General & Colorectal Surgery Flashcards Preview

Specialities > General & Colorectal Surgery > Flashcards

Flashcards in General & Colorectal Surgery Deck (13):
1

What is a pseudo-obstruction?

Which patients are more at risk?

What is the radiological sign that suggests this?

Large bowel obstruction without mechanical causes

Trauma, severe infection, post ortho/cardiac/pelvis surgery patients (leads to abnormal bowel motility)

Air throughout colon down to the rectum

2

When should you be worried about perforation in patients with large bowel obstruction?

When there is a fever and signs of peritonitis (suggests ischaemia)

When there is dilation above 10cm

3

What are the aetiological factors for perianal abscess formation?

Crohn's disease
Anal trauma
Anorectal carcinoma
Anal fissure
Pelvic abscess may form secondary to IBD/diverticulitis


Most are idiopathic

4

What are the differentials in female patient with RIF pain?

Surgical
- Acute appendicitis
- Crohn's
- Mesenteric adenitis
- Diverticulitis (with floppy sigmoid)

Gynea
- PID
- Ruptured ovarian cyst
- Ectopic preg
- Ovarian torsion
- Haemorrhage/Rupture of ovarian mass

Uro
- Ureteric colic
- Acut pyelonephritis

5

What is the rule of 2s?

Meckel's diverticulum
- 2% of population
- 2 inches from ileocaeacal valve
- 2 inches long

6

Surgical treatment of rectal cancer?

If within 5cm of anal verge => abdomino-perineal resection of anus and rectum with permanent end colostomy

If more the 5cm from anal verge => anterior resection +/- temporary defunct toning colostomy

7

What are the dispositions to a sigmoid volvulus?

Long, narrow mesocolon, chronic constipation or high roughage diet

8

What are the commonest causes of large bowel obstruction?

Carcinoma
Diverticulitis (repeated diverticulitis leads to strictures)
Volvulus
Intussusception
Colonic pseudo-obstruction

9

What is the Dukes staging for colon cancer?

A - Cancer does not breach the muscularis propria
B - Cancer breaches the MP but no lymph nodes
C - Local lymph node involvement
D - Distant metastases

10

What are the histological findings of Crohn's disease?

Non-casaeting granulomata with transmural inflammation of bowel mucosa and frequent lymph aggregates in the subserosa

11

What are the extra-intestinal manifestations of Crohn's?

Conjunctivitis and iritis
Cirrhosis of liver
Cholangiocarcinoma
Primary sclerosing cholangitis
Renal stones and gallstones
Erythema nodosum
Pyoderma gangrenosum
Psoriasis
Ankylosing spondylitis

12

What are the histological features of UC?

Acute and chronic inflammatory cells that are confined to the mucosa (Infiltrative in Crohn's)

BUT in severe disease there is fissuring and transmural inflammation (making differentiation difficult)

13

What are the differentials of an acute appendicitis?

Mesenteric adenitis
Meckel's diverticulum
Posts abscess
Crohn's disease

Also if female:
Ovarian cyst rupture
Ovarian torsion
Ectopic pregnancy