Surgery - Miscellaneous

Question 1

What is a rigid proctoscopy?

Answer 1

Endoscopic examination of anal canal using proctoscope

Question 2

What is rigid sigmoidiscopy?

Answer 2

Endoscopic examination of rectum - recto sigmoid junction using rigid sigmoidoscope

Question 3

What are the indications for rigid proctoscopy/sigmoidoscopy?

Answer 3

Suspicion of colonic neoplasia
Investigation of IBD
Biopsies under direct vision
Treatment of haemorrhoids
Prior to ano-rectal operations

Question 4

What is flexible sigmoidoscopy?

Answer 4

Endoscopic examination visualising up to splenic flexure

Question 5

What are the indications for flexible sigmoidoscopy?

Answer 5

Colorectal cancer screening
Surveillance of prev diagnosed malignancy
Endoluminal stent insertion for strictures
Prior to ano-rectal operations
Haematochezia requiring haemostasis

Question 6

What are the indications for tube thoracotomy?

Answer 6

Pneumothorax
Pleural effusion/empyema
Post-op
   -thoracotomy
   -oesophagectomy
   -cardiac surgery

Question 7

What are the steps for inserting a tube thoracotomy?

Answer 7

Inject LA to infiltrate skin/parietal pleura
Make 2cm incision near upper border of lower rib, in triangle of safety
Blunt dissect to parietal pleura
Insert drain & attach to underwater seal
Apply airtight dressing
Sit patient at 45o
Check position w/ CXR (repeat daily)

Question 8

What are the borders of the triangle of safety?

Answer 8

B/w lat border of pec major & lat dorsi
Sup to 5th ics
Inf to axillary border

Question 9

What is a stoma?

Answer 9

External opening in lumenated organ

Question 10

What are the common types of stoma?

Answer 10

Ileostomy
Colostomy
Urostomy
Gastrostomy
Jejunostomy

Question 11

What is an ileostomy?

Answer 11

Stoma formed from the small bowel

Question 12

What are the features of an ileostomy?

Answer 12

Spouted, prominent mucosal folds
Usually on RHS
Bilious contents in bag
One lumen
   -end ileostomy, permanent
Two lumens
   -loop ileostomy, temporary

Question 13

What is a colostomy?

Answer 13

Stoma formed form large bowel

Question 14

What are the features of a colostomy?

Answer 14

Flush to skin, flat mucosal folds
Usually on LHS
Contents often faeculent
Can be loop/end

Question 15

What are the indications for a colostomy?

Answer 15

Hartmann’s procedure
Left heimolectomy
Abdo-perineal resection

Question 16

What are the indications for an ilostomy?

Answer 16

One lumen
-definitive surgery to remove colon in UC
Two lumens
-rest distal bowel (IBD)
-protect distal anastomoses post op
-functional relief from severe incontinence

Question 17

What is a urostomy?

Answer 17

Stoma formed from short section of disconnected ileum, into which 1/2 ureters are directed after radical urinary tract surgery

Question 18

What is a gastrostomy?

Answer 18

Connect from ant stomach to ant abdo wall

Question 19

What are the features of a gastrostomy?

Answer 19

Narrow in calibre
Flush to skin
Usually LUQ
Indwelling access devices

Question 20

What are the indications for a gastrostomy?

Answer 20

Stomach drainage

Direct feeding

Question 21

What is a jejunostomy?

Answer 21

Connection from jejunum to abdo wall for direct feeding

Question 22

What are the potential early complications of a stoma?

Answer 22

Infarction/necrosis
Infection
High output from stoma –> severe dehydration

Question 23

What are the potential late complications of a stoma?

Answer 23

Parastomal hernia
Stoma prolapse
Stoma retraction
Stenosis

Question 24

How should a stoma be examined?

Answer 24

?pt pain
Gently palpate abo (?distension/tenderness)
Ask pt to cough (?parastomal hernia)
?signs of infection
Identify type of stoma
?complications (infarction, prolapse, retraction)
Listen for bowel sounds (below umbilicus)
View pts fluid balance chart

Question 25

What is Focused Assessment w/ Sonography for Trauma (FAST)?

Answer 25

USS used as early diagnostic investigation for suspected blunt abdo trauma

• 1st line in haemodynamically unstable pts
• equal diagnostic accuracy to peritoneal lavage

Question 26

What is a diagnostic peritoneal lavage?

Answer 26

Surgical diagnostic procedure to determine if there is free fluid (blood) in abdo cavity
-mostly replaced by FAST

Question 27

What are the indications for peritoneal lavage?

Answer 27

Suspected intra-abdominal bleeding

• blunt abdo injuries
• asymptomatic ant abdo stab wounds

Question 28

What are the contraindications to peritoneal lavage?

Answer 28

Absolute
   -prev abdo surgery
Relative
   -pre-existing coagulopathy
   -cirrhosis
   -morbid obesity
   -pelvic fracture
   -pregnancy >T1