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Phase II > Surgical Conditions > Flashcards

Surgical Conditions Flashcards

1
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A
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2
Q

What are some of the causes of RUQ pain?

A
  • Gallbladder: Acute Cholecystitis, cholangitis, biliary colic
  • Liver: hepatitis, hepatomegaly
  • Kidney: pyelonephritis
  • Lung: RLL pneumonia
  • Appendicitis
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3
Q

What are some of the causes of epigastric pain?

A
  • Acute pancreatitis
  • Peptic ulcer
  • Acute cholecystitis
  • MI
  • Perforated oesophagus
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4
Q

What are some of the causes of LUQ?

A
  • Spleen: ruptured spleen
  • Stomach: gastric ulcer
  • Aorta: AAA
  • Kidney: pyelonephritis
  • Lungs: LLL Pneumonia
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5
Q

What are some of the causes of periumbilical pain?

A
  • Intestine: intestinal obstruction, diverticulitis
  • Acute pancretitis
  • Early appendicitis
  • mesenteric thrombosis
  • AAA
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6
Q

What are some of the causes of RLQ pain?

A
  • Intestine: Appendicitis, crohn’s disease, Meckel’s diverticulitis, Incarcerated hernia, perforated caecum
  • Renal: kidney stones
  • Gynae: tubo-ovarian abscess, ruptured ectopic pregancny
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7
Q

What are some of the causes of LLQ pain?

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8
Q
  • GI: sigmoid diverticulitis, Crohn’s, UC, perforated colon, incarcerated hernia
  • Renal: kidney stones
  • Gynae: tubo-ovarian abscess, ruptured ectopic pregnancy
A
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9
Q

What are some endocrine causes of an acute abdomen/abdominal pain?

A

DKA, thyrotoxicosis, addison’s disease

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10
Q

What are some important questions to ask in hx for someone presenting with acute abdomen?

A
  • SOCRATES for pain
  • Assoc symptoms:
    • Vomiting?
    • malaena/haematemesis
    • Change in bowels? change in stool?
    • Fevers/rigors/weight loss?
    • Rash? - indicative of jaundice
    • Urinary symptoms/change in urine color/blood in urine?
  • Gynae/obstetric hx - last period? pregnant? hx of STI, ectopic?
  • Past surgeries?
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11
Q

What investigations for patient presenting with acute abdomen?

A
  • Bedside tests: BP, oxy sat, temperature, urine dip + pregnancy test!, ECG
  • Bloods:
    • FBC - for anaemia, infection, active bleeding
    • Inflammatory markers
    • LFTs - for hepatobiliary pathology
    • Serum amylase/lipase - if suspect pancreatitis
    • Glucose - DKA?
  • ABGs - sepsis? intestinal ischaemia?
  • Imaging:
    • AXR/erect CXR
    • ultrasound - for gallstones/kidney stones
    • Endoscopic investigations - gastroscopy? colonoscopy?
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12
Q

What is the initial management of patients with acute abdomen?

A
  • A to E assessment
  • Keep patients NBM
  • Oxygen as appropriate
  • IV fluids
  • Analgesia
  • NG tube if vomiting severely/obstruction suspected
  • Antiemetic
  • Prophylactic Antibiotics - IV ceph + metronidazole
  • Surgical/gynae review
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13
Q

Causes of intestinal obstruction?

A

Divided into:

  • Extramural:
    • adhesions - from previous surgery/peritoneal infection
    • Hernias
    • Tumours - from other organs
    • Volvulus
  • Intramural
    • Strictures - due to crohn’s, diverticulitis
    • Tumours - colon cancer
    • Intussusecption/hirschsprung’s
  • Luminal
    • Faecal impaction
    • Gallstones
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14
Q

What are some presentations of obstruction?

A

Symptoms

  • Nausea and vomiting - early in SBO, late (and faeculant) in LBO
  • Constipation - late in SBO, early in LBO
  • colicky abdominal pain - more frequent in SBO
  • Dysphagia
  • Abdominal distension

Signs

  • Dehydration - due to water remaining unabsorbed and vomiting
  • Abdominal distension, peristalsis
  • Percussion - hyperresonant
  • Auscultation - tinkling in obstruction, silent in paralysis
  • PR exam - empty rectal ampulla
  • Check hernial orifices
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15
Q

AXR signs for SBO and LBO?

A
  • SBO: valvulae conniventes, more centrally located, >3cm dilated
  • LBO: haustra present, peripherally located, >6cm
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16
Q

Management of bowel obstruction?

A
  • Resus: IV fluids, analgesia, restore metabolic abnormalities
  • Uncomplicated obstruction:
    • Intestinal decompression - endoscopic bowel decompression, dilatation of strictures, stents
    • bowel rest
  • Complicated obstruction
    • Surgical intervention indications:
      • Ischaemia, perforation, peritonitis, irreducible hernia.
      • Bowel resection of any non-viable bowel + anastomosis/stoma
17
Q

Causes of Upper GI Bleed?

A
  • Peptic ulceration
  • Gastroduodenal ulcerations
  • Oesophagitis
  • Oesophageal varies
  • Mallory Weiss tear
  • Oesophageal/stomah cancer
  • Drugs - steroids, NSAIDs, Anticoagulants
  • Vascular malformations
18
Q

How do you assess the risk of patients with UGIB

A

Using Glasgow-blatchford Score and Rockall Score:

  • GBS: to assess need for intervention
  • Rockall: to assess mortality
19
Q

Describe the assessment of patients with UGIB

A
  1. A to E assessment
  2. Resuscitation:
    • Two large bore IV access
    • Fluid resuscitation
    • Blood transfusion according to local guidelines
  3. Bloods for FBC, U&Es, LFTs, Coag Screen, Group and X-match (2-6 units).
  4. Risk assessment using GBS and Rockall score
  5. Endoscopy (within 24hrs):
    • Non-variceal bleed:
      • Clips/thermal coagulation/fibrin + adrenaline
    • Variceal bleed
      • Terlipressin - offered to patients with suspected variceal bleed at presentation.
      • Prophylactic antibiotics (co-amox) - offered at presentation.
      • Oesophageal varices: band ligation, TIPS if not controlled
      • Gastric varices: injection of N-butyl-2-cyanoacrylate, TIPS if not controlled.
20
Q

Causes of Lower GI Tract Haemorrhage?

A
  • Anatomical: diverticular disease, Meckel’s diverticulum
  • Vascular: colonic angiodysplasia, ischaemic colitis, vascular malformation
  • Inflammatory: IBD
  • Infectious: haemorrhagic gastroenteritis
  • Neoplastic: Colorectal cancer, polyps
  • Anorectal: internal haemorrhoids, rectal varices

VAAIINN

21
Q

Investigations to carry out for lower GI bleed?

A
  • Bedside: BP, temp, stool sample
  • Bloods: FBC, U&Es, LFTs, coagulation screen, inflammatory markers, Group and save
  • Imaging: AXR, sigmoidoscopy, colonoscopy, CT angio if suspect ischaemic colitis
22
Q

Red Flags for Lower GI tract bleed?

A
  • Weight loss
  • Age <50
  • Change in bowel habits
  • Blood in stool
  • Iron-deficiency anaemia
  • Strong Family Hx of colorectal cancer
23
Q

What are the watershed areas in the intestine and where are they located?

A

Collateralisation of blood flow is more limited and more prone to ischaemia. Located at splenic flexure and recto-sigmoid junction

24
Q

What is the management of Ischaemic colitis?

A
  • Resus - IV fluids, oxygen, correct co-morbidities
  • Empirical antibiotics
  • Medical:
    • Heparin, vasodilator (papaverine), thrombolysis (if aetiology is embolus)
  • Surgical
    • Embolectomy
    • angioplasty
    • Surgical resection - for non-viable areas
25
Q

Causes of Dysphagia?

A
  1. Inflammatory: oesophagitis, candidiasis, tonsilitis
  2. Neuromotility disorders: stroke, parkinson’s, MS, Achalasia, Oesophageal spasm, Myasthenia Gravis
  3. Mechanical obstruction:
    • Luminal - foreign bodies
    • Mural - strictures, tumours, diverticulum
    • Extramural - retrosternal goitre, lung/bronchial Ca, rolling hiatus hernia, thoracic aortic aneurysm.
26
Q

How do you investigate dysphagia?

A
  • Barium swallow
  • Endoscopy
  • Manometry
27
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A

Phase II (4 decks)

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