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Semester 1 > Surgery > Flashcards

Surgery Flashcards

1
Q

Cystitis

A

lower ab pressure
dysuria, pyuria, hematuria, frequency

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2
Q

Pyelonephritis

A

UTI and systemic features- fevers, rigors, nausea, vomiting

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3
Q

MSK

A

sciatica, lumbar disc, bony mets

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4
Q

gastroenteritis

A
  • abdo pain
  • diarrhea + blood.mucus
    vomit
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5
Q

acute mesenteric ischemia

A

risk - elderly, afib, cardiac disease
vomiting, diarrhea, ileus
very severe pain unrelieved by analgesia

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6
Q

chronic mesenteric ischemia

A

post prandial pain
weight loss
change in bowel habit

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7
Q

bowel obstruction

A

vomit - green (bilious or brown (faeculent)
constipation/obstipation
(no flatus in complete obstruction)
Distension
perforation (sudden)
- decreased resonance on percussion
SBO (high) - first bilious vomit, then constipation
LBO (low) - first constipation then faeculent vomit - on exam distension, tympanic abdomen and high pitched bowel sounds

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8
Q

appendicitis

A

migratory umbilical pain to rif pain
worse on movement and coughing (inflammatory)
fevers, chills, rigors
nausea/vomiting
anorexia -> lack of appetite
deep tenderness at mcburney’s point 1/3 distance from asis to umbilicus
and rebound tenderness (peritonitis)
rovsing’s sign -> lif palpation inc rif pain
obturator sign -> retrocaecal appendicitis - inflame obturator internus
psoas sign -> ilieo psoas

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9
Q

inguinal hernia

A

lump
incarcerated or not
strangulation - constant pain.
exam - fever, tachycardia, localized tenderness, irreducible hernia

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10
Q

ureteric stone

A

severe pain
loin to groin
restless with pain
hematuria
dysuria, urgency
vomiting

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11
Q

inflammatory bowel disease (IBD)

A

changes in bowel motion (what’s normal?)
hematochezia/ bloody diarrhea
systemic symptoms:
- weight loss
- joint pain
- eye trouble
- skin rash

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12
Q

Diverticulitis

A

Left iliac fossa pain (LIF)
change in bowel motion
hematochezia , bloody diarrhea
fever, chills, rigors, anorexia
prior colonoscopy?

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13
Q

Suprapubic pain

A

urine retention, uti, prostitis, PID, IBD

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14
Q

NGT

A

wide bore to decompress obstruction/relieve vomiting

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15
Q

LFTs

A

PTT - coag screen
albumin - malnutrition, pancreatitis

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16
Q

Analgesia contraindications

A

opioids in SBO (constipation)
NSAIDs in PUD, AKI, asthma

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17
Q

rutherford morrison incision

A

renal transplant

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18
Q

Drains

A

they remove collections of blood (hemothorax) ,
fluid (ascitic drain),
pus (empyema or subphrenic abscess)
air (pneumothorax)
prevent accumulation of fluid around operative site (bile after biliary surgery)
drains removed when nothing comes out, or when they fall below 30-50ml in 24 hrs
may damage underlying structures due to migration/miscplacement
and route for infection

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19
Q

Poor nutrition leads to

A

impaired albumin production
impaired wound healing and collagen deposition
ICU myopathy (skeletal muscle weakness)
reduced neutrophil and lymphocyte function

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20
Q

central venous cathereisation

A

damage to surrounding structures ->
pneumothorax, air embolism, cardiac dysrhythmias , carotid artery dissection

hematoma

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21
Q

Medications in surgery

A

CCBs and BBs must be continued
patients on long-term steroids - risk of adrenal atrophy - unable to mount a physisiological stress response to surgery - severe hypotension can occur if steroids are discontinued.
Steroid dose is doubled to counter inc steroid requirement

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22
Q

Cyclizine

A

avoid in fluid retention (heart failure)

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23
Q

Metoclopramide

A

dopamine antagonist
avoid in patients with parkinson’s

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24
Q

TED stockings

A

contraindicated in peripheral arterial disease

25
Q

Hypovolaemic signs

A

reduced urine output, tachycardia, postural hypotension, low bP, reduced cap refill, cool peripheries, reduced skin turgor, sunken eyes, higehr urea and creatinine, higher Na

26
Q

Hypervolemic signs

A

inc resp rate, hypertension, circ overload, jugular venous pulse, bibasal creps,
low hematocrit , low hb,
low urea, creat,
cxr = pul oedema

27
Q

Fluid requirements

A

fluid intake - 2.5 L
losses = 2.5
1.5 L urine
0.8 insensible (skin, lungs)
0.2 l stool

elec 120-140 sodium
K 70 mmol

h20 - 2/3 of body mass
thirds

ECF = 1/3
intravasc = 1/3
intersitial = 2/3

ICF = 2/3

28
Q

IV fluid prescription

A

Resuscitation
hypotensive/techycardic

500ml bolus over 10-15 mins

or 250 ml in heart failure

reassess - heart rate, blood pressure, and urine output

-

hypovolemic
1 L 4-6 H

-
maintenance
1 L 9-10 hrs

elderly
1L 10-18 hrs

fluid challenge
shock, low urine output
500 ml normla saline /30 min

250 if frail/overload risk

GI loss - replace K if vomiting or diarrhea or high output stoma -

29
Q

Sepsis

A

take 3, give 3

30
Q

Direct inguinal Hernia

A

acquired, most common in older pts, medial to epigastric vessels

31
Q

femoral hernia

A

most likely to incarcerate

32
Q

intusscepsion

A

telescoping

33
Q

Retroperitoneal structure

A

suprarenal (Adrenal), aorta/ivc, duodenum, pancreas, ureters, colon (ascending/descending), kidneys, esophagus, rectum

34
Q

intraperitoneal structures

A

stomach, spleen, liver, jejunum, ileum, transverse colon, sigmoid colon

35
Q

transition between small intestine to colon

A

ileocecal valve

36
Q

hypovolemia -> where do they get ischemia?

A

watershed era is splenic flexure and rectosigmoid junction

37
Q

risk factors for biliary colic

A

female, forty, fat, familial, fertile, tpn, rapid weight loss

38
Q

pathophys of biliary colic

A

fatty food -> cck release -> gallblader contraction - obstructed cystic duct

39
Q

same symptoms with temp, and murphy’s sign

A

acute cholecystitis

40
Q

findings on U/S

A

gallstones, gallbladder wall thickening, pericholcystic fluid, sonographic murphy’s sign

41
Q

subtypes

A

air in gallbladder wall -> emphysematous cholecystitis = immunocomprimised (diabetic)
gastric forming bacteria (clostridium)
- is life threatening

42
Q

acalculous cholecystitis

A

severly ill patients -> sepsis, organ failure, burns
cholecystectomy, percutanoues cholestotomy

43
Q

hesselbach’s triangle

A

inferior epigastric artery
rectus abdominus
inguinal ligament

direct inguinal hernia - defect in abdominal wall
medially to inferior epigastric vessels

44
Q

midpoint of inguinal ligament

A

femoral nerve (to tubercle)

45
Q

midinguinal point

A

asis to symphysis
femoral artery (pulsates)

46
Q

indirect inguinal hernia

A

laterally to triangle

47
Q

gastric ulcers

A

should always be biopsied (ogd) to rule out malignancy, and repeat to confirm healing

48
Q

triple therapy for h. pylori

A

1-2 weeks two antibiotics = amoxicillin 1g BD
clarithromycin 500 mg BD
PPI BD 1-2 weeks, then OD 4-6 weeks

49
Q

complications in achalasia

A

nocturnal aspiration
bronchiectasis
lung abscess
carcinoma (scc) of esophagus

50
Q

chagas disease

A

chronic infection with parasite tyrpanosoma cruzi
intramuscular ganglion cells destruction - cardiomyopathy and megacolon etc.

51
Q

scleroderma

A

80% have oesophageal involvement
seen in CREST

52
Q

CREST

A

Calcinosis
Raynaud’s
Oesophagitis
Scleroderma
Telengiectasia

53
Q

Oesophageal cancer - SCC

A

SCC most common globally
associated with mucosal damage from alcohol, smoking, and poor diet
also from achalasia and strictures
nitrosamines, ac def, coeliac disease, PUD, strictures

54
Q

Adenocarcinoma

A

acid and bile reflux leading to metaplasia and dysplasia
lower third of oesophagus
risk is barrets oesophagus
Gord, obesity, high fat,

55
Q

disseminated disease of oesophageal cancer

A

cervical lymphadenopathy (virchow’s node)
hepatomegaly due to metastasis
epigastric mass due to para aortic lymphadenotpathy

local invasion -
hoarseness, cough and haemoptysis, neck sweilling in svc obstruction, horners syndrome if sympathetic chain invasion

56
Q

investigations for oesophageal cancer

A

local stationg, regional staging and disseminated disease

57
Q

gastric cancer

A

adenocarcinoma most common
(mucosa)
>50 yrs

neuroendorine -> carcinoid
lymphoma -> h pylori

risk factors
family history , blood type A, chronic gastric ulceration due to H PYLORI , NITROSAMINES, ebv

58
Q

gastrectomy complications

A

dumping syndrome

59
Q
A

Semester 1 (13 decks)

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