Surgery conditions (4) Flashcards
What’s gangrene?
Death of tissue from poor vascular supply
Classification of gangrene (3)
- Wet: tissue death + infection
- Dry: tissue death only
- Pregangrene: tissue on the brink of gangrene
Gas gangrene
- organism responsible
- risk factors
Gas Gangrene
- Clostridium perfringes myositis
- Risk factors: DM, trauma, malignancy
Presentation of gas gangrene
- Toxaemia
- Haemolytic jaundice
- Oedema
- Crepitus from surgical emphysema
- Bubbly brown pus
Management of gas gangrene
- Debridement (may need amputation)
- Benzylpenicillin + metronidazole
- Hyperbaric O2
What’s synergistic gangrene?
Synergistic Gangrene→ involves aerobes + anaerobes
• Fournier’s: perineum
• Meleney’s: post-op ulceration
• Both progress rapidly to necrotising fasciitis + myositis
Treatment of synergistic gangrene
- take cultures
- Debridement (including amputation)
- Benzylpenicillin ± clindamycin
Necrotising fascitis classification (2)
It can be classified according to the causative organism:
- type 1 → caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
- type 2 → caused by Streptococcus pyogenes
Features of Necrotising Fascitis
- acute onset
- painful, erythematous lesion develops
- often presents as rapidly worsening cellulitis with pain out of keeping with physical features
- extremely tender over infected tissue
Management of Necrotising fascitis
- urgent surgical referral debridement
- intravenous antibiotics
Epidemiology of Pyloric Stenosis
- Sex: M>F=4:1
- Race: ↑ in Caucasians
Presentation at 6-8wks
Presentation/symptoms of Pyloric stenosis
- 6-8wks
- Projectile vomiting minutes after feeding
- RUQ mass: olive
- Visible peristalsis
Ix of pyloric stenosis
- Test feed: palpate mass + see peristalsis
- Hypochloraemic hypokalaemic metabolic alkalosis
- US
Management of Pyloric Stenosis
- Resuscitate and correct metabolic abnormality
- NGT
- Ramstedt pyloromyotomy: divide muscularis propria
What’s angiodysplasia?
- Submucosal AV malformations
- 70-90% occur in right colon
- Can affect anywhere in GIT
Presentation of Angiodysplasia
Angiodysplasia →Submucosal AV malformations
- 70-90% occur in right colon
- Can affect anywhere in GIT
Presentation
- Elderly
- Fresh PR bleeding
Examination in angiodysplasia
To exclude other diseases
- PR exam
- Ba enema
- Colonoscopy
- Mesenteric angiography or CT angiography
- Tc-labelled RBC scan: identify active bleeding
Treatment of angiodysplasia
- Embolisation
- Endoscopic laser electrocoagulation
- Resection
Sebaceous cysts
- two types
- pathophysiology of these types
Sebaceous cysts is a general term which encompasses both:
- epidermoid cyst
- pilar cyst
Epidermoid cysts → proliferation of epidermal cells within the dermis
Pilar cysts (also known as trichilemmal cysts or wen) derive from the outer root sheath of the hair follicle
Common locations of sebaceous cyst
Location: anywhere but most common scalp, ears, back, face, and upper arm (not palms of the hands and soles of the feet)
They will typically contain a punctum
Inspection of sebaceous cyst
- Occur @ sites of hair growth
- Scalp, face, neck, chest and back
- NOT soles or palms
- Central Punctum
Palpation of sebaceous cyst
- Firm
- Smooth
- Intradermal
