Abdo Flashcards
(68 cards)
What are the indications for laparoscopy?
✅ Diagnostic Purposes – Undiagnosed Abdominal Pain, Trauma, Suspected Malignancy
✅ Therapeutic Procedures – Cholecystectomy, Appendicectomy, Hernia Repair
✅ Emergency Cases – Perforated Viscus, Ectopic Pregnancy, Trauma
✅ Staging of Cancers – Ovarian, Gastric, Pancreatic Cancers
What are the types of stoma?
✅ Ileostomy – Usually Right Iliac Fossa, Spouted, Liquid Output
✅ Colostomy – Usually Left Iliac Fossa, Flush, Formed Output
✅ Urostomy (Ileal Conduit) – Urinary Diversion Using Ileum
✅ Loop vs End Stoma – Loop for Temporary Diversion, End for Permanent
What are the complications of renal transplant?
✅ Early (<1 Month): Rejection, Vascular Thrombosis, Infection
✅ Intermediate (1-6 Months): Opportunistic Infections (CMV), Medication Side Effects
✅ Late (>6 Months): Chronic Rejection, Malignancy (PTLD, Skin Cancer)
✅ General: Hypertension, Diabetes (from Immunosuppressants)
What potential surgeries may have been done for a midline laparotomy scar?
✅ Emergency Laparotomy (Perforation, Peritonitis, Ischaemic Bowel)
✅ Elective Surgery (Pancreatic, Gastric, Small Bowel Resection)
✅ Open AAA Repair
✅ Anterior Resection, Hartmann’s Procedure
What are the differentials for a midline laparotomy scar?
✅ Elective Surgeries: Anterior Resection, APER, Open AAA Repair
✅ Emergency Surgeries: Bowel Perforation, Adhesiolysis, Trauma Laparotomy
✅ Other Considerations: Small Bowel Resection, Peritoneal Dialysis Catheter
What could a small curved scar near the umbilicus indicate?
✅ Laparoscopic Port Site (Appendicectomy, Cholecystectomy)
✅ Umbilical Hernia Repair
✅ Feeding Tube (PEG, Jejunostomy)
✅ Drain Site (Peritoneal Dialysis, Abscess Drainage)
What medications are used in renal transplant?
✅ Immunosuppressants:
Calcineurin Inhibitors (Tacrolimus, Cyclosporine)
Antimetabolites (Mycophenolate, Azathioprine)
Steroids (Prednisolone)
✅ Other Important Medications:
Antibiotic Prophylaxis (Co-trimoxazole)
Antiviral Prophylaxis (Valganciclovir for CMV Prevention)
Statins, Antihypertensives (To Reduce Cardiovascular Risk)
What two classes of medications are most important to monitor in renal transplant?
✅ Immunosuppressants (Tacrolimus, Mycophenolate, Prednisolone) – Monitor Drug Levels, Side Effects, Infection Risk
✅ Antihypertensives (ACE Inhibitors, Calcium Channel Blockers) – Prevent Graft Hypertension & Prolong Survival
What could a 15 cm subcostal scar be for if it is relatively fresh?
✅ Open Cholecystectomy (If Right-Sided, Below Ribcage)
✅ Liver Resection (If More Extensive, Hepatic Surgery)
✅ Splenectomy (If Left-Sided, Trauma, Haematological Condition)
What could the well-healed scar across the abdomen and the lack of umbilicus indicate?
✅ Paraumbilical/Umbilical Hernia Repair with Mesh (Explains No Umbilicus)
✅ Previous Laparotomy with Mesh Repair (If Extensive Scar Across Abdomen)
✅ Abdominal Wall Reconstruction (For Recurrent Hernias, Complex Repairs)
What could two small haematomas on the abdomen indicate?
✅ Subcutaneous Injection Sites (LMWH, Insulin, Heparin)
✅ Post-Surgical Bruising (Recent Laparoscopy, Stoma Surgery, Port Insertion)
✅ Coagulopathy (Liver Disease, Anticoagulants, Thrombocytopenia)
✅ Trauma (Minor Blunt Injury, Post-Procedure Bleeding)
What could an oblique scar in the RIF with a tiny mass indicate?
✅ McBurney’s Scar (Open Appendicectomy)
✅ Hernia Repair (Inguinal, Femoral, Incisional Hernia)
✅ Renal Transplant Scar (If Near Rutherford-Morrison Region)
✅ Benign Soft Tissue Mass (Lipoma, Fibroma, Sebaceous Cyst)
What could two masses in the abdomen, one in RIF and a suprapubic mass, indicate?
✅ Renal Transplant (RIF Mass, Paramedian Scar, Dull to Percussion)
✅ Simultaneous Pancreas-Kidney Transplant (Midline Scar, Second Mass in Suprapubic Area)
✅ Bladder Distension (If Suprapubic Mass is Soft, Dull, and Discomfort Present)
✅ Previous Pelvic Surgery (Hysterectomy, Ovarian Cystectomy, Urological Surgery)
🔹 Midline Scar Instead of Rutherford-Morrison → More Likely SPK Transplant
What does a paramedian scar overlying a mass in RIF suggest?
✅ Paramedian Scar in RIF + Mass in RIF → Common for Renal Transplant
✅ Dull to Percussion → Solid Organ, Likely Kidney
✅ Hickman Line Scar in Upper Chest → History of Dialysis Before Transplant
✅ No Cluster of Scars → Unlikely Laparoscopic or Stoma-Related Surgery
🔹 Hickman Line Often Used for Haemodialysis → Supports Renal Transplant History
What are other potential indications for a paramedian scar?
✅ Previous Renal Transplant (Common for Older Surgical Techniques)
✅ Ileal Conduit (Urostomy) Surgery
✅ Bowel Surgery (Ileocaecal Resection, Right Hemicolectomy for Crohn’s)
✅ Retroperitoneal Surgery (Aortoiliac Bypass, Lymph Node Dissection)
What do multiple abdominal scars suggest?
Previous Laparoscopic Surgery (Cholecystectomy, Hernia Repair, Appendicectomy)
Suprapubic Scar → Possible Previous C-Section, Urological or Gynaecological Surgery
Circular RIF Scar → Possibly a Stoma or PEG Site
✅ How Would You Like to Complete the Exam?
Check for Stoma, Hernias, and Surgical Changes (Palpation, Percussion, Auscultation)
Assess for Any Associated Organomegaly or Masses
Check for Peripheral Stigmata of Chronic Disease (Pallor, Jaundice, Clubbing)
How would you examine the hernial orifices?
✅ Patient Positioning:
Standing First (More Likely to Protrude), Then Lying Down
✅ Inspection:
Look for Visible Swelling at Groin, Umbilicus, Incisional Sites
Ask Patient to Cough or Perform Valsalva (See If Hernia Becomes More Prominent)
✅ Palpation:
Assess for Reducibility (Soft, Compressible vs. Irreducible Hernia)
Check Cough Impulse (Positive in Most Hernias, Absent in Strangulated Ones)
Differentiate Between Direct & Indirect Inguinal Hernia Using Finger in Inguinal Canal
✅ Percussion & Auscultation:
Percuss for Bowel Sounds (Suggests Hernia Contains Bowel, Likely Indirect Inguinal or Incisional Hernia)
🔹 Key Hernial Orifices to Examine:
Inguinal (Direct/Indirect), Femoral, Umbilical, Incisional, Spigelian
Why would someone have an ileostomy?
✅ Inflammatory Bowel Disease (IBD) – Crohn’s, Ulcerative Colitis (UC)
✅ Bowel Obstruction (Strictures, Volvulus)
✅ Colorectal Cancer (Resection Requiring Stoma Formation)
✅ Diverticular Disease (Complicated Perforation, Fistula Formation)
✅ Trauma (Bowel Injury, Resection Required)
What is the difference between temporary and permanent ileostomy?
✅ Temporary Ileostomy – Diverts Stool to Allow Bowel to Heal (E.g., Following Resection in IBD, Diverticular Disease, Perforation, Trauma)
✅ Permanent Ileostomy – Used If Entire Colon/Rectum Is Removed (E.g., Panproctocolectomy in UC, Familial Adenomatous Polyposis - FAP)
✅ Bowel Rest Needed To:
Prevent Further Inflammation/Injury (E.g., Acute Severe Crohn’s, Fistulating Disease)
Allow Resection Sites to Heal Without Faecal Contamination
Reduce Symptoms Like Severe Diarrhoea, Pain, Perforation Risk
What are the types of IBD?
✅ Ulcerative Colitis (UC) – Affects Colon Only, Continuous Mucosal Inflammation
✅ Crohn’s Disease – Anywhere in GI Tract (Mouth to Anus), Skip Lesions, Transmural Inflammation
✅ Indeterminate Colitis – Features of Both UC & Crohn’s, Often Diagnosed Post-Colectomy
🔹 UC = Mucosal Disease | Crohn’s = Transmural, Skip Lesions, Fistulae
Why else would someone with IBD have an ileostomy apart from bowel rest?
✅ Severe Fistulating Crohn’s Disease (To Divert Stool & Reduce Fistula Output)
✅ Refractory IBD Not Responding to Medical Treatment (Steroids, Biologics Failed)
✅ Colorectal Cancer in IBD (High-Risk Dysplasia, Resection Needed)
✅ Toxic Megacolon (Life-Threatening Complication of UC, Requires Surgery)
What type of IBD needs a panproctocolectomy?
✅ Ulcerative Colitis (UC) – If Severe, Unresponsive to Treatment, Risk of Malignancy
✅ Familial Adenomatous Polyposis (FAP) – Prevents Colorectal Cancer
🔹 Panproctocolectomy = Removal of Colon, Rectum, & Anus → Permanent Ileostomy
Who would you give an ileo-anal pouch?
✅ Patients Undergoing Panproctocolectomy for UC or FAP Who Want Continence
✅ Good Sphincter Function Needed (Otherwise, Risk of Incontinence)
✅ Younger Patients Preferable (Better Functional Outcomes)
🔹 J-Pouch Formed from Ileum, Connected to Anus → Allows Normal Defecation
What are other potential indications for the paramedian scar?
✅ Renal Transplant (Older Technique Before Rutherford-Morrison Incision Used)
✅ Urostomy (Ileal Conduit for Bladder Cancer, Urological Conditions)
✅ Right Hemicolectomy (For Caecal/Ascending Colon Cancer)
✅ Retroperitoneal Surgery (Lymph Node Dissection, Aortic Surgery)
