Surgical shorts Flashcards

1
Q

Explain the difference between a Modified Hartmann’s and an Anterior Resection

A

A Modified Hartmann’s involves resection of a portion of colon + end colostomy + oversewed rectal stump. Later there can be a reversal of Hartmann’s to formed a delayed anastomosis.

An anterior resection also involves resection of a portion of colon. (Typically the term was limited to just rectum but now can be used for most descending colon). However, there is an immediate formation of an immediate anastomosis. Sometimes to protect this anastamosis a defunctioning loop ileostomy is formed. This can be reversed after 6 weeks.

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2
Q

What are the complications of thyroidectomy?

A

Acute but rare

  • haemorrhage
  • thyroid storm

Damage to local structures

  • recurrent laryngeal nerve palsy -> hoarse voice
  • hypoparathyroidism

Late but common

  • Hypothyroidism
  • Recurrent hyperthyroidism
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3
Q

What is the triad of a thyroid storm?

A

Hyperthermia + fast AF + pulmonary oedema

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4
Q

How do you avoid damage to the recurrent laryngeal nerve in a thyroidectomy?

A

Remain anterior to the pre-tracheal fascia that separates it from the thyroid and parathyroid

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5
Q

What are the causes of cervical lymphadenopathy?

A

LIST

Lymphoma and Leukaemia
Infection
Sarcoid
Tumours - breast, bronchus and stomach.

Infections

  • Bacterial - tonsillitis, TB
  • Viral - EBV, HIV
  • Protozoa - Toxo
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6
Q

Complications of a stoma

A

FOUL SHITS

Fluid loss - haemorrhage and high output
Odour
Ulceration of the skin
Leakage

Stenosis and stricture
Herniation and prolapse
Ischaemia
Terminal ileum loss - bile salt and B12
Sexual and psychological
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7
Q

Breast Ca risk factors

A
Bleeding - early menarche (55)
Oestrogen (OCP, HRT)
Age of first child (>35y increases risk)
Breastfeeding protective
Other breast disease
FHx breast disease
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8
Q

What is the difference between an incarcerated and a strangulated hernia?

A

An incarcerated is irreducible, sometimes with a loss of cough impulse.

A strangulated hernia has an occlusion of the vascular supply leading to infarction with subsequent peritonitis and abscess formation.

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9
Q

What are the borders of the femoral triangle?

A

SAIL

Medial = sartorius
Lateral = adductor longus
Base = inguinal ligament
Roof = skin and fascia
Floor = iliopsoas + pectineus + adductor longus
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10
Q

What are the borders of the femoral ring?

A

The femoral ring is the opening to the femoral canal which is the medial compartment of the femoral sheath.

Anterior = inguinal ligament
Posterior = Pectineus
Medial = Lacunar ligament
Lateral = Femoral vein (within middle compartment of femoral sheath)
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11
Q

What is a Richter’s hernia?

A

This is where only part of the bowel herniates through a narrow orifice.

This can allow for strangulation without obstruction.

Common in narrow orifices - femoral hernia.

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12
Q

What is the difference anatomically between an inguinal and femoral hernia?

A

An inguinal hernia is superior and medial to the pubic tubercle whilst a femoral hernia is inferior and lateral.

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13
Q

What are the borders of the inguinal canal?

A
Floor = inguinal ligament
Anterior = External oblique
Posterior = Transversalis fascia
Roof = Internal oblique and Conjoint tendon
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14
Q

What structure has a defect in both an epigastric and paraumbilical hernia

A

Linea alba.

In an epigastric hernia this defect can be anywhere from the xiphisternum to the umbilicus.

In a paraumbilical hernia this defect is just above or below the umbilicus.

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15
Q

What is the difference and relevant of the mid-point of the inguinal canal and the mid-inguinal point?

A

Mid-point of the inguinal canal is between ASIS and pubic tubercle and marks the deep inguinal ring.

Mid-inguinal point is between the ASIS and pubic symphysis and marks the femoral artery.

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16
Q

Scrotal lump DDx:

Get above it? - No

A

Inguino-scrotal hernia

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17
Q

Scrotal lump DDx:
Get above it? - Yes
Testis separately palpable - No
Transilluminable - Yes

A

Hydrocoele

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18
Q

Scrotal lump DDx:
Get above it? - Yes
Testis separately palpable - No
Transilluminable - No

A

Tumour
Orchitis
Haematocoele

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19
Q

Scrotal lump DDx:
Get above it? - Yes
Testis separately palpable - Yes
Transilluminable - Yes

A

Epididymal cyst

20
Q

Scrotal lump DDx:
Get above it? - Yes
Testis separately palpable - Yes
Transilluminable - No

A

Varicoele
Spermatocoele
Sperm granuloma
Epididymitis

21
Q

Definition of a hydrocoele

A

Accumulation of fluid within the tunica vaginalis

22
Q

Definition of varicocoele

A

Dilated veins of the pampiniform plexus

23
Q

Grey-Turner sign indicates what and what are the common causes?

A

Retroperitoneal haemorrhage.

Acute haemorrhagic pancreatitis
leaking AAA
Ruptured ectopic pregnancy

24
Q

Management of an acute oculogyric crisis?

A

STOP offending agent - e.g. post-op prochlorperazine

IV procyclidine (anti-cholinergic)

Consider BDZs

25
Specific operative complication of (damage to local structure): Breast cancer surgery with axillary dissection.
Lymphoedema of the arm
26
Specific operative complication of (damage to local structure): Panproctocolectomy
Damage to the pre-sacral plexus Men: erectile impotence Women: Reduced vaginal lubrication and anorgasmia
27
Specific operative complication of (damage to local structure): Thyroidectomy
Recurrent laryngeal nerve - hoarse voice Parathyroids - hypoparathyroidism - hypoCa
28
Specific operative complication of (damage to local structure): Total hip replacement
Damage to sciatic nerve
29
Specific operative complication of (damage to local structure): Femoral-popliteal bypass
Damage to femoral nerve
30
Specific operative complication of (damage to local structure): Removal of parotid tumour
Damage to facial nerve
31
Specific operative complication of (damage to local structure): Branchial cyst excision
Damage to accessory and hypoglossal nerves
32
Laporoscopic cholecystectomy
Biliary peritonitis.
33
Definition of a stoma
An abnormal communication between an internal viscera and the external environment
34
Defition of a hernia
Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity.
35
What are the risk factors for an incisional hernia?
Pre-op - Co-morbidites - DM, CKD - Drugs - steroids - Obese Operative - Incision site - midline - Closure technique - Drains through wounds Post-op - ↑ intra-abdominal pressure: cough, - infection - haematoma
36
2 hours after a football game in which a 34 year old man was struck with a ball in the groin, he is brought to hospital with a swelling in the scrotum that has not resolved with application of an ice pack. O/E there is a small scar in the right groin, the left testis is lying slightly higher than the R. The testicular adnexae are firm but non-tender. These findings are suggestive of: ``` Torsion of hydatid of Morgagni Epididymo-orchitis Seminoma Teratoma Scrotal haematoma ```
Seminoma Testicular tumours are often found incidentially after minor trauma to the scrotum, the mass is often mistakenly attributed to the trauma. Torsion is often heralded by pain and rarely a blue spot. The scar in the groin points to perhaps a previous surgery for undescended testis which is associated with testicular tumour. Seminomas are more common in those over 30 than teratomas.
37
Adjuvant chemotherapy agent for Duke C colorectal Ca
5-FU Reduces mortality by 25%
38
Indications for a mastectomy over a WLE
Pt preference Multi-focal disease (often lobular) Large lump over a large area (>4cm) Nipple involvement
39
What are the features of an acute pancreatitis on AXR?
NB. Often normal. Loss of psoas shadow - due to retroperitoneal fluid. Sentinel loop - segment of gas-filled proximal jejunum.
40
Complications of TURP
TUR syndrome: fluid overload + dilutional hyponatremia + glycine toxicity. Urethral stricture Retrograde ejaculation Perforation of prostate
41
Grading of diverticulitis and assoc management
Hinchey grading 1) Small abscess limited to colon 2) Large abscess extending into pelvis 3) Purulent peritonitis 4) Faecal perionitis Mx Resus: admit, NBM, fluids, abx Hinchey 1 + 2: mainly supportive Hinchey 3: Wash-out Hinchey 4: Hartmann's
42
Jenkin's Rule
Suture length = 4x incision length
43
Important anatomical landmark to locate in Laparoscopic cholecystectomy?
Identify Calot's Triangle: 1) Superior = inferior liver edge 2) Medial = Common Hepatic Duct 3) Hypotenuse = Cystic duct + GB Identify Cystic duct and cystic artery (within Calot's triangle) and clip them.
44
4 anatomical locations of oesophageal narrowing
1) Junction w/ pharynx at level of the cricoid 2) Posterior to aortic arch 3) Posterior to L main bronchus 4) Lower oesophageal junction
45
Surface anatomy of the renal pelvis
L1 on left, slightly lower on right
46
Cushing reflex
HTN + Bradycardia + irregular breathing