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General Surgery Flashcards

1
Q

Causes of appendicitis

A
  • Faecolith = stone made of faeces
  • Lymphoid hyperplasia
  • Filarial worms
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2
Q

Presentation of appendicitis

A
  • Abdominal pain in umbilical region that migrates to right iliac fossa (McBurney’s point) after a few hours
  • Loss of appetite
  • Nausea and vomiting
  • Constipation (occasionally diarrhoea)
  • Tenderness in RIF (McBurney’s = 2/3rds of way from umbilicus to ASIS) Guarding to RIF
  • Rebound tenderness and percussion tenderness = peritonitis
  • Tachycardia, fever
  • Rovsing’s sign = press on LIF, hurts on RIF
  • Psoas sign = pain on extending hip if retrocaecal appendix
  • Cope sign = pain on flexion and internal rotation of R hip if appendix in close relation to obturator internus
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3
Q

Gold standard investigation for appendicitis

A

CT = reduces risk of removing healthy appendix

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4
Q

Investigations to rule out other pathology similar to appendicitis

A

Pregnancy test
Urinalysis
Pelvic/abdo US

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5
Q

Management of appendicitis

A
  • Appendicectomy laparoscopically
  • IV antibiotic pre-op to reduce wound infections = IV metronidazole/ cefuroxime
  • Analgesia
  • Resuscitation with IV fluids
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6
Q

Complications of appendicitis

A
  • Perforation
  • Appendix mass = When inflamed appendix becomes covered in omentum
  • Appendix abscess = if mass fails to resolve but instead enlarges and patient gets more unwell
  • Early surgical complications = surgical site infection, wound haemotoma
  • Late surgical complications = SBO due to adhesion, incisional hernia
  • Anaesthetic risks
  • Removal of normal appendix
  • VTE
  • Peritonitis from ruptured appendix
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7
Q

What is acute mesenteric ischaemia?

A

Sudden decrease in blood supply to the bowel usually caused by an embolism in the superior mesenteric artery

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8
Q

Risk factors for acute mesenteric ischaemia

A
  • Atherosclerosis
  • Smoking
  • COPD
  • Arrhythmia (AF)
  • Clotting disorders
  • Medications = OCP, migraine
  • Cocaine
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9
Q

Presentation of acute mesenteric ischaemia

A
  • Acute severe sudden onset abdominal pain
  • Diarrhoea
  • Weight loss
  • Melaena
  • Rapid hypovolaemia = shock
  • Pale skin, weak rapid pulse, reduce urine output, confusion
  • Out of keeping with physical exam findings
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10
Q

Investigations for acute mesenteric ischaemia

A
  • Bloods
    o High lactate
    o Raised Hb and WCC
    o Persistent metabolic acidosis
  • CT/MRI angiography = Provides non-invasive alternative to simple arteriography
  • Colonoscopy
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11
Q

Management of acute mesenteric ischaemia

A
  • Immediate laparotomy usually required esp if signs of advanced ischaemia
  • Fluid resuscitation
  • Antibiotics = IV gentamicin and IV metronidazole
  • IV heparin to reduce clotting
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12
Q

Complications of acute mesenteric ischaemia

A
  • Septic peritonitis = Due to perforation
  • Systemic inflammatory response syndrome progressing into multi-organ dysfunction syndrome
  • Gangrene
  • Scarring and narrowing of intestines
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13
Q

Risk factors for ischaemic colitis

A
  • Atherosclerosis
  • Drugs = contraceptive pill, antihypertensive, vasopressin, nicorandil drug
  • Surgery = Cardiac bypass, aortic dissection and repair, aortoiliac reconstruction
  • Vasculitis = SLE, sickle cell disease, polyarthritis nodosa
  • Coagulation disorders  thrombophilia
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14
Q

Presentation of ischaemic colitis

A
  • Sudden onset lower left side abdominal pain
  • Passage of bright red blood with/out diarrhoea
  • Shock = Pale skin, weak rapid pulse, reduce urine output, confusion
  • Evidence of underlying cardiovascular disease
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15
Q

Investigations of ischaemic colitis

A
  • Urgent CT scan to exclude perforation
  • AXR = thumbprinting
  • Flexible sigmoidoscopy = Biopsy shows epithelial cell apoptosis
  • Colonoscopy and biopsy
    o Only done after patient has fully recovered to exclude stricture formation at site of disease
    o Confirm mucosal healing
  • Barium enema = Thumb printing of submucosal swelling at splenic flexure
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16
Q

Management of ischaemic colitis

A
  • Fluid replacement
  • Antibiotics
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17
Q

Complications of ischaemic colitis

A
  • Gangrenous ischaemic colitis
    o Presenting with peritonitis and hypovolaemic shock
    o Requires prompt resuscitation following by surgical resection of affected bowel and stoma formation
  • Inflammation
  • Ulceration
  • Haemorrhage
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18
Q

Epidemiology of oesophageal tumour

A
  • SCC (upper 2/3) = common in China, Africa, Iran
  • Adenocarcinoma (lower 1/3) = western countries
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19
Q

Risk factors for oesophageal tumour

A
  • Diets low in fibre, carotenoids, folate and vit C
  • Alcohol
  • Smoking
  • Obesity = increased reflux
  • GORD/ Barrett’s oesophagus
  • Achalasia
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20
Q

Presentation of oesophageal tumour

A
  • Progressive dysphagia
    o Initially difficulty swallowing solids but then liquids follows within weeks
    o If dysphagia to solids and liquids from start = benign
  • Weight loss and Anorexia
  • Hoarseness and cough = upper 1/3
  • Pain
  • Difficulty in swallowing saliva, coughing and aspiration into lungs = oesophageal obstruction
  • Vomiting
  • Sx of GI blood loss
  • Lymphadenopathy
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21
Q

Investigations of oesophageal tumour

A
  • Upper GI endoscopy (Oesophagoscopy) with biopsy
  • Barium swallow = See strictures
  • Endoscopic US
  • CT scan/MRI/PET for tumour staging
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22
Q

Management of oesophageal tumour

A
  • Surgical resection
    o if tumour has not infiltrated outside oesophageal wall
    o Combined with chemotherapy before surgery +/- radiotherapy
  • Treatment of dysphagia
    o Endoscopic insertion of expanding metal stent across tumour to ensure oesophageal patency
    o Laser and alcohol injections = tumour necrosis and increase lumen size
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23
Q

Epidemiology of gastric tumours

A
  • Incidence increases with age = peak at 50-70 yrs
  • Highest incidence in Eastern Asia, Eastern Europe and South America
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24
Q

Risk factors for gastric tumours

A
  • First degree relative with gastric cancer = CDH1 gene
  • Dietary factors  High salt and nitrates, Pickled food
  • Alcohol
  • Smoking
  • Helicobacter pylori infection
  • Loss of p53 and APC genes
  • Pernicious anaemia = accompany atrophic gastritis
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25
Q

Protective factors for gastric tumours

A

Non-starchy veg, fruit, garlic and low salt

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26
Q

Types of gastric tumours

A
  • Intestinal/ type 1
    o Well-formed and differentiated glandular structures
    o More likely distal stomach and occur in patients with atophic gastritis
  • Diffuse/ type 2
    o Poorly cohesive undifferentiated cells
    o Tend to infiltrate the gastric wall
    o Can involve any part of stomach, especially cardia
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27
Q

Presentation of gastric tumours

A
  • Epigastric pain = constant and severe
  • Nausea and vomiting
  • Weight loss and anorexia
  • Dysphagia
  • Dyspepsia (indigestion)
  • Liver metastasis  jaundice
  • Anaemia = occult blood loss
  • Metastases occur in bone, brain and lung
  • Palpable lymph node in supraclavicular fossa (Virchow’s node) usually on left side
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28
Q

Investigations for gastric tumours

A
  • Gastroscopy and biopsy
  • Endoscopic ultrasound to evaluate the depth of invasion
  • CT/MRI for staging
  • PET scan to identify metastases
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29
Q

Management of gastric tumours

A
  • Nutritional support
  • Surgery and combination chemotherapy = Epirubicin and Cisplatin + 5-fluorouracil
  • Post-op radiotherapy
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30
Q

Colorectal carcinoma risk factors

A
  • Diet  Low fibre, high red meat and sat animal fat, high sugar
  • Colorectal polyps
  • Alcohol and smoking
  • Obesity
  • Adenomas
  • Ulcerative colitis
  • Familial adenomatous polyposis
  • Lynch syndrome (HNPCC)
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31
Q

Protective factors for colorectal carcinoma

A

Vegetables, garlic, milk, exercise, low-dose aspirin

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32
Q

Metastases of colorectal carcinoma

A

Liver and lung

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33
Q

Presentation of colorectal carcinoma

A
  • Closer cancer to outside more visible blood and mucus
  • Right sided = asymptomatic, weight loss, abdo pain, Iron deficiency anaemia due to bleeding, Mass
  • Left sided and sigmoid
    o Change in bowel habit with blood and mucus in stools
    o Alternation constipation and diarrhoea
    o Colicky abdominal pain
  • Rectal carcinoma Rectal bleeding and mucus
    o When cancer grows = thinner stools and cramping rectal pain
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34
Q

Emergency presentation of colorectal carcinoma

A

Absolute constipation, Colicky abdominal pain, Abdominal distension, Vomiting

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35
Q

Investigations for colorectal carcinoma

A
  • Colonoscopy with biopsy = removal of polyps
  • MRI/CT chest, abdo, pelvis = determine spread
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36
Q

Screening test for colorectal carcinoma

A

Faecal immunochemical testing = screening

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37
Q

Tumour marker for colorectal carcinoma

A

CEA

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38
Q

Classification of colorectal carcinoma

A

Dukes
- A = limited to inner lining of bowel
- B = extension through muscle layer of bowel
- C = involvement of regional lymph nodes
- D = distant metastases

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39
Q

Management of colorectal carcinoma

A
  • Surgery  Only indicated if no metastasis
  • Endoscopic stenting  For palliation in malignant obstruction (Decreases need for colostomy)
  • Radiotherapy  Palliation for colonic cancer or used pre-op in rectal cancer
  • Chemotherapy  If Dukes C then give chemo post-op = reduce risk of death
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40
Q

Causes of acute upper GI bleeding

A
  • Oesophageal
    o Oesophageal varices
    o Oesophagitis
    o Cancer
    o Mallory Weiss tear
  • Gastric
    o Gastric ulcer
    o Gastric cancer
    o Dieulafoy lesion
    o Diffuse erosive gastritis
  • Duodenal
    o Duodenal ulcer
    o Aorto-enteric fistula
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41
Q

Presentation of acute upper GI bleeding

A
  • Haematemesis  bright red/coffee ground
  • Melena  black, tarry stool
  • Raised urea
  • Oesophageal varices  stigmata of chronic liver disease
  • Peptic ulcer disease  abdominal pain
42
Q

Risk assessment used before endoscopy

A

Blatchford score (used at first assessment)
o Urea
o Hb
o Systolic blood pressure
o Pulse
o Presentation with melaena
o Presentation with syncope
o Hepatic disease
o Cardiac failure

43
Q

Risk assessment used after endoscopy

A

Rockall score (used after endoscopy)
o Risk of rebleeding and mortality
o Age, features of shock, co-morbidities, aetiology of bleeding, endoscpic stigmata of recent haemorrhage

44
Q

Management of upper GI bleeding

A
  • Resuscitation
    o Platelet transfusion  actively bleeding and platelet count of <50
    o FFP  fibrinogen <1g/L or prothrombin time >1.5x normal
    o Prothrombin complex concentrate  warfarin and actively bleeding
  • Urgent Endoscopy within 24 hrs
  • Non-variceal bleeding  PPI after endoscopy
  • Variceal bleeding  terlipression and prophylactic Abx before endoscopy
    o Band ligation for oesophageal varices
45
Q

Causes of small bowel obstructions

A
  • Adhesions = Usually secondary to previous abdominal surgery
  • Hernia
  • Malignancy
  • Crohn’s disease
  • Abdominal surgery
46
Q

Presentation of small bowel obstruction

A
  • Colicky abdominal pain
  • Vomiting (bilious containing bright green bile)
  • Nausea and anorexia
  • Constipation
  • No passage of wind = occurs late in SBO
  • Tenderness = Strangulation
  • Abdominal distension
  • Tinkling bowel sounds
47
Q

Abdo XR findings in small bowel obstruction

A

o Central gas shadows completely cross lumen and no gas in large bowel
o Distended loops of bowel proximal to obstruction
o Fluid levels seen

48
Q

Management of small bowel obstruction

A
  • Nil by mouth + IV fluids
  • NG tube on free drainage
  • Bowel decompression
  • Analgesia and antiemetic
  • Surgery = Remove obstruction done by laparotomy
49
Q

Complications of small bowel obstruction

A
  • Ischaemia
  • Necrosis
  • Perforation
50
Q

Causes of large bowel obstruction

A
  • Colorectal malignancy (US/Europe)
  • Volvulus (Africa)
  • Diverticular disease
51
Q

Presentation of large bowel obstruction

A
  • Abdominal pain = more constant than SBO
  • Late vomiting = more faecal like
  • Constipation
  • Fullness/bloating/nausea
  • Abdominal distension
  • Bowel sounds normal then increased then quiet later
  • Palpable mass = hernia, distended bowel loop or caecum
52
Q

Abdo XR findings in large bowel obstruction

A

o Coffee bean sign
o Peripheral gas shadows proximal to blockage
o Caecum and ascending colon distended

53
Q

Other investigations for large bowel obstruction

A
  • Digital rectal exam = empty rectum, hard stools, blood
  • FBC = Low Hb sign of chronic occult blood loss
54
Q

Management of large bowel obstruction

A
  • Sigmoid volvulus  rigid sigmoidoscopy with rectal tube insertion
  • Caecal volvus  right hemicolectomy
  • Bowel decompression
  • Surgery = Remove obstruction done by laparotomy
55
Q

Risk factors for a Mallory-Weiss tear

A
  • Alcoholism
  • Forceful vomiting
  • Eating disorders
  • Male
  • NSAID abuse
56
Q

Presentation of Mallory-Weiss tear

A
  • Postural hypotension
  • Vomiting
  • Haematemesis after vomiting
  • Retching
  • Dizziness
57
Q

Management of Mallory-Weiss tear

A
  • Most bleeds are minor and heal in 24 hrs
  • Endoscopy
  • Haemorrhage may be large but tend to stop spontaneously
  • If surgery required then involves oversewing of tear but this is rarely needed
58
Q

Risk factors for gallstones

A
  • Female, Fat, Forty, Fair, Fertile (more kids increases risk of gallstones)
  • Smoking
  • Rapid weight loss (weight reduction surgery)
  • Diet high in animal fat and low in fibre
  • Diabetes mellitus
  • COCP
  • Liver cirrhosis
  • Crohn’s disease
  • Fibrates
59
Q

Complications of gallstones

A
  • Acute cholecystitis
  • Empyema = gallbladder fills with pus
  • Carcinoma
  • Mirizzi’s syndrome = stone in gallbladder presses on bile duct  jaundice
  • Obstructive jaundice
  • Cholangitis = inflammation of bile duct
  • Pancreatitis
  • Gallstone ileus
60
Q

What is acute cholecystitis?

A

Gallbladder inflammation secondary to retained bile within gallbladder

61
Q

Causes of acute cholecystitis

A
  • Gallstone blocking cystic duct
  • Injury during surgery
  • Septicaemia
62
Q

Presentation of acute cholecystitis

A
  • Initially continuous epigastric pain
    o Progression with severe localised right upper quadrant abdominal pain
    o Pain may radiate to right shoulder
    o Pain associated with RUQ tenderness and muscle guarding or rigidity
  • Vomiting
  • Fever, sweating and signs of systemic upset
  • Loss of appetite
  • Local peritonitis
  • Gallbladder mass
  • Murphy’s sign positive  inspiratory arrest upon palpation of RUQ
63
Q

Investigations for acute cholecystitis

A
  • Blood tests = Raised WCC, CRP, serum bilirubin, ALP, aminotransferase levels
    o LFTs normal
  • Abdo US  Thick walled, shrunken gallbladder, stones, pericholecystic fluid, CBD
  • AXR = porcelain gallbladder
64
Q

Management of acute cholecystitis

A
  • IV fluids
  • IV antibiotics = co-amoxiclav
  • Laparoscopic cholecystectomy within 1 week of diagnosis
65
Q

What is ascending cholangitis

A

Infection and obstruction of biliary tree caused by a gallstone

66
Q

Risk factors for ascending cholangitis

A
  • Gallstones
  • Benign biliary strictures following biliary surgery
  • Cancer of head of pancreas  bile duct obstruction
  • Parasites can cause blockage = Far East and Mediterranean
67
Q

Presentation of ascending cholangitis

A
  • Charchot’s triad
    o RUQ pain
    o Fever with rigors
    o Jaundice (cholestatic) = Dark urine, pale stools, itchy skin, yellow
68
Q

1st line investigation of ascending cholangitis

A

Transabdominal US = dilation of common bile duct

69
Q

Gold standard investigation for ascending cholangitis

A

MRCP

70
Q

Management of ascending cholangitis

A
  • IV antibiotics = cefotaxime and metronidazole
  • Urgent (24-48 hrs) biliary drainage using endoscopic retrograde cholangio-pancreatography (ERCP) with sphincterotomy
    o Removal of stones using basket or balloon
    o Crushing of stones
    o Stent placement
  • Percutaneous Transhepatic Cholangiography (PTC)
71
Q

What is primary biliary cholangitis?

A

Autoimmune chronic liver disorder where interlobular bile ducts become damaged by chronic inflammatory process causing progressive cholestasis

72
Q

Associations of PBC

A
  • Sjogren’s syndrome
  • Rheumatoid arthritis
  • Systemic sclerosis
  • Thyroid disease
73
Q

Presentation of primary biliary cholangitis

A
  • Early: asymptomatic or fatigue, pruritus
  • Cholestatic jaundice
  • Hyperpigmentation (especially over pressure points)
  • RUQ pain (10%)
  • Xanthelasmas, xanthomata
  • Clubbing
  • Hepatosplenomegaly
  • Late: liver failure
74
Q

Investigations for PBC

A
  • Anti-mitochondrial antibodies (M2 subtype)
  • Smooth Muscle antibodies
  • Raised serum IgM
  • US or MRCP required before diagnosis to exclude extrahepatic biliary obstruction
75
Q

Management of PBC

A
  • Ursodeoxycholic acid
  • Pruritus  cholestyramine
  • Fat-soluble vitamin supplementation
  • Liver transplantation if bilirubin >100
76
Q

Complications of PBC

A
  • Cirrhosis  portal hypertension  ascites, variceal haemorrhage
  • Osteomalacia and osteoporosis
  • Hepatocellular carcinoma
77
Q

What is primary sclerosing cholangitis?

A

Biliary disease of unknown cause characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts

78
Q

Associations of PSC

A
  • Ulcerative colitis
  • Crohn’s
  • HIV
79
Q

Presentation of PSC

A
  • Cholestasis  jaundice, pruritus
  • RUQ pain
  • Fatigue
80
Q

Investigations for PSC

A
  • Raised bilirubin and ALP
  • ERCP or MRCP  multiple biliary strictures giving ‘beaded’ appearance
  • P-ANCA positive
  • Liver biopsy  fibrous, obliterative cholangitis, ‘onion skin’
81
Q

Risk factors for cholangiocarcinoma

A
  • Primary sclerosing cholangitis
  • Associated with infestation with parasitic worms
  • Typhoid
  • Liver fluke
  • Biliary cysts
  • Inflammatory bowel disease
82
Q

Presentation of cholangiocarcinoma

A
  • Painless jaundice
  • Weight loss and anorexia
  • Malaise
  • Nausea and vomiting
  • Fever
  • Abdominal pain +/- ascites
83
Q

Investigations of cholangiocarcinoma

A
  • CA19-9, CEA, CA 125 raised
  • Raised bilirubin and ALP
  • CT/MRI
  • MRCP to take biopsy
84
Q

Management of cholangiocarcinoma

A
  • Early diagnosis can be cured with surgical resection
  • ERCP can place stent in bile duct to allow drainage of bile and improve Sx
  • Resistant to chemo and radiotherapy
85
Q

Risk factors for Pancreatic adenocarcinoma

A
  • Smoking
  • Excessive intake of alcohol or coffee
  • Excessive use of aspirin
  • Diabetes
  • Chronic pancreatitis
  • Genetic mutation predisposing to pancreatic cancer
  • Family history
86
Q

Presentation of pancreatic adenocarcinoma

A
  • Non-specific upper abdominal/back pain
  • Painless obstructive jaundice = pale stools and dark urine
  • Unintentional weight loss and anorexia
  • Steatorrhoea
  • Palpable mass in epigastric region
  • Non-tender palpable gallbladder
  • Acute pancreatitis
  • Diabetes
87
Q

Tumour marker for pancreatic cancer

A

CA19-9

88
Q

Investigation for pancreatic cancer

A
  • CT scan for staging
  • Endoscopic ultrasound with biopsy
89
Q

Management for pancreatic cancer

A
  • Whipple’s procedure
    o Tumour of head of pancreas with no spread
    o Remove head of pancreas, gallbladder, duodenum and pylorus
  • Distal pancreatectomy of tumour body/tail
  • Adjuvant chemotherapy
  • Palliative care
90
Q

Causes of ascites

A
  • Local inflammation
    o Peritonitis or intra-abdominal surgery
    o Abdominal cancers
    o Infection
  • Low protein
    o hypoalbuminaemia
    o nephrotic syndrome
    o malnutrition
    o Peritoneal carcinomatosis
    o Tuberculous peritonitis
    o Pancreatitis
    o Bowel obstruction
    o Biliary ascites
    o Postoperative lymphatic leak
    o Serositis in connective tissue diseases
  • Low flow
    o Cirrhosis/ alcoholic liver disease
    o Acute liver failure
    o Liver mets
    o Budd-chiari syndrome,
    o Right heart failure,
    o constrictive pericarditis
    o Portal vein thrombosis
    o Myoxoedema
91
Q

Presentation of ascites

A
  • Mild abdominal pain and discomfort
    o If severe pain = bacterial peritonitis
  • Distended abdomen
  • Respiratory distress and difficulty eating
  • Fullness in flanks and shifting dullness
  • Scratch marks on abdomen causing by itching due to jaundice
  • Peripheral oedema
92
Q

Investigations for ascites

A
  • Aspiration of 10-20ml of fluid using ascitic tap
    o Raised WCC = bacterial peritonitis
    o Gram stain and culture
    o Cytology to find malignancy
    o Amylase to exclude pancreatic ascites
  • Protein measurement of ascitic fluid from ascitic tap
    o Transudate = low protein (<30g/L) – less bad
    o Exudate = high protein (>30g/L) – very bad
    o Serum-ascites albumin gradient >11g/L indicates portal hypertension
93
Q

Management of ascites

A
  • Treat underlying cause
  • Reduce dietary sodium to reduce fluid retention
  • Fluid restriction if Na <125
  • Aldosterone antagonist (oral spironolactone)
  • Drain fluid  Relieve symptomatic tense ascites
  • Prophylactic oral ciprofloxacin for pts with cirrhosis and ascites with ascitic protein 15g/l or less
  • Transjugular Intrahepatic Portosystemic Shunt
94
Q

Causes of peritonitis

A
  • Bacterial (more common)  E.coli, staph. aureus
  • Chemical  bile, old clotted blood, ectopic pregnancy
95
Q

Presentation of peritonitis

A
  • Sudden onset with acute severe abdominal pain followed by general collapse and shock
    o When peritonitis secondary to inflammatory disease, onset less rapid with initial features being those of underlying disease
    o Pain relieved by resting hands on abdomen = stopping movement of peritoneum and pain
    o Poorly localised then moving to one point on abdomen and becoming localised
  • Rigidity, Tender hard abdomen  ascites
  • Fever
  • Tachycardia
  • Shock = hypotension, hypoxia
  • Silent abdomen
  • Guarding  Speedbumps are painful
  • Nausea and vomiting
96
Q

Investigations for peritonitis

A
  • Blood test
    o Raised WCC and CRP
    o Blood cultures
  • Paracentesis  neutrophil count >250
  • Erect CXR  Free air under diaphragm indicates performed colon
  • Abdominal XR  Exclude bowel obstruction and foreign body
  • CT abdomen/pelvis  Exclude ischaemia as cause of pain
97
Q

Management of peritonitis

A
  • IV broad spectrum antibiotics = cephalosporin/ cefotaxime
  • Surgery
    o Peritoneal lavage of abdominal cavity
    o Specific treatment of underlying condition
98
Q

Complications of peritonitis

A

Sepsis
Local abscess formation
Kidney failure
Paralytic ileus

99
Q

Risk factors for inguinal hernia

A
  • Male
  • Chronic cough (cystic fibrosis)
  • Constipation
  • Urinary obstruction
  • Heavy lifting
  • Ascites
  • Past abdominal surgery
  • Smoking
  • Low BMI
100
Q

Presentation of inguinal hernia

A
  • Patient can usually reduce hernia themselves
  • Commonly painless swelling in groin that develops over time (May come and go)
    o But if painful then indicates strangulation
  • Bulging associated with coughing or straining = bowel movement, heavy lifting
  • Scrotal swelling in males
  • Constipation/ change in bowel habit
  • Burning sensation in groin
  • Strangulation  pain, fever, increase in size of hernia, erythema, peritonic features, bowel obstruction, bowel ischaemia
101
Q

Management of inguinal hernia

A
  • Use of truss to contain and prevent further progression of hernia
  • Surgery
    o Only if very symptomatic or strangulated
    o Prosthetic mesh, open repair, laparoscopy
    o Pre-op = diet and stop smoking

Finals (23 decks)

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