Gen Surgery Flashcards
(96 cards)
1
Q
Which type of stoma spouts at least 2cm from the skin?
A
Ileostomy - bc ileal contents have digestive enzymes that cause skin irritation
(Colostomy is at mucosa level)
2
Q
Which colostomy is temporary and done in emergencies?
A
Loop colostomy
3
Q
Classes of hemorrhagic shock based on blood loss?
A
1 <750
2 750-1500
3 1500-2000
4- >2000
think of it in terms of bottle of wine
4
Q
What’s the minimum amount of fluid in abdomen that a FAST scan can detect?
A
250-500ml
5
Q
What’s the lethal triad?
A
coagulopathy
acidosis
hypothermia
6
Q
What inherited disorder puts you at increased risk of colon cancer?
A
Lynch syndrome (HNPCC)
7
Q
What is tenesmus?
A
Discomfort after emptying bowels
8
Q
What does Duke’s stage A mean?
A
It’s spread into but not beyond the muscularis propia (10%)
9
Q
What does Duke’s stage B mean?
A
It’s spread through full thickness of bowel wall (30%)
10
Q
Typical surgical option for tumours of transverse colon?
A
Extended right hemicolectomy
11
Q
Surgical option for cancers involving rectosigmoid and upper rectum?
A
Anterior resection (high ligation of inferior mesenteric artery)
12
Q
Emergency procedure for obstructed rectosigmoid cancers?
A
Hartmann’s procedure (resection with end colostomy)
13
Q
What is done in a loop colostomy?
A
A loop of the bowel is pulled through abdomen. The loop is then opened to form two new openings, one to active bowel one to inactive
14
Q
What’s a double barrel stoma?
A
Bowel is separated and two sep stomas are formed. One functional, one for mucus. May be brought back together once area of bowel has rested
15
Q
What fluid imbalances often occur in ileostomy?
A
Low sodium, high potassium. low magnesium (addison’s picture) = dehydration, AKI
16
Q
Difference between Lockwood approach and McEvedy approach?
A
Lockwood - enter below inguinal ligament
McEvedy - from above by entering rectus sheath and displacing rectus abdominis medially
17
Q
Inheritance pattern of Lynch syndrome?
A
autosomal dominant
18
Q
What genes can have inactivating mutations in lynch syndrome?
A
MSH2, MLH1, MSH6 and PMS2
19
Q
What is Duke’s C?
A
spread to involve lymph nodes
20
Q
What is Duke’s D?
A
distant metastases
21
Q
When might total mesorectal resection be done?
A
For low rectal cancers, improves survival
22
Q
What is first line chemo agent for colorectal cancer?
A
Capecitabine - metabolised to 5-FU
23
Q
What monoclonal antibody can be used to treat colorectal cancer?
A
Cetuximab - monoclonal antibody to EGFR
24
Q
What blood test can be used to monitor colorectal cancer?
A
Serum CEA - Carcinoembryonic antigen
25
Difference in presentation right sided vs left sided cancers? And rectal?
R- anemia, easy fatihuability
L- change in bowel habits, constipation, bleeding
Rectal - rectal bleeding, tenesmus
25
Difference between anterior resection and abdominoperineal resection?
anterior resection - intact sphincter, APR - rectum not preserved
26
Which muscle are stomas placed in?
rectus abdominis
27
What is considered high output in stomas?
Greater than 1.5 to 2 litress
28
What are the most common types of hernias for newborns, men and women?
newborn - indirect inguinal hernia
men - direct inguinal hernia
women - femoral hernia
29
Wherabouts do you tend to find femoral hernias?
Just below inguinal ligament (medial to mid inguinal point). Inguinal hernias tend to be above
30
Difference between incarcerated and strangulated hernias?
incarcerated - when contents cant be reduced back (at risk of progressing to strangulated)
strangulated - where blood supply is compromised (severe pain, tenderness, signs of sepsis)
31
Hernia medial to the inferior epigastric vessels?
direct inguinal hernias
32
What is the next most common cancer associated with HNPCC after colon cancer?
Endometrial cancer
33
When should FIT test be done in over 60s?
In any anaemia even in absence of iron deficiency. Should be done even if perosn had a negative FIT result through screening programme
34
Positive FIT test result what should you do?
Refer on suspected cancer pathway
35
What antigen can help stage colorectal cancer?
carcinoembryonic antigen
36
what kind of antibody is cetuximab?
monoclonal antibody to EGFR (used often in metastatic disease)
37
Firstline adjuvant chemotherapy for Duke's C colorectal cancer?
capecitabine
38
How should be people with Lynch syndrome be managed?
Colonoscopy every 1-2 years from age 25 or 5 years younger than the youngest affected relative
39
Small bowel volvulus presentation?
symptoms of small bowel obstruction, abdo pain, absolute constipation, distended bowel, high pitched tinkling bowel sounds due to fluid filled dilated loops of small intestine
40
Risk factor for sigmoid volvulus?
elderly patients or those with chronic constipation
41
Gastric volvulus - what is Borchardt's triad?
severe epigastric pain, retching without vomiting and inability to pass a nasogastric tube
42
Coffee bean sign?
due to dilated loops of bowel, suggests sigmoid volvulus
43
Treatment for sigmoid volvulus?
Initial management can be done with flexible sigmoidoscopy and rectal tube placement for decompression, but high recurrence rate so definitive surgery should be planned.
44
Conservative treatment for varicose veins?
leg elevation, weight loss, regular exercise, graduated compression stockings
45
When might refer varicose veins for secondary care?
troublesome lower limb symptoms, previous bleeding from the veins, skin changes secondary to chronic venous insufficiency, superficial thrombophelbitis or leg ulcer
46
treatments for varicose veins?
endothermal ablation, foam sclerotherapy, surgery
47
classification of surgical site infection?
superficial - within 30 days, only skin or sub cut. deep incisional, the deep soft tissuewithin 30 days or up to a year if implant in place - fever, tenderness absccess. Organ - within 30 days or within a year if implant
48
primary, secondary, tertiary classifications of peritonitis?
primary - no identifiable source of infection, associated with conditions leading to ascities,
secondary - contamination from intra-abdominal source eg perforation
tertiary - persistent or recurrent after treatment for primary or secondary
49
symptoms of peritonitis?
constant and diffuse abdo pain, rebound tenderness, guarding, nausea and vomiting, constipation, fever,
50
Neutrophil count greater than 250 cells/mm3 in ascitic fluid?
indicative of spontaenous bacterial peritonitis
51
Treatment for perianal abscess?
incision and drainage under local anesethetic. Antibiotics not necessary unless systemic infection
52
pancreatic cancer symptoms?
weight loss, jaundice, abdominal pain radiating to the back and anorexia
53
Most common type of pancreatic cancer?
pancreatic ductal adenocarcinoma, most pancreatic cancers are from the exocrine component
54
What us Trousseau's syndrome?
migratory thromboplebitis, blood clot nodules under the skin that change location. Associated with malignancy in particular pancreatic cancer
55
2 week wait criteria for pancreatic cancer?
anyone over 40 with jaundice
56
What is Whipple procedure?
pancreaticduodenectomy
57
Most common types of oesophageal cancer?
in the UK - adenocarcinoma, lower 1/3
in developing world - squamous cell cancer - upper 2/3
58
primary diagnostic modality of oesophageal cancer?
upper GI endoscopy and biopsy
59
Most common cause of large bowel obstruction?
Carcinoma - around 60%. Volvulus is most common benign cause (10%)
60
feature of LBO on CT?
Transition point with a proximal dilated colon of greater than 8cm and a collapsed distal colon to this point
61
Use of contrast enema for bowel obstruction?
can be diagnostic - show a bird's beak sign and also can be therapeutic by dislodging faeces
62
contraindications for contrast enema?
contraindicated in perforation due to leak of contrast into abdo cavitiy
63
difference in presentation between small bowel and large bowel obstruction?
SBO more acute, LBO more gradual. In SBO, abdo pain intermittent and colicky and more focal, while in LBO pain is more continuous and diffuse.
64
Management of LBO?
If bowel perforation not suspected and where cause of obstruction doesnt need surgery then conservative management up to 72 hours can be trialled
IV fluid
Nasogastric tube
65
Gold standard for diagnosing paralytic ileus?
CT scan - often can see a distinct transition point. Dilated bowel loops proximal to transition >3cm SBO, >5cm LBO
66
High-pitched, tinkling sounds paralytic ileus or bowel obstruction?
mechanical bowel obstruction. Sounds would be completely absent in paralytic ileus
67
Leading cause of small bowel obstruction?
Post-op adhesions 60-70%
68
Ideal investigation for a suspected SBO?
Plain radiography, but if there's high clinical suspicion and xray neg recommended to get a CT
69
Most common cause of acute mesenteric ischaemia?
Arterial embolism
70
Hallmark feature of acute mesenteric ischamia?
sudden onset severe abdominal pain, sharp or stabbing which is often described as "pain out of proportion"
71
Imaging modality of choice for acute mesenteric ischaemia?
multidetector computed tomography angiography (MDCTA) - provides detailed visulation or arterial and venous systems and assesses bowel wall viability
72
Risk factors for chronic mesenteric ischaemia?
May be thought of as intestinal angina - seen in elderly patients with history of smoking, hypertension and hyperlipidemia
73
Signs of chronic mesenteric ischaemia?
postprandial abdo pain (about 30 mins -2 hours after eating), weight loss and food aversion, nausea vomiting and diarrhoea
74
Location of femoral hernias?
inferior to inguinal ligament and medial to femoral vein
75
What does incarcerated hernia mean?
when hernia cant be reduced back to abdo cavity due to tight femoral ring, incarcerated hernia at risk of progressing to strangulation (dont use hernia belts/trusses for femoral hernias)
76
How to differentiate between direct and indirect inguinal hernias?
indirect, finger pressure applied over deep inguinal ring, the finger pressure will control the hernia. For direct hernias, ask patient to cough and bulge should appear medial to point of finger pressure
77
Management of asymptomatic hernias?
watchful waiting if risk of bowel obstruction low, but 6 month regular clinic follow up needed
78
Where do internal haemorrhoids originate from?
superior rectal plexus (above the dentate line)
79
differentiating between fissures and haemorrhoids?
fissure pain is sharp and severe, haemorrhoid pain less intense and more like discomfort and itching
80
conservative management of haemorrhoids?
fibre supplementation, analgesia (paracetamol and topic anaesthetics) and topical corticosteroid for short term symptom relief
81
Two biggest risk factors for peptic ulcers?
NSAIDs and H.Pylori infection
82
The classic triad of symptoms in perforated peptic ulcer?
abdominal pain, tachycardia and abdominal rigidity
83
First-line imaging for xray?
xray - useful as approx 75% with perforated ulcer will have free air under diaphragm
84
The initial resus plan for perforated peptic ulcer?
IV fluids, nasogastirc tube insertion, IV proton imhibitors (enhance fibrin formation), antibiotics
85
What should be done post-operatively for perforated peptic ulcer?
upper endoscopy to identify cause, if H Pylori pos then H pylori eradication
86
Wjy does biliary colic happen after a fatty meal?
Bc cholecystokinin is released which leads to gallbladder contraction and exacerbation of pain
87
differentiating biliary colic and acute cholecystitis?
acute cholecystitis - pain lasts more than 6 hours and might get leukocytosis. Also Murphy's sign is pos in acute cholecystitis
88
Charcot's triad?
Jaundice, fever, RUQ abdominal pain - indicates ascending cholangitis
89
First-line imaging for ascending cholangitis?
ultrasound, can use CT where ultrasound inconclusive. MRCP used before potential ERCP interventions
90
What is familial adenomatous polyposis?
rare autosomal dominant condition which leads to polyps and inevitably carcinoma. Due to mutation on APC gene, patients will nomrally get a. total colectomy
91
What is psoas sign?
Pain on extending hip if retrocaecal appendix
92
Risk factors for AAA?
Smoking history, COPD, poorly controlled hypertension
93
Referral criteria for AAA?
>5.5cm refer to be seen within 2 weeks of diagnosis. AAA that is 3-5.4cm to a regional vascular service within 12 weeks
94
Management of acute anal fissure?
high fibre diet, bulk forming laxatives, lubricants, topical anaesthetics, analgesia
95
What levels can help differentiate between upper GI bleed vs lower GI bleed?
Urea levels - high urea can indicate upper GI bleed (bc when upper GI bleeding occurs the blood is digested into proteins and these proteins are transported to liver to be metabolised in urea cycle)
