Surgery Flashcards
tx of rectal cancer (especially anal verge)
abdomino-perineal excision of rectum
high VS low anterior resection
high: excise upper rectal tumours, remove proximal rectum, sigmoid colon but the ana sphincter is intact. loop ileostomy is performed to defunction the colon for healing
low: for low rectal tumours but not anal verge tumours. excise the distal colon, rectum and anal sphincters. does not result in permanent colostomy.
fibroadenoma - management plan
if <3cm - watch and observe
if >3cm, excise
causes of small bowel obstruction
adhesions
hernias
causes of large bowel obstruction
cancer
management of SAH
non-contrast CT-Head
(if done within 6 hours and negative) -> no LP & consider other causes
(if done out of 6 hours and negative) -> LP
(if positive) -> do CT-angiography of head
(if show aneurysm) -> aneurysm causes
(if not show aneurysm) -> MRA/digital subtraction angiography
difference between inguinal and femoral hernia
inguinal: above & medial to pubic tubercle, can be reduced completely, common in male
-DIRECT: above the opening of inguinal canal
- INDIRECT: at the opening of inguinal canal
femoral: below & lateral to pubic tubercle, cannot be reduced completely, common in female, needs surgery as HIGH risk of strangulation/obstruction
what to do on day of surgery if still using diabetic medications?
metformin: continue does (unless taking TDS, then omit one dose)
sulphonylureas: omit one dose (unless the procedure is in the afternoon, then omit both BD doses)
DPP IV inhibitors: no change
GLP-1 analogues: no change
SGLT2 inhibitors: omit on the day
long0acting insulin OD (lantus, levemir): reduce dose by 20%
twice daily biphasic or ultra long acting insulin (novomix 30 or humulin M3): halve the morning dose and continue eveningdose.
spigelian hernia
richter hernia
what are these??
spigelian: lateral ventral hernia. rare and seen in elderly patients. hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and semilunar line laterally)
richter: rare, only the anti-mesenteric border of the bowel herniates through the fascial defect. can present with strangulation without symptoms of obstruction
what is Hartmann’s procedure?
done in emergencies - bowel obstruction/perforation
complete resection of rectum and sigmoid colon with formation of end colostomy and closure of rectal stump
grading of internal haemorrhoids
1 - do not prolapse out of anal canal
2 - can reduce spontaneously
3 - manual reduction
4 - cannot be reduced
treatment of renal stones
if <5mm - watch and wait
5-10mm - shockwave lithotripsy
10-20mm - shockwave lithotripsy or ureteroscopy
>20mm - percutaneous nephrolithotomy
treatment of ureteric stones
<10mm - shockwave lithotripsy +/- alpha blockers
10-20mm - uretersocopy
difference between strangulated and incarcerated?
strangulated: ischaemia due to blockage of blood vessels
incarcerated: stuck and cannot be reduced
surveillance for aortic aneurysm
single abdo USS at 65yo
