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Flashcards in Surgery Deck (222)
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1

What is the Modified Glasgow Score?

tool to assess severity of acute pancreatitis

2

In the Modified Glasgow Score, what score indicates severe pancreatitis

>=3 within 48hrs onset

3

What is the tumour marker for pancreatic cancer?

Ca 19-9

4

What is the tumour marker for ovarian cancer?

CA 125

5

What is the tumour marker for hepatocellular carcinoma

AFP - alpha-feto protein

6

What is the tumour marker for colorectal cancer?

CEA - carcinoembryonic antigen

7

What are the key features of Crohn's disease (macroscopic and microscopic)

macroscopic:
mouth to anus
skip lesions
transmural
mucosal oedema

Microscopic:
epitheloid granulomas`

8

Which part of the bowel does Crohn's most commonly affect?

terminal ileum

9

What kind of perianal disease can occur in crohn's

fistulae
fissure
abscess
skin tags
ulcers

10

What skin changes can occur in crohn's

erythema nodosum
pyoderma granulosum

11

What investigations should be carried out in suspected crohn's

FBC, U+E, ESR, CRP, LFT, B12, folate
stool mc+s, c diff toxin
Colonoscopy with biopsies, small bowel enema, capsule endoscopy

12

What are the expected blood results in chron;s

anaemia
raised inflammatory markers

13

What is the management of crohn's to induce remission

supportive: IV fluids, nutrition

1. corticosteroids eg IV hydrocortisone
2. 5-ASA eg. mesalazine
3. add on mercaptopurine, azathioprine or methotrexate
4. if no response, consider infliximab or adalimumab

14

What is the management of crohn's to maintain remission

1. mercaptopurine or azathioprine
2. methotrexate
3. mesalazine

15

What are indications for surgery in Crohn's

peritonitis
obstruction
abscess
fistula
not responding to medical therapy

16

What are the aims of surgery in crohn's

resect worst areas
defunction distal disease

17

What are the compications of crohn's

strictures
fistulae
osteoporosis
anaemia
renal stones
gallstones
primary sclerosing cholangitis
cholangiocarcinoma

18

What age is crohn's most common

15-30

19

What age is UC most common

15-25
55-65

20

Describe the typical macroscopic and microscopic features of UC

macro:
rectum up
continuous
mucosal
pseudopolyps

micro:
crypt abscesses
reduced goblet cells

21

What investigations should be done in suspected UC

FBC, U+E, LFTs, CRP, ANCA, p-ANCA, ANSA
stool culture and CDT
AXR, erect CXR
colonoscopy

22

How is the severity of UC classified?

mild - <4 stools per day, little blood

moderate - 4-6 stools per day, no systemic upset

severe - >6 stools per day, systemic upset (raised HR, raised inflammatory markers, anaemia, pyrexia)

23

What is the treatment for UC to induce remission

mild/moderate
1. oral or rectal mesalazine or sulfasalazine
2. oral or rectal prednisolone

severe
1. IV steroids - hydrocortisone

24

What is the treatment for UC to maintain remission

1. oral/rectal mesalazine or sulfasalazine (aminosalicylates)
2. azathioprine or mercaptopurine

25

What are the complications of UC

toxic megacolon
VTE
depression and anxiety
primary sclerosing cholangitis

26

State seven differences between crohn's and UC

transmural, mucosal
mouth to anus, rectum up
skip lesions, continuous
granulomas, crypt abscesses
strictures and fistulae, no
smoking increases risk, smoking decreases risk
ulcers and perianal disease, no
no, increased risk colorectal cancer

27

State some mechanical ways of preventing VTE in post op patients

Early ambulation after surgery
Compression stockings
Intermittent pneumatic compression devices

28

State some ways of preventing VTE in post op patients with medications

stop the pill 4 weeks prior to surgery
LMWH, unfractionated heparin if patient in renal failure or fondaparinux
continued for 5-7days post op or until mobile
major cancer or hip/knee replacement for 28days+

29

What is chronic liver disease?

progressive inflammation and destruction of liver parenchyma leading to fibrosis and cirrhosis

30

What are the causes of chronic liver disease

alcohol
hep B/C
non-alcoholic fatty liver disease
genetic - Wilson's, haemochromatosis
autoimmune - primary biliary sclerosis
drugs - methotrexate,isoniazid, amiodarone, sodium valproate
vascular - Budd-Chiari