Surgery + Met Flashcards
Vovlulus Ix + mx
AXR - coffee bean sign (sigmoid - more in elderly)
CT contrast for dx
NBM, NG, IV fluids, endoscopic decompression, flexi sig +/- surg
Gallstones Ix and outcomes of these
↑ bili, pale stool, dark urine = obstruction
↑ ALP = obstruction
US = 1st line +/- MRCP
Maintenance fluids
25-30ml/kg/day water
1 mmol/kg/day Na/K/Cl
50-100g/day glucose
Pancreatic cancer - most common type, symptoms, 2ww referral
Most adenocarcinoma
Obstructive jaundice
Survival 6m
New onset DM, worsening control
40+ jaundice or 60+ WL = additional symptoms (CT direct access)
Cholangiocarcinoma Rfs, symptoms
RF = PSC (UC is RF) , liver flukes (parasites)
Obs jaundice - pale stool, dark urine, jaundice, itching, painless J (more common in pancreatic ca)
Palpable gallbladder - mass in RUQ
↑ Ca19-9
2 ww for bowel cancer
40+ abdo pain + UE WL
50+ unexplained rectal bleeding
60+ change in bowel/IDAFIT 60-74 every 2 years
Haematuria, loin pain, abdo mass, varicoele
Renal carcinoma
Radical nephrectomy
Haematuria, loin pain, abdo mass, varicoele
(blader is more painless haematuria)
Fluid resus in burns
Parkland f (in 24hrs)= 4 x TBSA% x weight kg.
Half of this is given in first 8 hours
occlusion in distal aorta-thigh/bum claudication + absent fem pulse, male impotence
Leriche syndrome
Normal ABPI
0.9-1.3 = N
0.6-0.9 = Mild PAD
0.3-0.6 = Mod-severe PAD
<0.3 = severe-critical
Hemosiderin staining, venous eczema, lipodermatosclerosis
Gaiter area
chronic venous insufficiency
Male smoker 25-35
Painful blue discoloration fingertips/toes -> ulcers/gangrene
Corkskrew collateral ona angiogram
Buerger disease - thrombosis in small/m blood vessels
AAA - size and surveillance
> 3cm
US - 65 for Dx, CT in stable pts with symptoms for repair
3-4.4 = yearly follow up
4.5-5.4 = 3m follow up
5.5+. symptoms/ 1cm+ growth in a year = repair
Pulsus paradoxus, hypotension, ↑ JVP, quiet heart sounds
cardiac tamponade
Ejection systolic high pitched murmur, slow rising pulse, narrow pulse pressure
aortic stenosis
What congenital problem is coarctation of aorta ass with
turner syndrome
Pneumothorax mx
No SOB, <2cm = follow up 2-4 weeks
SOB +/- >2cm = aspiration and if fails then chest drain
Unstable/bilat/secondary ones - chest drain
Tension - large bore cannula into 2nd ICS in midclavicular line
Painless, smooth, round, well circumscribed mobile lump. 20-40. Respond to female hormones
fibroadenoma
2 ww BC
(Hard, irregular tethered)
UE lump in 30+
Unilateral nipple changes 50+
30-50, often perimenopausal
Smooth, mobile, fluctuant
Breast cyst
hormonal tx for breast cancer
Tamoxifen - premenopausal
Aromatase inhibitors for post-M (letrozole)
For 5-10 years for ER+
Breast cancer surgery - no palp LNs in axilla vs palpable Las in axilla
Prior to surg:
No palp LNS in axilla - pre op axillary US. If + then sentinel node biopsy
Palp LNs - axillary node clearance at surg 9can give arm lymphoedema etx)
Whole breast radiotherapy after surgery (WLE). if mastectomy offered to T3-4 or 4+ LNs.
Causes gynaecomastia
More oestrogen
↑ prolactin or dopamine antagonist (anti-psych)
Physiological/idiopathic
↑ Oestrogen - obesity, testicular ca, hyperT, SCLC
↓ testosterone
Anabolic steroids, digoxin, spironolactone, GNrh agonists, opiates, marijuana, alcohol
Galactorrhoea causes
Breast milk production not ass with preg/breast feeding
Usually raised prolactin
Prolactinomas - MEN1
Mx - dopamine agonists
