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Year 6 > General surgery > Flashcards

General surgery Flashcards

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1
Q

Causes of dysphagia

A

Oesophageal cancer
Achalasia
Pharyngeal pouch
Plummer vision

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2
Q

Ix of dysphagia

A

Barium swallow- achalasia, pouch
OGD- malignancy
Manometry- if achalasia is suspected for diagnosis

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3
Q

Sx of pouch

A

Gurgling
Halitosis
Regurgitation

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4
Q

GORD sx

A

Heartburn worse laying down and after meals
Better with antacids
Belching

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5
Q

Tx of GORD

A

Antacids
PPI- trial 1-2 months

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6
Q

Urgent OGD criteria

A

Dysphagia
Mass
>55 and wt loss and reflux/dyspepsia

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7
Q

Non urgent OGD

A

Haematemesis
>55, High plts
>55, Low Hb and pain
>55, N+V and upper GI sx

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8
Q

Dyspepsia Ix and tx

A

Urea breath test
If +ve triple therapy- amox, clarith, omeprazole
If -ve PPI

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9
Q

Cause of upper GI bleed

A

Order of likeliness
PUD
Gastritis
MWT
Variceas

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10
Q

Blood diagnosis of pancreatitis

A

Amylase 3x ULN

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11
Q

Drugs that cause pancreatitis

A

F-MASS

Furosemide, mesalazine, azathioprine, steroids, sodium valproate

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12
Q

Ix of acute abdomen

A

PREG TEST
FBC, U&E, LFT, amylase, CRP, calcium, glucose, bilirubin
Faecal elastase- chronic panc, IBD
X match and G+S- suspected bleed
ABG
AXR- if suspected obstruction
Stool testing

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13
Q

Types of hernia and location

A

Femoral- lateral and inferior to tubercle
Inguinal medial and superior
Epigastric- midline between xiphi and umbilicus
Paraumbilical- next to umbilicus in midline

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14
Q

Biliary colic features

A

Unlikely if first presentation >60
RUQ pain- goes to back
After fatty food

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15
Q

When to order ERCP/MRCP

A

If bile duct look dilated on USS

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16
Q

If suspected acute cholecystitis what Ix

A

FBC, U&E, LFT, bilirubin
Urine- bilirubin
USS- if negative HIDA scan
Erect CXR

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17
Q

Sx of pancreatitis

A

Radiates to the back
Relieved by sitting forward
Vomiting

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18
Q

Biliary colic sx

A

RUQ pain radiating to scapula
May be following a fatty meal
Obstructive jaundice may occur- pale stools and dark urine

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19
Q

Diverticulitis sx

A

Colicky pain in LLQ
Fever
Hx of constipation

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20
Q

Causative organism of ascending cholangitis

A

E coli

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21
Q

Mx of ascending cholangitis

A

ABx and ERCP after 24-48hrs

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22
Q

Mx of acute cholecystitis

A

IV ABx
Early lap chole- <1 week

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23
Q

Ix for intestinal obstruction

A

Abdo CXR
CT AP

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24
Q

Types of colorectal surgical approaches

A

Right hemicolectomy- tumour in caecum- ileocolic AN
Left- tumour in descending
Hartmann- diverticulitis- stoma in LIF
AP resection - rectal Ca <5cm to verge- stoma in LIF
Anterior Resection- double lumen loop ileostomy in RIF
Pan-procto colectomy- ileostomy

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25
Small bowel causes of obstruction
Adhesions Hernia Tumour
26
LBO causes
Cancer Volvulus Strictures- diverticula
27
Colorectal cancer screening
FIT screening Every 2 years to 60-74 Colonoscopy once +
28
Tx of post op ileus
NG and IV fluids
29
Tx of volvulus
Sigmoidoscopy and rectal tube insertion- sigmoid Laparotomy and right hemi- caecal
30
Tx of femoral hernia
Urgent Elective- lockwood Emergency- McEvedy
31
Extra-intestinal features of IBD
A PIE SAC Aphtous ulcer- Crohns Pyoderma gangrenosa Iritis/uveritis- CD Erythema nodosum Sclerosing Cholangitis- UC/ stones- CD Arthritis Clubbiong- CD
32
When to give pneumococcal vaccine with splenectomy
2 weeks before
33
Signs of wound dehiscence and action
Bowel protruding Pink discharge Urgent senior help
34
Tearing chest pain and creps over chest wall dx
Boerhavers
35
Sudden abdo pain, out of keeping of exam findings and AF
Acute mesenteric ischaemia
36
Ischaemic colitis sx
Bloody diarrhoea Less severe Resolves spontaneously
37
Sulphonylureas on say of surgery
Withold morning Give in afternoon
38
Tx of thromboses haemorrhoid
>72 hours- stool softener, ice pack, analgesia <72- excision
39
Ix for leaking anastomosis
CT PA
40
Sx of ileus
Hypovolaemic Electrolytes disturbances Absent bowel sounds No emptying of bowels
41
Anastomotic leak sx
Septic picture Peritotism
42
When to refer for colonoscopy for cancer
>40 unexplained wt loss and pain >50 bleeding >60 IDA or change in bowel habits
43
Indications for thoracotomy in haemothorax
Blood loss >1.5L
44
Brown coloured urine, abdo distension and obstruction of bowel
Colovesical fistula ? CT
45
Diagnostic test of chronic pancreatitis
CT With IV contrast
46
Gastric volvulus triad
Vomiting, pain, failed attempts to pass NG tube
47
Polyp and hypokalaemia
Villous polyp
48
Mx of strangulated hernia in GP
Call 999- get assessed urgently DO not attempt to manually reduce
49
Ruptured AAA blood products
6 units of blood
50
Test for hernias
Cough impulse Reducible Place over deep inguinal ring See if reappears
51
If pain and drain with green fluid after cholecystectomy
Biliary leak
52
Anterior vs AP resection
Anterior- >5cm- or mid to upper tumours AP- <5cm or lower
53
Dx of Boerhaaves syndrome
CT contrast swallow
54
Bsoas sign
Pain beneath right scapula in cholecystitis
55
Pancreatic cancer sign on USS/CT
Double duct sign- obstruction on CBD and pancreatic duct
56
Nissen fundoplication tests before surgery
pH and mamonetry
57
Tx of asymptomatic gallstones
Reassurance- if sx free for 12m
58
Node in umbilicus and its meaning
St Marys Joseph node Malignancy in pelvis or abdo
59
Recurrent natal cleft pain and mx
Pilonodal sinus disease Cystectomy
60
Feeding after oesophagectomy
Jejunostomy
61
When to give FIT test
To new symptoms not meeting 2ww criteria Or to 60-74 screening every 2 years
62
What happens in Hartmanns
Resect relevant bowel End colonostomy Can have future anastomosis
63
Dukes staging
A- mucosa B- muscle C- lymph D- Distant mets
64
Hasselbach triangle
Direct hernia passes through Made out of Inguinal ligament Inferior epigastric Rectus Abdominis
65
Unilateral vs bilateral surgical approach
Unilateral- open Bilateral- laproscopically
66
Layers in abdomen
Skin, fatty superficial fascia- campers Membranous- Scarpas Ext oblique Int oblique Transverse abdominus
67
Arcuate line significance
No posterior rectus sheath underneath umbilicus Allows immediate access to peritoneum
68
Sigmoid volvulus with peritonitis
sigmoid volvulus who have bowel obstruction with symptoms of peritonitis, skip the flexible sigmoidoscopy and treat with urgent midline laparotom
69
Ultrasound of hepatic hemangioma
Hyperechoic
70
ABx for diverticulitis
IV cef and met
71
What condition is associated with Squamous cell carcinoma
Achalasia
72
Pancreatitis nutrition mx
Only NBM if vomitting Otherwise encourage oral feeding
73
If procedure to remove gallstone and afterwards febrile what is the dx
Pancreatitis secondary to ERCP

Year 6 (28 decks)

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