Surgery conditions (4)

Question 1

What’s gangrene?

Answer 1

Death of tissue from poor vascular supply

Question 2

Classification of gangrene (3)

Answer 2

• Wet: tissue death + infection
• Dry: tissue death only
• Pregangrene: tissue on the brink of gangrene

Question 3

Gas gangrene

• organism responsible
• risk factors

Answer 3

Gas Gangrene

• Clostridium perfringes myositis
• Risk factors: DM, trauma, malignancy

Question 4

Presentation of gas gangrene

Answer 4

• Toxaemia
• Haemolytic jaundice
• Oedema
• Crepitus from surgical emphysema
• Bubbly brown pus

Question 5

Management of gas gangrene

Answer 5

• Debridement (may need amputation)
• Benzylpenicillin + metronidazole
• Hyperbaric O2

Question 6

What’s synergistic gangrene?

Answer 6

Synergistic Gangrene→ involves aerobes + anaerobes

• Fournier’s: perineum

• Meleney’s: post-op ulceration

• Both progress rapidly to necrotising fasciitis + myositis

Question 7

Treatment of synergistic gangrene

Answer 7

• take cultures
• Debridement (including amputation)
• Benzylpenicillin ± clindamycin

Question 8

Necrotising fascitis classification (2)

Answer 8

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

Question 9

Features of Necrotising Fascitis

Answer 9

• 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

Question 10

Management of Necrotising fascitis

Answer 10

• urgent surgical referral debridement
• intravenous antibiotics

Question 11

Epidemiology of Pyloric Stenosis

Answer 11

• Sex: M>F=4:1
• Race: ↑ in Caucasians

Presentation at 6-8wks

Question 12

Presentation/symptoms of Pyloric stenosis

Answer 12

• 6-8wks
• Projectile vomiting minutes after feeding
• RUQ mass: olive
• Visible peristalsis

Question 13

Ix of pyloric stenosis

Answer 13

• Test feed: palpate mass + see peristalsis
• Hypochloraemic hypokalaemic metabolic alkalosis
• US

Question 14

Management of Pyloric Stenosis

Answer 14

• Resuscitate and correct metabolic abnormality
• NGT
• Ramstedt pyloromyotomy: divide muscularis propria

Question 16

What’s angiodysplasia?

Answer 16

• Submucosal AV malformations
• 70-90% occur in right colon
• Can affect anywhere in GIT

Question 17

Presentation of Angiodysplasia

Answer 17

Angiodysplasia →Submucosal AV malformations

• 70-90% occur in right colon
• Can affect anywhere in GIT

Presentation

• Elderly
• Fresh PR bleeding

Question 18

Examination in angiodysplasia

Answer 18

To exclude other diseases

• PR exam
• Ba enema
• Colonoscopy
• Mesenteric angiography or CT angiography
• Tc-labelled RBC scan: identify active bleeding

Question 19

Treatment of angiodysplasia

Answer 19

• Embolisation
• Endoscopic laser electrocoagulation
• Resection

Question 20

Sebaceous cysts

• two types
• pathophysiology of these types

Answer 20

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

Question 21

Common locations of sebaceous cyst

Answer 21

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

Question 22

Inspection of sebaceous cyst

Answer 22

• Occur @ sites of hair growth
• Scalp, face, neck, chest and back
• NOT soles or palms
• Central Punctum

Question 23

Palpation of sebaceous cyst

Answer 23

• Firm
• Smooth
• Intradermal