Surgery

Question 1

Abscess drainage

Answer 1

Fluctuant mass < 5cm and not on special area (hands, perineum, perianal, face, breasts)

US: cellulitis appears like cobblestoning and abscess as a collection

Find area that is most fluctuant and make 1cm incision.
Allow drainage and probe incision to open up cavity.
No need to pack.

Antibiotics if systemic illness, immunosuppressed or extremes of age.

Question 2

Xray findings for AXR

Answer 2

Xray
Small bowel: central position, valvulae conniventes (across whole width of bowel, close together) > 3cm diameter
Large bowel: dilated with no valvulae, > 6cm
Sigmoid volvulus: elderly, comorbid, bed bound, coffee bean sign, from LLQ
Caecal volvulus: from RLQ
Rigler’s sign: free air either side of gas filled loop
Thumb printing: bowel wall thickening

Question 3

Small bowel obstruction

Answer 3

Most common cause: adhesions 75% then hernias, intussusception and malignancy rare
Bowel > 2.5-3cm on CT
Central bowel
Valvulae are close together
Dilated fluid filled loops
Transition point
Faecalisation (normally fluid filled, faeces only in large bowel)

Question 4

Large bowel obstruction

Answer 4

Mass/cancer most common cause
Haustra present
> 6cm or > 9cm caecum