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UCPEX > Surgery/Urology > Flashcards

Surgery/Urology Flashcards

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1
Q

Most common causes of acute abdominal pain

A

Nonspecific - 43%
Acute appendicitis - 4-20%
Acute cholecystitis - 3-9%
SBO - 4%
Uterolithiasis - 4%

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2
Q

Most common, non-obstetric cause of surgical emergency in pregnancy

A

Appendicitis

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3
Q

2 causes of appendicitis

A

Obstructing faecolith (adults)
Enlarged mesenteric lymph node (children)

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4
Q

Best signs of appendicitis in adults vs children

A

Adults:
RLQ pain
Periumbilical pain localising to RIF
Abdominal rigidity

Children:
Decreased bowel sounds
Positive psoas sign - extension hip
Positive obturator sign - internal rotation thigh
Positive Rovsing’s sign

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5
Q

Complications of appendicitis

A

Perforation 17-32%
Peritonitis
Intraabdominal abscess
Bowel obstruction
Sepsis

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6
Q

Causes of pancreatitis

A

Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps, malignancy
Autoimmune
Scorpion sting
Hypercalcaemia, hyperlipidaemia
ERCP
Drugs

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7
Q

Pathognomonic signs of pancreatitis

A

Cullen’s sign - periumbilical subcutaeneous ecchymosis and oedema
Grey Turner sign - flank bruising

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8
Q

Atlanta criteria for diagnosis of pancreatitis

A
  1. Abdominal pain suggestive of pancreatitis
  2. Raised serum lipase/amylase x3 normal limit
  3. Characteristic findings on radiological imaging
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9
Q

Risk factors for AAA

A

Screening criteria:
Male
>65
Smoker

HTN
Atherosclerosis
Connective tissue disorder
Hyperlipidaemia

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10
Q

70 male with acute severe abdominal pain and haematuria.
Diagnosis not to miss:

A

AAA rupture involving renal arteries

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11
Q

Lifetime risk of AAA rupture of diameters:
5cm
6cm
7cm

A

5cm - 20%
6cm - 40%
7cm - 50%

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12
Q

4 types of bowel obstruction

A

Small bowel obstruction
Large bowel obstruction
Ileus
Psuedoobstruction (Parkinson’s, MS, hypothyroidism, Hirschsprung, diabetic neuropathy)

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13
Q

Diverticular disease
- location by ethnicity
- Age group prevalence

A

Caucasian - sigmoid colon
Asian - ascending colon
Age 40+, 65% prevalence by age 85

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14
Q

Management of diverticulitis in community

A

Mild uncomplicated - analgesia, liquid diet 2-3 days

Consider abx in patients with comorbidities, systemically unwell (but not for hospital), no improvement in 48 hours:

Metronidazole 400mg tds 5-7 days
PLUS
Cotrimoxazole 960mg BD 5 days
OR
Amoxicillin 500mg tds 7 days
OR
Cefalexin 500mg 2-3 times/day 5 days

OR
Augmentin 625mg tds 5 days

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15
Q

Risk factors for renal stones

A

Family hx renal stone
Prev renal stone
Chronic dehydration
Abnormality of renal tract
Obesity
Hyperparathyroidism
Gout
Idiopathic hypercalciuria

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16
Q

Referrral criteria for ureteric stones

A

Fever >38 deg
Pain uncontrolled
Bilateral stones
Stone >7mm
Known renal disease
Solitary kidney
Creatinine >160
Peritonitis

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17
Q

Obstructive causes of urinary retention

A

Neoplasm
Calculus
Blood clot
Faecal impaction
Strictures
FB

Men: BPH, phimosis, paraphimosis
Women: pelvic organ prolapse, pregnancy

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18
Q

Infection/inflammatory causes of urinary retention

A

Varicella
Lyme disease
Cystitis
Urethritis
HSV

Men: balanitis, prostatitis, prostatic abscess
Women: vulvovagnitis, Behcet disease, vaginal skin disease

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19
Q

Medication causes of urinary retention

A

Anticholinergics
Antihistamines
Antihypertensives
Antidepressants
Anti-Parkinson’s
Antipsychotics
Muscle relaxants
Sympathomimetics
Beta adrenergic

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20
Q

Neurological causes of urinary retention

A

Diabetic cystopathy
Spinal cord injury
Cauda equina
Spinal abscess
Guillain Barre
CVA
MS

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21
Q

AUA scoring for BPH severity

A

In the past month:
1. Frequency of sensation of not complete emptying
2. Frequency of repeat urination within 2 hours
3. Frequency of stopping and starting multiple times during void
4. Difficult to postpone urination
5. Weak stream
6. Push or strain to urinate
7. Number of time urinating overnight

Scoring 0-5 - none, less than 20%, less than half, half, more than half, always
Mild 0-7, moderate 8-19, severe 20-35

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22
Q

Criteria for post obstructive diuresis

A

Risk >1.5L draining post IDC
Creatinine >200

> 200mL/hour for 2 hours
3L over 24 hours

Replace with IVF 50% previous hour’s urine output

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23
Q

Risk for gallstones

Study These Flashcards
A

Fat, female, fair (European), fertile (pre-menopausal), forty
Family hx
Sudden weight loss
Diabetes
Oral contraceptive
Pregnancy
Haemolytic disorder

24
Q

Charcot’s triad for ascending cholangitis

Study These Flashcards
A

RUQ pain
Jaundice
Fever

25
Complications of gallstones
Mirizzi syndrome Gallstone ileus Gallbladder cancer
26
Differentiating internal haemorrhoids vs external haemorrhoids
Internal: - Above dentate line - No sensation (visceral innervation) - Rectal mucosal lining - Grade 1 - bulge into lumen - Grade 2 - Prolapse with straining, spontaneous reduction - Grade 3 - Prolapse with straining, manual reduction - Grade 4 - Prolapsed and non-reducible, risk of strangulation External: - Below dentate line - Painful (somatic innervation) - Squamous epithelium
27
High risk features for colorectal cancer
Family history Personal hx ca or polyps Persistent change in bowel habit Blood mixed in stools Tenesmus Unexplained weight loss Iron deficiency anaemia
28
Risks for haemorrhoids
Constipation Frequent defecation Pregnancy Prolonged sitting
29
Causes of mesenteric ischaemia
Arterial thromboembolism - Age >60 - AF - Vasculopath - Smoker - Recent MI - Valvular heart disease - Aortic atherosclerosis/aneurysm Venous thrombosis - Younger patients - Hypercoagulable - Dehydration - Portal HTN - Abdominal infection - Blunt trauma - Pancreatitis - Splenectomy - Portal malignancy
30
Mesenteric ischaemia vs colonic ischaemia presentation
Mesenteric: Age >50 Usually has precipitating medical cause Pain more severe Patient seriously ill Colonic: >90 Can have predisposing lesion - ca, stricture, diverticulitis, faecal impaction Moderate rectal bleeding/bloody diarrhoea
31
Xray findings of ischaemic bowel
Thumb printing/thickened bowel loops Air in portal vein (late finding)
32
Risk factors for anal fissure
Constipation IBD Trauma Anal cancer STI, HIV Childbirth and pregnancy
33
Locations for anal fissures
Posterior midline - most common Anterior midline - 8-25% Lateral regions - consider Crohn's, malignancy, HIV, TB
34
Management of anal fissures
Topical anaesthetic gel Topical GTN/diltiazem Stool softeners Frequent warm baths Chronic (>6 weeks) - consider botox, internal sphinterotomy Acute referral - Large bleeding - Concurrent infection/abscess
35
Areas of abscess and fistula extension for complex perianal abscess
Ischiorectal abscess - in ischiorectal fossa Intersphincteric abscess - Between internal and external anal sphincters Fistulae: - Intersphincteric - Transphincteric - Suprasphinteric - Extrasphincteric
36
Risk factors for perianal abscess
Male Mean age 40 Diabetes, immunocompromised STI Anal fissures Crohn's disease Receptive anal intercourse
37
2 types of mastitis/breast abscess and microbial causes
Lactational - Milk stasis, nipple damaged, latch problems, missed feeds/pump - Usually peripheral breast - Staph aureus, Staph epidermidis, Strep - Fluclox 1g tds 5-7 days Non-lactational - Squamous metaplasia of lactiferous ducts causing blockage - Usually periareolar/subareolar - Cracked, damaged nipples - Aerobic and anaerobic bacteria - Augmentin 625mg tds 7 days
38
Signs and symptoms of ischaemic limb
Pain Pallor Paraesthesia Pulselessness Poikylothermia Paralysis
39
Palpable lump in testis, no pain or mild ache, possible concurrent hydrocoele Dx? Management?
Testicular ca - 97% germinal seminoma Average age 32 >urgent USS
40
Gradual increasing unilateral testicular pain. Fever, discharge. Tender swollen epididymis, normal cremasteric reflex. Dx? Mangement?
Epididymitis Most common cause of painful testicular swelling in post-pubertal males - STI in sexually active to age 35 - UTI pathogen in others STI swabs, MSU, contact trace and treat partners last 3 months, no intercourse for 2 weeks and 7 days after contacts treated Ceftriaxone 500mg IM stat + doxycycline 100mg BD 14 days If UTI - augmentin 625mg tds 10 days OR cotrimoxazole 960mg BD 10 days OR ciprofloxacin 500mg BD 10 days
41
Dull ache/throbbing in scrotum, worse on prolonged standing, "bag of worms" scrotal swelling Dx? Management?
Varicocoele Cause of reversible infertility NSAIDs Supportive underwear Varicocoelectomy
42
Painless scrotal swelling, not reducible, transilluminable
Hydrocoele Presents in infancy or adulthood Self-limiting in children (patent processus vaginalis) Adults - aspirate and USS to r/o malignancy, infection
43
Sudden onset testicular pain and high fever, nausea and vomiting. Testicle enlarged, indurated, tender.
Orchitis Check parotid glands to rule out mumps Scrotal support Ice Bed rest Abx if indicated Mumps orchitis risk of infertility
44
Painful, red, firm scrotal mass. Vomiting. Irreducible. Non transilluminating.
Incarcerated inguinal hernia Acute general surgery referral
45
Acute severe testicular pain, swelling, ecchymosis, vomiting. Hx trauma.
Testicular rupture/haematoma Acute urology referral
46
Risk groups for testicular torsion
Neonates - undescended testes Age 12-25 FHx or PHx testicular torsion Bell clapper deformity
47
Acute severe testicular pain, no fever, blue dot sign on scrotum
Torsion of testicular appendage Need to rule out torsion
48
Acute severe testicular pain, no fever, nausea and vomiting, abnormal gait. May have hx preceding intermittent episodes. High riding testicle, suprapubic tenderness, abnormal ipsilateral cremasteric reflex
Urgent paeds surg/urology referral Surgical exploration within 6 hours of onset
49
Causes of priapism
- Idiopathic - most common - Blunt trauma - Intracavernosal injection of medication - Medications - anticoagulants, antipsychotics, sildenafil - Drugs - alcohol, cannabis, cocaine - Sickle cell disease - ischaemic priapism
50
Priapism: Presentation Examination Management
Persistent erection >2 hours in absence of sexual excitation Engorged corpora cavernosa, flaccid corpus spongiosum and glans Analgesia Ice Walk up stairs (arterial steal) Refer to urology if not resolving
51
Complications of paraphimosis
Ischaemia Skin necrosis Penile necrosis Glans infarct Gangrene Urinary obstruction Bladder distension Post reduction scarring, phimosis
52
Management of paraphimosis
Analgesia, lignocaine gel/EMLA Ice method - wrap penis in glove, ice over swollen foreskin Osmotic agent - do not use if penile necrosis. - Sugar - apply to glans, cover, 2 hours - 50% dextrose - soak in gauze, apply to glans, cover, 1 hour - 20% mannitol - soak in gauze, apply to glans, cover, 45 mins Compression - wrap compressive bandage distal > proximal. Leave for 20 mins Manual reduction - lubricant, draw swollen foreskin forward, push glans backwards Advice: - No retraction 1/52 - No sexual intercourse - Avoid irritants - Observe for infection
53
Bacterial causes of acute prostatitis
Gram-negative organisms (E. coli, Klebsiella, Proteus, Enterococcus) Pseudomonas in IDUC STI Trimethoprim 300mg OD 2-4 weeks Ciprofloxacin 500mg BD 4 weeks Complicated, risk of resistance (recent travel Middle East, Asia, Africa) - Cefalexin 500mg BD/augmentin 625mg BD 2-4 weeks 4-6 weeks if chronic
54
Complications of prostatitis
Chronic prostatitis Chronic pelvic pain Prostatic abscess Bacteraemia Epididymitis Spinal/sacroiliac infection Endocarditis (valvular disease)
55
Symptoms and signs of prostatitis
Fever, malaise Perineal pain dysuria, frequency, slow flow, urgency Prostate on DRE: firm, oedematous, tender +++
56
Definition of microscopic haematuria
>20x10^6/L RBC in 2 of 3 properly collected midstream urine specs, 7 days apart No evidence of infection
57
Causes of haematuria
Renal trauma Renal disease Acute glomerulonephritis (acute HTN, oliguria, oedema, ACR >30, red cell casts, rise eGFR) Cystitis, pyelonephritis Renal calculus Prostatitis BPH Prostate ca Menses Vigorous exercise Recent urological instrumentation Bladder ca Rupture AAA

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