Surgery Flashcards
(133 cards)
0
Q
What causes colicky abdominal pain in intestinal obstruction
A
Increased peristalsis against the obstruction
1
Q
What is wallaces rule of 9s
A
For burns Head and neck = 9% Upper limb = 9% Anterior lower limb = 9% Whole lower limb = 18% Anterior torso = 18% Posterior torso = 18% Perineum = 1% Hand = 1%
2
Q
What is a volvulus
A
Twisting of a bowel loop around its mesenteric axis
3
Q
Risk factors for volvulus Development
A
Long sigmoid,
narrow mesenteric attachment,
constipated loop
4
Q
What does the coffee bean sign on abdo xr indicate
A
Volvulus
5
Q
Management of volvulus
A
Passage of a flatus tube into the sigmoid colon
Failure - laparotomy
6
Q
What is gallstone ileus
A
Gallstone erodes into the duodenum
Forms cholecysto-duodenal fistula
Gallstone then blocks the ileo-caecal valve - obstruction
Air enters the biliary tree - can be seen on xray.
7
Q
Causes of paralytic ileus
A
Post op Peritonitis Spinal surgery Hypokalaemia Uraemia Anticholinergic drugs
8
Q
Presentation for paralytic ileus
A
Vomiting, distension, absolute constipation
NO pain
9
Q
Abdominal x-ray findings of paralytic ileus
A
Gas in the whole small and large bowel
No discrete obstruction
10
Q
Management of paralytic ileus
A
Fluids
NG tube
Pethidine for pain (doesnt slow GI motility)
Anti-emetics
11
Q
What is hartmann’s pouch
A
The neck of the gallbladder
12
Q
Why is biliary colic not true colic
A
The pain is continuous and not in waves
13
Q
Where is the pain of biliary colic felt
A
Initially epigastric for right upper quadrant
Then Radiates around both costal margins
14
Q
Differential diagnosis of severe upper abdominal pain
A
Biliary colic
Pancreatitis
Perforated peptic ulcer
Ruptured aneurysm
15
Q
What is a right sub-costal incision used for
A
Open cholecystectomy
16
Q
Gas used for insuflation in laparoscopic surgery
A
CO2
17
Q
Benefits of laparoscopic surgery
A
Smaller wounds/scars Less post-operative pain Reduced risk of wound infection Reduced post-operative chest infections Earlier mobilisation Earlier discharge
18
Q
Contraindications to laparoscopic surgery
A
Suspected cancer
Bleeding disorders
(Multiple adhesions)
19
Q
What is a mucocele of the gallbladder
A
Gallstone impacts the gallbladder neck
Mucus builds up and distends the gallbladder
20
Q
What is cholangitis
A
Infection of the biliary tree
Usually associated with obstruction
21
Q
Presentation of cholangitis
A
Pain
Jaundice
Pyrexia and rigors
22
Q
Risk factors for gallbladder carcinoma
A
Long term gallstones
Gallbladder polyps
Gallbladder calcification
23
Q
What is a porcelain gallbladder
A
Calcification of the gallbladder
24
Types of pancreatic cancer
Ductal adenocarcinoma (poor prognosis)
Ampullary carcinoma
Islet cell tumours
Cystic tumours
25
Presentation of ductal pancreatic cancer
```
Obstructive jaundice (if at head of pancreas -80%)
Severe upper abdominal pain
Weight loss
Anorexia
Malaise
Thrombophlebitis migrans
```
26
Management of pancreatic cancer
If too advanced for resection - biliary stent
Surgical resection (15% of ductal ca)
27
When is whipples procedure done?
Tumours of the head of the pancreas / peri-ampullary
28
Compenets of the modified Glasgow score
```
PaO2 < 8kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L
```
30
Define hernia
Protrusion of a viscus, or part of a viscus, through the walls of its containing cavity into an abnormal position
31
What is the neck of a hernia
The margin of the defect through which it has protruded
32
What does a 'reducible' hernia mean
When the contents of the hernia can be returned to the abdominal cavity.
Either spontaneously or with manipulation
33
What does an 'incarcerated' hernia mean
An irreducible hernia
Which is irreducible due to adhesions within the sac.
Not obstructed or strangulated.
34
What does an 'obstructed' hernia mean?
Bowel within the hernia is obstructed.
| Patient may have - pain, distension, vomiting and absolute constipation
35
What does a 'strangulated' hernia mean
The blood supply to the contents of the hernia is occluded by pressure from the neck of the hernia
Usually veins occlude 1st - causing swelling - causing arterial occlusion
36
What is a richters hernia
Where part of the bowel wall is caught in the sac and may become strangulated.
37
Where do femoral hernias herniate through
Through the femoral canal - usually contains fat and LN
| Appear below and lateral to the pubic tubercle
38
What hernias are below and lateral to the pubic tubercle
Femoral hernias
39
When does a femoral hernia need repairing
ALL femoral hernias require repair
| High risk of strangulation
40
Types of inguinal hernia
Direct inguinal hernia
| Indirect inguinal hernia
41
What hernia is above and medial to the pubic tubercle
```
Inguinal hernia
(But they leave the abdominal cavity above and lateral to the pubic tubercle)
```
42
Passage of indirect inguinal hernias
Through the deep inguinal ring
Along inguinal canal
Emerge through the superficial inguinal ring
43
Passage of direct inguinal hernias
Enter the inguinal canal directly via a weakness in its posterior wall.
Emerge from the superficial inguinal ring
44
What type of hernia often extends into the scrotum
Indirect inguinal hernias
45
Differential diagnosis of a lump in the groin
```
Inguinal hernia
Femoral hernia
Inguinal lymph node
Saphena varix
Femoral artery aneurysm
Encysted hydrocoele
Lipoma
```
46
Factors leading to the development of incisional hernias
```
Obesity
Old age
Chronic cough
Straining due to constipation
Post-op wound infection
Post-op haematoma
```
47
What is the normal difference between adult and congenital umbilical hernias
Congenital umbilical hernias herniate through the umbilicus itself.
Adult umbilical hernias are usually para-umbilical.
48
What is a spigelian hernia
A hernia into the posterior rectus sheath at the point where it becomes deficient.
49
What is an obturator hernia
V rare hernia.
In pelvic area - into obturator foramen.
Can cause pain to be felt on inner thigh
Old F
50
What does a modified Glasgow score of 3 or more indicate
Severe pancreatitis
51
What is fibrocystic breast disease
Aberrations of normal development
Small cyst formation
Fibrosis
Hyperplasia of duct epithelium
52
Presentation of fibrocystic breast disease
Bilateral, diffuse lumpiness and breast pain.
| Often cyclical
53
Features of a fibroadenoma
Discrete, firm, freely mobile lump
2-3cm in size
Most common aged 15-25
54
What is a phyllodes tumour
Rapid growing
Tumour of Fibroepithelial stroma of breast
Leaf-like appearance on histology
Usually benign
55
What is peau d'orange
Orange skin appearance of skin of breast
Can occur in breast cancer
Cutaneous lymphoedema
Skin dimpling
56
What is a cystic hygroma
Congenital benign proliferation of lymph vessels.
Posterior triangle of neck.
Multi-cystic swelling.
57
Features of a cystic hygroma
Posterior triangle of neck.
Multi-cystic swelling.
Fleshy and compressible
Trans illuminate brightly
58
Boundaries of the posterior triangle of the neck
SCM muscle anteriorly
Anterior border of trapezius
Middle 1/3 of clavicle
59
Features of a salivary duct carcinoma
```
>50yo
Rapid growth
Regional lymph node involvement
Rapid metastasis
Facial nerve involvement --> weakness
```
60
What is a branchial cyst
Cystic degeneration of lymphoid tissue
Commoner in M on LHS
Anterior triangle
61
Features of a branchial cyst
Anterior triangle - anterior to bordere of SCM
Smooth
Non-tender
Fluctuant swelling
Does not trans-illuminate
Aspiration reveals creamy fluid containing cholesterol crystals
62
What is a thyroglossal cyst
Congenital cystic remnant of the thyroglossal tract
63
Features of a thyroglossal cyst
Smooth midline lump
| Moves on tongue protrusion
64
What is a sialolithiasis
Salivary gland stone
65
Presentation of salivary duct stone
Immense pain on salivation
| Enlarged gland
66
Post-hepatic causes of jaundice
```
Biliary obstruction
- Extrahepatic cholestasis:
> Bile duct strictures (can be benign or malignant).
> Common duct stone.
> Cancer of the head of the pancreas.
> Tumour of the ampulla of Vater.
> Pancreatitis.
> Cancer of the gallbladder.
- Intrahepatic cholestasis:
> Primary biliary cirrhosis
> Drugs (e.g phenothiazines).
> Primary sclerosing cholangitis
> Dubin-Johnson syndrome (autosomal recessive)
> Rotor's syndrome.
```
67
What type of jaundice causes pale stools and dark urine
Conjugated
| Suggests a post-Hepatic cause
68
What type of incision is used for an appendicectomy?
Gridiron (at right angles to the line between ASIS and umbilicus -1/3 way along)
Lanz (more transverse and closer to ASIS)
69
Where is McBurney's point
1/3 way between the ASIS and umbilicus
| Tender on palpation in acute appendicitis
70
When is a midline laparotomy incision used + where is it
For urgent abdominal surgery or exploratory surgery
Upper = Xiphisternum to umbilicus
Lower = umbilicus to pubic symphysis
Trauma cases = Xiphisternum to pubic symphysis
71
When is a pfannenstiel incision used
Caesarean section
Ovarian operations
Bladder and prostate operations
72
When is a subcostal (kocher) incision used
Right sided for cholecystectomy
| Left sided for splenectomy
73
Management of thrombophlebitis caused by cannula
Remove cannula
Elevate limb
NSAIDs
If signs of infection start abx
74
Presentation of the breast cyst
Sudden, painful swelling in the breast
| Commonest in 40s
75
What is mastitis
Infection of a lactiferous duct by staphylococcus aureus
| Transmitted by infants nasopharynx in lactation
76
Presentation of mastitis
Cellulitis of breast
Pyrexia
tachycardia
leucocytosis
77
Presentation of fat necrosis in the breast
Middle age obese women
History of breast trauma
Painless, irregular, firm lump
+/- Skin thickening, retraction
78
What is mondor's disease of the breast
Rare
Thrombophlebitis of superficial veins of bathe breast and anterior chest wall.
Painful, inflamed cord-like structure tethered to skin
79
Presentation of a cervical rib
Lump in the neck
Paresthesia / pain in T1 distribution
Horners syndrome
Subclavian artery can be pinched - reduced blood flow to arm
80
Commonest benign tumour of the salivary glands
Pleomorphic adenoma
81
What is a chemodectoma
Tumour of the carotid body chemoreceptors arising in carotid bifurcation
Slowly enlarging neck mass with carotid pulsation
82
Presentation of sternocleidomastoid tumour
Tilting of head - torticollis
Painless fibrous mass in SCM muscle
Tx = passive stretching of muscle
83
When can aorto-enteric fistulas occur
| How do they present
Rare complication of abdominal aortic aneurysm repair
| Presents as massive GI bleeding, hypovolaemia, collapse
84
Risk factors for gastric carcinoma
```
Chronic peptic alteration
Helicobacter pylori infection
Gastric polyps
Pernicious anaemia
Ménétrier's disease
Blood group A
Eating pickled foods
Smoking
Alcohol
```
85
What is Ménétrier's disease
Rare condition of hyperplasia of mucus producing cells in stomach,
Causes protein losing enteropathy
And reduced gastric acid secretion
86
What is the most common type of gastric cancer
Adenocarcinoma
87
What is troisiers sign
Supraclavicular lymphadenopathy on the left hand side = vichows node
Gastric cancer
88
What is a krunkenburg tumour
Secondary ovarian tumour - From adenocarcinoma of the stomach
89
What is a sister Joseph nodule
Hard red lump in the umbilicus
| Signifies gastric carcinoma
90
Management of haemorrhoids
```
Increase dietary fibre
Increase water
Injections sclerotherapy
Banding
Surgical haemorrhoidectomy
```
91
What is an amyand hernia
Hernia containing the appendix in the sac
92
Management of achalasia
Balloon dilation of the oesophagus
| Hellers cardiomyotomy
93
What malignancy does achalasia predispose to?
Squamous cell carcinoma of the oesophagus
94
Symptoms of hiatus hernia
Asymptomatic
Gastro-oesophageal reflux
Dyspepsia
95
Complications of hiatus hernia
```
Weight loss
Oesophagitis
Oesophageal ulceration
Oesophageal stricture
Aspiration pneumonia
```
96
What is the surgical procedure for hiatus hernia
nissen's fundoplication
97
Presentation of toxic megacolon
```
Acute
Abdominal pain
Abdominal distension
Diarrhoea
Blood stained stools
Fever
Tachycardia
```
98
Xray findings of toxic megacolon
Colon dilation >6cm
Colonic wall thickening
Multiple air-fluid levels
Disrupted haustral pattern
99
Management of toxic megacolon
HDU
Fluid rescus
Antibiotics
Corticosteroids
Daily abdominal X-rays to assess progression
If dilation worsening consider collectomy
100
What is CA-19-9 raised in
Pancreatic cancer
101
Tumour marker of pancreatic cancer
CA 19-9
102
Tumour marker of ovarian cancer
CA 125
103
When is CA 125 raised
Ovarian cancer
104
What tumour is alpha-fetoprotein raised in
Hepatocellular carcinoma
Liver metastasis
Germ cell tumours
105
What tumour maker is raised in prostate cancer
PSA
| prostate specific antigen
106
When is CA15-3 raised
Breast cancer
107
Tumour marker of breast cancer
CA 15-3
108
What is beta-HCG a tumour marker for
Choriocarcinoma (trophoblastic disease)
| Testicular tumours
109
What is calcitonin a tumour marker for
Medullary thyroid cancer
110
What is CEA (carcino-embryonic antigen) a tumour marker for
Colorectal cancer
111
Tumour marker of colorectal cancer
CEA
| carcino-embryonic antigen
112
When is monoclonal immunoglobulin G raised
Multiple myeloma
113
What is s-100 a tumour Marker for
Malignant melanoma
114
What cystic neck lump occurs at the lower posterior edge of SCM
Cystic hygroma
| Lymph-angioma
115
What cystic neck lump occurs at the upper anterior edge of SCM
Branchial cyst
116
When does a cystic hygroma present
Birth / early childhood
117
When does a branchial cyst present
Adolescence / easily adulthood
118
What nerve is contained in the posterior triangle of the neck
Accessory nerve
119
Where can a lipoma NOT form?
Palms
Soles
Scalp
120
Does a lipoma have a punctum
No
121
What nerve runs through the parotid gland
5 branches of the facial nerve
122
Signs of peritonitis
```
Tenderness
Reflex guarding
Absent bowel sounds
Pyrexia
Pain to percussion
Extremely unwell
Distant palpation pain
```
123
Is small of large bowel obstruction more common?
Small
124
Mechanism of sentinel node identification in breast cancer
Injection of vital blue dye + technetium labelled colloid
To identify sentinel node
Allows histology on single node
125
What type of drug is herceptin + when is it used
Immunotherapy / biological therapy
| Used in breast cancer following chemotherapy
126
What is tamoxifen
Oestrogen receptor antagonist
127
Complications of hernias
```
Irreducibility
Obstruction
Strangulation
Peritonitis
Infarction
```
128
What % of patients presenting with a hernia have bilateral ones
10%
129
Presentation of an incisional hernia
Appear months after surgery
Usually abdominal
Exaggerated when lying by lifting head off bed
Wide neck - low risk of obstuction / strangulation
130
Where is the inguinal ligament
Between the pubic tubercle and the ASIS
131
What is the difference between the mid-inguinal point and the mid-point of the inguinal ligament
mid-inguinal point = 1/2 way between symphysis pubis and ASIS = location of femoral pulse
Mid-point of inguinal ligament = 1/2 way between pubic tubercle + ASIS = location of deep inguinal ring
132
What is the process behind dupuytrens contracture
Thickening of the palmar aponeurosis
Doesn't involve flexor tendons but prevents them working properly.
Is not painful
133
Risk factors for dupuytrens contracture
```
Family hx
Alcohol excess
Cigarette smoking
Diabetes
Peyronie's disease
Phenytoin
```
