Surgery (Standard non-specialised) Flashcards
What is the Charcots Triad for Ascending Cholangitis?
What makes it a Pentad triad?
Jaundice
RUQ pain
Fever
Pentad if: above 3 AND hypotension + confusion
Management for ASCENDING CHOLANGITIS?
Antibiotics AND ERCP (to relieve any obstruction)
Blood tests for erectile dysfunction?
Free testosterone, FSH & LH, prolactin
Risk factors for Acute Pancreatitis:
Gallstones
Ethanol
Trauma
Steroids
Mumps & Coxsackie B
Auto-immune (polyarteritis nodosa)
Scorpion bites
Hypertriglyceridaemia, hypothermia, hypercalcaemia
ERCP
Drugs: mesasalazine, azithioprine, sodium valproate, bendroflumethiazide, furosemide, steroids, pentamidine, didasonine)
Management for bright red + painful rectal bleeding?
Anal fissures:
1) GTN ointment 0.2% or diltiazem cream applied topically is the usual first line treatment.
2) Botulinum toxin for those who fail to respond.
3) Internal sphincterotomy for those who fail with botox, can be considered at the botox stage in males.
Management for painless fresh rectal bleeding?
This is haemorrhoids:
Lifestyle advice.
For small internal haemorrhoids can consider injection sclerotherapy or rubber band ligation.
For external haemorrhoids consider haemorrhoidectomy.
Modern options include HALO procedure and stapled haemorrhoidectomy.
Spouted: Yes/No and why?
I) Small bowel
II) Colons
Small bowel stomas should be spouted so that their irritant contents are not in contact with the skin.
Colonic stomas do not need to be spouted as their contents are less irritant.
Breast stuff:
Three snowstorm signs:
- Hydatiform mole (USS)
- Implant rupture (USS)
- Thyroid mets to lungs (CXR)
When would you offer colorectal cancer 2WW
- patients >= 40 years with unexplained weight loss AND abdominal pain
- patients >= 50 years with unexplained rectal bleeding
- patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces (see below)
Features of EXTRA-dural haematoma/haemorrhage?
a) What causes it?
b) Features wrt consciousness
c) Mass effect yes/no and if so, what do u see?
d) Signs on CT imaging
e) Management
Caused by low-impact trauma.
Classically presents with a loss of consciousness, then a LUCID interval and then a rapid DECLINE in consciousness.
Mass effect on the brain will cause uncal herniation and a FIXED, DILATED PUPIL due to third cranial nerve compression.
CT imaging features are a hyperdense (bright), biconvex (lemon or lentiform) collection around the surface of the brain.
Definitive management is craniotomy and evacuation of the haematoma.
Features of ACUTE SUB-dural haematoma/haemorrhage?
a) What causes it?
b) Features wrt consciousness
c) Mass effect yes/no and if so, what do u see?
d) Signs on CT imaging
e) Management
An acute subdural haematoma is a fresh collection of blood that is under the layer of the dura mater of the meninges.
It is most commonly caused by TRAUMA but can be caused by vascular lesions (e.g. arteriovenous malformations). It is typically caused by high-speed injuries or acceleration-deceleration injuries and is therefore commonly associated with other brain injuries.
There is a spectrum of severity of clinical presentation from an asymptomatic patient to those who are severely comatose.
CT imaging will show a hyperdense (bright), crescenteric (BANANA) collection surrounding the brain that is not limited by suture lines.
Definitive treatment is a decompressive craniectomy.
Features of CHRONIC SUB-dural haematoma/haemorrhage?
a) What causes it?
b) Features wrt consciousness
c) Mass effect yes/no and if so, what do u see?
d) Signs on CT imaging
e) Management
A chronic subdural haematoma is an old collection of blood that is under the layer of the dura mater of the meninges.
It is more common in elderly patients, alcoholics, people on anticoagulation or in infants due to the fragility and/or predisposition of the bridging veins to bleed.
Patients typically present SEVERAL WEEKS AFTER a mild HEAD INJURY with PROGRESSIVE confusion, loss of consciousness, weakness or higher cortical function.
CT imaging will show a HYPODENSE (dark), crescenteric (BANANA) collection around the surface of the brain that is not limited by suture lines.
In symptomatic patients, definitive treatment is burr hole drainage.
Complications of transurethral resection of the prostate.
TURP Syndrome:
It is caused by irrigation with large volumes of glycine, which is hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up during prostate resection
Urethral strictures
Retrograde ejaculation
Perforation
