Surgery

Question 1

Acute Abdomen

Answer 1

• Acute abdomen = sudden onset of severe abdo pain over short period.
• Urgent - Bleeding, perforated viscus or ischaemic bowel. Less acute - is colic/ peritonism
• Ix - Urine disptick, ABG, Bloods, Blood cultures. Erect CXR, US, CT imaging, ECG
• Mx - depends on cause but symptomatic is IV access, NB, analgesia, antiemetics, initial imaging, VTE proph, urien dip, catheter, NG…

Question 2

Appendicitis

Answer 2

• Acute appendicitis = Inflammaitonoft ehappendix typically due to luminal obstruction secondary to faecolith or lymphoid hyperplasia, impacted stool or rarely tmour. This allows ocmmensal bacterial to multiply and the increased pressure can cause ischaemia/
• RF - FH, ehtnicity
• Ix - Clinical but US/Ct can help exclude
• Clinical - Abdo pain (periumbilical -> RIF), vom, nausea, diarrhoea, constipation, reboudn tenderness, percussion pain over McBurneys (2/3 form umbilicus to R.ASIS), rovsings (RIF pain on palpation LIF), Psoas sign (RIF pain with extension right hip). if severe sepsis, tahcycardic, hypotensive.
• DDx - Gynae (ectopci preg, Pelvic ID), renal (ureteric stone,s UTI), GI (iBD, meckels, diverticular disease), Uro (testicular torsion, epididymo-orchitis)
• Mx - Laparscopic appendicectomy (abs favoured if mass) and sent check malignancy
• Complications - Perforation, surgical site infection, appendix mass, pelvic absces.

Question 3

Acute Pancreatitis

Answer 3

• Acute pancreatitis = inflammation of pancreas (acute as no gros sstructural damage devloping but cna lead to chronic)
• Patho - premature + exaggerated activation dgestive enzymes wihtin pancreas. Autodigestion of fats + blood vessels. FFA reelased which react with Ca to chalky depositis (->hypocalcaemia).
• DDX - AAA, renal calculi, chronic Pancreatitis, aortic dissection, pptic ulcer disease
• Ix - Serum amylase x3 normal, LFTs, seurm lipase, abdo USif cause unknown (sentinel loop sign), or contrats enhanced CT
• Causes: Gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hypercalcaemia, ERCP, drugs (azathioprine, nSAIDs, diuretics)
• Presentation - sudden onset severe epigastric pain (can radiate to back), epigastric tenderness, in severe haemodynamically unstable. Less common is cullens sig (umbilical bruising) or grey turners (flank brusiing) represents retroperitoneal haemorrhage.
• Scoring - Modified glasgow criteria within 48hours admission. >/3 severe.
  
  • ‘pancreas’ = pO2<8, Age>55, Neutrophils/WCC>15x10^9, Calcium<2, Renal function (urea)>16, Enzymes LDH>600/AST>200, Albumin<32, Sugar (Blood glucose)>10
• Mx - supportive, treat underlyign cause. V fluid resus, O2, NG if vom. catheter to monitor output, opioid analgesia. HDU/ITU if severe and if confirmed pancreatic necrosis then BS Ab.
• Systemic complications - DIC, Acute resp distress syndrome, Hypocalcaemia, Hyperglycaemia
• Local complications - pancreatic necrosis (peristsent infection 7-10das after, confirm CT/necrosectomy), [ancreatic pseudocysts (weeks after, if dont go by 6w then surgery)

Question 4

Gallstones (choleliths)

Answer 4

• RFs - Female, fat, fertile, forty, FH. (Also preg, oral contraceptives, hemolytic anaemia, malabsorption)
• DDx - GORD, peptic ulcer disease, acute pancreatitis, IBD.
• Ix:
  
  • Lab - FBC, CRP, LFT, Amylase, urine analysis
  • Imaging - transabdominal US. then if inconclusive MRCP (ERCP can remove gallstones too).
• Types: Cholesterol stones (mostly in women + obese) and Pigment stones (blakc or brown), or mixed
• Causes:
  
  • Biliary colic (RUQ pain after fatty meals) - lifestyle factors, laparscopic electiev cholecystectomy within 6wks
  • Cholecystitis (inflamm GB) - IV Abs, analgesia, antiemetics, laparscopic cholecsytectomy<1weeks (ideally 72hrs) or drain. Can retain CBD stones sometimes fater.
  • Choledocholithiasis (in CBD)
  • CHolangitis (infalmm CBD) - IV Abs, treat sepsis, ercp, laparscopic cholecsytectomy. Charcots tria - RUQ pain, fever, jaundice.
• Complications:
  
  • Mirizzi syndrome - stone in Hartmanns pouch or cystic dct can compress hepatic duct and obstructivejaundice. MRCP then Lap chole
  • Gallbaldder Empyema - filled with pus, become septic. US/CT then lap chole or percutaneous cholesytectomy
  • Chronci Cholecystitis - lead to peristsent inflamm of gallbladder wall, RUQ pain or epigatsric pain, nausea, vom. CT then elective chole. Complications are gallblader carcinoma + biliary enteric fistula
  • Bouverets syndrome- fstula then stone impacts in prox duodenum gastric outlet obstruction
  • Gallstone ileus - fistula then gallstones passes and impacts temrinal ileum.

Question 5

Diverticular Disease:

Answer 5

• Diverticulum =outpuchign of bowel wall (mostly sigmoid colon), due to weaker bowels as age and stool increases lumina pressure. bacteria then grows and can cause inflamm, perforate etc.
• Diverticulosis = presence diverticula, asymptomatic
• DIverticula disease = symptoms arising form diverticula (abdo pain, intermittend, colicky, relieved by pooing. Altered bowel habit, nausea, flatulence).
  
  • Mx - uncomplicated the analgesia, oral fluid, colonscopy to check no malignancies after.
• DIverticulitis =inflamm of diverticula. Acute abdo pain, sharp, LIF, worse on movement. Localised tenderness, systemic upset feature (decreased app, pyrexia, nause). Signs peritonism- v unwell
  
  • most conservative (Ab, fluid, analgesia), tend to improve 2-3days but if not then repeat imaging to check progression. With perforation with faecal peritonitis or overwhelming sepsis then surgery (Hartmanns- sigmoid colectomy + end colostomy) and reversal posisbly later on.
• DIverticula bleed = diverticulum erodes in to vessel.
  
  • Mnanged conservatively and if cant control thn embolisation or surgical resection
• RFs - Age, low dietary fibre, obesity, smoking, FH, NSAID use
• DDx - IBD/bowe cancer, other causes of abdo pain.
• Lab = routien bloods, fecal calprotectin, G&S, Venous blood gas, urine dipstick
• Imaging - CT abdo-pelvis 9htickeing oclonic wall abseess, air), uncompl diverticulae then flexible sigmoidoscopy.
• Complications - diverticular strriture form repeated inflamm (bowel scars, fibrotic -> large bowel obstruction), and fistula formation.

Question 6

Bowel Obstruction

Answer 6

• Bowel obstuction - mechanical blockage
• Clinical - abdo pain (colicky/cramping), vomiting, distention, absoloute constipation. Mya have tinkling bowel sounds.
• DD x- pseudoobstruction, paralytic ileus, toxic megacolon, constipation
• Ix: Labs, bloods, venous blod gas (high lactate-ischaemia), ct with contrast (abdo+pelvis- better than AXR), erect CXR, poss water solubel contrast study (if small one doesnt resolve 24h + if in 6hrs doesnt work then theatre).
• Types- closed loop (2nd obst. proximal), mechanical blockage funcitonal obstruciton or paralytic ileus (doesnt work prop)
• Causes:
  
  • Intraluminal (foreign body, faceal impaction)
  • Mural (cancer, strictures, intususseption, meckels diverticulum)
  • Extramural (hernias, adhesions, metastasis, volvulus)
• Small bowel:
  
  • Mostly from adhesions, scar tissue, hernia, cancer
  • urgent fluid resus, urinary catheterm urgent surgery if ev ischami. NBM, NG tube to decompress, corretc electrolytes, analgesia
  • Small bowel resection can sticky ends together if heslthy with ileostomy. Or strictureplasty for with Crohns.Lap/open
• Large bowel:
  
  • Mostly form malignancy, diverticular disease, volvulus
  • Removed surgically if totla blcokage. Lap/open and if two ends stiched together may have colostomy.

Question 7

Peritonitis

Answer 7

• Peritonitis = redness + swelling (ifnlammation) of the peritoneum that lines abdomen
• Causes - Infection. Bacteria enter from hole in GI tract from burst appendix, colon etc. Mght be from pelvic inflamm diseas ein women, surgery etc.
• Presentation -severe belly pain (worse with motion), nausea+ vom, fever, sore/swollne belly, fluid in belly, not being able to have bowel mvoement or pass gas, less urine, thirst, trouble breathing, low BP + shock
• Early Mx - antibitoics, surgery (remove infected tissue, treat underlying cause an dprevent psread), pain meds, iV fluids, O2, sometimes blood transfusion
• Ix - Hsitory, exam, bloods (WBC, blood culture), imaging (xray- holes/perforation, also poss US or CT)
• Mx - 10-14days recovwry, IV Abs, feeding tube or liquid nutrients, surgery to drian abscesses, treat cause etc.

Question 8

Inguinal Hernias

Answer 8

• Inguinal hernia = abdominal cavity contents enter the inguinal canal
• Direct inguinal hernia = bowel enters inguinal canal ‘directly’ through a weakness in the posterior wall of the canal, termed “Hasselbachs” triangle. Occurs more commonly in older patients, often secondary to abdominal wall laxity or significant increase in inta-abdominal pressure. Medial to epigastric vessels.
• Indirect inguinal hernia = bowel enters inguinal canal via deep inguinal ring. Arise from incomplete closure of process vaginalis, an outpuching of peritoneum allowign for embryonic testicular descent, therefore are usually deemed congenital in origin. Lateral to inferior epigastric vessels
• RFs = Male, increasing age, raised intra-abdominal pressure and obesity
• Clinical = lump in groin which will intiially dsiappear with minimal pressure or when patient lies down. mild to mod discomfort which can worsen with activity or standing.

Question 9

ASA classification

Answer 9

1. Normal healthy patient
2. Mild systemic disease
3. Severe systemic disease that limits activity but is not incapacitating
4. Incapacitating systemic disease; threat to life
5. Moribund patient not expected to survive 24hours with or without surgery

Groups 1 to 3 have no or little increased risk with normal anaesthesia. None are an absolute contraindication to anaesthesia, they are about comparing wellbeing of the patient to the important of the procedure.

Question 10

Surgery complications

Answer 10

• Immediate (24h): haemorrhage, basal atelectasis (minor lung collapse), shock (reduction in BP), low urine output, broken teeth, nausea and vomiting, allergy to anaesthetic
• Early (1-30): Pain, acute, confusion, nausea & vomiting, fever, secondary haemorrhage from infection, pneumonia, DVT, acute urinary retention, UTI, pressure sores. Parlytic ileus (Bowel doesn’t move for few days and get vomiting etc). PE

7s post operative pyrexia: chest, catheter, CVC line, cannula, cut, collections, calves.

• Late (>30days): Bowel obstruction, incisional hernia, recurrence of reason for surgery, keloid formation, cosmetic appearance, osteoporosis, failure of surgery etc..,

Inbowel - delayed return function, early mechanical obstruction, late mechanical obstruction, anastomotic leak, major breakdown leading to peritonitis.

vascular - haemodynamic instability, respiratory failure, Myocardial ischaemia, bleeding and coagulopathy, temp management, neurologic disorders, DVT, acute kidney injury

Question 11

Common incision sites

Answer 11

• Midline -avascula rnature linea alba.
• Paramedian incision - divide tendinou sintersections
• Pararectal

Question 13

Surgical Sieve

Answer 13

SURGICAL SIEVE

• Congenital Acquired
• Inflammatory
• Infective / autoimmune
  
  • Bacterial
  • viral
  • fungal
• Degenerative / mechanical / traumatic
• Metabolic
• Neoplastic
  
  • Benign
  • Malignant- Primary/Secondary
• Vascular
• Neurological
• Psychological
  *

Question 14

Anaesthesia

Answer 14

• General - not conscious, no sensation, no pain
• LA - topical
• Neuraxial (back- spine, epidural)
• Regional - nerve blocks
• Sedation
• Increased risk - co-mobidities - COPD, fibrosis, smoking, heart fialure, malnutrition, trauma
• cardiopulmonary testing for major operations only.

Question 15

Haemorrhage and surgery

Answer 15

• Primary - during surgery
• Reactive - within 24hours
• Secondary - within 10days, mostly from surical sit einfection
• Signs - tachycardia, hypotension, tachypnoea, cool peripheries, presyncope.

Question 16

PE

Answer 16

• RFs PE = Prgenancy, cancer, HRT, Pill, obesity, infeciton, smoking, recent fractures/surgery, recent immobility
• SYmptoms = SOB, chets pain, pain in calves, tachycardic, tachypnea, hemoptysis, swelling.rednnes in calves, pleural rub
• ECG - S1Q3T3 - Large S wave in Lead I, Q wave in Lead III, inverted t wave in Lead III

Question 17

Post op sepsis

Answer 17

• Signs - Pyrexia, confusion, tachycardic, low BP, cold, clammy, low urien output, localising signs, non blanching rash, malaise, dizziness.
• COmplete within one hour:
  
  • Esclaste to senior clinical
  • Oxygen if required
  • Obtain iV access, take bloods
  • Give IV Abs
  • Give iV fluids
  • Moniyor

Question 18

Fluids Presscribing

Answer 18

• Crystalloids - simple ions, can pass easily across semi-permeable membrane. Normal slaine, hartmanns, 5% glucose
• Colloids - larger molecules eg, proteins that cant eaisly pass semi-permebale membrane so expand plasma volume. Human albumin, blood products.
• ABCDE-> History -> Exam -> charts -> bloods+imaging
• Resus, maintainence, rpelacement, redistribution
  
  • Resuscitation = (CRT>2, SBP<100, HR>90, RR>20, cool peripheries, NEWS>5) Stat (15mins) 500ml bolus or crystalloid (250ml if elderly/frail), reassess and can give up to 2000ml
  • Routine maintainence .Requirements per kg/day: water 25-30ml, glucose 50-100g, potassium 1mmol, sodium 1mmol, chloride 1mmol
  • Replacement = urine output should be 0.5ml/kg/hour -> fluid challenge

Question 19

Bio of cancer basics

Answer 19

• Genomic instability
• Reissting celld eath - apoptosis, autophagy, necrosis
• Sustaining proliferative signalling
• Evading growth suppressors
• Enabling replicative immortality
• Inducing angiogenesis
• Activating invasion + metastasis
• Reporgramming enegry metabolism
• Tumour promoting inflammation
• EVading immune destruction

Question 20

Screening

Answer 20

• Lead-time bias = screenign earlier detects pre-symp individuals so survival can appear longer even though treatment does not change (due to time between diagnosis and death increasing)
• Length-time bias = screenign detects more indolent disease so then comapred to non screened people but same amoutn of aggressive tumours jus timproved survival through pick of indolent tumours which would have been picked up at later date when symptoms arise

ABility of screenign depends on:

• Ability to detect true positive (sensitivity) and reject true negative (specificity)
• Screenign principles
• Disease - recognisable at early stage, treatment available at early stage, sifficiently common in target pop
• Test - sensitive, specific, inexpensive
• Programme - adequate facilities for diagnosis, benefit mus totuweigth physical/psychologicla harm and benefit must justify financial cost.

Question 21

Peripheral Vascular Disease

Answer 21

• PVD = Slow + progressive circulation disorder. Narrow/blockage/saosns in blood vessel can cause it.
• Presentation = most asymptomatic -> leg cramping with exercise and relieved by rest (intermittent claudication), Other includes changes in the skin (decreased temp, thin, brittl, shiny), weak pulses in legs/feet, gangrene, hair loss on legs, wounds that wont heal over pressure points, numbness, weaknes, pain at rest, restricte dmobility, red/blue discolouraitone xtremities.
• Causes = atherscleorisis (decreased blood flow O2/nutrients to tissues), injuries.
• Rfs =
  
  • Cant change age >50, history heart disease, male, postmenopausal, FH high cholesterol, HBP, PVD
  • Can change - coronary arteyr disease, high chol, HBP, overweight, phsyical inactviity, smoking
• Ix = physical (pulse steth, wounds), ABPi, US (doppler), angiography, bloods (DM, cholesterol)
• Surgical Mx = Angioplasty (balloon on tip catheter to flatten plaque), Bypass surgery (around blocke dvessel)
• Mx = Thrombolytic therapy, cholesterol lowering, HB meds, meds for blood sugar, meds ot prevent sclots symptom relief (cilostazol- widens BVs to treat leg pain), exercise, lifestyle.

Question 22

Aneurysms

Answer 22

• Abdo An - men with RFs (emphysema/FH/HBP/cholesterol, smoking, obesity). Abdo pain, back/loin pain, distal embolisation. If ruptures (mor elikely with smaller ones in women) then also maybe syncope, vomiting, haemodynamically compromised with pulsatile abdo mass and tender.
• Cerebral An - in brain. Berry (saccular), fusiform and mycotic
• TAA
• Surgery: AAA>5.5, symptomatic in fit person, or expanding >/1cmyear
  
  • Open repair (midline lap or long transverse inciison/ prosthetic graft) or endovascular (graft via femoral arteries and stent)
• Non-Op Mx - High flo wO2, IV access (2xLbore cannulas), urgent bloods and crossmatch for min 6U units. Careufl with shock as raising BP cna dislodge clot so keep BP<100mmHg as long as cerebrating. Transfer to locla vascular unit with correct staff.
  
  • Unstable - transfere to theatre staright away for open repair
  • STable = CT angiograph to determine if suitable for endovascular repair.

Question 23

Lower limb Ischaemia

Answer 23

• Acute Lower limb ischaemia: Embolic (classic), thrombotic (more common), trauma/dissection (rare).
  
  • Pain, Pallor, Paraesthetic, pulseless, poikilothermic. If cold leg , paraesthetic + painful for more than 6hours then amputation (too late to revascularise as if u did gets K+ released from dead cells)
• Chronic LL Ischaemia: intermittent claudication (le gpain on exercise, not at rest due to metabolic prodiction accumulation), chronic critical ischaemia (rets pain- worse by elevation, days/weeks, distal extremities, tissue necrosis, more than 2weeks duration).
• RF: SMoking, DM, hypertension, hypercholesterolaemia, homocysteine.
• Causes - Athersclerosis and rarely beurgers disease, popliteal anerusym and entrapment, cystic adventitial disease, trauma.
• Ix - hsitory, examp, imaging.
  
  • ABPi = needs compliant vessels (not calcified, not obese, not ulcerated), normal is 0.9-1.2 (<0.9 atherosclerosis, >13 calcification)
  • Duplex SCAN, DSA, MRA (magnetic resonance angiogram)
• Management = correct RFs + RF behaviour, encourage to keep wlakign, stop smoking. For claudication structured exercise, angioplasty, bypass surgery.
• Critical limb ischamia - limb at risk (tissue necrosis, rets pain, reduced ankle pressure/toe pressre). Analesia, medical therapy, angioplasty, reconstructive surgery.

Question 24

Aortic Dissection

Answer 24

• Aortic dissection = disruption of medial layer of aorta due to blood, leading to separation of layers and true lumen/false lumen.
• Stanford classification: Type A (Ascending aorta involved) and Type B (Ascending Aorta is not involved)
• DeBakey: Type I (AA, extends arch and beyond), II (AA only), IIa (descending TA_, IIIb (descending TA and Abdo A)
• RFs - congenital (cT, turners, noonans…), acquired (arterial HBP, preg, traumat, iatrogenic
• Clinical - chets pain, back pain, abdo pain, dyspnea, syncope, intra-arm bp different, neuro deficit, horner sysndrome
• Cardiac tamponade - becks triad (raised JVP, muffled heart sound, LBP)
• Acute aortic regurg (diastole murmur, wide pulse pressure, signs HF)
• Ix - blodos, CXR, CTA, ECHO
• Mx - depends on time and locations.

Question 25

Varicose Veins

Answer 25

• Varicose Veins = dilated superficial veins commonly found on lower limbs
• Aetiology - increased pressure small superficial veins
• RFs - age, pregnancy, obesity, female, previous DVT
• Clinical - pain/tender, pruritis, cramps, restless legs, cramps, bleeding. dilated superficial veins, bleeding. lipodermatosclerosis, venous eczema, ulcers
• Ix - DUplex US
• Referral - vascular surgery for some to consider interventional techniques
• Mx - conservative (advice, weight loss, remove RFs, compression stockings), interventionsl (sclerotherapy, endothermal ablation, phebectomy high ligationa nd vein stripping)

Question 26

Colorectal Cancer

Answer 26

• Aetiology - msot develop from denocarcinoma. FAP, familial adenomatous polyposis- lots adenomas which can turn (APC mutation), Hereditary nonpolyposis colorectal cancer HNPCC- defects in DNA repair and can lead to lynch syndrome (MSH2/6 suspicous, endometrial cancer and others)
• RFs - older, male, FH, IBD, low fibre, high processed meat, smoking, excess alcohol
• Clinical - change in bowel habit, rectal bleeding,w eight loss, abdo pain, symptoms iron def anaemia
  
  • RS- abdo pain, iron def anaemia, present late // LS-rectal bleed, bowel habit, tenesmus. Rigors in old age
• Ix - FBC, CEA tumour marker, colonoscopy with iopsy then ct (metastasis), MRI (depth), Endo-anal US (trans anal resection suitbaility)
• DDx - IBD (blood an dmucus diarrhoea), haemorrhoids (bright red blood)-but usually not weight loss, change in bowel habit.
• Surgery - Discuss MDT, generally regional colectomy for tumour, lympahtic drainage etc and possibel stoma. Hartmanns is recto-sgimoid colon and end colostomy.
• Neoadjuvant therapy (before hand), adjuvant (after). chemo (systemic therpay), radiotherapy (in rectal, not usually colon)(can shrink tumour before).
• STomas: Colostomy (left side, solid), ileostomy (right, looser)
• Screening = 60-75 every 2 years M/W, FIT to detect blood antigens. then if +ve colonscopy and nurse apt. Thsi is expanding 56y/o and available >75 if ask.
  
  • increased detection, some have more tests but no cancer, some cancers dont cause symptoms or affect life expectancy and colonscopy has risks bowel perforation or bleeding. But lower number dying from CRC and developign disease.
• Follow up with CEA, CT chest/abdo/pevlis to check metastasis.

Question 27

Breast cancer

Answer 27

• Red flags - redness/flaky skin in nipple area, pulling of nippe/breast, discharge other than breast milk (blood), change in shape/size, lump (mostly fimr, irregula,r painless), swelling, asymmetry, pea de orange, weight loss
• Sarcoma (CT), Carcinoms (epithelial)- DCIS (pre cancer as can revert back to normal tissue) ,LCIS (wihtin BM), Invasive ductal/lobular,muvinous medullary, papillary, pagets disease (rough, red, slight ulceration nupple- mos tudnelryign neoplasm).
• RFs - female, age, mutations (BRCA1/BRCA2 (TSG)), FH, previous benign. obesity, alcohol, prev unopposed oestrogen exp (pill/HRT)
• ALLRED score - cells testing positive for hormone receptors. increased risk breast/ovarian cancer with bRCA1/2 (TSG- double stranded DNA repair)
• Nottingham prognostic index = (size lesion x 0.2) + nodal status + grade. NS (0=1, 1-4=2, >4=3) and grade on bloom richardson. Also think abotu receptor status.
• Triple Assessment (one stop clinic): Hsitory + exam -> Imagin (mamogrpahy >35, US<35) -> Histology/cytology (mostly core biopsy). Given scores by profesisonal then after assessment to check they match ish/similar of how likey cancer
• Discussed with MDT. Breast conserving (WLE if<4cm, ,1cm margin), mastectomy (for high risk), reocnstruction. Radiotherapy, chemo, hormonal, oopherectomy/LHRH agonists. Oncoplastic Mx is therapeutc mammoplasty and flap formation
• Assess axilla - sentinel node biiopsy si 1st LN drains to (identified w dye) or axillary node clearance if spread but complcistion like lymphedema.
• Hormonal: Tamoxifen (blocks oestrogen receptors), aromatase inhibtiors (letrozole,, bind to Oest receptor and inhibitr further malignant growth) and immunotherapy (for specific growth factor receptors eg, HER-2 positive then herceptin (trastuzumab).
• Adj chemo (tumoru dpeosits remaining), chemo (reduce risk of recoccurence)
• Screening - 50-71 every 3 years mammorgam registered females. Can ask if above 71.
  
  • reduce risk dying, early stage so more successsful treatment, can do conserving surgery not mastectomy)
  • Cant prevent cancer, mamography is Xrays and uncomfortable, false psoitive (unecessary worry), may need to be repeated if missign tissue or blury, cancer may be diagnosed between screening, may find cancer that doesnt need treatment.

Question 28

Non-malignant breast disease

Answer 28

• Fibroadenoma – develop form lobules, glandular tissue and ducts grow over and solidify
• Duct ectasia – Mild ducts shorten and thicken with age/hormones, cause lump/fluid to be expelled
• Breast pain – beware of inflammatory breast cancer but not this unless other features usually like red and angry
• Abscess/mastitis- lactating (specific bacteria from baby’s mouth) vs non-lactating breast. Smokers also get lots recurrent abscesses and infection.
• Breast cysts – can be cyclical. Very hormonal, just fluid in a pocket. Can use needle to drain as uncomfortable.
• Gynaecomastia – abnormal development of breast tissue in a man. Anabolic steroids can predispose males. Brain tumours etc. Anything that affects hormones. Usually presents with lump on chest wall
• Fat necrosis – preceding trauma. Fat dies from trauma and forms a lump. Check again in 6w time as if you hit breast lump this can get worse and cause it and bleed (don’t develop cancer from it, you already have it and gets worse )

Question 29

TNM for measure of spread of cancer (grade is measur eactivity or severity)

Answer 29