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Year 6 > Surgery Conditions > Flashcards

Surgery Conditions Flashcards

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1
Q

what are the main signs and symptoms of acute appendicitis?

A

symptoms:
- peri-umbilical abdo pain radiating to RIF
- pain worse on coughing
- vomiting once or twice
- mild fever
- anorexia

signs:
- rebound tenderness
- right-sided tenderness with pelvic appendix
- Rovsing’s sign
- Psoa’s sign

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2
Q

Diagnosis for acute appendicitis

A

increased ESR CRP
neutrophil leucocytosis
urine analysis: exclude pregnancy, renal colic and UTI
USS if female
CT if needed

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3
Q

what is the management for acute appendicitis?

A
  • lap appendicectomy
  • prophylactic ABx
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4
Q

what is the pathophysiology of acute pancreatitis?

A

auto digestion of pancreatic tissue by the pancreatic enzymes leading to necrosis

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5
Q

what are the signs and symptoms of acute pancreatitis?

A
  • severe epigastric pain radiating to back
  • vomiting
  • epigastric tenderness
  • low grade fever
  • Cullen sign: periumbilical discolouration
  • Grey-Turner sign: flank discolouration
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6
Q

what rare feature is associated with pancreatitis?

A

ishcaemic retinopathy

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7
Q

what are the investigations for acute pancreatitis?

A
  • increased serum amylase
  • increased serum lipase
    imaging
  • USS
  • contrast enhanced CT

bloods:
- hypocalcaemia
- hyperglycaemia
- elevated LDH
- elevated AST

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8
Q

what scoring systems are used for acute pancreatitis?

A

ranson score
glasgow score

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9
Q

what are the causes of acute pancreatitis?

A

GET SMASHED
gallstones
ethanol
steroids
mumps
autoimmune
scorpion venom
hyeprtryglyceridaemia
hypercalcaemia
hypothermia
ERCP
Drugs e.g. azathioprine, furosemide, pentamidine, steroids

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10
Q

what are the complications of acute pancreatitis?

A
  • peripancreatic fluid collections
  • pseudocysts
  • pancreatic necrosis
  • pancreatic abscess
  • haemorrhage
  • ARDS
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11
Q

what is the management of acute pancreatitis?

A

fluid resus:
- crystalloids
- aim for >0.5ml/kg/hr urine output
analgesia:
- IV opioids
nutrition:
- NBM
- enteral nutrition
surgery:
- if due to gallstones
- obstructed biliary system -> ERCP
- if necroses -> necrosectomy

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12
Q

what is the difference between acute and chronic anal fissures?

A

acute: less than 6 weeks
chronic: more than 6 weeks

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13
Q

what are the risk factors for anal fissure?>

A
  • constipation
  • IBD
  • STIs
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14
Q

what are the signs and symptoms of anal fissures?

A
  • painful bright red rectal bleeding
  • fissures seen posterior midline
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15
Q

what is the management of anal fissures?

A

acute:
- high fibre diet
- bulk forming laxatives
- lubricants
- topical anaesthetics
analgesia

chronic:
- topical GTN
- surgery e.g. sphincterectomy

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16
Q

what is the pathophysiology of aortic dissection?

A

tear in the tunica intimate of wall of aorta

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17
Q

what are the risk factors of aortic dissection?

A
  • hypertension
  • trauma
  • bicuspid aortic valve
  • marfans
  • Ehlers danlos
  • pregnancy
  • syphilis
  • turner’s
  • noonan’s
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18
Q

what are the signs and symptoms of aortic dissection?

A
  • sharp and severe chest and back pain
  • chest pain = type A
  • upper back pain = type B
  • weak carotid, brachial or femoral pulse
  • aortic regurgitation
  • hypertension
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19
Q

what is the classification of aortic dissection?

A

Stanford:
- type A: ascending aorta
- type B: descending aorta

DeBakey

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20
Q
A
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21
Q

what is the management of aortic dissection?

Study These Flashcards
A

type A:
- surgical management
- control BP

type B:
- conservative management
- bed rest
- labetalol to reduce BP

22
Q

what are the complications of aortic dissection?

Study These Flashcards
A

backward tear:
- aortic regurgitation

forward tear:
- unequal pulses and BP
- stroke
- renal failure

23
Q

what is aortic regurgitation?

Study These Flashcards
A

leaking of aortic valves that causes blood to flow in the reverse direction during ventricular systole

24
Q

what are the chronic causes of aortic regurgitation?

Study These Flashcards
A

valve disease:
- rheumatic fever
- calcific valve disease
- RA or SLE
- bicuspid aortic valve

aortic root disease:
- bicuspid aortic valve
- Ankylosing spondyl
- hypertension
- Marfan’sw

25
what are the acute causes of aortic regurgitation?
valve disease: - infective endocarditis aortic root disease: - aortic dissection
26
what are the signs and symptoms of aortic dissection?
- early diastolic murmur - collapsing pulse - wide pulse pressure - quincke's sign - de musset's sign
27
what are the investigations for aortic regurgitation?
echocardiography
28
29
What is the management of aortic regurgitation?
medical management of any associated heart failure surgery: aortic valve indications include symptomatic patients with severe AR asymptomatic patients with severe AR who have LV systolic dysfunction
30
What are the clinical features of aortic stenosis?
chest pain dyspnoea syncope / presyncope (e.g. exertional dizziness) murmur an ejection systolic murmur (ESM) is classically seen in aortic stenosis classically radiates to the carotids this is decreased following the Valsalva manoeuvre
31
What are the severe features of aortic stenosis?
narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure
32
What are the causes of aortic stenosis?
degenerative calcification (most common cause in older patients > 65 years) bicuspid aortic valve (most common cause in younger patients < 65 years) William's syndrome (supravalvular aortic stenosis) post-rheumatic disease subvalvular: HOCM
33
What is the management of aortic stenosis?
if asymptomatic then observe the patient is a general rule if symptomatic then valve replacement if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery options for aortic valve replacement (AVR) include: - surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined - transcatheter AVR (TAVR) is used for patients with a high operative risk balloon valvuloplasty - may be used in children with no aortic valve calcification - in adults limited to patients with critical aortic stenosis who are not fit for valve replacement
34
What is bicuspid aortic valve asssociated with?
Left dominantly coronary circulation and Turner’s syndrome
35
What are the complications of bicuspid aortic valve?
- Aortic stenosis and regurgitation - aortic dissection and aneurysm of ascending aorta
36
What are the most common valves need replacing?
Aortic and mitral valve
37
Describe the use of bio prosthetic valves
- deteriorates over time - warfarin given for first 3 months
38
Describe the use of mechanical valves
- most common is bileaflet valve - increased risk of thrombosis so you need long term anticoagulation -> use warfarin
39
What are the causes of ascites with SAAG >11g/L?
Liver disorders: - cirrhosis - acute liver failure - metastases Cardiac: - right heart failure - constrictive pericarditis Other: - budd chiari - portal vein thrombosis - veno-occlusive disease - myxoedema
40
What are the causes of ascites with SAAG <11g/L
Hypoalbuminaemia - nephrotic syndrome - severe malnutrition Malignancy: - peritoneal carcinomatosis Infections: - tuberculous peritonitis Other: - pancreatitis - bowel obstruction - biliary ascites - post op lymphatic leak
41
describe the management of ascites
- reduce sodium - fluid restriction if sodium is less than 125mmol/L - aldosterone antagonists e.g. spironolactone - drainage if tense ascites: paracentesis - prophylactic ABx
42
What are the signs and symptoms of mastitis?
Painful, tender red, hot breast Fever Malaise
43
What is the management of mastitis?
- continue breastfeeding - analgesia - warm compresses - if unwell after 12-24 hours: oral flucloxacillin for 10-14 days
44
What are the 2 main types of anti-oestrogen drugs?
Selective oestrogen receptor modulators SERM Aromatase inhibitors
45
What are SERMs used for?q
46
What are SERMS used for?
Example: tamoxifen Used in oestrogen receptor positive breast cancer
47
What are the side effects of tamoxifen?
Menstrual disturbance e.g. vaginal bleeding Hot flushes VTE Endometrial cancer
48
What are aromatase inhibitors used for?
- ER +ve breast cancer - reduces peripheral oestrogen synthesis E.g. anastrazole
49
What are the side effects of aromatase inhibitors ?
Osteoporosis Hot flushes Arthralgia Insomnia
50
What are the 2 types of malignant breast cancer?
Invasive ductal carcinoma Invasive lobular carcinoma
51
What is involved in the triple assessment for breast cancer?
- history and examination - USS or mammogram - fine needle aspiration or biopsy
52

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