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Surgery Flashcards

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1
Q

Signs of Cardiac Tamponade

A

Becks triad:
- Elevated venous pressure —> Distended neck veins
- reduced arterial pressure —> Decreased BP
- reduced heart sounds —> Distant heart sounds

Pulses paradoxus

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2
Q

Management of cardiac tamponade

A

Fluid resuscitation
Pericardiocentesis

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3
Q

Difference between cardiac tamponade and pericardial effusion

A

Cardiac tamponade = a pericardial effusion large enough to raise the pericardial pressure
—> reduced filling of the heart during diastole —> decreased CO during systole

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4
Q

DDx for Painful scrotal lump

A

Epididymis-orchitis
Testicular torsion
Varicocele
Epididymal cyst
Strangulated inguinal hernia

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5
Q

DDx for painless scrotal lump

A

Hydrocele
Testicular tumour

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6
Q

DDx for a perinatal lump

A

Abscess
Pilonidal Sinus
Fistula
Anal Fissure
Sebaceous cyst
Crohn’s disease
External haemorrhoids

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7
Q

What is Seton Suture drainage?

A

Treatment for Anal fistula
Piece of thread remains in fistula tract to keep it open and allow drainage
Gradually tightened to enable healing and closure

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8
Q

Conditions predisposing to anal fistula

A

Crohns
Diverticula’s disease
TB
Malignancy

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9
Q

Locations of anal cushions

A

3 o’clock (Left lateral)
7 o’clock (right posterior)
11 o’clock (right anterior)

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10
Q

Epithelium type below dentate line / above dentate line

A

Below = squamous
Above = columnar

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11
Q

Management of Haemorrhoids (conservative, non-surgical, surgical)

A
  1. Conservative: Fluid&fibre, laxatives, topical analgesia, toileting advise
  2. Non-surgical: rubber band ligation / injectable sclerosants
  3. surgery: haemorrhoid artery ligation / haemorrhoidectomy

ACUTELY PAINFUL THROMBOSED HAEMORRHOID: analgesia + ice pack + instillagel + laxative

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12
Q

Causes of unilateral hydronephrosis

A

Pelvic - ureteric obstruction
Aberrant renal arteries
Calculi
Tumours of renal pelvis

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13
Q

Causes of Bilateral Hydronephosis

A

Stenosis of urethra
Urethral valve
Prostatic enlargement
Bladder tumour
Retro-peritoneal fibrosis

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14
Q

Most common type of colorectal cancer

A

Adenocardinoma

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15
Q

Which bladder cancer does Schisotosoma infection increase risk of ?

A

Squamous cell carcinoma

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16
Q

Glad standard imaging for suspected renal colic

A

Non-contrast CT KUB

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17
Q

Surgical causes of Right Upper Quadrant pain

A

Gallstone disease
- biliary colic
- cholecystitis
- cholangitis
Hepatitis
Liver abscess

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18
Q

Causes of Epigastric pain

A

Pancreatitis
Peptic ulcer
Inferior MI
Oesophagitis/GORD

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19
Q

Causes of Left Upper Quadrant pain

A

Spenic abscess
Splenic rupture

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20
Q

Causes of Flank pain

A

Renal calculi
Pyelonephritis
UTI

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21
Q

Causes of umbilical region pain

A

Early appendicitis
Bowel obstruction
Strangulated umbilical hernia

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22
Q

Causes of Right iliac fossa pain

A

Late appendicitis
Ureteric colic
Crohns
Testicular torsion
Ectopic pregnancy
Meckel’s diverticulitis
PID
Ovarian Cyst
Salpingitis
Hernia

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23
Q

Causes of hypogastric region pain

A

Testicular torsion
Urinary retention
Cystitis
PID

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24
Q

Causes of Left iliac fossa pain

A

Diverticulitis
Ulcerative colitis
Testicular torsion
Ectopic pregnancy
Sigmoid volvulus
Constipation
PID
Ovarian cyst
Salpingitis
Hernia

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25
When to consider mesenteric ischemia?
Out of proportion pain +/- metabolic acidosis
26
Medical causes of acute abdominal pain
DKA UTI Basal lobe pneumonia Poisoning / OD Addison's disease Hypercalcaemia Bacterial peritonitis Mesenteric adenitis Constipation
27
What is Mesenteric adenitis?
a syndrome characterized by right lower quadrant pain secondary to an inflammatory condition of mesenteric lymph nodes. Commonly mistaken for acute appendicitis
28
Character of peritonitic pain
Worse on inspiration pt often lies still, shallow breaths Rigidity / guarding
29
Difference between MRCP and ERCP?
Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for investigating biliary obstruction. MRCP = non-invasive procedure Both used in suspected pancreatic cancer, pancreatitis, gallstones and bile duct problems
30
Causes of Acute Appendicitis
I GET SMASHED Idiopathic (20%) Gallstones (40%) Ethanol (35%) Trauma (15%) Steroids Mumps (CMV, EBV) Autoimmune (SLE, polyarteritis nodosa) Scorpion venom (lol) Hyperlipidaemia, hypercalacemia, hypothermia ERCP Drugs (thiazides, sulphonamides, ACEi, NSAIDs)
31
Investigations in Acute pancreatitis
Routine bloods - FBC, U&Es, LFTs, clotting, calcium, lipids Pregnancy test Serum lipase/amylase Erect CXR - to rule out perf. ABG - monitor the acid-base status USS - if gallstones suspected MRCP/CT - extent of damage Endoscopic USS - if other imaging negative
32
Scoring system for severity of acute pancreatitis
Modified Glasgow Score (MGS) or Ranson's criteria
33
Why is pancreatitis caused by hypercalcaemia and causes hypocalcemia
Hypercalcaemia - calcium deposition in the pancreatic duct and calcium activation of trypsinogen in the pancreas. Enzymes released from the pancreas -> autodigestion of fats and blood vessels --> fat necrosis and sometimes hemorrhage Fat necrosis --> release of fatty acids --> react with serum calcium --> hypocalcemia
34
APACHE II Score
Assesses disease severity in patients admitted to ICU
35
Early complications of acute pancreatitis
Hypovolaemic shock ---> renal failure Hyperglycaemia / hypocalacemia DIC & Sepsis Acute respiratory distress syndrome
36
Late complications of pancreatitis
Pseudocyst (= collection of necrotic tisssue and fluid forming 4-6 weeks after acute pancreatitis) Abscess Splenic/duodenal/SMA infarct Chronic pancreatitis --> cancer
37
Management of pancreatitis
1. ABCDE: IV fluids, O2, catheter, analgesia 2. Identify and treat the cause e.g. cholecystectomy for gallstones 3. Close monitoring 4. only NBM if very unwell (consider NG tube)
38
What is third space fluid loss?
third-spacing occurs due to decreased oncotic pressure in the intravascular space --> fluid will “leak out” of the intravascular space into the interstitial space (this can include the interstitial spaces in the brain leading to cerebral oedema!)
39
Causes of third-spacing
Decreased protein levels Heart Failure Increased capillary permeability Liver failure Lymphatic obstruction Major Surgery Pancreatitis Sepsis syndrome Severe Burns Trauma Viral and Bacterial infections
40
What is meckel's diverticulum?
One of most common GI congenital disorders May have ectopic acid-secreting gastric or pancreatic tissue Remnant of embryological vitello-intestinal duct Located in the distal ileum
41
Meckel's diverticulum: Rule of 2s
2% of population 2 years old = peak presentation 2:1 ratio M:F 2 inches long 2 feet proximal to ileocaecal valve 2 types of ectopic tissue (gastric/pancreatic)
42
Meckel's diverticulum: Presentation/complications
Could be asymptomatic for whole life General inflammation: presents similar to acute appendicitis GI Bleeding - bright red blood in stools Obstructive symptoms (Abdo pain, vomiting, constipation) - Intussuseption - Caecal volvulus Pain = RIF
43
Meckels diverticulum: Investigations
Technetium Scan CT (USS)
44
What is +ve Rovsing's Sign?
Pain in RIF when LIF is pressed Suggests acute appendicitis
45
What is +ve Psoas sign?
Pain on right hip extension Elicited by having the patient lie on his or her left side while the right thigh is flexed backward. Pain may indicate an inflamed appendix overlying the psoas muscle
46
What is +ve Obturator sign?
Pain on internal hip rotation Discomfort felt by the subject/patient on the slow internal movement of the hip joint, while the right knee is flexed. It indicates an inflamed pelvic appendix that is in contact with the obturator internus muscle
47
Where is McBurney's Point?
1/3 of the way between anterior, superior iliac spine and umbilicus
48
Difference between: - Diverticula - Diverticulum - Diverticulosis - Diverticular disease - Diverticulitis
Diverticular (Pleural) and Diverticulum (Singular) = outpouching of bowel wall at areas of high pressure Diverticulosis = asymptomatic presence of diverticula Diverticular disease = Diverticulosis + symptoms Diverticulitis = inflammation of diverticula (due to stagnated contents)
49
Complications of diverticular disease
Perforation Obstruction Fistula Pericolonic abscess (Pus in bowel wall)
50
Common site for diverticulum
Sigmoid colon
51
Risk factors for diverticular disease
Diet: Low fibre, high fat (constipation) Age: >50yrs, male gender Obesity Connective tissue disease e.g. Marfan's, Ehlers danlos (weak bowel wall)
52
Management of diverticular disease
Conservative: fluids & fibre, smoking cessation & weight loss Medical: Analgesia, bulk-forming laxatives
53
Management of diverticulitis
ABCDE Analgesia Broad spectrum Abx if unwell IV fluids
54
Presentation of diverticular disease
Left sided colicky pain Relief with defecation Altered bowel habit Sudden Painless bleed - bright read *mimics colorectal cancer*
55
Presentation of diverticulitis
Severe LIF pain - acute, worse with movement Localised guarding and tenderness in LIF Systemic upset
56
Causes of Paediatric bowel obstruction
Intussusception Faecal impaction Hernia Malrotation/atresia Hirschsprung's Pyloric stenosis Adhesions Imperforate anus
57
Tumour marker for colorectal cancer
Carcinoembryonic antigen (CEA)
58
Management of a reducible femoral hernia
Surgical repair within 2 weeks All femoral hernias needs to be repaired - regardless of whether they are symptomatic High risk of strangulation
59
Define incarcerated hernia
Non-reducable
60
Define strangulated hernia
Can follow incarceration It is where the arterial supply is compromised
61
Common causes of acute mesenteric ischaemia
1. EMBOLISM (50%) (Acute Mesenteric Arterial Embolism, AMAE) - cardiac causes 2. Thrombus-in-situ (Acute Mesenteric Arterial Thrombosis, AMAT) - atherosclerosis 3. Non-occlusive cause (Non-Occlusive Mesenteric Ischemia, NOMI) - e.g. hypovolaemia shock, cardiogenic shock
62
Clinical features of acute mesenteric ischaemia
Generalised abdominal pain, out of proportion to the clinical findings Diffuse and constant pain, with associated nausea/vomiting non-specific tenderness Late stages - globalised peritonism from perf
63
Acute mesenteric ischemia: ABG results
Increased Lactate Acidosis
64
Imaging for acute mesenteric ischemia
CT with IV contast (oral contrast avoided)
65
Acute mesenteric ischaemia - findings on CT
Oedematous bowel (secondary to the ischaemia and vasodilatation) Then may progress to a loss of bowel wall enhancement and then to pneumatosis (gas within the wall)
66
Acute mesenteric ischemia - management
Urgent resusitation Broad spectrum antibiotics Definitive management: - revascularisation of the bowel - Excision of necrotic or non-viable bowel
67
Acute mesenteric ischaemia definitive diagnosis
CT angiography
68
Equation for serum osmolality
(2 x Na+) + glucose + Urea
69
Normal urine output
0.5-1.5 mL/kg/hour
70
Type of urine sample for suspected epididymo-orchitis
Guided by age sexually active younger adults: NAAT for STIs (first catch) older adults with a low-risk sexual history: MSSU
71
Function of a loop ileostomy
= defunctioning stoma, diverts bowel contents away from the entire colon Easier to reverse than a loop colostomy

FINALS (19 decks)

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