Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS - Year 3 > The Digestive System - GI Surgical Emergencies > Flashcards

The Digestive System - GI Surgical Emergencies Flashcards

1
Q

Peritonitis

A

Infl of serial membrane lining abdo cavity and the organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of peritonitis

A

Primary - spontaneous
Secondary - to pathology in a visceral organ
Tertiary - persist/ recurs adequate initial treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Primary peritonitis

A

Spontaneous bacterial peritonitis (SBP)
Infection of ascitic fluid which arises in the absence of any other source of sepsis within the peritoneum or the adjacent tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk factors for primary peritonitis

A

Co-existence of GIT bleeding
Previous SBP
Low ascitic protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is SBP commonly seen in

A

Alcoholism and cirrhosis
Malignant mets
Hepatitis
CHF
SLE
Usually develops on top of pre-existing ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Px of SBP

A

Pyrexia - seen in 80%
Abdo pain
Peritoneal irritation - pain, rebound tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is diagnostic for SBP

A

> 250 polymorphonuclear WBCs in peritoneal fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common organisms in SBP

A

E. coli
Strep
Enterococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of SBP

A

Broad spectrum abx before culture results
3rd gen cephalosporins
Best-lactam combi e.g. piperacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Secondary peritonitis

A

Spillage of GI or gU micro-organism –. loss of integrity of mucosal barrier
May be disease, perforation, trauma, gangrene, obstruction, malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diseases that may cause secondary peritonitis

A

Appendicitis
Diverticulitis
Pancreatitis
IBD
In females, from an infected Fallopian tube or ruptured ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Px of 2’ peritonitis

A

Local pain from ruptured organ
Pts lie motionless/ curled
Rebound tenderness
Febrile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Death in 2’ peritonitis

A

Typically Gram-ve rod sepsis and potent endotoxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogens causing 2’ peritonitis - contamination form upper GI

A

Gram+ve organisms usually predominate
Incl yeasts, lactobacilli
Gram-ve rods if gastr9c acid suppressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathogens causing 2’ peritonitis - contamination from distal bowel

A

Polymicrobial incl yeasts
GNR and anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathogens causing 2’ peritonitis - bloodstream/ lymphatic spread

A

Strep pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When does 3’ peritonitis occur

A

Within 48hrs of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is 3’ peritonitis typically caused by

A

Multidrug resistance organisms (ESBL, VRE) - difficult to treat
Abscesses
Severe complications of sepsis following surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Common sources of pyrexia in a surgical pt

A

Chest (infection)
Cut (wound infection)
Catheter (UTI)
Collections (abdo, pelvis)
Calves (DVT)
Cannula (infection)
Central line (infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CAPD

A

Continous ambulatory peritoneal dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does CAPD peritonitis involve

A

Skin organisms’ vs endogenous flora
Similar to endovascular device infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Px of CAPD peritonitis

A

Same as 2’ peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would be seen in dialysate in CAPD peritonitis

A

Cloudy
>100 WBCs, 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a peritoneal abscess

A

Infected fluid collection
Encapsulates by fibrinoid exudate, momentum and/or adjacent visceral organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Loculation

A

Compartmentalisation of fluid-filled cavities by septa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where do peritoneal abscesses usually occur

A

Sub-hepatic
Pelvic region
Paracolic gutter

Half with loculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What may cause intra-ab abscesses

A

Faecal spillage from colonic source
Diverticular abscess
Necrotising abscess
Necrotising pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which antimicrobials to use for Gram-ve organisms

A

Amoxi*
Gentamycin
Co-amoxiclav
Cefuroxime
Cipro
Piperacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which antimicrobials to use Gram+ve organisms

A

Amoxi
Gentamycin*
Co-amoxiclav
Piperacillin/ tazobactam
Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which antimicrobials to use for anaerobes

A

Metronidazole
Co-amoxiclav
Piperacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hernia

A

Abnormal protrusion of a cavities through its wall
Defect in wall creates neck of hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Types of abdominal hernias

A

Epigastric
Umbilical
Spighelian
Excisional
Inguinal
Femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Is divarification of recti a hernia

A

No
There is no defect of wall
Recti shifted away from midline and sheath becomes lax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Who does divarification of recti affect

A

Seen in women after childbirth
Elderly men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Epidemiology of hernias

A

9x more common in men (except femoral)
Men have lifetime risk of 27%
Most commonly presents in ages 40-59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Px of hernias

A

Bulge or mass
Discomfort
Cough impulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Px of obstructive hernias

A

N & V
Abdo pain
Distention
Absent bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Px of strangulated hernias

A

Tenderness
Severe pain
Gangrenous mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Classification of non-reducible hernias

A

Incarcerated
Obstructed
Strangulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Spigelian hernias

A

Occurs between lateral border of rectus abdominis and linea semilunaris
Area of central weakness pushed dup - doesn’t go through anterior sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Incisional hernias

A

Occurs at sites where there gas been a previous surgical incision has been made
Range from small (few cm) to v large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Incarcerated hernias

A

Cannot be returned as they have formed adhesions outside but are still viable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Obstructed vs strangulated hernias

A

Bowel lumen becomes obstructed –> intestinal obstruction
Strangulated - blood flow to bowel stooped (ischaemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How are hernias repaired

A

Identify neck and sac of hernia, open up sac and reduce hernia content intra-ab
Neck is brought back together and covered w/ mesh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Different placement of mesh in hernia repairs

A

Onlay - over the top
Inlay - in between gap of muscle
Retro-muscular - beneath muscles
Preperitoneal and intraperitoneal - in peritoneal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Best and worst place to put mesh in hernia repair

A

Inlay - worst, can be moved if intra-ab pressure increases
Pre/intraperitoneal - strongest, if intra-ab pressure increases, mesh is pushed up against muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Ddx for groin hernias

A

Malignant
Aneurysm caused by IVDUs
Venous swellings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How can we tell the difference between inguinal and femoral hernias

A

Relation to pubic symphysis
Femoral is below and lateral
Inguinal is above and medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Features of direct inguinal hernias

A

Protrudes through Hesselbach trinagle - herniates through external and internal ring
Low rich of strangulation
Common in M
Seen in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Features of indirect inguinal hernia

A

Protrudes through inguinal ring (external only) - failure of processus vaginalis to close
Low risk of strangulation
Common in M
May occur in infants - congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Differentiating between direct and indirect inguinal hernia

A

Locate deep inguinal ring (midway of ASIS and pubic tubercle)
Manually reduce hernia towards deep ring and apply pressure
Ask pt to cough - if reappears, direct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Referral guidelines for hernia

A

Sx of strangulation/ obstruction
All females
Symptomatic males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ix if diagnostic uncertainty for hernias

A

USS
if still unclear, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Operative mx of hernias

A

Open vs laparoscopic (less painful, reduced recovery)
Incl herniotomy or hernioplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When is conservative mx used for hernias

A

Asymptomatic hernias (typically have wide neck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Features of femoral hernias

A

Protrudes below inguinal ligament
High risk of strangulation
More common in F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Ddx for femoral hernias

A

Lymphadenopathy
Abscess
Femoral artery aneurysm
Lipoma
Inguinal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Are trusses useful for femoral hernias

A

No - risk of strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Complication of hernia repair

A

Bleeding
Infection
Recurrence - 10%
C/c pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Cardinal sx of bowel obstruction

A

Absolute constipation - obstipation
Vomiting
Pian
Distended abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Richter’s hernia

A

Only part of bowel walls and lumen herniate, other part remains in peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Madyl’s hernia

A

Two diff loops of bowel contained within hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Hesselbach’s triangle boundaries

A

Rectus abdominis - medial
Inferior epigastric vessels - superior/ lateral
Inguinal ligament - inferior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Boundaries of femoral canal

A

Femoral vein - lateral
Lacunar ligament - medially
Inguinal ligament - anteriorly
Pectineal ligament - posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

A/c abdo pain

A

Non-traumatic abdo pain lasting 5/7 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

C/c abdo pain

A

Recurring or constant abdo pain of 2/12 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Sx of a/c or c/c abdo pain

A

Constant or episodic
Spp pain characteristics
Red flags
Dysphagia/ odynophagia
Palpitation
Chest sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Signs of a/c or c/c abdo pain

A

Abdo distention
Tenderness
Grey Turner’s sign
+ve Carnett’s sigan
Rovsing sign
Guarding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Ddx of a/c abdo pain - diffuse

A

Pancreatitis
Bowel obstruction
Sickle cell crisis
Gastroenteritis
Mesenteric thrombosis
Extras - metabolic disorder , psychogenic illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Ddx of a/c abdo pain - focal

A

A/c appendicitis
Biliary colic
A/c pancreatitis
A/c diverticulitis
Extras - ruputured adnexa cysts, ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Ddx of c/c abdo pain

A

Functional dyspepsia
IBS
IBD
PUD
Diverticular disease
Narcotic bowel syndrome (opined induced GI hyperplasia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Ix for c/c abdo pain

A

Tends to be more focussed
Guided by red flag sx and signs
If c/c pancreatitis and 20-49yrs, excl CF, but if >40, excl cancer
Fecal fat/ elastase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Intestinal obstruction

A

Interruption in normal flow of intestinal content either due to mechanical occlusion of the intestinal lumen or black of peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Pathophysiology of intestinal obstruction

A

Mechanical obstruction
Fluid and electrolyte loss
Bacterial translocation and toxaemia
Ischaemia
Perforation and peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

6 Fs of abdo distension

A

Fat
Foetus
Flatus
Fluid
Faeces
Fulminnat masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Ddx of SBO - neonates

A

Duodenal/ jejunal atresia
Meconium ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Ddx of SBO - children

A

Pyloric stenosis
Intussusception
Parasites

78
Q

Ddx of SBO - young adults

A

Adhesions
Hernias
Ileus
Gallstone ileus
Malignancy
Strictures

79
Q

Ddx of SBO - older age

A

Paralytic ileus
Malignancy

80
Q

Ddx of LBO

A

Hirchsprung’s disease
CRC
Diverticular
Volvulus
Ischaemic bowel
Faecal impaction

81
Q

Main causes of bowel obstruction

A

Adhesions (SBO)
Hernias (SBO)
Malignancy (LBO)

82
Q

Adhesions

A

Pieces of scar tissue binding abdo contents together

83
Q

Main causes of intestinal adhesions

A

Abdo or pelvic surgery (esp open)
Peritonitis
Abdo or pevic infections
Endometriosis

84
Q

Ix for bowel obstruction

A

Haemorrhage/ biochem - amylase may be raised in SBO
AXR (first line)
Gastrogratin (meal/ enema)
US - may show fluid or gas
CT - w/ IV +/- oral contrast (definitive dx)

85
Q

AXR for bowel obstruction

A

Distended loops of bowel - 3-6-9 rule

Valvuale conniventes - mucosal folds across ENTIRE width of small bowel
Haustra - folds halfway across large bowel

Pneumonperitoneum suggest perforation

86
Q

What type of shock are pts w/ bowel obstruction like to have

A

Hypovolameic - fluid stuck in bowel intreat of intra-vascular space (third-spacing)

87
Q

Initial mx of bowel obstruction

A

‘Drip and suck’

NBM
IV fluids
NGT drainage
Analgesia

Hydostatic or pneumatic enema may be used for decompression

88
Q

Definitive mx of bowel obstruction

A

Exploratory surgery to correct underlying cause
Adhesiolysis
Hernia repair
Emergency resection

89
Q

Carnett’s sign

A

A/c abdo pain remains unchanged or increases earn abs muscles tensed
Differentiates intra-ab and abdo wall pathology

90
Q

Differentials for pain in R hypochondrium

A

Gallstones
Hepatitis
Liver abscesses
Cholangitis
Cardiac/ lung causes

91
Q

Differentials for pain in epigastrium

A

Oeosphagitis
PUD
Perforted ulcer
Pancreatitis

92
Q

Differentials for pain in L hypochondrium

A

Spleen abscess
Spleen rupture
Splenomegaly

93
Q

Differentials for pain in lumbar regions

A

Renal colic - comes in waves
Pyelonephritis

94
Q

Differentials for pain in RIF

A

Appendicitis
CD flare
Ovarian cyst
Hernias
Ectopic cyst

95
Q

Differentials for pain in umbilical region

A

Early appendicitis
Meckel diverticulitis
Lymphoma

96
Q

Differentials for pain in hypogastric region

A

Testicular torsion
Urinary retention
Cystitis

97
Q

Differentials for pain in LIF

A

Diverticulitis
UC flare
Constipation
Hernias

98
Q

Mechanisms leading to bowel perforation

A

Ischaemia: obstruction –> hypo perfusion –> necrosis
Infl/ infection: diverticulitis, IBD (esp CD), appendicitis
Erosion: ulceration, tumour
Physical disruption: trauma, iatrogenic

99
Q

Sx of bowel perforation

A

Septic shock
Abdo pain
Distension
Fever/ chills
Guarding

100
Q

Mx of bowel perforation

A

Surgical repair
Bowel rest
IV fluids
IV broad-spectrum abx

101
Q

Tools used in pre op risk stratification

A

ASA
Performance status
POSSUM
APACHE

102
Q

POSSSUM

A

Physiological and Operative Severity
Score for enumeration of mortality and morbidity

103
Q

ASA tool

A

American Society of Anaesthesiologist
Ranges from 1 - 6
1 is healthy and 6 is brain dead, 4 is severe disease that is a constant threat to life

104
Q

What do pre-op tests depend on

A

Minor, intermediate, major or complex surgery
Depends on ASA grade

105
Q

Examples of minor surgery

A

Excising skin lesions
Draining breast abscess

106
Q

Examples of intermediate surgery

A

Primary repair of inguinal hernia
Excising VVs in legs
Tonsillectomy

107
Q

Examples of major or complex surgery

A

Joint replacement
Colonic resection
Hysterectomy
Lung operations

108
Q

When would cardiopulmonary exercise testing be required

A

Thoracic and upper GI major surgeries

109
Q

Pre op consent process

A

Procedure
Benefits
Risks/ complications
Alternatives
Info leaflets

110
Q

Effects of resp disease in surgery

A

Air trapping & bronchospasm - seen in asthma, emphysema
Excess pulm secretions - bronchiectasis, c/c bronchitis
Reduced lung compliance - pulm fibrosis, pleural plaques
Reduced ventilatory capacity - OSA, neuromuscular disease

111
Q

Optimisation of resp conditions pre op

A

Smoking cessation, nicotine testing (reduces risk of infection by 50% in just 8/52)
Pre-op PT
Optimising medical therapy

112
Q

When are METs performed

A

Metabolic equivalent tests
Part of detailed hx and exam in pts w/ CDV disease
Pts who cannot meet 4x the metabolic demands of normal daily activities are at increased risk

113
Q

Peri-op mx in cardiac disease

A

Don’t start cardiac meds w/ possible exception of diuretics
Consider adding drugs e.g. BB - reduces cardiac complication in high-risk pts
Ideally should start several weeks before surgery

114
Q

Pacemaker checks pre -op

A

What type - single/ dual chamber, biventricualr, ICD
When was it inserted, indication
Last check and next check
Check w/ anaesthetists

115
Q

Pre-op mx - renal disease

A

Detailed hx and exam
Consultant w/ pts renal physician
Assessment of current renal function

116
Q

Peri-op mx - renal disease

A

Careful attention to fluid and electrolyte balance
Careful attention to drugs, contrast dyes

117
Q

What are we aiming for in peri-op mx in DM

A

Avoiding hypoglycaemia
Aim for mean blood glucose conc of 5-7
Monitor capillary glucose every 2-4hrs during surgery

118
Q

What does peri-op mx in DM depend on

A

Usual diabetes mx e.g. diet only, insulin
Grade of surgery - minor (eating within few hrs) or major (NBM > 6 hrs)

119
Q

Depending of clinical urgency, what can anaemia be treated w/ pre-op

A

Oral or parenteral iron
Blood transfusion
Epo pre-op or peri-op

120
Q

Issues w/ treating anaemia in Jehovah’s witness’ peri-op

A

Discuss w/ pt and think of auto transfusion, cell saver, plasma

121
Q

Peri-op mx for bleeding risk

A

Assess for bleeding risk - coagulopathy from platelet disorder, organ dysfunction, meds etc
Pts on anti-coag usually require pre-op stoppage/ reversal

122
Q

How long should warfarin be withheld for pre op

A

5/7 to allow INR to fall to <1.5

123
Q

Common indications for bridging therapy peri-op

A

Metal valves
Cardiac stents
Stroke
Uncontrollable AF

124
Q

How long should clopi + asp be withheld for pre op

A

7 to 10 days

125
Q

Post-op problems near

A

Confusion

126
Q

Post-op problems - GI

A

Ileus
Nausea
Vomiting

127
Q

Post-op problems - kidneys

A

Low urine output

128
Q

Metabolic effect of unrelieved pain post-op

A

Catabolism due to increased cortisol, glucagon, catecholamines

129
Q

CDV effect of unrelieved pain post-op

A

Increased myocardial oxygen demand
Increased coagulation

130
Q

Resp effect of unrelieved pain post-op

A

Decreased functional residual capacity
Retention of sputum

131
Q

GI effect of unrelieved pain post-op

A

Vomiting ileus

132
Q

Renal effect of unrelieved pain post-op

A

Water and Na retention

133
Q

Psychological effect of unrelieved pain post-op

A

Anxiety, depression
Increased subjective pain experience

134
Q

WHO analgesic ladder

A

Step 1 - paracetamol, NSAIDs
Step 2 - tramadol, codeine plus Step 1
Step 3 - Morphine, methadone, oxycodone plus Step 1

135
Q

Resp complications post-op

A

Atelactasis, chest infection
PE
Pulm oedema

136
Q

Post-op mx to prevent resp complications

A

Effective analgesia - allows deep breathing, mobilisation
Chest physio
Nutrition
Fluid balance

137
Q

Cardiovasc complications post-op

A

MI
Arrhythmias
Sinus tachycardia
Sinus Brady

138
Q

Mx of arrhythmias post-op

A

Treat electrolytes, hypotension, hypoxia, amiodaron cardioversion

139
Q

What might cause sinus tachy post op

A

Pain
Anxiety
Hypovolaemia
Sepsis
Hypoxia

140
Q

Preventing cardiac complications post-op

A

Adequate analgesia
Supplemental oxygen therapy
Maintaining an even fluid balance

141
Q

Pre-renal causes of a/c renal failure post-op

A

Hypotension
Hypovolaemia

142
Q

Renal causes of a/c renal failure post-op

A

Nephrotoxic drugs
Myoglobinuria (muscle damage)
Sepsis

143
Q

Post renal causes of a/c renal failure post-op

A

Ureteric injury
Blocked catheter

144
Q

How may post-op confusion px as

A

Restlessness
Anxiety
Incoherent speech
Pulling of cannula

145
Q

Causes of post-op pyrexia

A

Wound
Intra-ab collection
Chest infection
Leaks (seen in GI surgery)
VTE
Urine catheter infection
Line infection

146
Q

Where are pressure sores typically seen in

A

Sacrum
Greater trochanter
Heels

147
Q

Who are most at risk of pressure sores

A

Those w/ nutritional stratus
Dehydration
Lack of mobility - early mobilisation is key

148
Q

What are haemorrhoids

A

Enlarged anal vascular cushions - VV of anal can

149
Q

Sx of haemorrhoids

A

Bleeding - typically painless
Prolapse
Irritation

150
Q

Internal vs external haemorrhoids

A

External - below dentate line, more painful and prone to thrombosis
Internal - above

151
Q

Risk factors for haemorrhoids

A

Grade 1 - mno prolapse
Grade 2 - prolapse but reduces spontaneously (after defecation)
Grade 3 - prolapse, stay reduced if pushed back manually
Grade 4 - irreducible

152
Q

Risk factors/ causes of haemorrhoids

A

Constipation +/- straining
Heavy lifting
C/c cough (increased intra-ab pressure) - COPD
Pregnancy/ childbirth

153
Q

Ddx of haemorrhoids

A

Anal tissue
Ano-rectal polyps
Mucosal prolapse
Ano-rectal carcinomas

154
Q

Mx of haemorrhoids - Grade 1

A

Conservative - reassurance, diet
Topical steroids to alleviate itch

155
Q

Mx of haemorrhoids - Grade 1

A

Conservative - reassurance, diet, anaesthetic ointments
Topical steroids to alleviate itch

156
Q

Mx of haemorrhoids - Grade 2

A

Rubber band ligation
Sclerotherapy
Infrared photocoagulation

157
Q

Mx of haemorrhoids - Grade 3

A

Ruber band ligation

158
Q

Mx of haemorrhoids - Grade 4

A

Surgical haemorrhoidectomy

159
Q

Risks of haemorrhoidectomy

A

Removal of anal cushions may result in faecal incontinence
Recurence
Pain
Impacted faeces

160
Q

Cause of thrombosed haemorrhoids

A

Strangulation at base of haemorrhoids –> thrombosis

161
Q

Px of thrombosed haemorrhoids

A

Significant pain
Purplish, oedematous, tender perianal mass

162
Q

Mx of thromboses haemorrhois

A

If pts presents within 72hrs, refer for excision
Pts can be managed with stool softeners, ice packs and analgesia

163
Q

Effects of sclerotherapy injection in haemorrhoids

A

Fixation - prevents prolapse
Fibrosis protects veins
Prevents distension

164
Q

Anal fissure

A

Tear causing a painful, linear ulcer at margin of anus (squamous lining)
<6 wks is a/c and more is c/c

165
Q

Risk factors/ causes of anal fissures

A

Constipation
IBD (CD)
STI e.g. HIV, Herpes, syphilis
Pregnancy

166
Q

Sx of anal fissures

A

Severe pain during and after boowel motion
Bright red rectal bleeidng
Itch

90% of anal tissues on posterior midline, if alternative locations, consider causes like CD, lymphoma, anal cancer etc

167
Q

Dx of anal fissures

A

Physical exam is diagnostic - difficult due to pain
Triad of sentinel skin tag (externally), fissure and a hypertrophied papilla (internally)

168
Q

Sentinel pile

A

Oedematous skin tag at the lower end of c/c anal fissure

169
Q

Mx of a/c anal fissure

A

Soften stool - diet, bulk-forming laxatives
Lubricants before defecation e..g vaseline
Topical anesthetics

170
Q

Mx of c/c fissure

A

Topical GTN or CCB - 1st line
Botox injection
Surgery - sphincterotomy

171
Q

Presentation of superficial abscesses

A

Pain
Swelling
Discomfort on walking and sitting
Tenderness
Fever

172
Q

Px of deep abscesses

A

Lack typical features
Diffuse pelvic pain and raised body temp

173
Q

Cause of perianal abscess

A

Cryptoglandular theory

Anal glands may become infected when a crypt is occluded by impaction of fecal matter, oedema, IBD, trauma 2’ to hard stool or foreign body

174
Q

Anal fistula

A

Abnormal communication between the interior of the anal canal or rectum and skin surface

175
Q

Px of fistula

A

Depends on the severity of inflammation.
Excretion of pus, serous fluid or faeces may lead topruritus ani, itching and skin maceration.

176
Q

Ix for perianal abscess and fistula

A

Physical exam is diagnostic
Rectoscopy/ proctoscoy (if tolerated)
MRI for deeper abscesses

177
Q

Mx of anal abscess

A

Surgical drainage - cruciate incision
Sometimes a drain may be left

178
Q

Mx of anal fistula

A

Seton - helps drain and prevent abscess
Fistulotomy
Fibrin glue

179
Q

Pruritus ani

A

Condn characterised by intense perianal icthing and burning

180
Q

Pruritus ani

A

Condn characterised by intense perianal icthing and burningSx

181
Q

Sx of pruritus ani

A

Itching
Burning
Irritation
Worse at night

182
Q

Examination findings for pruritus ani

A

Reddened oedematous ulcerations
Excoriations
Skin atrophic or hypertrophic w/ associated nodularity and scarring

183
Q

Ix for pruritus ani

A

Proctoscopy and sigmoidoscopy
Stool assessment

184
Q

Ddx fro pruritus ani

A

Haemorrhoids
Anal fistula
Contact dermatitis
DM
Pin worm

185
Q

Mx of pruritus ani

A

Keep area dry
Diet modification
Soothing creams
Topical steroids
Gloves to avoid nocturnal scratching

186
Q

Types of stoma

A

Colostomy - large bowel (L)
Ileostomy - small bowel (R)

187
Q

Indications for ileostomy

A

Defunctioning bowel to protect distal anastomosis e.g. rectal cancer surgery
CD
Faecal incontinence
Bowel ischaemia

188
Q

Indications for colostomy

A

Bowel cancer
CD
Diverticulitis
Anal/ vaginal/ cervical cancer
Bowel incontinence

189
Q

Psychosocial implications of stoma

A

Anxiety/ depression
Poor body image
Social isolation
Adjustment problems
Embarrassment
Sexual function

190
Q

Common complications of stomas

A

Parastomal hernias
Proplase
Retraction
Ischaemia
Pyoderma gangrenosum

MBBS - Year 3 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions