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Flashcards in surgery Deck (56):
1

what can cause acute abdominal pain

appendicitis most common. lower lobe pneum may cause pain referred to abdomen, primary peritonitis in nephrotic syndrome, DKA, UTI

2

symptoms appendicitis

anorexia, vomiting, abdominal pain- initially central then localises to RIF

3

signs appendicitis

tenderness with guarding RIF, flushed face, oral fetor, fever, abdominal pain aggravated by movement, Rovings sign

4

what is rovsings sign

if palpate left lower quadrant and it produces pain in the right lower quadrant

5

complications of appendicitis

abscess, perforation

6

what is complicated appendicitis

presence of appendix mass, abscess, perforation

7

if there is generalised guarding consistent with perforation what is the management

fluid resus, IV antibiotics, laparotomy

8

if there is a palpable RIF mass but no signs peritonitis what is the management

conservative- IV antibiotics

9

when is an appendicetomy done

after several weeks. if symptoms progress- laparotomy

10

what is intussusception

invagination of proximal bowel into distal segment. ileum passes through ileocaecal valve to the caecum

11

what is the commonest cause of intestinal obstruction in neonates

intussusception

12

age intussusception

3m-2y

13

complications intussusception

stretching and constriction of the mesentery, venous obstruction- engorgement and bleeding from bowel mucosa, fluid loss- perforation, peritonitis, gut necrosis

14

presentation intussusception

paroxysmal colicky pain which can recover in between but becoming more lethargic, vomiting, refusing feeds, sausage shaped mass, redcurrant jelly like stools, abdominal distension and shock

15

what may AXR show in intussusception

distended small bowel, absence of gas in distal colon

16

investigations in intussusception

AXR, abdominal US

17

management intussusception

reduction by rectal air enema- by radiologist. if fails- laparoscopy or laparotomy

18

how recurrent is intussusception

5%

19

what is meckel diverticulum

in 2% there is an ileal remnant of vitello intestinal duct containing ectopic gastric mucosa or pancreatic tissue

20

presentation meckel diverticulum

most asymptomatic. can present with severe rectal bleeding. neither bright red or true malaena.

21

investigation in meckel diverticulum

technetium scan

22

management meckel

surgical resection.

23

what happens in malrotation

during rotation of small bowel in fetal life if the mesentery is not fixed at the duodenojejunal flexure or in ileocaecal region base is shorter than normal and predisposed to volvulus

24

presentation malrotation

obstruction (due to Ladd bands) or with compromised blood supply (ischaemic bowel)

25

presentation malrotation

obstruction with bilious vomiting in first few days of life, or later on - volvulus. dark green vomiting

26

management malrotation

upper GI contrast, laparotomy if vascular compromise. operate- volvulus untwisted, mobilise duodenum, bowel placed in non rotated position.

27

what type of inguinal hernia is it almost always

indirect- due to patent processus vaginalis. more freq in boys

28

what type of infant is inguinal hernia common in

premature

29

presentation inguinal hernia

swelling in groin, scrotum, crying, straining. may be an irreducible lump in groin or scrotum. firm and tender lump.

30

when would the groin swelling become more visible

increase intra abdominal pressure- press on abdomen or ask them to cough

31

if the lump cant be reduced what happens (inguinal hernia)

emergency surgery as can lead to bowel strangulation and damage to testes

32

why would surgery be delayed by 24-48 hours

allow resolution of oedema

33

what is a hydrocele

patent processus vaginalis allows peritoneal fluid to track down and around the testis

34

features hydrocele

scrotal swelling, bilateral sometimes bluish discoloration, non tender, transilluminates

35

when is surgery necessary hydrocele

most resolve spontaneously. but if it is persistent past 18-24 months then need surgery

36

what is varicocele

varicosities of testicular veins - abnormal enlargement of pampiniform plexus

37

what is varicocele associated with

subfertility

38

symptoms varicocele

visible or enlarged palpable vein, aching sensation within scrotum, feeling of heaviness

39

management varicocele

obliteration testicular vein, surgery, laparoscopic

40

what happens in testicular torsion

spermatic cord twists cutting off blood supply

41

presentation testicular torsion

pain may be in scrotum, groin or lower abdomen. examine all young males with inguinal or lower abdominal pain

42

management testicular torsion

must be relieved within 6-12h for testicular viability. Doppler US to look at flow, surgery

43

why is fixation of contralat testicle in torsion surgery necessary

as may be predisposition to torsion eg bell clapper deformity

44

what is a risk factor for torsion

undescended testes

45

what is an undescended testis

has been arrested along its normal pathway of descent. present in 4% term births.

46

what is the term for bilateral undescended testes

cryptorchidism

47

in who is undescended testes more common

prem- as testicular descent occurs in 3rd trimester

48

in examination of undescended testis what is done

gently massage the contents of the inguinal canal to bring the testes down to a palpable position

49

classification undescended testis

retractile, palpable, impalpable

50

what is a retractile undescended testis

can be massaged down into bottom of scrotum but retracts back into inguinal region due to the cremasteric muscle

51

what is a palpable and impalpable testis

palpable- testis can be felt in the inguinal region but cant be manipulated into scrotum. impalpable- cant be felt- in the inguinal canal, intra abdominal or absent

52

investigations in undescended testis

ultrasound, hormonal- watch for rise in testosterone when inject HCG if bilateral impalpable, laparoscopy

53

what is the surgery for undescended testis

orchidopexy- move testis into scrotum and permanently fix it there

54

indications orchidopexy

fertility, malignancy, cosmetic, psychological

55

what is fertility reduced to in bilateral orchidopexy

50%

56

when is the risk of malignancy higher in undescended

if bilateral and intra abdominal