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Flashcards in General Surgery Deck (42):
1

System for Investigations

Cultures (blood/sputum/urine)
Bloods (arterial vs. venous)
Imaging
Scopic/Biopsy (bronchospy/endoscopy)
Functional (relate to system: ECG, spyrometry)

2

% water in average human body

60% of body weight (in litres)

3

% body water in different compartments

2/3 intracellular

1/3 extracellular, of which
- 2/3 intravascular
- 1/3 extravascular

4

Daily reqs water and electrolytes

Water: 40ml/kg
Na: 100mmol/day
K: 60-70 mmol/day

5

Indications: IV fluids

pre-op resus
post-op resus
replace normal losses
replace additional losses
electrolyte disorders

6

Contents of Ringer's Lactate

Anions
Cations
Calcium
Lactate

7

Avoid Ringer's Lactate in:

renal impairment
liver impairment

8

Signs of poor fluid status

1. confusion
2. cool peripheries
3. reduced cap refill
4. tachycardia
5. tachypnoea
6. reduced BP (but have to lose 30% before drop)
7. sunken eyes
8. dry mouth
9. JVP not elevated
10. lungs clear
11. reduced urine output
12. no peripheral oedema

9

Arterial supply of duodenum

Segments 1-2: sup pancreaticoduodenal artery (from coeiliac axis)
Segments 3-4: inf pancreaticoduodenal artery (from sup mesenteric)

10

Arterial supply of gut

Foregut (mouth to D2): coeliac axis
Midgut (D3- distal transverse colon): sup mesenteric a.
Hindgut (distal transverse colon - anus): inf mesenteric a.

11

Define Ogilvie's syndrome

Pseudo-obstruction
Radiographic appearance of obstruction but no "point"
Occurs in elderly who are ill
i.e. functional obstruction

12

Classify Bowel Obstruction

Mechanical
- in the lumen (faeces, FB, gallstones)
- in the wall (atresia, stenosis, neoplasia, inflammation)
- outside the wall (adhesions, hernia, volvulus)

Functional
- surgical
- medical

13

AXR limits indicating distension

small bowel >3
larger bowel >6
caecum >9

14

In obstruction with competent ileocaecal valve, which part is most likely to perforate?

Caecum

15

Indications: surgery for mechanical bowel obstruction

1. neoplasia
2. failed conservative approach
3. closed loop obstructions
4. strangulation
5. perforation

16

Features of bowel obstruction

pain
constipation/obstipation
vomiting
distension

17

Why are bowel sounds important in bowel obstruction

no B/S = functional obstruction

18

Aetiology of Appendicitis

1. obstruction (e.g. faecolith, neoplasia)
2. lymphoid hyperplasia (phlegmanous)

19

Signs and symptoms appendicitis

nausea
anorexia
pain
pyrexia
patient sits still with flexed hips
guarding/rebound tenderness over McBurney's point
rigid/tender over abdomen

20

Blood supply Gallbladder

arterial: cystic a. from r. hepatic a.
venous: direct to liver sinusoids

21

Gallstone types

1. Mixed/bile
2. Cholesterol
3. Pigment

22

Sites of gallstone impaction (affects complications)

1. gall bladder
2. biliary tract
3. outised biliary tract

23

Define acute cholecystitis

obstructed gallbladder with infection
(10% is acalculous)

24

Describe Murphy's sign

Palpate liver margin in gallbladder region. Ask patient to inspire, apply gallbladder pressure during inspiration. Inspiration will abruptly stop. Must be negative on left to be accurate.

25

Complications: acute cholecystitis

recurrence
gangrene --> perforation
mucocele/empyema
Mirrizi's syndrome

26

Name the incision used for open cholecystectomy

Kocher's incision

27

Complications: laparascopic cholecystectomy

Immediate:
vessel/visceral damage
CBD injury
stone spillage

Early:
acute pancreatitis

Late:
incisional hernia

28

Complications from gallstone impaction in biliary tree

1. obstructive jaundice
2. ascending cholangitis
3. pancreatitis

29

Charcot's Triad

1. fever with rigors
2. pain
3. jaundice

30

Courvoisier's Law

in painless obstructive jaundice, a palpable gall bladder is unlikely to be caused by a stone (i.e. probably neoplastic)

31

Scopic investigations in gall stones

1. ERCP
2. PTC
3. MRCP

32

Signs of pancreatitis

unwell patient with fever/tachy/jaundice
peritonism with shock/ileus
cullen's sign
grey-turner sign

33

Cullen's sign

paraumbilical echymosis

34

Grey-Turner sign

flank echymosis

35

Define Hernia

protrusion of viscus and its coverings through defect into an abnormal position

36

components of a hernia

1. sac
2. contents
3. defect

37

Define Spigelian Hernia

protrusion through linea semilunaris
causes pain over medial knee!

38

VINTA MEDIC surgical sieve

Vascular
Infection
Neoplasia
Trauma
Autoimmune
Metabolic/nutritional
Electrolytes
Degenerative
Iatrogenic
Congenital

39

Normal urine output

0,5-1ml/kg/hour

40

Blood tests in nutritional assessment

Albumin
Pre-albumin
Phosphate
Transferrin
Lymphocytes

41

Indication for parenteral feeding

Non-functioning bowel
- short bowel syndrome
- ileus prolonged
- severe Crohns

42

Complications: parenteral feeding

FEED ITSELF
1. reactive hypoglycaemia
2. fatty liver
3. vitamin deficiencies
METHOD OF DELIVERY
1. central line complications
2. infection around site; sepsis
3. malposition