Flashcards in General Surgery 1 Deck (100):
Second investigation for pneumoperitoneum is CXR not helpful?
CT - if stable
Most common cause of splenic rupture?
Blunt trauma - immediately or delayed
Investigation for suspected bowel obstruction?
Ruptured AAA - which imaging should be done before surgery if possible?
Pre-operatvie management of ruptured AAA?
Fluid resus - aim for systolic of 100 - no higher
O-ve blood until crossmatch available
Approximately how many units of crossmatched blood are required during a ruptured AAA repair?
Primary and secondary intention healing - which is quickest?
How does healing occur in secondary intention healing?
From the deeper layers by granulation tissue
Primary and secondary healing - edges opposed or unopposed?
Primary - opposed
Secondary - unopposed
Which type of healing has the worst scarring?
4 indications for splenectomy?
Splenic injury - trauma
Splenic rupture following splenomegaly - infectious mononucleosis
Hypersplenism - hereditary spherocytosis
What % of idiopathic thrombocytopenia purport patients are cured by a splenectomy?
Which organisms are splenectomy patients more at risk of?
Encapsulated - neisseria meningitides, h influenza, strep pneumoniae
4 symptoms of post operative adhesion obstruction of the small bowel?
Colicky pain, distention, constipation, vomiting
Management of small bowel obstruction post op?
Fluids, NG - most resolve spontaneously
Indication of urgent surgery in small bowel obstruction?
Strangulation - continuous pain, decreased bowel sounds fever, tachycardia
Oesophageal varies are secondary to what? and what else can present with this?
Where is a common site of atherosclerosis?
At a vessel bifurcation
When is the pain of intermittent claudication felt?
After walking a set distance, always the same distance
Why do legs with peripheral artery disease turn red when lowered during burgers test?
Because ischaemia causes vasodilation so blood rushes into the legs more than normal
5 stages of the fontaine classification?
I - asymptomatic vascular disease
II - Claudication >200m
III - Claudication <200m
IV - rest pain
V - gangrene or ulcers
How is ABPI calculated?
Ankle pressure/brachial pressure
0.4-0.85 (severe <0.4) lower pressure in the ankle
Why might a calcified vessel give a false ABPI reading?
Because it is not compressible
3 types of phase on doppler?
Triphasic - normal
Biphasic - disease
Monophasic - severe disease
Benefit of duplex doppler?
Assesses the speed of flow - blood will speed up and slow down depending on occlusions
Definition of critical limb ischaemia?
Rest pain of 2 week and tissue loss - pain particularly when lying down with feet up
What is acute limb ischaemia?
Thrombosis at the site of existing disease
6 P's of acute limb ischaemia?
What % of amputations need to be converted to higher amputations due to non healing?
Nerve at risk of damage during carotid endarterectomy?
Two drugs to be started in peripheral vascular disease?
Statin (regardless of cholesterol)
What intervention should be performed first in PVD?
Name 3 surgical options in the management of PVD?
When is AAA screening performed?
What diameter or aorta is classed as an aneurysm?
At what size should an aneurysm be surgically repaired?
What type of ulcers are diabetic patients with neuropathy more likely to get?
Neuropathic ulcers - at pressure points
What is a Marjolines ulcer?
A squamous cell carcinoma at the site of previous injury
What type of ulcer is associated with IBD?
What is the imaging of choice for osteomyelitis?
What is the most common vessel used in CABG?
left internal mammary
What might cause a groin swelling after vascular surgery?
Femoral artery aneurysm
Name 1 sign of a dissected thoracic aneurysm?
Different BP's on each arm
Which vessels are affected in burgers disease?
Small and medium sized arteries, often tibial and radial
Name 1 non vascular examination to be done in the case of varicose veins?
Abdominal examination - can be caused by abdominal mass e.g. pregnancy
Which nerve palsy is the most common in cavernous venous sinus thrombosis?
6th nerve palsy
What causes hyper pigmentation in a venous ulcer?
Where is the most common site for a AAA?
What are the two options in repairing a AAA?
Open repair or EVAR
Open is higher risk - but better for younger fitter patients
EVAR - better for older patients with short life expectancy
What causes varicose veins?
Failure of the venous valves causes back flow in to the superficial venous system and high venous pressure
What are the 3 options of treatment for varicose veins?
What two points does the inguinal canal run between?
Deo inguinal ring and superficial ring
What is the contents of the inguinal canal (male)?
3 arteries - vas deferens, testicular, cermasteric
3 fascial layers
3 others - pampiniform plexus, vas deferens, lymphatics
3 nerves - genital, sympathetic, ilioinguinal
What is in the inguinal canal (female)?
Ilioinguinal nerve and round ligament
What are the borders of the inguinal canal?
Superior -internal oblique, tranversus abdominus
Anterior - 2 aponeurosis - internal and external oblique
Inferior - 2 ligaments - inguinal and lacunar
Posterior (2T's) - transversals fascia, conjoint tendon
Where does the inguinal ligament attach?
ASIS and pubic tubercle
What two factors are needed to form a hernia?
Weakness and an increase in pressure
What happens in a strangulated hernia?
There is a compromise to the blood supply
What happens in an incarcerated hernia?
The hernia is stuck in its sac
Name 3 risk factors for inguinal hernias?
What forms the sac of the hernia?
A protrusion of peritoneum
Where are inguinal hernias located anatomically?
Above the level of the pubic tubercle
Where are indirect and direct inguinal hernias in relation to the inferior epigastric artery?
Indirect - lateral
Direct - medial
Do indirect or direct hernias reach the scrotum?
Indirect - possible
Direct - rarely
Indirect and direct hernias, most common in which age groups?
Direct - older patients
Indirect - younger, may be congenital
Which type of hernia travels along the inguinal canal?
Indirect inguinal hernia
Which type of hernia pushes from behind the inguinal canal?
Direct inguinal hernia
What are the borders of the femoral Canal?
Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament
Where are femoral hernias anatomically?
Below and lateral to the pubic tubercle
Which gender is more at risk of femoral hernias?
Why should femoral hernias be fixed more quickly?
Higher risk of complications, risk of small bowel obstruction
What is a herniorraphy?
Surgical repair of abdominal wall with a suture
What is herniotomy?
Excision of hernial sac after reducing contents
If there is a recurrence of a hernia how should it be fixed?
in the opposite way from original repair
Which nerve is at risk of damage during inguinal hernia repair?
What are the categories of surgical complications?
Local - immediate, early, late
Systemic - immediate, early, late
What is a Madyl's hernia?
W shaped hernia, patient may be very unwell
What is a differential diagnosis for groin swelling in an IVDU?
What adjuvant treatment is given after all WLE's in breast cancer?
When is hormonal therapy given in breast in cancer?
If oestrogen receptor positive +ve
What 2 drugs are used at hormonal therapy in breast cancer?
Pre and peri menopausal - Tamoxifen
Post menopausal - Aromatase inhibitors e.g. anastrozole
Name 3 side effects of hormonal therapy in breast cancer?
Endometrial cancer risk
When is biological therapy used in breast cancer?
When HER2 positive
Name 1 biological drug used in breast cancer?
What is CA125 a marker of?
What is CA 19-9 a marker of?
What is Ca 15-3 a marker of?
What is AFP a marker of?
HCC and teratoma
What is CEA a marker of?
What is Thumb printing on AXR suggestive of?
What is ascending colangitis?
Bacterial infection of the biliary tree
What is the most common cause of extra dural haematoma?
Name 2 causes of subdural haematoma?
When should you do a CT in a patient with head injury while on warfarin?
Within 8 hours - if no obvious signs of bleed
What is the most common type of oesophageal cancer and what is associated with?
Adenocarcinoma - GORD and Barrets
Used to be squamous - smoking
What topical treatment is used for anal fissures?
Where does a marjolin ulcer arise from?
Site of previous injury