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General surgery Flashcards

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1
Q

What features are ~ pathognomic for rectal cancer?

A

Tenesmus and urgency and feeling of incomplete evacuation

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2
Q

What are the pathological stages of developing colorectal adenocarcinoma?

A

Normal colon acquires defect leading to hyperproliferation of epithelium
Methylation or the APC gene causes this to develop into an adenoma/polyp
Deletion of k-ras or p53 causes this to develop into a carcinoma

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3
Q

Explain the dukes’ criteria?

A

Extent of colorectal cancer and relates to prognosis.
A = tumour within the muscular wall. Does not excees the muscularis propria
B = tumour is through the muscular wall
C = lymph node involvement (C2 = >3 nodes)
D = distant metastases

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4
Q

How is colorectal cancer managed?

A

Surgical resection with temporary defunctioning stoma

Chemotherapy post-op in stage C and above

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5
Q

What is the blood supply to the foregut?

A

Coeliac trunk

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6
Q

What is the blood supply to the midgut?

A

Superior mesenteric artery

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7
Q

What is the blood supply to the hundgut?

A

Inferior mesenteric artery

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8
Q

Which area of the bowel is most vulnerable to ischaemia?

A

Splenic flexure as is between the blood supplies of mid and hindgut

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9
Q

What is the main cause of bowel ischaemia?

A

Arterial thromboembolism

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10
Q

Give three risk factors for bowel ischaemia

A 
Atrial fibrillation
Increasing age
Smoking
Hypertension
Diabetes
Cocaine use
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11
Q

What is the difference between acute and chronic bowel ischaemia?

A

Acute involves sudden onset abdominal pain and requires emergency laparotomy and resection
Chronic is long-term post-prandial abdominal pain managed conservatively

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12
Q

What blood abnormalities are found in acute bowel ischaemia?

A

Leukocytosis
Raised amylase
Metabolic acidosis

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13
Q

What are the features of ischaemic colitis?

A

Arteriopathic patient
Abdominal pain (unrelated to food)
Diarrhoea
Rectal bleeding

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14
Q

How is ischaemic colitis managed?

A

Resuscitation

Early nutritional support

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15
Q

What are the three main complications of an acute hepatitis B infection?

A

Hepatocellular carcinoma
Cirrhosis
Chronic hepatitis

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16
Q

What are the main phases of infection with hepatitis B?

A

Initial phase is replicative with little liver damage and relatively normal LFTS
Second phase is inflammatory as CD8 cytotoxic cells are involved, with raised liver enzymes. Some people progress to chronic hepatitis at this point.
Some people enter the inactive phase where viral replication stops and liver enzymes normalise with no ongoing inflammation

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17
Q

Give 5 risk factors for developing hepatitis B

A 
Promiscuous sexual activity
Men who have sex with men
Sharing drug paraphernalia
Received blood transfusions or transplantation
Healthcare occupation
Tattoos, body piercing and acupuncture
Sharing toiletry items
Infants born to infected mothers
Travel to high risk areas
Sex workers
Chronic renal failure
Chronic liver disease
Prison inmates and staff
Hajj pilgrims
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18
Q

GIve three factors that increase your risk of developing chronic Hep B from an acute infection

A

Newborn child
Less severe acute disease
Immunocompromise

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19
Q

How is hepatitis B managed?

A 
Symptoms relief
Notify health protection unit
Peg interferon alpha
Screen for HCC
test for Hep C and HIV
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20
Q

What is the post-exposure prophylaxis for Hep B?

A

Hep B immunisation at 0,1, and 6 months + immunoglobulin

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21
Q

Roughly how many people infected with Hep C develop a chronic infection?

A

Around 80%

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22
Q

Give 3 extra-hepatic manifestations of hepatitis

A 
Thyroiditis
Porphyria
Thrombocytopenia
Lichen planus
Diabetes mellitus
B cell lymphoproliferative disease
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23
Q

How is Hep C diagnosed?

A

Positive anti-HCV on two separate occasions, 6 months apart

Raised HCV RNA indicates active infection

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24
Q

How is hepatitis C managed pharmacologically?

A

Peg interferon alpha weekly
Daily ribavirin
Protease inhibitor

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25
Give three side effects of Hep C treatment
``` Haemolytic anaemia THyroid disease Flu like illness Depression Eczema Sleep disturbance Weight loss Fatigue Alopecia Teratogenesis ```
26
What is the typical course of hepatitis A infection?
Person working/living in an institution. Vague flu like illness followed by jaundice and hepatosplenomegaly that is self-limiting
27
How is Hep A diagnosed?
Raised anti-HAV levels | Raised IgM indicates recent infection
28
Which form of viral hepatitis does not have an available vaccine?
E
29
What is the difference between a hepatitis coinfection and superinfection?
Co-infections mean infection occured at the same time | Superinfections mean one strain was already present and then a subsequent infection occurred
30
How is hepatitis D diagnosed?
Raised anti-HDV and HDV-RNA
31
How is Hep D managed?
Interferon alpha
32
How is hepatitis A managed?
Symptomatically. Rarely causes significant problems
33
How is Hep A transmitted?
Faeco-orally
34
How is Hep E transmitted?
Faeco-orally and vertically
35
What is the typical pattern of Hep E infection?
Incubation period of around 40 days. Often asymptomatic but if symptoms: Pre-icteric few days of epigastric pain Icteric phase of jaundice and arthralgia
36
How is Hep E diagnosed?
Raised anti-HEV IgG and anti-HEV IgM
37
How is Epstein Barr diagnosed?
FBC and WCC shows more than half of leukocytes are made up of lymphocytes and more than 20% of lymphocytes are atypical
38
Which vessels carry blood to the liver?
Portal veins | Hepatic artery
39
What is Budd-chiari syndrome?
Obstruction of hepatic venous outflow at any level
40
What can cause budd-chiari syndrome?
Hypercoagulable states | Local tumour exerting pressure
41
How may budd-chiari syndrome present?
Ascites with high SAAG Hepatomegaly RUQ pain
42
How is Budd-Chiari syndrome managed?
Anticoagulation Treat ascites with spironolactone ?thrombolysis ?Transplantation
43
Give three causes of portal vein thrombosis
``` Cancer Portal hypertension Cirrhosis Intra-abdominal inflammation Thrombophilia Dehydration ```
44
Give three causes of cardiac cirrhosis
``` Ischaemic heart disease Valvular heart disease eg TR Cardiomyopathy Restrictive lung disease Pericardial disease ```
45
What is the triad of cardiac cirrhosis?
Hepatomegaly Right heart failure Ascites (raised SAAG)
46
What are the LFT findings in cardiac cirrhosis?
Mildly elevated AST/ALT/ALP Raised bilirubin Normal albumin and PT
47
What are three common non-specific signs of autoimmune hepatitis?
``` Amenorrhoea Fatigue Rheumatological disorder eg arthritis Thyroid disease Spider naevi Palmar erythema ```
48
Give 2 conditions associated with autoimmune hepatitis
Systemic sclerosis Polymyositis Neuritis multiplex Polyglandular autoimmune syndrome type 3
49
What autoantibodies are associated with autoimmune hepatitis?
Anti nuclear factor Smooth muscle antibodies Anti-LKM
50
How is autoimmune hepatitis diagnosed?
LFTs, autoantibodies and liver biopsy
51
How is autoimmune hepatitis managed?
High dose corticosteroids | Immunosuppression
52
Give three iatrogenic causes of non-alcoholic fatty liver disease
``` Amiodarone Tamoxifen IV glucose therapy Parenteral nutrition Abdominal surgery Glucocorticoids ```
53
What are the findings on examination of someone with non-alcoholic fatty liver disease?
Findings of associated metabolic syndrome RUQ pain Hepatomegaly
54
What LFT abnormalities are there in non-alcoholic fatty liver disease?
Mildly raised transaminases | ALT>AST
55
Give three factors which increase the risk of non-alcoholic fatty liver disease progressing to cirrhosis
``` Increasing age Diabetes mellitus Obesity Rapid weight loss AST:ALT>1 ALT >twice normal Raised triglycerides ```
56
How should non-alcoholic fatty liver disease be managed?
Moderate and slow weight loss Increased exercise Treat associated metabolic syndrome features
57
What is a diverticula?
Herniation of colonic muscosa through the colonic muscular wall
58
What are the features of diverticular disease?
``` Change in bowel habit Rectal bleeding Abdominal pain Nausea Flatulence ```
59
Name three complications of diverticular disease
``` Perforation Haemorrhage Fistulae Stricturing Abscess formation ```
60
What are the features of diverticulitis?
``` Change in bowel habit Rectal bleeding Abdominal pain Fever High white cells Tenderness Peritonism ```
61
What are the signs of an abscess formation?
Swinging fever High white cells Localising signs
62
What is the proposed cause of diverticular disease?
Low dietary fibre

Surgery (4 decks)

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