Surgery Flashcards
(113 cards)
1
Q
What type of pain is colicky?
A
A squeezing pain which sometimes comes and goes
2
Q
When suspecting peritonitis, you should ask if it hurts when?
A
Laughing, coughing or going over speedbumps
3
Q
What will be the difference in movement of patients with peritonitis or colicky pain?
A
Peritonitis- completely still
Colicky- move about, can’t be comfortable
4
Q
Where does gallbladder pain radiate?
A
Round to back
5
Q
Where does pancreas pain radiate?
A
Through to back
6
Q
The appendix is what kind of structure?
A
Midgut
7
Q
Describe pain of appendicitis?
A
Starts in umbilical region and then shifts to RIF
8
Q
What is spread pain?
A
When it starts localised and then spreads all over- different to shift!!
9
Q
What causes somatic pain?
A
Area of inflammation
10
Q
Inflammation from only one structure causes pain where? What is this known as?
A
In its corresponding area (foregut, midgut, hindgut)- local peritonism
11
Q
Where is sore to touch in peritonitis?
A
Everywhere
12
Q
What is a really important thing to know about the onset of pain?
A
If it came on suddenly or gradually
13
Q
What type of pain will inflammation give you?
A
Throbbing
14
Q
What kind of pain will an obstruction give you?
A
Colicky
15
Q
When does pain make patients unable to breathe?
A
Peritonitis
16
Q
What can cause shoulder tip pain?
A
Gallbladder or liver pain from aggravation of the diaphragm
17
Q
What is the best pain relief but what is its downside?
A
IV morphine- all patients who have had this must be admitted
18
Q
What cases don’t get IV morphine, what do they get instead?
A
Colic- anti-inflammatory
19
Q
What causes tenderness to percussion?
A
Peritonism
20
Q
What is voluntary guarding?
A
Patients tense up for first/second exam but this will go away
21
Q
What is involuntary guarding?
A
Physiological response to peritonitis- will not go away
22
Q
What type of pain does cholecystitis cause?
A
Biliary colic
23
Q
What type of pain does diverticulitis cause?
A
LIF pain
24
Q
What type of pain does an intestinal obstruction cause, what are some associated symptoms?
A
Colic- nausea and vomiting
25
What age are people with appendicitis?
Either young or old
26
What are some other symptoms of appendicitis?
Sick maybe once, fever
27
What will the CRP on day 1 of appendicitis be?
Normal usually
28
What should you find out about abdominal masses during a history?
Size (changes), tender, duration, associated symptoms
29
What are important investigations to do for an abdominal mass?
CXR, AXR, ultrasound, CT, sigmoid/colon/endoscopy + biopsy, ERCP, laparoscopy and biopsy
30
What is abdominal mass with a history of collapse and pain radiating to the back likely to be? What would be the investigation of choice to confirm?
AAA- CT
31
What is abdominal mass with a history of weight loss, jaundice and hepatomegaly to the back likely to be? What would be the investigation of choice to confirm?
Hepatic mass- US, CT liver biopsy
32
What is abdominal mass with a history of trauma and weight loss with splenomegaly likely to be? What would be the investigation of choice to confirm?
Splenic mass- CT, MRI, PET
33
What is abdominal mass with a history of renal failure and weight loss likely to be? What would be the investigation of choice to confirm?
Renal mass- US, CT
34
What is abdominal mass with a history of weight loss, alcohol and non-tenderness likely to be? What would be the investigation of choice to confirm?
Pancreatic mass- ERCP, CT, biopsy
35
What is abdominal mass with a history of weight loss, altered bowel habit and PR bleeding likely to be? What would be the investigation of choice to confirm?
Colorectal cancer- CT, colonoscopy
36
What is another really important cause of abdominal masses?
Hernias
37
What type of hernia is caused by an insufficiently healed wound?
Incisional
38
Where do midline hernias come out between?
The two rectus muscles
39
What is more sinister than bleeding while defecating?
Bleeding into pants
40
What is absolute constipation?
No flatus or faeces
41
What does a tinkling bowel sound mean?
Obstruction
42
When can bowel sounds be absent?
Very obese people
43
What are Cullen's and Grey Turner's signs suggestive of?
Acute pancreatitis
44
What is a really important investigation to do for acute pancreatitis?
Amylase
45
What are cases of people who would not go to theatre immediately?
Pancreatitis or diabetic ketoacidosis
46
What are examples of patients who would go to theatre immediately?
Faecal peritonitis, ischaemic gut
47
What can free air under the diaphragm be suggestive of?
Perforated ulcer
48
What determines if an obstruction is an emergency or not?
Competent ileocaecal valve- emergency
| Not competent- not emergency
49
Incisional and midline hernias will do what on coughing and lying flat?
Coughing- bulge
| Lying flat- disappears
50
Why is there more pain below the pectinate line than above?
That is skin, not mucosa
51
What are haemorrhoids?
Enlarged vascular cushions in the lower rectum and anal canal
52
What are symptoms of haemorrhoids?
Painless bleeding, fresh red blood not mixed with the stool
53
What are common symptoms of bowel problems which are NOT the case in haemorrhoids?
Change in bowel habit and weight loss
54
Where do the positions of haemorrhoids relate to?
Branches of the superior haemorrhoidal artery occurring at 3, 7 and 11 o clock
55
What position should the patient be in when looking for haemorrhoids?
Lithotomy
56
What exams should be done for haemorrhoids?
PR exam, rigid sigmoidoscopy, proctoscopy
57
What test should be done for >50 with suspected haemorrhoids?
Flexible sigmoidoscopy
58
When should haemorrhoids be managed?
When symptomatic (normally constipation)
59
What are different ways of surgically treating haemorrhoids?
Rubber band ligation
Open/stapled haemorrhoidectomy
HALO/THD procedure
60
What is the HALO procedure?
Use a Doppler to find vessel, tie off the vessel and the haemorrhoid shrinks
61
What happens to cause partial rectal prolapse?
Prolapse of anterior muscle
62
What is a rectal prolapse?
Protruding mass from the anus, especially during defaecation
63
What is it common to pass with a rectal prolapse?
Blood or mucus
64
How do you treat complete rectal prolapse?
Perianal/abdominal rectopexy
65
How is an incomplete prolapse treated in children?
Diet advice and treat constipation
66
How is an incomplete prolapse treated in adults?
Similarly to haemorrhoids
67
What is an anal fissure?
A tear in the anal margin due to passage of a constipated stool
68
How is an anal fissure differentiated from haemorrhoids?
Fissure is painful
69
What could multiple anal fissures suggest?
Crohn's
70
Who are anal fissures more common in?
Younger people, particularly women
71
How long does the pain of an anal fissure last after defaecation?
Half an hour
72
What type of PR bleeding will anal fissures cause?
Bright red
73
What is the non surgical treatment for an anal fissure?
Dietary advice and stool softeners
74
Ointments containing what drugs can be used for anal fissures?
GTN and diltiazem
75
What is a treatment used to paralyse the internal anal sphincter?
Botox
76
What is an anal fistula?
Internal opening in the anal canal and one or more on peri-anal skin
77
What are rare causes of anal fistulae?
Crohn's, TB and carcinoma
78
What are treatments for anal fistulae?
Laying open, setons
79
What are complications of anal fisulae?
Pain, bleeding, incontinence, recurrence
80
What are cardiovascular surgery complications?
Haemorrhage, MI, DVT
81
What two types of haemorrhage can occur as a complication of surgery?
Reactionary (during) or secondary (infection- later)
82
What are some presentations of haemorrhage?
Tachycardia, hypotension, oliguria (low urine output)
83
How can haemorrhage in surgery be prevented?
Good technique, avoiding sepsis, correction of coagulation disorders
84
What increases risk of MI in surgery?
Severe angina, previous MI
85
What is the rule on operating on patients with MI?
Try to avoid 6 months following
86
How can an MI following surgery present?
Often silent, can be cardiac failure or arrhythmias
87
What increases risk of DVT?
Age > 40, previous DVT, major surgery, obesity, malignancy
88
What causes DVT as a complication?
Immobility during surgery and hypercoagulable state
89
How can a DVT present?
Low grade fever, unilateral ankle swelling, calf/thigh tenderness, shiny skin, pitting oedema
90
What is a first line rule out test for DVT?
D-dimers (degradation product of fibrin)
91
What are other tests for DVT?
Doppler ultrasound, venography
92
How can DVT be prevented?
Compression stockings, low dose subcutaneous heparin, early mobilisation
93
What are respiratory complications of surgery?
Lung collapse, pneumonia, PE
94
What does atelectasis/lung collapse during surgery lead to?
Pneumonia
95
How is there an increased risk of pneumonia in surgery?
Anaesthetic inhibits cilia,, postoperative pain inhibits coughing, aspiration
96
What is the presentation of a chest infection?
Fever, dyspnoea, productive cough, confusion
97
How can a chest infection be prevented?
Stop smoking, adequate analgesia, physiotherapy
98
What causes a PE?
DVT
99
How does a PE present?
Tachypnoea, dyspnoea, confusion, pleuritic pain, haemoptysis
100
What is a good test for PE?
V/Q scan or CTPA
101
What are GI complications of surgery?
Ileus, anastomosis, adhesions
102
What does ileus mean?
Paralysis of intestinal motility
103
How does an ileus present?
Vomiting, abdominal distension, dehydration, silent abdomen
104
How can an ileus be prevented?
Minimal operative trauma, laparoscopy, avoidance of sepsis
105
What is an adhesion?
Fibrin to fibrous tissue
106
Where are common adhesions?
Bowel to abdominal wall, lung to chest wall
107
What can cause adhesions?
Inflammatory response, ischaemia
108
What can adhesions present as?
An intestinal obstruction
109
What complications can arise with a wound?
Infection, splitting, hernia
110
How does a wound infection present?
Pyrexia, redness, pain, swelling, discharge
111
What are urinary surgical complications?
Acute retention of urine, UTI, urethral stricture, acute renal failure
112
What are neurological surgical complications?
Confusion, stroke, peripheral nerve lesions
113
What does confusion occur as a result of?
Hypoxia
