Week 4 - General Surgery

Question 1

The head and neck in general surgery consist of:

Answer 1

Thyroid
Para-thyroid
Larynx

Question 2

Breast surgeries can consist of:

Answer 2

Biopsy (simple)
Wide excision and hook wire biopsy
Sentinal Node biopsy
Mastectomy (simple, total, radical, modified)
\+/- lymph node dissection

Question 3

Signs and symptoms of breast cancer

Answer 3

Palpable lump
Swelling in or around the breast, clavicle or armpit
Skin thickening or redness
Nipple changes
Nipple discharge
Pain

Question 4

What is DCIS (non-invasive - contained - easier to treat)?

Answer 4

DCIS (Ductal Carcinoma In-Situ): abnormal cells contained within the milk ducts

Question 5

What is LCIS (non-invasive - contained - easier to treat)?

Answer 5

LCIS (Lobular Carcinoma In-Situ): abnormal cells form within the lobules or milk glands within the breast.

Question 6

What is IDC (invasive) in breast cancer?

Answer 6

Invasive Ductal Carcinoma: abnormal cells that originated from the milk ducts have now invaded surrounding tissue.

Large incision - for clearer margins

Question 7

What are types of peptic ulcers?

Answer 7

Gastric ulcers
Duodenal ulcers
Stress ulcers

Question 8

Common causes of IBS?

Answer 8

IBS, diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, cholecystitis, pelvic inflammatory disease, valvular insufficiency

Question 9

Precipitating factors of IBS

Answer 9

Stress, psychological factors, prior gastroenteritis, specific food intolerances

Question 10

Inflammatory disorders can be treated by:

Answer 10

Drug therapy, surgical therapy, nutritional therapy

Question 11

Anorectal problems

Answer 11

Anal fissure
Anorectal abscess
Anal fistula
Pilonidal sinus

Question 12

Laryngectomy

Answer 12

Removal of the larynx (voice box) - partial, total or permanent

Question 13

Signs and symptoms of breast cancer

Answer 13

Palpable lump
swelling in and around the breast, clavicle or armpit
skin thickening or redness
nipple changes 
nipple discharge
pain

Question 14

Lumpectomy

Answer 14

is also called breast-conserving surgery or wide local excision. It is to remove cancer or other abnormal tissue from the breast.

Question 15

Radiotherapy

Answer 15

Becoming decreasingly invasive - more specific targeting
Side effects: scarring
E.g if it’s hitting the chest wall, it can hit the heart and lungs e.g/
Pain on inspiration, SOB.

Question 16

TRAM (Transverse Rectus Abdominus Muscle flap) - e.g of reconstructive surgery post-mastectomy

Answer 16

Large operation
Lower abdomen - incision
Take muscle fat and blood supply
Tunnelled from the abdomen underneath the skin and comes into the chest

Question 17

Hernia

Answer 17

Occurs when it becomes weakens and then separates and then moves
When under pressure contents from the peritoneal cavity through the muscle wall
The risk is if the small bowel is moving through the muscle wall, it can become stuck (incarcerated - necrotic)
Reduced blood supply.
Painful
Can occur anywhere along the abdominal wall.

Question 18

Types of Hernias

Answer 18

• Epigastric hernia
• Umbilical hernia
• Massive Ventral Hernia (straight up the midline)
• Inguinal Hernia (usually male dominated) - repaired by a small opening - laparoscopic or open. Trochar through abdomen. Trochar to gas - distend the abdomen. Mesh inserted as a layer to prevent contents to move up through the gap. The mesh will adhere to the abdominal wall. Scarring will occur.

Question 19

Cholelithiasis

Answer 19

Chole = Gall
Lithiasis = Stones
= Gallstones

Question 20

Cholecystitis

Answer 20

inflammed gallstones

Question 21

Hiatus Hernia

Answer 21

Portion of the stomach that moves up and down the diaphragm. It can become stuck and a pouch develops. Food and fluid can collect there and over time it can become inflammed and irritation and this is where oesophagitis occurs and reflux.
Traumatic to a patient.

Question 22

Hiatus Hernia

Answer 22

Portion of the stomach that moves up and down the diaphragm. It can become stuck and a pouch develops. Food and fluid can collect there and over time it can become inflammed and irritation and this is where Oesophagitis occurs and reflux.
Traumatic to a patient.
Pt with gastric reflux or hiatus hernia are at risk of aspiration!!
Simple procedure - laparoscopic
Extended fasting needed
need good pre op preparation
Nasogastric tube

Question 23

Peptic ulcer disease

Answer 23

Gastric ulcers
Duodenal ulcers
Stress ulcers

Complications
haemmorage
perforation
gastric outlet obstruction

Question 24

Colorectal

Answer 24

IBS, diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, cholecystitis, pelvic inflammatory disease, valvular insufficiency

Question 25

Factors of Colorectal disorders

Answer 25

stress, psychological, prior gastroenteritis

Question 26

Polyps of the large intestine

Answer 26

Removed in a colonoscopy with loop, diathermy to seal a bleed

Question 27

Colorectal Cancer

Answer 27

Lower incidence in Vegans
Surgical therapy
Potential for radiotherapy or chemotherapy

Question 28

Right and left hemicolectomy

Answer 28

right or left side removed

Question 29

Transverse colectomy

Answer 29

The middle removed

Question 30

Subtotal or Total Colectomy

Answer 30

Most or all of the bowel removed

Question 31

Ostomy Surgery

Answer 31

Ascending Colostomy 
Descending "             "
Ileostomy
Sigmoid Colostomy
Transverse Colostomy

Question 32

Hartmann’s procedure

Answer 32

Surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis, etc.).
Can be temporary or permanent

Question 33

Anorectal problems

Answer 33

Anal fissures
Anorectal abcess
Anal fistula
Pilonidal Sinus

More common in males. Not usually detected early. Usually from an ingrown hair.