1. Feeding 2. Diverting 3. Decompression 4. Externalisation

1. Valvulae conniventes(Stack of coins) 2. String of beads appearance 3. Dilated bowel loops 4. Air fluid levels 5. These are centrally located

1. Dilated small bowel loops >2.5cm 2. Small bowel feces sign 3. Closed loop obstruction

General Stuff Flashcards by Ang Qing Kang Dominic

Borders of Hasselbachs triangle

Medial border: lateral border of rectus abdominis
Lateral border: Inferior epigastric vessels
Inferior border;inguinal ligament

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Wish list for hernia exam

1) Auscultate hernia
2) Abdo exam for ascites, masses,palpable bladder
3) Respi exam for chronic cough causes(COPD,asthma)
4) DRE for BPH, constipation, Rectal masses
5) Social Hx

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How to differentiate direct and inguinal hernia

Medial vs lateral to inf. Epigastric vessels
Cannot vs can extend into scrotum
Emerges from Hasselbachs triangle vs superficial ring

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Mid inguinal point vs midpoint of inguinal ligament

Location of femoral artery vs location of deep ring(2FBs above)

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Femoral hernia vs inguinal hernia

Femoral hernia below inguinal ligament, inferio lateral to pubic tubercle

Inguinal hernia above inguinal ligament, superior medial to PT

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Risk factors for acquired hernia

1) Old age
2) Smoking
3) Connective tissue disease
4) Male
5) High BMI
6) Causes of increased intraabdominal pressure eg pregnancy

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Contents of spermatic cord

3 arteries: Testicular artery, cremasteric artery, artery to vas deferens

3 nerve: Ilioinguinal nerve,genital branch of genitofemoral nerve, autonomic nerves

3 others: Vas deferens, pampiniform plexus, lymphatics from testes

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Mx of hernia

Conservative:
-lifestyle mod eg less standing and heavy lifting
-treat underlying causes
-abdominal truss

Surgical
1) tension free mesh repair(lichtenstein)
2) Tissue repair(tension): Shouldice
3) Transabdominal pre peritoneal repair
4) totally extraperitoneal repair

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Specific risks of hernia repair

Early
1) Hematoma or Seroma
2) ARU
3) Injury to vas deferens

Delayed
1) Chronic pain
2) Mesh infection
3) Mesh migration
4) Hernia recurrence
5) Ischemic orchitis
6)Impotence

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Indications for laparoscopic inguinal hernia repair

1) Bilateral inguinal hernia
2) Recurrent hernia from OPEN repair
3) Patient preference

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General complications of cancers 4Bs

Bleed
Block
Burst
Burrow

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Threshold to place IDC instead of in and out for ARU

Bladder scan shows vol>500ml due to risk of bladder rupture, obstructive uropathy etc

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Crescent sign of umblicus suggests

Paraumbiliical hernia

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Cx of new stomas

Ischemia and necrosis
Dehiscence
Retraction

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Cx of old/mature stomas

Stenosis
Prolapse
Cellulitis
Fistula
Parastomal Hernia

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Features that help identify type of stoma

Size of lumen
Number of lumens+stoma key
Location of stoma
Stoma effluent(output) type
spouted or not

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Complications of hernias

Obstruction
Incarceration
Strangulation
Perforation
Sx eg pain

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Functions of a stoma

Feeding
Diverting
Decompression
Externalisation

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Common causes of intestinal obstruction

Adhesions
Incarcerated hernia
CR Ca

Rarer: Strictures due to RT, IBD, extrinsic tumors, gallstone,

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3 6 9 rule of bowel obstruction

SB >3cm

LB >6cm

Caecum >9cm

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Signs of SB IO on XR

Valvulae conniventes(Stack of coins)
String of beads appearance
Dilated bowel loops
Air fluid levels
These are centrally located

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Signs of SB IO on CT

Dilated small bowel loops >2.5cm
Small bowel feces sign
Closed loop obstruction

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Classification for pelvic ring fractures

Young Burgess Classification

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Most common type of pelvic ring fx

Lateral compression

Commonly pedestrians in RTA

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8 parts of extended FAST scan

1. Apical 4 chamber cardiac 2. Morrison's pouch 3. Splenorenal 4. Bladder/Pouch of Douglas 5. Lung apices and bases

Physiological related cx of stoma

1. High output stoma 2. Electrolyte imbalances 3. Dehydration 4. Nutritional deficiencies 5. Psychosocial

Early cx of stoma

1. Ischemia/necrosis 2. Retraction 3. Dehiscence 4. Stoma bleeding 5. Ileus

Late cx of Stoma

1. Obstruction/adhesions 2. Prolapse 3. Stenosis 4. Parastomal hernia 5. Parastomal dermatitis 6. Wound infection 7. Diversion colitis/diffuse proctitis

Landmark differentiating Upper and lower BGIT

Ligament of treitz at duodenaljejunal junction

Formula for caloric intake

Harris Benedict formula

Estimated numbers for protein and caloric intake for adults

20-30kcal/kg/day 0.8-2.5g/kg/day

Complications of TPN

1. Glucose derangements hypo and hyper 2. Hypertriglyceridemia 3. PNALD (Associated Liver Disease) -steatosis, cholestasis and GB sludge/stones 4. Infection 5. Fluid overload 6. Electrolyte abnormalities 7. Metabolic bone disease

Causes of small bowel IO

Adhesions Hernia Volvulus

Scars for appendicectomy

Lower midline,lanz,gridiron

Repair of paraumblical hernia

Mayo repair “vest over pants repair”

Location of ligament of Treitz

Duodenojejunal flexure, differentiates UBGIT and LBGIT

Principles of Mx of fistula

1. Source control 2. Delineate anatomy 3. Prevent recurrence

Standard tests for diarrhea workup

Stool c/s OCP TFT Fecal calprotectin C diff

Definition of paraneoplastic syndrome

Clinical features caused by altered systemic immune response or release of hormones/proteins and not by local tumor cells

Classification of CT kidneys for RCC

Bosniak classification

Mechanism of HyperCa in malignancy

1) Paraneoplastic esp SCLC 2) Bone mets/primary 3) Multiple myeloma

Most common primary for metastasis to adrenal glands

Metastatic melanoma

DIfferent forms of BCC

Nodular, cystic, pigmented, sclerosing/morpheaform, superficial

Margins for melanoma

2cm due to high risk of local recurrence

Location where lipoma does not give positive slip sign

Forehead: lipomas are attached to frontalis?

Toxic dose of lignocaine for local anesthesia

3mg/kg without adrenaline 7mg/kg with adrenaline

Toxic dose of marcaine for local anesthesia

2mg/kg without adrenaline 4mg/kg with adrenaline

What kind of anesthesia is a Bier's block

Local regional anesthesia

Systemic side effects of local anesthesia

CNS: Seizures, AMS CVS: Arrhythmia(lignocaine is a class 1B antiarrhythmic)

Eponymous name for omental patch repair

Graham patch repair

Type of intestinal obstruction best treated by "drip and suck"

Adhesion IO

Indications for surgery in patient with IO

1. Failure of conservative treatment 2. Perforation 3. Closed loop obstruction 4. Ischemic bowel 5. Recurrent IO needing adhesiolysis

Rigler's triad of gallstone ileus

1. Gallstone 2. IO 3. Pneumobilia

Mx of acute anal fissures

Medical 1) High fibre diet to reduce constipation 2) Laxatives/ stool softeners 3) Anal sphincter relaxants: Topical GTN or nifedipine

Most common site of GIST

Stomach

Area where GIST has best prognosis

Stomach

Mx of chronic anal fissures

1. Botox 2. Lateral anal sphincterotomy

Cancers that require staging laparoscopy

Cancers at high risk of transcoelomic spread (Peritoneal metastases) 1. Esophageal esp GEJ 2. Gastric 3. Pancreatic 4. Gallbladder 5. Cholangiocarcinoma

High risk lipomas at risk of malignant transformation to liposarcoma

Retroperitoneal, groin and in deep subfascial muscles of the extremities(LL>UL) Large lipoma >7cm

What does IPOM repair stand for

Intra peritoneal Onlay Mesh Repair

Risk factors for Bezoar

1. Poor dentition 2. Gastrectomy with removal of pylorus 3.

Types of bezoar

1. Phytobezoar 2. Lactobezoar 3. Trichobezoar 4. Pharmacobezoar

Management of bezoar

1. Removal via OGD/ Colono 2. Open/ Laparoscopic surgery if bezoar is stuck in small bowel

General Stuff Flashcards

(66 cards)