Surgery Flashcards by Kevin Zhang

Management of testicular cancer

sperm bank
orchidectomy
can insert prosthesis
CT TAP for mets
chemo for mets
LN dissection

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Management of kidney stones with no obstruction

Hydration and NSAIDs (diclofenac PR)

<5mm or <10mm and pt agrees: expectant management +/- alpha blocker/CCB

<10mm: SWLT +/ alpha blockers

10-20mm: SWL OR uroscopy
2nd: percutaneous nephrolithotomy

> 20mm: percutaneous nephrolithotomy

post: increase fluids, lemon juice, avoid fizzy drinks, decrease salt
consider metabolic testing

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Management of kidney obstruction

Ureteric stent past obstruction
OR
percutaneous nephrostomy tube via interventional radiology

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BPH management

Alpha blockers (tamsulosin)
5-alpha inhibitors (finasteride)

Surgery: TURP
REZUM
HoLEP
Urolift

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Difference between stomas

ileostomy: spouted, right side, corrosive paste-like stools
colostomy: flush, left side, poo stools
urostomy: spouted, lower right side, mucus and urine

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Indications for Hartmann’s procedure

obstruction/perforation secondary to sigmoid tumour or diverticulitis

colostomy stoma

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Management of colorectal cancer

Sigmoidoscopy -> colonoscopy
Contrast CT
Check for spread (liver)

resection
(anterior and abdomino-perineal = rectum to sigmoid, left and right hemicolectomy for colon, hartmann = emergency sigmoid)

High rectal cancer = Anterior
Middle rectal = Anterior
Low = AP

+/- neoadjuvant chemoradiotherapy

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complications post-operatively abdominal surgery

ileus: peristalsis halted, low electrolytes and dehydration but positive fluid balance (NG + fluids)
dehiscence: day 6 fever and sepsis

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why is splenic flexure vulnerable to ischaema

marginal artery of Drummond is tenuous here and absent in 5% of pt

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Management of duct ectasia

conservative management

consider microdochetomy if young
consider total duct excision if old

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management of breast fat necrosis

triple assessment

conservative

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management of acute mastitis

conservative: analgesia, warm compresses, continue breastfeeding

Abx: fluclox
2nd: amoxi
MRSA: trimethoprim

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management of breast abscess

USS only as MMG untolerated

analgesia, warm compresses, continue breastfeeding if possible

USS guided aspiration (consider I+D if necrotic)
culture fluid
abx

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management of fibroadenoma

rescan in 3-6m of first instance for rapid enlargement

<4cm conservative
>4cm or quickly enlarging consider excision

biopsy if over 25/large conscerns regarding phyllodes tumor

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management of fibroadenosis

conservative

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management of intraductal papilloma

microdochetomy (excision of single duct behind nipple)

if older/finished family, remove all ducts behind nipple (but not the nipple)

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management of Phyllodes tumour

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consider surgery

Types of breast cancer

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invasive ductal most common
invasive lobular 2nd most common

DCIS
LCIS

What is the triple assessment

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history and exam
imaging: USS <40, mammogram and USS >40, MRI if implants
FNA/biopsy

Management of breast cyst

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USS aspiration if large and painful

Nipple discharge colour diagnoses:
green
yellow
milky
Blood

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Green: multi-duct discharge (smokers)
Yellow: ectasia
Milky: prolactinoma
Blood: cancer, DCIS, papilloma

management of cancer with blood nipple discharge

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removal of nipple-areolar complex

treat cancer

management of breast cancer

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USS +/- biopsy of abnormal axillary lymph nodes

triple assessment
MRI if lobular cancer suspected

CT for staging
consider bone scan if >3cm/LN+

Surgery: mastectomy or WLE
removal of lymph nodes

Chemo: if LN+, triple negative disease OR HER2+ve

Radiotherapy: >4cm, LN+, skin/muscle involvement

Tamoxifen if ER+: tamox if premenopausal, letrozole if post-menopausal

management of prostate cancer

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most conservative + follow-up

consider surgery, radiotherapy, hormonal therapy

Investigations for RCC

cystoscopy, renal USS, CT urogram

management of stress incontinence

referral to specialist lifestyle advice: WL, pelvic floor exercises 3m duloxetine consider surgery

management of urge incontinence

lifestyle advice: bladder retraining for 6w, avoid triggers oxybutinin, tolterodine mirabegron Sacral nerve stimulation surgery: botox injection

Difference between testicular lumps ``` hydrocele varicocele epididymal cyst spermatocele cancer ```

hydrocele: painless, transillumination, testicle palpable within cyst varicocele: bag of worms, worse standing up, post-sex epididymal cyst: smooth cyst in head of epididymis, fluctuant, separate from testicle, transilluminates spermatocele: exactly same as epididymal cyst, just full of sperm cancer: craggy, hard, solid mass

management of PAD

conservative: no smoking, WL, foot care, 12w supervied exercise programme medical: statin, anti-platelet, management of risk factors Intermittent claudication: naftidrofuryl, cilostazol, pentoxifylline surgical: bypass, embolectomy

Management of chronic venous insufficiency

compression bandanges if ABPI >0.8 moisturising cream Medical: pentoxifylline, consider abx, NOT nsaids ulcer: dress ulcer varicose: sclerotherapy, ablation, ligation

management of Raynaud's

smoking cessation avoid cold nifedipine

management of venous thrombophlebitis

compression stockings NSAIDS if <5cm DOAC if >5cm surgery +/- LMWH

major haemorrhage protocol

baseline bloods inc fibrinogen if trauma and <3h from injury, tranexamic acid 1g 10 mins IV infusion of 1g over 8h warm fluids ``` specific blood products ASAP low hb -> red cells PT >1.5 -> FFP fibrinogen <1.5 -> cryo platelets <75 -> platelets ```

indications for amputation

Dead: gangrene Deadly: Wet gangrene, AV fistula, spreading cellulitis Dead useless: severe intractible pain with CLI, paralysis, trauma

Types of amputations

Above knee: easiest to do, may not be able to walk with prosthesis Below knee: harder, heal less reliably, may be more mobile Transmetatarsal: Diabetes mellitus Also through knee, ankle

Below knee amputation flaps

AP (Fish mouth) | Lateral-medial

Two forms of AAA

Fusiform (aneurysm everywhere) | Sacular (bulb)

Location of most AAA

infrarenal

``` Buzzwords for Fibroadenoma Phyllodes tumour Duct ectasia Fibroadenosis Intraductal papilloma Breast cyst Paget's disease of nipple ```

Fibroadenoma: young, breast mouse Phyllodes tumour: similar to fibroadenoma, bigger/grows faster, 40s Duct ectasia: menopause, green discharge, tender lump around areola Fibroadenosis: middle aged women, lumpy tender breasts, worse before period Intraductal papilloma: blood stained discharge, 40-60s, local areas of hyperplasia Cyst: sudden tender tense lump Pagets: eczematoid change, may be bloody discharge, nipple inversion

What does breast screening involve

3yearly national screening, 2 mammograms | between ages 50-71

Colorectal cancer screening

56, 60-74: FIT testing every 2y. If +ve, colonoscopy

describe Gleason scale

Made of two numbers e.g. 2+2 Made of grading of cells of largest area of tumour + cells of 2nd largest 6 or less = slow growing, watchful waiting 8 or more = aggressive

Surgery Flashcards

(42 cards)