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Year 4 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Changing point of the external iliac to femoral

A

Once it passes the inguinal ligament becomes the common femoral

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2
Q

Vessels to avoid in laparoscopy

A

Inferior epigastric vessels - paired structures

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3
Q

Contents of the Inguinal Canal (Males)

A

Rule of 3
Arteries - vas, testicular, cremasteric
Nerves - genito-femoral, ilio-inguinal
Fascial Layers - external, cremasteric, internal
Other Things - pampiniform plexus, vas, lymphatics

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4
Q

What is contained in the femoral sheath?

A

Artery and vein

Nerve travels outside of the femoral sheath

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5
Q

What structures does the inguinal ligament run between?

A

Pubic tubercle and ASIS

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6
Q

Borders of the femoral canal

Problem with the femoral canal

A 
Femoral vein
Lacunar ligament 
Inguinal canal 
Pectineus 
These borders are rigid, there is little room for expansion, high risk of strangulation in femoral hernias
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7
Q

Incarcerated VS Strangulated Hernia

A 
I = hernia is stuck, usually contained within it's sac 
S = disruption to the blood supply: first venous drainage disrupted then arterial supply > ischaemic
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8
Q

Types of Hernia Fixation (2)

A 
Herniorronaphy = fix the hernia and fix the wall 
Herniotomy = fix the hernia, do nothing to the wall
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9
Q

Differential of Groin Lump in IVDU (not hernia)

A

1st. Groin Abscess

2nd. Pseudoaneurysm - will have a thrill and bruit

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10
Q

Clinical Test for Direct vs Indirect Hernia

Result

A

= control hernia at the deep ring, ask patient to cough
Re-Appears = direct
Doesn’t Re-Appear = indirect

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11
Q

Immediate Hernia Surgery Complications

A

Bleeding
Anaesthetic Reaction
Bowel Perforation

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12
Q

Early Hernia Surgery Complications

A 
Infection 
Loss of Testicle (ischaemia)
Haematoma
Systemic Sepsis 
Procedure Failure
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13
Q

Late Hernia Surgery Complications

A

Chronic Pain
Recurrence
PE

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14
Q

Pathophysiology of Femoral Hernias

A

Most often in elderly ladies who were previously overweight and now are not
The femoral space is now empty and so a small section of bowel slips down

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15
Q

Presentation of Femoral Hernias

A

Colicky Midgut Pain

Normal AXR

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16
Q

Scrotal Lump VS Hernia

A

Can get above a scrotal lump

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17
Q

Differentiating Duodenal and Gastric Ulcer

A

Duodenal ulcer pain relieved by eating

Gastric ulcer pain made worse by eating

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18
Q

Choice of Ix in Appendicitis (Pregnancy)

A

MRI

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19
Q

Sensitivity of Mammogram and Age

A

Increases with age

Need to be >40 for mammogram to be helpful/effective

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20
Q

When to use MRI to investigate breast pathology

A

High risk young patietns

Previous surgery

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21
Q

Paralytic ileus =

A

= temporary impairment of peristalsis causing obstruction

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22
Q

Most common causes of small bowel obstruction

A

Adhesions

Incarcerated hernia

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23
Q

Most common causes of large bowel obstruction

A

Malignant tumours

Volvulus

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24
Q

Presentation of large bowel obstruction

A

Constipation occurs early

Vomiting occurs late

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25
Q

AXR Findings in Bowel Obstruction

A

Small bowel >3cm
Colon >6cm
Caecum >9cm

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26
Q

Gallbladder wall thickening =

A

= inflammation

Can differentiate between biliary colic and acute cholecystitis

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27
Q

Rosving’s Sign

A

Press in LIF feel pain in RIF with appendicitis

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28
Q

Charcot’s Triad

A

Fever
RUQ pain
Jaundice

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29
Q

Complications of ERCP (3)

A

Pancreatitis
Duodenal Rupture
Haemorrhage

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30
Q

Where does haemorrhage come from in ERCP?

A

Gastroduodenal artery

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31
Q

Risk in popliteal artery aneurysm

A

Thromboembolism

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32
Q

Infectious causes of aneurysm (2)

A

Luetic aneurysm - syphilis

Mycotic aneurysm - TB

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33
Q

Mirizzi’s Syndrome =

A

= gallstone becomes impacted in cystic duct causing extrinsic compression of common hepatic duct

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34
Q

Procedure to allow drainage of Gallbladder

A

Cholecystostomy

= stoma into gallbladder allows drainage

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35
Q

Stoma Types

Stoma Techniques

A
  • Colostomy, ileostomy, urostomy

- End or loop

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36
Q

Complications of Stoma (5)

A 
Leakage 
Retraction 
Prolapse
Hernia 
Mucocutaneous Separation
37
Q

Artery between SMA and IMA

A

Marginal artery of Drummond

Means that splenic flexure is at risk of ischaemic colitis

38
Q

Mesenteric adenitis

A

= inflamed lymph nodes in abdomen in association with viral illness
Seen in kids

39
Q

Tests for peritonism (3)

A

Jump - mainly kids
Cough
Percussion of abdomen

40
Q

Definition of varicose veins

A

Dilated
Tortuous
Elongated superficial veins

41
Q

What is CEA?

What is it raised in?

A

= carcinoembryonic antigen

- Can be raised in bowel cancer and smokers

42
Q

Drug which can trigger/worsen IBD flares

A

NSAIDs

43
Q

Pressure dependent organs (3)

A

Brain
Kidneys
Heart

44
Q

Mild Flare of UC

A

<4 bowel movements a day

No systemic features

45
Q

Moderate Flare of UC

A

4-6 bowel movements a day

No systemic features

46
Q

Severe Flare of UC

A 
>6 bowel movements a day 
Temperature >37.8
Heart Rate >90 
Abdominal Distension 
CRP >30 
Hb <10.5g/dL
47
Q

Colon Cancer and UC

A

If UC >10 years need annual colonoscopy due to ++ cancer risk

48
Q

Ileal Involvement in UC

A

Can affect the ileum if there is an incompetent ileo-caecal valve

49
Q

Surgical Indications in UC

A

Acute Colitis
Chronic Symptomatic Colitis
Perforation
Neoplasia

50
Q

Surgical options in UC

A
  1. Proctocolectomy with ilionanal pouch formation - most common
  2. Pan proctocolectomy with end ileostomy - needs a stoma
  3. Subtotal colectomy with ileostomy - emergency situations
51
Q

Scoring System Used in Upper GI Bleeding

A

Rockall Scoring System

52
Q

Urea in Upper GI Bleed

A

Disproportionately high compared to kidney function

= GI tract digests the blood producing urea

53
Q

Dark PR Bleeding + Isolated High Urea

A

= urgent OGD

54
Q

Stage of shock associated with confusion

A

Stage 4

55
Q

GI bleeding is a risk factor for…

A

Decompensation of existing liver disease

56
Q

RIF discriminator

A

Appetite - reliably reduced in appendicitis

57
Q

Appendicitis Presentation but Older Age Group

A

Perforated Caecal Cancer

58
Q

Reversing Warfarin

Time taken to work

A

Oral Vitamin K - takes 24 hours

IV 10mg Vitamin K - takes approx 4 hours

59
Q

INR needed to operate

A

<1.5

60
Q

Association of Ovarian Pain

A

Often mid-cycle, associated with ovulation

61
Q

Where is McBurney’s Point?

A

2/3rds between the ASIS and umbilicus

62
Q

Ix of Choice for Ovarian Pathology

A

USS

Especially if suspected ovarian torsion

63
Q

Scoring System Appendicitis

A

Alvarado’s Score

Especially useful in children - try to avoid imaging children if possible

64
Q

What is Hartmann’s Procedure?
Reversibility
Uses

A

= resection of the rectosigmoid colon with closure of anorectal stump
Results in formation of end colostomy
= reversible
Use to treat colon cancer or inflammation

65
Q

Management of ER+VE Breast Cancers

A

Pre and perimenopausal - tamoxifen

Post menopausal - anastrozole

66
Q

Iliac VS Femoral Claudication

A

Buttock pain = iliac

Calf pain = femoral

67
Q

Finding in Takayasu’s Arteritis

A

Pulseless peripheries

68
Q

Calcium and Glasgow Score

A

Hypocalcaemia is part of the scoring system

Indicates increased severity

69
Q

Indications for Endarterectomy

A

<14 days from event
70-99% stenosis of carotid
Don’t do endarterectomy in 100% stenosis: no risk of embolism

70
Q

What is amaurosis fugax?

A

= clot in the ophthalmic artery

An indication for endarterectomy as O.A is a branch of the internal carotid

71
Q

What is diaphragmatic splinting?

A

= diaphragm not moving down as much due to abdominal pain or increased abdominal pressure

72
Q

When do you give antibiotics in pancreatitis?

A

Only give in necrotising pancreatitis

73
Q

Formal boundary between upper and lower GI tracts

A

Duodenojejunal junction

Marked by the ligament of Treitz

74
Q

Association with Lynch Syndrome

A

RIGHT sided colon cancers

75
Q

Associated with achlasia

A

Squamous cell carcinoma of oesophagus

76
Q

Nature of carotid occlusive disease

A

Mostly embolic

77
Q

Indications for excision of fibroadenoma

A

> 3cm

78
Q

Medication used in PAD

A

Clopidogrel

79
Q

Findings in amoebiasis (3)

A

Colonic ulceration
Abdominal pain
Bloody diarrhoea

80
Q

Association of Primary Gastric Lymphoma

A

H. pylori

81
Q

Anatomical source of rectal varices

A

Superior rectal veins

82
Q

Signet ring sign

A

Gastric adenocarcinoma

83
Q

Complications:

  1. Crohn’s
  2. UC
A 
Crohn's = fistulae, abscesses 
UC = bowel cancer, toxic megacolon
84
Q

Non-Medical Method to Induce Remission in Crohn’s

A

Exclusive enteral nutrition

85
Q

Femoral hernia relative to the pubic tubercle

A

Below and lateral

86
Q

Inguinal hernia relative to the pubic tubercle

A

Above and medial

87
Q

Borders of Hesselbach’s Triangle

A 
Medial = rectus abdominus 
Lateral = epigastric vessels 
Inferior = inguinal ligament
88
Q

Direct VS Indirect Hernia

A

Direct goes through the wall of the inguinal canal, will reappear on reduction and occlusion of the deep ring
Indirect goes through the canal itself

89
Q

INR needed to perform surgery

A

<1.5

Year 4 (27 decks)

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