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Y3 Surgery > General surgery > Flashcards

General surgery Flashcards

1
Q

What are hormones that reduce acid production?

A
  • Somatostatin
  • Secretin
  • CCK
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2
Q

What are common pathologies in GI?

A
  • Peptic ulcer disease
  • GORD
  • Hiatus hernia
  • Gastric cancer
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3
Q

What is the most common pathology you see with the pancreas?

A

Acute pancreatitis

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4
Q

Where is Calot’s triangle useful?

A

Laparascopic cholecystectomy
- View of safety
- Location of the cystic artery

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5
Q

When do you do a splenectomy with trauma?

A

Grade 4 injury
Splenic vein and artery have been ruptured

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6
Q

9/10/11 rib fracture on the left side?

A

Think about damage to the spleen!

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7
Q

What is the most common cause of upper GI bleed?

A

Peptic ulcer disease

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8
Q

What do you give in fluid resuscitation?

A

500ml of 0.9% saline within 15 minutes

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9
Q

What is propanolol given for and what drug group is it?

A

Non selective beta blocker
Primary prophylaxis for portal hypertension

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10
Q

What medical management should be given to Mark to manage his variceal bleed?

A

IV terlipressin and broad-spectrum Abx to reduce risk of SBP

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11
Q

What scoring tool can be used to estimate the mortality risk of a patient with an upper GI bleed?

A

Rockall score
split into pre-endoscopic and post-endoscopic

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12
Q

What is the Glasgow-Blatchford bleeding score used for?

A

Identify would we be able to manage this medically or is this an urgent OGD

Risk stratifying as to who they are going to call. They don’t go to surgery straight away

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13
Q

What is the first line definitive treatment for bleeding oesophageal varices?

A

Variceal band ligation
In reality (adrenaline is given first)

Transjugular hepatic portosystemic shunt is second line

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14
Q

What is a last resort for stopping an oesophageal variceal bleed?

A

Sengstaken-Blakemore tube

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15
Q

What number from GBS can you be discharged as outpatient?

A

1 or less you can be treated as an out-patient

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16
Q

What medication should be stopped in an upper GI bleed?

A

Ibuprofen

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17
Q

What is the next step of an gastric ulcer that is no longer bleeding?

A

Urea breath test (before you give PPI)

1 month supply of a high dose PPI

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18
Q

What test has the highest specificity for identifying both active H.pylori infection and successful eradication?

A

C13 urea breath test

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19
Q

What is the definition of specificity?

A

Proportion of disease-free people who are negative to the test (ruling out)

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20
Q

What is the definition of sensitivity?

A

Proportion of people with the disease who are positive to the test

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21
Q

What are some indications to surgery?

A

(Said in the trauma meeting 18/03/2024)

Neutropenia and sepsis

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22
Q

What is Kehr’s sign?

A

Kehr sign has traditionally been described as pain referred to the left shoulder on gentle palpation of the abdomen when the patient is lying down with legs elevated. It is classically associated with splenic rupture.

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23
Q

What are the volumes of what we secrete daily?

A

1.5L- Saliva
1.5L- Gastric
Bile- 750ml
Pancreatic juice- 750ml

7.5L

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24
Q

Common bowel obstruction conditions in newborns?

A

HPS- hypertrophic pyloric stenosis
- Hypokalemia, metabolic alkalosis
- Shift oxygen dissociation curve to the left

Duodenal atresia

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25
Q

What is duodenal atresia?

A

Duodenal atresia is a congenital intestinal obstruction that can cause bilious or non bilious vomiting within the first 24 to 38 hours of neonatal life, typically following the first oral feeding.

Gas bubble in the stomach (double bubble seen on x-ray)

26
Q

What are bowel obstruction conditions, affecting children from about 1 year?

A
  • Intussception (teloscoping of the bowels)
  • Hirschsprung disease
  • Imperforated anus
27
Q

Common causes of bowel obstruction in elderly patients?

A
  • Hernia
  • Adhesion
  • Malignancy
  • Volvulus
  • Constipation/ fecal impaction
  • Diverticulitis (stricture)
  • Gallstone ileus
  • Crohn’s disease
  • Foreign body
28
Q

What is gallstone ileus?

A

Gallstone ileus is an infrequent complication of cholelithiasis and is defined as a mechanical intestinal obstruction due to impaction of one or more gallstones within the gastrointestinal tract.

29
Q

Where do adhesions have to attach onto to become pathological?

A
  • Adhesion that fixes onto the anterior abdominal wall- causes volvulus and strictures/obstruction
30
Q

What is the most sensitive structure in your intestines?

A

The parietal peritoneum

31
Q

Common presentations of adhesions

A
  • Intermittent colicky pain (crescendo-decrescendo)
  • Recurrent pain
  • Tinkling bowel sounds (increased bowel sounds)
32
Q

What are common causes of small bowel obstruction?

A

Adhesions or hernia

33
Q

What are common causes of large bowel obstruction?

A

Malignancy or diverticular disease

34
Q

How can the majority of bowel obstruction caused by adhesions be treated?

A

Drip and suck approach
- Make the patient nil-by-mouth (NBM) and insert a nasogastric tube (Fig. 4) to decompress the bowel (“suck”)

  • Start intravenous fluids and correct any electrolyte disturbances (“drip”)
  • Urinary catheter and fluid balance
    Analgesia as required with suitable anti-emetics
35
Q

Definition of a hernia

A

A hernia is defined as the protrusion of part or whole of an organ or tissue through the wall of the cavity that normally contains it.

36
Q

Examination of a hernia

A
  • Bowel sounds on ascultation
  • Asking the patients the hernia will protrude
37
Q

Most common complication of a hernia

A

Strangulated hernia/ischemia

38
Q

What are the features of acute mesenteric ischaemia?

A
  • Diffuse and constant generalised abdominal pain
  • Nausea and vomiting in 75% of cases
39
Q

Therapeutic causes of gastrogaffin

A
  • Gastrointestinal Imaging: Helps visualize the digestive tract in imaging studies.
  • Treatment of Small Bowel Obstruction: Can be given orally or via tube to diagnose and treat blockages.
  • Fistulography: Injected into fistulas to aid diagnosis.
  • Meconium Ileus Treatment: Helps relieve bowel obstruction in newborns.
  • Intussusception Reduction: Used as an enema to non-surgically treat bowel telescoping.
40
Q

What is a common presentation of caecal malignancy?

A

Iron deficiency anaemia
In the early stages, colorectal cancer may not cause noticeable symptoms such as changes in bowel habits, abdominal pain, or weight loss. Therefore, iron deficiency anemia may be the first indication of an underlying problem.

41
Q

Why do caecal malignancy not commonly present with constipation?

A

The contents in the bowel is liquid

42
Q

First presentation of bowel cancer

A
  • Overflow diarrhoea (constipation is later)
43
Q

First presentation of rectal cancer

A
  • PR bleeding
  • Tenesmus
  • Wet wind (soiling with flatulance)
44
Q

What is the emergency surgical management for a sigmoid volvulus?

A

Hartmann’s procedure

45
Q

What is the conservative management of a volvulus?

A
  • Decompression by sigmoidoscope and insertion of a flatus tube.
46
Q

Pathophis of diverticular disease

A

Weakening of the colonic wall may occur due to alterations in connective tissue and increased intraluminal pressure.

Low-fiber diets and altered colonic motility contribute to increased pressure and diverticula formation.

Dysbiosis of the gut microbiota may lead to inflammation and mucosal damage.

47
Q

Complications of diverticular disease

A
  • Abscess- perforation
  • Stricture-bowel obstruction (can occur without stricture)
48
Q

3 basics to bowel obstruction

A
  • Site
  • Electrolyte imbalance/dehydration
  • Management
49
Q

What is significant with bowel obstruction?

A

You are short of 10L of secretions- loss to the third space
Severely dehydrated

50
Q

Indication for erect abdominal x-ray

A

Gas in the bowel- perforation

51
Q

Difference between small and large bowel obstruction on abdo x-ray

A
  • Valvulae conniventes (coiled spring
  • > 3cm
  • H
52
Q

Why do we use an NG tube to decompress an obstruction

A

To prevent aspiration

53
Q

Landmark to ballot the kidneys

A

Renal angle
The angle between the last rib and the lateral border of erector spinae

54
Q

What is an acute abdomen?

A

Acute undiagnosed abdominal pain

55
Q

What should you ask when a patient presents with symptoms of appendicitis (young patient)?

A

Have you had a recent cold?- mesenteric adenitis is very common

56
Q

Examination of a patient with appendicitis

A
  • Patient will be very still
  • Ask them to cough
  • Ask them with one finger, show me where it hurts you (McBurney’s point)
  • Start palpation away from the area that hurts
  • Guarding (superficial)
  • Rebound tenderness. Push your hand down in RIF and ask them to cough (elicits same pain)
  • Rovsing’s sign – right iliac fossa pain on palpation of the left iliac fossa
  • Psoas sign – right iliac fossa pain with extension of the right hip, suggestive of a retrocaecal appendix abutting the psoas muscle
57
Q

Positions of the appendix

A
  • Retrocaecal (difficult to elicit)
  • Pelvic (lower down- psoas)
  • Retroilieal
58
Q

Why is laparascopic appendectomy the gold standard?

A
  • Risk of thrombosis and ischaemia (rupture)
  • Blood supply is from the ileocolic artery (branch from the SMA)
59
Q

What antibiotics are used in acute appendicitis?

A
  • Co-amoxiclav or metronidazole
60
Q

What is the firs line imaging modality for an uncertain diagnosis of acute appendicitis?

A

Ultrasound

61
Q

When should you stop the COCP and re-start it before major elective surgery, or any surgery involving the lower limbs/pelvis, or surgery involving prolonged immobilisation of the lower limb

A

Stop it 4 weeks before
Re-start 2 weeks after mobilisation

62
Q

In an inflammatory response after surgery, what pyrogenic cytokines are released?

A

Damage to tissues during the operation causes the release of pyrogenic cytokines IL-1, IL-6, TNF-alpha and interferon-gamma. The fever is self-limiting and resolves within 2-4 days.

Y3 Surgery (7 decks)

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