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Daisy Finals Revision > Surgery (not ortho) > Flashcards

Surgery (not ortho) Flashcards

1
Q

What is dumping syndrome?

A

Post gastric surgery
Hyperosmolar load rapidly enters jejunum. Osmosis drags water into lumen, resulting in lumen distension then diarrhoea
Also excessive insulin release -> hypoglycaemia

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2
Q

causes of small bowel obstruction?

A

adhesions
hernias
malignancy

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3
Q

features of small bowel obstruction on auscultation?

A

tinkling bowel sounds

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4
Q

initial mgt small bowel obstruction?

A

NBM
IV fluids
NG tube

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5
Q

small bowel obstruction on XR?

A

valvulae conniventes full width

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6
Q

large bowel obstruction on XR?

A

haustra only part width

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7
Q

dx: 36 year old day 3 post op after open appendicectomy presents with abdo distention and vomiting

A

paralytic ileus

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8
Q

initial mgt for paralytic ileus?

A

NBM
NG
IV fluids

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9
Q

how to speed up resolution of paralytic ileus?

A

mobilising
chewing gum

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10
Q

dx: 87 year old nursing home resident with acute abdo pain and vomiting

A

volvulus

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11
Q

types of volvulus?

A

sigmoid
caecal

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12
Q

x ray finding in volvulus?

A

coffee bean sign

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13
Q

conservative management option for volvulus?

A

endoscopic decompression

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14
Q

surgery options for sigmoid volvulus?

A

hartmann’s procedure

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15
Q

surgery options for caecal volvulus?

A

ileocaecal resection
right hemicolectomy

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16
Q

complications of hernias?

A

incarceration
obstruction
strangulation

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17
Q

surgical options for hernias?

A

tension free repair
tension repair (less preferred)

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18
Q

how to distinguish between a direct and indirect inguinal hernia?

A

indirect remains reduced with pressure at the deep ring

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19
Q

what are the boundaries of hesselbach’s triangle?

A

RIP
Rectus abdominis (medial)
Inferior epigastric vessels

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20
Q

types of hiatus hernias?

A

sliding (GOJ comes through) and rolling (fundus comes through)

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21
Q

risk factors for hiatus hernia?

A

inc age
obesity
pregnancy

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22
Q

usual surgical procedure for hiatus hernia?

A

laparoscopic fundoplication

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23
Q

clockface locations of the anal cushions?

A

3, 7 and 11 o’clock

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24
Q

classification off haemorrhoids?

A

1st degree: no prolapse
2nd: prolapse returns on relaxing
3rd: prolapse can be pushed in
4th: prolapse permanently

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25
procedure to internally visualise haemorrhoids?
proctoscopy
26
non surgical options for haemorrhoids?
rubber band ligation injection sclerotherapy IR coagulation bipolar diathermy
27
definitive investigation for small bowel obstruction?
abdo CT
28
treatment for fissure in ano?
stool softeners topical diltiazem or GTN botulinum toxin sphincterotomy
29
mgt for fistula in ano?
lay open if low, no sphincter involvement or IBD if complex, high or IBD insert seton and consider other options
30
presentation of mesenteric infarction?
31
key risk factor for mesenteric ischaemia?
AF
32
initial imaging for mesenteric ischaemia?
contrast CT
33
ABG findings in acute mesenteric ischaemia?
metabolic acidosis raised lactate
34
objectives during surgery for acute mesenteric ischaemia?
remove necrotic bowel remove/bypass the thrombus
35
overall mortality rate in acute mesenteric ischaemia?
over 50%
36
management of femoral hernia?
always need repair due to risk of strangulation
37
pneumoperitoneum (free air under diaphragm on cxr and severe upper abdo pain?
perforated peptic ulcer
38
fluid requirement formula in burns?
total requirement in 24h = 4 ml x (total burn surface area (%)) x (body weight (kg)) 50% given in first 8 hours 50% given in next 16h
39
scrotal swelling in 3 year old boy, mass doesnt transilluminate and impossible to palpate normal cord above it
indirect inguinal hernia
40
surgery for distal transverse or descending colon cancer?
left hemicolectomy
41
surgery for a mid-rectal tumour?
low anterior resection
42
surgery for upper rectal tumour?
anterior resection
43
surgery for lower rectal tumour?
abdomino-perineal resection
44
surgery for caecal, ascending or proximal transverse colon cancer?
right hemicolectomy
45
what does the coffee bean sign indicate?
volvulus
46
associations with sigmoid volvulus?
- older pts - chronic constipation - chagas disease - neurological conditions eg parkinson's, duchenne muscular dystrophy - psychiatric conditions eg schizophrenia
47
associations with caecal volvulus?
- all ages - adhesions - pregnancy
48
mgt of sigmoid volvulus?
decompression via rigid sigmoidoscopy and flatus tube insertion
49
surgery for perforation as result of sigmoid colon tumour?
hartmann's procedure
50
mgt for chronic anal fissure?
topical GTN try for 8 weeks then secondary care referral for sphincterotomy or botox
51
mgt of acute anal fissure?
soften stool lubricants eg petroleum jelly before defecation topical anaesthetics analgesia
52
AAA >5.5cm mgt?
refer to vascular surgery within 2wks for probable intervention
53
AAA 4.5-5.4cm mgt?
rescan every 3 months
54
AAA 3-4.4cm mgt?
rescan every 12 months
55
AAA <3cm mgt?
no further action
56
when does AAA screening take place?
single abdominal ultrasound for males aged 65
57
mgt for AA aneurysms increasing in size by over 1cm in a year?
refer to vascular surgery within 2 weeks
58
medications for all patients with peripheral arterial disease?
clopidogrel atorvastatin
59
management for superficial thrombophlebitis?
- antiembolic stockings and consider for LMWH - if LMWH contraindicated, 8-12 days of oral NSAIDs should be offered
60
initial management of acute limb ischaemia?
analgesia, IV heparin and vascular review
61
conservative mgt for varicose veins?
leg elevation wt loss regular exercise graduated compression stockings
62
surgical management for short segment stenosis eg <10cm in limb ischaemia?
endovascular revascularisation (percutaneous angioplasty)
63
surgical management for short segment stenosis eg <10cm in limb ischaemia?
surgical revascularization (bypass)
64
features of extradural haemorrhage?
lentiform midline shift caused by middle meningeal artery
65
features of subdural haemorrhage?
slower onset of symptoms crescent shaped on CT fluctuating confusion/consciousness
66
best imaging for ?C spine injury in trauma?
CT c spine
67
criteria for CT head within 1 hour?
GCS <13 on initial assessment GCS <15 at 2 hours post injury suspected open or depressed skull fracture post-traumatic seizure focal neurological deficit >1 episode of vomiting
68
management for patients who have had a head injury and are on warfarin? (regardless of whether they have risk factors for intracranial bleed)
CT head within 8 hours
69
electrolyte imbalance complication of subarachnoid haemorrhages?
hyponatraemia (due to SIADH)
70
vessels responsible in subdural haematoma?
bridging veins
71
when should LP be done to detect a SAH?
at least 12 hours after the start of the headache
72
6 tests to confirm brain death?
pupillary reflex corneal reflex oculo-vestibular reflex (no eye movt in response to 50ml of ice cold water into each ear) cough reflex absent response to supraorbital pressure no spontaneous respiratory effort
73
triad of ascending cholangitis features?
fever, jaundice and RUQ pain = charcots triad
74
glasgow score for pancreatitis severity?
PANCREAS PaO2 <7.9kPa Age >55 Neutrophils (WCC >15) Calcium <2mmol Renal function - urea >16 Enzymes (lactate dehydrogenase >600) Albumin <32 Sugar BG >10
75
what score on glasgow pancreatitis scale indicates high risk for severe pancreatitis?
3 and above
76
local complications of acute pancreatitis?
peripancreatic fluid collections pseudocysts pancreatic necrosis pancreatic abscess haemorrhage
77
systemic complication of acute pancreatitis?
acute respiratory distress syndrome
78
most common organism causing cholangitis?
e coli
79
which malignancy does PSC put you at risk of?
cholangiocarcinoma
80

Daisy Finals Revision (25 decks)

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