiac:
- right heart failure
- constrictive pericarditis

Other:
- budd chiari
- portal vein thrombosis
- veno-occlusive disease
- myxoedema

40
Q

What are the causes of ascites with SAAG <11g/L

A

Hypoalbuminaemia
- nephrotic syndrome
- severe malnutrition

Malignancy:
- peritoneal carcinomatosis

Infections:
- tuberculous peritonitis

Other:
- pancreatitis
- bowel obstruction
- biliary ascites
- post op lymphatic leak

41
Q

describe the management of ascites

A
  • reduce sodium
  • fluid restriction if sodium is less than 125mmol/L
  • aldosterone antagonists e.g. spironolactone
  • drainage if tense ascites: paracentesis
  • prophylactic ABx
42
Q

What are the signs and symptoms of mastitis?

A

Painful, tender red, hot breast
Fever
Malaise

43
Q

What is the management of mastitis?

A
  • continue breastfeeding
  • analgesia
  • warm compresses
  • if unwell after 12-24 hours: oral flucloxacillin for 10-14 days
44
Q

What are the 2 main types of anti-oestrogen drugs?

A

Selective oestrogen receptor modulators SERM
Aromatase inhibitors

45
Q

What are SERMs used for?q

A
46
Q

What are SERMS used for?

A

Example: tamoxifen
Used in oestrogen receptor positive breast cancer

47
Q

What are the side effects of tamoxifen?

A

Menstrual disturbance e.g. vaginal bleeding
Hot flushes
VTE
Endometrial cancer

48
Q

What are aromatase inhibitors used for?

A
  • ER +ve breast cancer
  • reduces peripheral oestrogen synthesis

E.g. anastrazole

49
Q

What are the side effects of aromatase inhibitors ?

A

Osteoporosis
Hot flushes
Arthralgia
Insomnia

50
Q

What are the 2 types of malignant breast cancer?

A

Invasive ductal carcinoma
Invasive lobular carcinoma

51
Q

What is involved in the triple assessment for breast cancer?

A
  • history and examination
  • USS or mammogram
  • fine needle aspiration or biopsy
52
Q
A

Year 6 (1 decks)

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