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Finals Revision > General Surgery > Flashcards

General Surgery Flashcards

(42 cards)

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1
Q

What is the water distribution in the body?

A

2/3rds ICF
1/3rd ECF

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2
Q

What is the water distribution in the extracellular space?

A

Intravascular - 20%
Interstitial space - 80%

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3
Q

What is the third space

A

Areas that can collect fluid but shouldn’t. - e.g peritoneal cavity or joints

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4
Q

What is hypovolaemia?

A

Low amount of ECF

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5
Q

What are signs of hypovolaemia?

A

Hypotension
Tachycardia
CRT >2
Cold peripheries
Raised RR
Dry mucous membranes
Reduced skin turgor
Reduced urine output
Sunken eyes
Reduced body weight from baseline
Feeling thirsty

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6
Q

What are the indications for IV fluids?

A

Resuscitation
Replacement
Maintenance

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7
Q

What is the guidance for resuscitation fluids?

A

Initial 500ml fluid bolus over 15 mins (‘stat’)
Repeat boluses of 250ml-500ml if required each time followed by a reassessment

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8
Q

The rate of potassium infusion should not exceed what?

A

10mmol/hr

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9
Q

What are the recommendations for maintenance fluid amounts?

A

25-30ml/kg/day water
1mmol/kg/day of sodium, potassium and chloride
50-100g/day of glucose, to prevent ketosis

Weight is IBW

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10
Q

What is diverticulitis associated with?

A

Increased age
Low fibre diets
Obesity
NSAIDs

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11
Q

What type of laxatives should be avoided in diverticular disease?

A

Stimulant laxatives (e.g. Senna)

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12
Q

What is the management of acute uncomplicated diverticulitis?

A

Oral co-amoxiclav
Analgesia (avoiding NSAIDs and opiates)
Only taking clear liquids, avoiding solid food until symptoms improve
Follow up within 2 days

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13
Q

What are the complications of acute diverticulitis?

A

Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage
Fistula
Ileus/obstruction

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14
Q

What are the three main branches of the abdominal aorta that supply the abdominal organs?

A

Coeliac artery
Superior mesenteric artery
Inferior mesenteric artery

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15
Q

What is the foregut?

A

Stomach, part of the duodenum, biliary system, liver, pancreas and spleen. Supplied by the coeliac artery

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16
Q

What is the midgut?

A

Distal duodenum to the first half of the transverse colon. Supplied by the superior mesenteric artery

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17
Q

What is the hindgut?

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A

Second half of the transverse colon to the rectum. Supplied by the inferior mesenteric artery

18
Q

What is the classic triad of chronic mesenteric ischaemia?

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A

Central colicky abdo pain after eating (starting around 30 mins after eating and lasting 1-2 hrs)
Weight loss
Abdo bruits

19
Q

What is the cause of chronic mesenteric ischaemia?

Study These Flashcards
A

Atherosclerosis

20
Q

What is the management of chronic mesenteric ischaemia?

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A

Reducing modifiable risk factors
Secondary prevention of CVS disease
Revascularisation to improve blood flow - percutaneous mesenteric artery stenting or open surgery.

21
Q

What causes acute mesenteric ischaemia?

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A

Thrombus - key risk factor is atrial fibrillation

22
Q

How does acute mesenteric ischaemia present?

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A

Acute, non-specific abdominal pain, disproportionate to examination findings
Shock, peritonitis, sepsis
Necrosis and perforation

23
Q

How is acute mesenteric ischaemia diagnosed?

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A

Contrast CT
Metabolic acidosis and raised lactate

24
Q

What is the management for acute mesenteric ischaemia?

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A

Surgery to:
Remove necrotic bowel
Remove or bypass the thrombus in the blood vessel

Very high mortality still

25
What type of cancer are most pancreatic cancers?
Adenocarcinoma, usually in the head
26
How do pancreatic cancers present?
Painless obstructive jaundice Also: Non-specific upper abdo or back pain Unintentional weight loss Palpable mass in the epigastric region Change in bowel habit Nausea or vomiting New-onset diabetes or worsening of T2DM
27
What are the guidelines on suspected pancreatic cancer for GPs?
Direct access CT abdo if patient has weight loss and any of: Diarrhoea Back pain Abdominal pain Nausea Vomiting Constipation New-onset diabetes
28
What is Courvoisier's law?
Palpable gallbladder along with jaundice is unlikely to be gallstones - usually cholangiocarcinoma or pancreatic cancer
29
What is Trousseau's sign of malignancy?
Migratory thrombophlebitis (blood vessels become inflames with an associated blood clot reoccurring in different locations over time) Sign of pancreatic adenocarcinoma
30
What is a tumour marker for pancreatic cancer?
CA 19-9 CT TAP MRCP ERCP
31
What is the Whipple Procedure?
Remove a tumour in the head of pancreas that has not spread. Huge op. Removes: head of pancreas, pylorus of stomach, duodenum, gallbladder, bile duct, relevant lymph nodes
32
What are the three main causes of pancreatitis?
Gallstones Alcohol Post-ERCP
33
What does IGETSMASHED stand for?
The long list of causes of pancreatitis: Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidaemia ERCP Drugs (furosemide, thiazide diuretics and azathioprine)
34
How does acute pancreatitis typically present?
Acute onset of: Severe epigastric pain Radiating through to back Vomiting Associated tenderness Systemically unwell
35
What are the investigations for acute pancreatitis?
FBC U&E LFT Calcium ABG Amylase (raised x3) Lipase (sensitive and specific) CRP USS CT abdo
36
What does the Glasgow score assess?
The severity of pancreatitis 0 or 1 - mild 2 - moderate 3 or more - severe
37
What are the criteria for the Glasgow score?
PANCREAS PaO2 <8KPa Age >55 Neutrophils (WBC >15) Calcium <2 uRea >16 Enzymes (LDH >600 or AST/ALT >200) Albumin <32 Sugar (Glucose >10)
38
Management of acute pancreatitis?
ICU or HDU Initial resuscitation IV fluids Nil by mouth Analgesia Careful monitoring Treatment of gallstones Antibiotics if infection Treatment of complications
39
What are complications of acute pancreatitis?
Necrosis of the pancreas Infection in a necrotic area Abscess formation Acute peripancreatic fluid collections Pseudocysts (can develop 4 weeks after) Chronic pancreatitis
40
What is the most common cause of chronic pancreatitis?
Alcohol
41
What are the complications of chronic pancreatitis?
Chronic epigastric pain Loss of exocrine and endocrine function Damage and strictures to the duct system, obstructing excretion of pancreatic juice and bile Formation of pseudocysts or abscesses
42
What is the management of chronic pancreatitis?
No alcohol or smoking Analgesia Replacement pancreatic enzymes (Creon) Subcutaneous insulin regimes ERCP with stenting Surgery

Finals Revision (20 decks)

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