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eMRCS questions > Abdo surgery > Flashcards

Abdo surgery Flashcards

1
Q

Which hernias can only be found in laparotomy

A

Obturator; Gluteal; Sciatic; Pelvic; Pudendal Hernia

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2
Q

Only arteries supplying rectus abdominus if patient has had CABG

A

Inferior epigastric

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3
Q

If difficult access in AAA surgery what structure needs to be divided

A

Left renal vein

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4
Q

Types of arterial aneurysm

A

Fusiform Aneurysms
Appear as symmetrical bulges around the circumference of the aorta. They are the most common shape of aneurysm.

Saccular Aneurysms
Asymmetrical and appear on one side of the aorta. They are usually caused by trauma or a severe aortic ulcer.

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5
Q

Which direction do aortic aneurysms rupture

A
  • 20% rupture anteriorly into the peritoneal cavity. Very poor prognosis.
  • 80% rupture posteriorly into the retroperitoneal space
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6
Q

Spurarenal AAA mx

A

hese patients will require a supra renal clamp and this carries a far higher risk of complications and risk of renal failure.

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7
Q

Features favoring a suitable aneurysm for EVAR

A
  • Long neck
  • Straight iliac vessels
  • Healthy groin vessels
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8
Q

Anatomical relations of coeliac axis

A

Anteriorly -Lesser omentum

Right -
Right coeliac ganglion and caudate process of liver , IVC
Left- Left coeliac ganglion and gastric cardia

Inferior -
Upper border of pancreas and renal vein

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9
Q

What does the gasproduodenal artery branch into

A

Right gastroepiploic artery and the superior pancreaticoduodenal artery

Supraduodenal branches off it earlier

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10
Q

Branches of IVC and vertebrae levels

A

T8 Hepatic vein, inferior phrenic vein, pierces diaphragm
L1 Suprarenal veins, renal vein
L2 Gonadal vein L1-5 Lumbar veins
L5 Common iliac vein, formation of IVC

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11
Q

Patient has SVC obstruction, which collateral can be an alternative pathway

A

Azygos venous system

Internal mammary venous pathway- connect to superficial epigastric

Lateral thoracic venous system with connections to the sueperficial circumflex iliac and vertebral veins (2 pathways)

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12
Q

Relations of SMA

A

Superio- neck of pancreas

Postero-inferior- third part of duodenum , ucinate process

Posterior-left renal vein

Right- superior mesenteric vein

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13
Q

Branches of SMA

A

M iddle colic
I liocolic (Appendicular artery is the branch of iliocolic artery) I nferior pancreaticoduodenal
R ight colic
J ejunal+ i leal (12-15 branches)

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14
Q

Which structure does the midgut bend around to form midgut loop

A

SMA

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15
Q

Arteries encountered in each colorectal surgery

A

Right hemi- RC, iliocolic (+middle if extended

splenic- right extended

Left- IMA
Hartmann- high ligation of IMA
AP- IMA
A- IMA

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16
Q

Pudendal nerve branches

A

Inferior rectal - around anus, anal canal below pectinate line
Perineal - post scrotum
Dorsal penis/clotoris- body and glans of penis

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17
Q

Structures at transpyloric plane

A

From posterior to anterior, the significant structures crossed by transpyloric plane in midline are:
The conus or termination of the spinal cord L1 vertebra
Aorta
Superior mesenteric artery
Neck of the pancreas Superior mesenteric vein The pylorus of the stomach

More laterally at this level:
Kidney hila
Renal vein
Hilum of the spleen
Second part of duodenum
Origin of the portal vein Duodenojejunal flexure
Fundus of the gall bladder
9th costal cartilage

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18
Q

Content of rectus sheath

A

2 muscles- RA and pyramidalis

4 vessels
* Superior Epigastric Artery and Vein
* Inferior Epigastric Artery and Vein

6 nerves
* Lower five intercostal nerve (T7-T11)
* Subcostal nerve (T12)

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19
Q

Arterial supply of anterior abdomen

A

Lateral side (Deep Branches)
* 10th and 11th Posterior Intercostal Arteries (← Descending Aorta)
* Subcostal Artery (← Descending Aorta)
* Lumbar Arteries(all 4) (← Descending Aorta)

Anteriorly From Above Downwards(Deep Branches)
* Musculophrenic Artery (← Internal Mammary Artery)
* Superior Epigastric Artery (← Internal Mammary Artery)

Anteriorly From Below Upwards (Deep Branches)
* Inferior Epigastric Artery (← External Iliac Artery)
* Deep Circumflex Iliac Artery (← External Iliac Artery)

Superficial Arteries
* Superficial Circumflex Iliac Artery (← Femoral Artery) * Superficial Epigastric Artery (← Femoral Artery)

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20
Q

Thoracoepigastric veins

A

These are Longitudinal venous connections between Lateral Thoracic Vein (→ from Cephalic Vein) and Superficial Epigastric Vein (→ GSV).

Provide a collateral route for venous return if a caval or portal obstruction occurs.

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21
Q

Border of ischiorectal fossa

A

Anterior- perineal membrane

Post- G max, sactotuberous lig

Lateral- ischial tuberosity, obturator internees, pudendal canal (Alcock canal)

Medual- levator ani, ext anal sphincter

Apex- meeting of ob fascia and inf fascia pelvic diaphragm

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22
Q

Most common sites for intra abdominal collection when supine

A

Hepatorenal Pouch of Rutherford-Morrison (Right Subhepatic Space)

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23
Q

Features which should be expected/ or occur without pathology on abdo radiology

A
  • In Chiladitis syndrome, a loop of bowel may be interposed between the liver and diaphragm, giving the mistaken impression that free air is present.
  • Following ERCP (and Sphincterotomy) air may be identified in the biliary tree.
  • Free intra abdominal air following laparoscopy / laparotomy, although usually dissipates after 48– 72 hours.
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24
Q

Mushroom, caterpillar, claw, thumb printing and coffee bean sign on AXR

A

Caterpillar and mushroom- pyloric stenosis

Thumb printing- pseudomembranous colitis, UC, crohns, DD, IC

Claw- interssusception

Coffee- sigmoid

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25
Q

Derivatives of Dorsal Mesogastrium

A

G. omentum (gastrosplenic, gastrophrenic, gastrocolic) Splenorenal ligament (pancreas tail is here…)

Spleen pancreas develop within but not from

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26
Q

Derivatives of ventral Mesogastrium

A

Liver
Lesser omentum

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27
Q

Nerve supply of oesophagus

A

The parasympathetic component of the cervical part is supplied by the recurrent laryngeal nerve (a branch of the vagus nerve (CN X)) while the sympathetic fibers arise from the cervical sympathetic trunk.

The thoracic part of the esophagus is innervated by the esophageal plexus, an autonomic nervous network surrounding the esophagus. The parasympathetic component of the plexus originates from the vagus nerve, while the sympathetic fibers also stem from the sympathetic trunk running along the neck.

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28
Q

LN drainage of oesophagus

A

Upper- deep cervical
Mid - posterior mediastinal
Lower- left gastric

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29
Q

GORD gold standard

A

pH monitoring

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30
Q

Red flags for upper GI malignancy

A

Any patient with dysphagia

Any patient >55yrs with weight loss and upper abdominal pain, dyspepsia, or reflux

Patients with persistent symptoms, despite trialling conservative management

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31
Q

Surgical intervention for GORD

A

Floppy Nissen 3600 fundoplication(Post. Partial & Ant. Partial)

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32
Q

Which cells are present in barrets

A
  • Presence of goblet cells important in identification
  • Squamous epithelium replaced by columnar epithelium in the lower oesophagus
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33
Q

Corkscrew sing on barium swallow

A

Diffuse oesophageal spasm

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34
Q

Pseudoachalasia

A

Extrinsic tumour at GEJ

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35
Q

Cancer at risk in achalasia

A

SCC

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36
Q

Tx of DOS

A

Nifedipine

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37
Q

Ix of achalasia

A

Endoscopy to exclude malignancy

Mamometry gold standard

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38
Q

Mx of achalasia

A

Endoscopic Balloon Dilatation

then Heller Myotomy

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39
Q

Mx of oesophageal cancer

A

Surgical resection–
o Neoadjuvent chemotherapy is given in most cases prior to surgery
o In general resections are not offered to those patients with distant metastasis, not to those with N2
disease.

In situ disease – Endoscopic Mucosal Resection

Ivor Lewis

Or Mckneown

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40
Q

Ivor lewis procedure

A

– Initial laparotomy and construction of a gastric tube(A Rooftop Incision is made)
– Right thoracotomy to excise tumor and create an esophagogastric anastomosis. (Incision through
5th ICS performed 10cm above the tumour)
– Preferred for middle & lower third tumor
– Azygos Vein is divided to allow mobilization of oesophagus

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41
Q

Post Ivor lewis complications

A

*Atelectasis– due to the effects of thoracotomy and lung collapse

*Anastomotic leakage – High risk because of a relatively devascularised stomach as the only blood supply is from Gastroepiploic Artery and others have been divided.

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42
Q

Arteries effected by ulcers

A

Post gastric- splenic

Lesser curv- left gastric

Greater- gastroepiploic (GDA)

Post duodenal- gastro duodenal (CHA)

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43
Q

Regulation of gastric acid production

A

Factors increasing
Vagus
Gastrin
Histamine

Decreasing
SS
Secretin
CCK

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44
Q

Dilafeuoy Lesion

A

Vascular malformation in gastric fundus

Difficult to see on endoscopy

Big haematemesis
No prior episodes

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45
Q

Upper GI bleed management

A

Blatchford - Hb, serum urea, pulse rate and blood pressure
>0 endoscopy
Rockall- mortality

Varices should be banded or subjected to sclerotherapy. If this is not possible owing to active bleeding then a Sengstaken- Blakemore tube -should get terli and abx before

Patients with erosive oesophagitis / gastritis should receive a proton pump inhibitor.

Identifiable bleeding points should receive combination therapy of injection of adrenaline

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46
Q

What needs to be divided to gain access to coeliac axis

A

Lesser omentum

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47
Q

Post gastrectomy complications

A

Anaemia
Metabolic Bone syndrome
Cancer- adeno
Dumping/diarrhoea
Early satiety
Bile reflux
Gastroparesis
Recurrent ulceration

ABCDEFG

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48
Q

Gastrectomy surgeries

A

Billroth 1- Distal 3rd stomach removed & anastomosis - duodenum

Bilroth 2- Removal of distal 2/3rd stomach & gastro– jejunostomy

Total and subtotal gastrectomy with Roux en. Y- oesophagus or stomach to jejneum and duodenojejenostomy
So stomach to jejenum and duodenum cut from stomach and stuck to jejenum

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49
Q

What can you use to identify appendix in surgery

A

Caecal taenia coli converge at base of appendix and form a longitudinal muscle cover over

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50
Q

Nerve injured in appendectomy

A

Illiohypogastric

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51
Q

Which parts of colon are intraperitoneal

A

The sigmoid,transverse and appendix are wholly intraperitoneal.

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52
Q

Colon polyp appearance in HNPCC

A

Mucinous, poorly differentiated and “signet-ring” in appearance.

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53
Q

Referral for colonoscopy

A

≥40yrs with unexplained weight loss and abdominal pain
≥50yrs with unexplained rectal bleeding
≥60yrs with iron‑deficiency anaemia or change in bowel habit
Positive occult blood screening test

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54
Q

Ix for rectal cancer tissue invasion

A

MRI

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55
Q

Dukes staging

A

Dukes A- bowel wall
B1- Musculosa propia
B2- through MP and serosa no LN
C- LN, no mets
C2->4
D- distant mets

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56
Q

Differentiating between UC and Crohns

A

EIM more common in UC

UC spares rectum

Fistula, fissure, mass, strciture, fat wrapping- CD

Psuedopolyp, goblet depletion, crypt abscess, malignancy- UC

Non- caesating granuloma, cobblestone mucosa- CD

Bleeding more common in UC

GB and kidney stones- CD

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57
Q

EIM of IBD

A

Arthritis
Uvesitis
Pyoderma gangrenosum
Clubbing
PSC- UC

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58
Q

Surgery for UC

A

Emergency - toxic megacolon, colonic perforation, or uncontrolled bleeding- Subtotal colectomy + end ileostomy

Electively- pan protocolectomy +/- ileoanal pouch

Dysplasia with mass- proctocolectomy

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59
Q

Mx of high output fistula

A

Octreotide

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60
Q

Fascia of rectum

A

Anteriorly lies the fascia of Denonvilliers.

Posteriorly lies Waldeyers fascia.

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61
Q

Nerve supply above and below pectinate line

A

Above- inf hypogastric L1,2
Pelvic splanchnic

Below- inferior rectal

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62
Q

Tx of haemorrhoids

A

Symptomatic 1st or 2nd- band ligation

2nd-3rd- Haemorrhoidal artery ligation - main vessel supplying the haemorrhoid is identified through Doppler and then tied off, such that the haemorrhoid infarcts and falls off.

3rd-4th- haemorrhoidectomy

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63
Q

Goodsall rule

A

Anterior- straight path
Posterior curved path

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64
Q

Types of anal fistula

A

Superficial - superficial to sphincters

Intersphincteric- fistula penetrates through the internal sphincter but spares the external sphincter.

Suprashincteric - penetrates through the internal sphincter and then extends superiorly in the plane between the sphincters to pass above the external sphincter before extending to the perineum

Transphinteric- The fistula passes through both the internal and external sphincters through both

Extrasphincteric - laterally to the internal and external sphincter.

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65
Q

Tx of anal fistula

A

Intersphincteric- fistulotomy-make continuous with anus

Denatate line and above- seton suture

Others- fistulectomy- cut out

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66
Q

Mx of anal fissure

A

1st line- GTN- 8wks

2nd- if headache- diltiazem

Chronic- botulism toxin
Lateral internal sphincterotomy
Advancement flaps

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67
Q

Abdo pain, fever, multiple fine lesions between liver and abdo wall

A

Fitz High Curtis syndrome

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68
Q

Abdominal compartment syndrome dx

A

Sustained intra abdominal pressure >20mmHg along with new organ dysfunction / failure.

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69
Q

Tx of abdominal compartment syndrome

A

Non operative
Gastric decompression
Muscle relaxants
Drain fluid and consider fluid restrict

Surgical
Laparotomy and laparotomy with Bogota or VAC

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70
Q

Different GI parasitic infections

A

Enterobiasis- pruitis ani
Mebendazole

Ancylostoma- hookworm- larvae in stool- IDA- medendazole

Ascariasis- duodenum, lungs- mebendazole

Strongyloidiasis- skin- lungs- motile larvae in stool-
Mebendazole

Giardiasis- pear shaped- watery diarrhoea
Metronidazole

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71
Q

LN drainage of vagina

A

Superior – drains to external iliac nodes
Middle – drains to internal iliac nodes
Inferior – drains to superficial inguinal lymph nodes.

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72
Q

Where is leptin produced and what is its function

A

Produced by adipose tissue and acts on satiety centres in the hypothalamus and decreases appetite.
More adipose tissue (e.g. in obesity) results in high leptin levels.

Leptin stimulates the release of melanocyte

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73
Q

Where gherlin is produced and function

A

It is produced mainly by the fundus of the stomach and the pancreas. Ghrelin levels increase before meals and decrease after meals

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74
Q

Guidelines for bariatric surgery

A

BMI >/= 40 kg/m2 or between 35– 40 kg/m2 and other significant disease (for example, type 2 diabetes, hypertension) that could be improved with weight loss.

  • All non– surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months.
  • They are generally fit for anaesthesia and surgery
  • They commit to the need for long– term follow– up
  • First– line option for adults with a BMI > 50 kg/m2 in whom surgical intervention is considered appropriate; consider Orlistat if there is a long waiting list.
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75
Q

Types of bariatric surgery

A

Banding- laparoscopic reversible, slower WL

Bypass- jejunum bypass stomach but duodenum attached - greater WL, irreversible, B12 def in 50%

Sleeve gastrectomy-
Resection of stomach using stapling devices
* Body and fundus resected to leave a small section of stomach

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76
Q

Quadrate lobe borders

A

Porta hepatis lies behind
On the right lies the gallbladder fossa
On the left lies the fossa for the umbilical vein- ligamentum teres

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77
Q

Caudate lobe borders

A

-Lies behind the plane of the porta hepatis
* Anterior and lateral to the inferior vena cava
* Bile from the caudate lobe drains into both right and left hepatic ducts
- ligamentum venosum to left

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78
Q

Falciform ligament attachments and origin

A

2 layer fold peritoneum from the umbilicus to anterior liver surface
* Contains ligamentum teres (remnant umbilical vein)
* On superior liver surface it splits into the coronary and left triangular ligaments(which attach to diaphragm)

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79
Q

Ligamentum venosum

A

Remnant of ductus venosum- which allowed bypassage of liver

Sits posteriorly to left of caudate

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80
Q

Types of benign liver lesions

A

Haemangioma- most common of mesenchyme origin
Separated from liver by fibrous tissue
Hyperechoic US

Adenoma- women, OCP, hypotenuse on CT

Abscess- RUQ pain, fever, jaundice

Amoebic- fever, RUZ- US fluid filled poorly defined boundaries
Aspiration- anchovy paste- metronidazole

Hydatid- daughter-fibrotic reaction surrounding, mebendazole + surgical resection

Polycystic- PKD

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81
Q

What should be avoided with HCC

A

Liver biopsy

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82
Q

Liver biopsy of alcholic hepatitis

A

Mallory bodies

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83
Q

If CBD distended before operation

A

ERCP before operation- try to clear the duct by ERCP,sphincterotomy

Then operation later date

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84
Q

PSC vs PBC vs AIH

A

PSC- ulcerative colitis
Onion skin fibrosis
Intra and extra hepatic ducts
pANCA

PBC- Anti Mitochondiral AB
intra
IgM
Granuloma
CREST syndrome

AIHA- ANA SMA (1); Anti-Liver Kidney Microsome type I antibody (2)

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85
Q

CBD relations at origin

A

Medially- hepatic artery
Posterior- portal vein

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86
Q

CBD relations distally

A
  • Duodenum - anteriorly
  • Pancreas - medially and laterally
  • Right renal vein - posteriorly
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87
Q

Features making each gall stone more likely

A

Multiple- mixed, Ca

Cholesterol- solitary

Bile- haemolytic anaemia, black

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88
Q

Outpouching in chronic cholecystiticits

A

Aschoff-Rokitansky Sinuses

→ These are outpouchings of GB mucosa into the GB muscle layer and subserosal tissue
→ Result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the GB wall.
→ They are usually referred to as Adenomyomatosis

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89
Q

Absolute Contraindication of Lapchole

A
  • VwB disease
    – Abdominal sepsis
    – Late pregnancy
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90
Q

Mirizzi syndrome

A

Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

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91
Q

Most frequent organisms causing cholangitis

A

Escherichia coli Klebsiella species Enterococcus species Streptococcus species

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92
Q

Ix for cholecystitis

A

USS: 1st line

MRCP if any inconclusion

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93
Q

Cholangitis ix

A

USS

ERCP gold standard

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94
Q

Mx of biliary atresia

A

Roux-en-Y portojejunostomy (Kasai procedure)

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95
Q

When is pancreatitis severe on Glasgow scale

A

3 or more

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96
Q

Pancreatitis sequelae

A

Peripancreatic fluid collection- Located in or near the pancreas and lack a wall of granulation or fibrous tissue

Pseudocyst- collection is walled by fibrous or granulation tissue (lack an epithelial lining)and typically occurs 4 weeks or more after an attack of acute pancreatitis
Elevated amylase
Investigation is with CT, ERCP and MRI or Endoscopic USS
* Symptomatic cases may be observed for 12 weeks as up to 50% resolve
* Treatment is either with endoscopic or surgical cystogastrostomy or aspiration

Pancreatic necrosis- nvolve both the pancreatic parenchyma and surrounding fat- Radiological drainage or surgical necrosectomy.

Abscess

Haemorrhage

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97
Q

Ix and mx of pancreatic necrosis

A

CT - FNA If definitive needed
Pancreatic necrosectomy (open or endoscopic)

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98
Q

Systemic complications of pancreatitis

A

Disseminated Intravascular Coagulation (DIC)

Acute Respiratory Distress Syndrome (ARDS)

Hypocalcaemia
Fat necrosis from released lipases, results in the release of free fatty acids, which react with serum calcium to form chalky deposits in fatty tissue

Hyperglycaemia

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99
Q

Mx of acute pancreatitis

A

DCC

Fluid resus
NG tube
Catheterisation
Opioid analgesia

Broad spectrum ABx

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100
Q

Main cause of chronic pancreatitis

A

chronic alcohol abuse (60%) and idiopathic (30%).

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101
Q

Presentation of chronic pancreatitis

A

Chronic abdominal pain, however may also develop malabsorption, diabetes mellitus,

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102
Q

Ix of chronic pancreatitis

A

Serum amylase or lipase levels are often not raised

A faecal elastase level will be low

CT- pancreatic atrophy or calcification, as well as any pseudocysts present

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103
Q

Mx of chronic pancreatitis

A

enzyme replacement (including lipases), such as Creon®

fat-soluble vitamins (A, D, E and K), tand check bone density routinely.

Those with pancreatogenic diabetes may benefit insulin regimes, along with annual surveillance with HbA1c.

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104
Q

Where does pancreatic cancer occur and where does it often spread to

A

Head

Liver

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105
Q

Mx of pancreatic cancer in head and tail

A

Head- Whipples procedure
Dumping and ulcers

Tail- distal pancreatectomy and splenectomy with regional lymphadenectomy

All surgical patients should receive adjuvant chemotherapy

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106
Q

Sx of pancreatic cancer

A

WL
Painless jaundice
Trousseaus sign- Migratory superficial thrombophlebitis
Abdominal pain (non-specific) – due to invasion of the coeliac plexus or secondary to pancreatitis

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107
Q

Endocrine Tumours of the Pancreas

A

Gastrin-g- Zollinger Ellison

Glucagon-a- hyperglycaemia, necrolytic migratory erythema

Insulin-b- hypoglycaemia

SS-d- inhibits GH, TSH, prolactin- DM, steathorrea, gallstones (due to CCK inhibition)

VIP- non islet cells- normal secrete water and electrolytes into gut with relaxation-
Prolonged diarrhoea, severe hypokalaemia (verner Morrison syndrome)

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108
Q

Sx of insulinoma

A

Whippples triad

  • Hypoglycaemia symptoms during fasting - ↓ FBS
  • low glucose
  • Symptoms relieved by i/v Dextrose
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109
Q

VIPoma sx

A

Wa : Watery
D Diarrhoea (Octreotide therapy gives prompt relief from diarrhea.)
H : Hypokalamia
A : Achlorhydria- no acid

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110
Q

Where are most of gastrinomas found

A

In gastrinoma triangle:
Superior- CBD
2/3rd part of duodenum (inferior)
Neck and body of pancreas (medial)

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111
Q

Mx of Zollinger Ellison syndrome

A

Octreotide- suppressing gastrin

Most gastrinomas in the pancreas can be removed by enucleation, and large tumors can be removed by
resective procedures.

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112
Q

What tissue is spleen derived from

A

Mesenchyme

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113
Q

What is in close relation to pancreatic tail

A

Splenic hilum

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114
Q

Ligaments of spleen and what is contained within them

A

Gastrosplenic- short gastric , Left Gastro-Epiploic Vessels

Splenorenal- tail of the pancreas. splenic artery. splenic vein.

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115
Q

Function of spleen

A

FISH
F iltration of encapsulated organisms and blood cells I mmunological function
S torage of platelets
H aematopoiesis in the foetus

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116
Q

Indication of splenectomy

A
  • Trauma: 1/4 are iatrogenic
  • Spontaneous rupture: EBV
  • Hypersplenism: Hereditary Spherocytosis or Elliptocytosis - causing anaemia
  • Malignancy: Lymphoma or Leukaemia
  • Splenic Cysts, Hydatid Cysts, Splenic Absces
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117
Q

Cell changes after splenectomy

A

PLATELETS WILL RISE FIRST

  • Immediately - Agranulocytosis (mainly Neutrophils), which is replaced by a Lymphocytosis & Monocytosis over the following weeks.
  • In First Few Days - Target Cells, Siderocytes & Reticulocytes will appear.
  • over Following Weeks - Cytoplasmic Inclusions seen e.g., Howell Jolly Bodies
    .
  • Other changes include Target Cells and Pappenheimer bodies
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118
Q

Complications of splecentomy

A
  • Haemorrhage (may be early and either from Short Gastric or Splenic hilar vessels)
  • Pancreatic fistula (from iatrogenic damage to pancreatic tail)
  • Thrombocytosis: Prophylactic aspirin
  • Encapsulated bacterial infection
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119
Q

Gross pathology of ulcers

A

50% <2cm
Oval with straight walls
Smooth base

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120
Q

histology of ulcers

A

1- superficial necrotic fibrinoid
2- active cellular nets infiltrate
3- granulation
4- fibrocartilingeous scar, arteries thick and thromboses

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121
Q

When to use surgery for ulcer

A

If perf or massive haemorrhage

Non resolving or relapsing

> 3cm - medical not working for 6-8w

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122
Q

SE of vagotomy

A

Obstruction
Gallstones
Vomiting
Diarrhoea

Dumping syndrome
IDA
B12 def

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123
Q

Tx of perforated small stomach ulcer

A

Excisions and closure

Due likely being malignant

If larger- total or partial gastrectomy

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124
Q

H pylori appearance

A

Gram neg
Flagellated spiral bacillus
Urease enzyme

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125
Q

H pylori test and mx

A

Urea breath test or stool antigen

If test neg- PPI for 1/2 months until ulcer healed

Positive- PPI + amor 1g/met 400mg + clarith 500mg 7d

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126
Q

Factors assessed in blatchford score

A

Urea
Hb
SBP
Pulse
CO morbidities- melena, syncope, hepatic disease, HF

PHUCS

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127
Q

Factors Rockall score asseses

A

Age
Shock-BP/pulse
Source of bleeding
Comorbidities
Stigmata of recent bleeding- e.g clots

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128
Q

mx of UGI haemorrhage

A

Endoscopy- <24hrs presentation
Adrenaline injections- 4 quadrant
Clips, bipolar

Then pharm therapy- pH >6, eradication of H pylori

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129
Q

Indications of surgical tx bleeding ulcer

A

Continue bleeding
1 rebleed, 2 if <60

> 50 requiring 4U of blood
<50 6U in 24 hrs

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130
Q

Surgical mx of bleeding ulcer

A

Underunning vessel with suture

Peptic- excision if on greater curve
Gastrotomy if lesser

Duodenal - duodenotomy then vagotomy and pyloroplasty

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131
Q

Ulcer perforation tx

A

Laparotomy

Gastric- greater curve- ulcer excision and closure with omental patch
Lessier- distal- billroth
Proximal- subtotoal

Duodenal - simple closure with mental patch and peritoneal lavage

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132
Q

Presentation of gastric outlet obstruction

A

Projectile of undigested food
Epigastric pain
Electrolyte imbalance
Palpable stomach

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133
Q

Mx of gastric outlet obstruction

A

Correct fluid and electrolyte imbalance

Endoscopy- diagnostic and enable balloon dilation

Surgical- gastroenterostomy

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134
Q

What increases risk of gastric carcinoma

A

Chronic atropic gastritis
Men
Pernicious anaemia
H pylori

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135
Q

Microscopic feature of gastric carcinoma

A

All adenocarcinoma

Intestinal - malignant glands
Diffuse- small malignant cells- better prog
Signet- large vacuole of mucin - worse prog

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136
Q

Diagnosis of gastric carcinoma

A

Endo wits biopsy
Staging with CT

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137
Q

Mx of gastric carcinoma

A

Pre op PEG if malnourishment or obstruction

Only to those with widespread mets

Sub total- >5-10cm from OGJ
Total <5cm
Oesophagogastrectomy- type 2 extending to oesophagus
endoscopic resection- confined
Lymphadenectomy- D2
Chemo- most

138
Q

Gastric lymphomas type and mx

A

B cell 98%- MALT
Peyers patches
Paraproteinaeomia
H pylori eradication

T cell

Full thickness high grade solitary lesion- surgery

Diffuse low grade- chemo

139
Q

Common location of GI ulcers

A

80% duodenum- first part

Stomach- lesser curvature or border of antrum/body

140
Q

Complications of ulcers

A

Strictures and obstruction
Haemorrhage
Perforation

141
Q

Signs of appendicitis

A

Rovsing Sign
Rebound tenderness over McBurney point
Psoas sign- passive extension of right hip
Obturator - internal rotation of hip

142
Q

Appendicits dx

A

Clinical - important in children
Elevation of neutrophils
USS

143
Q

Presentation and dx of acute SI ischaemia

A

Severe out of proportion pain
Vomitting
Raised WCC
Acidosis

Angiogram and CT

144
Q

Non occlusive mesenteric ischamia causes

A

Prolonged low flow state

CHF, arythmie, hypovolaemai

145
Q

Mesenteric vein thrombosis signs and mx

A

Patchy necrosis

Hypercoagulable state- sepsis, OCP

Thick abdo bowel wall on AXR

Mx with anticoagulation

146
Q

Small bowel bleeding dx and mx

A

Occult- non visible
Evert- visible

Angiogrpahy or enteroscopy

Excision
Mesenteric angiography with embolisation or injection of vasocontrictor

147
Q

Merkels diverticulum presentation

A

Usually asymptomatic
Present before 2
Painless bleed

If pain- complications- obstruction, intusseption ect

Bleed- heterotopic mucosa

148
Q

Tx of mickel Diverticulum

A

Lap resection
Resection of diverticulum and adjacent areas

149
Q

Cell types of GI stromal tumour

A

Smooth muscle pacemaker cell of Cajal

150
Q

Mutation of GI stromal tumour

A

KIT gene

pdf less common

151
Q

Cells identifiable on pathology of stromal tumours

A

Spindle cells

152
Q

Small bowel lymphoma RF and dx

A

Coeliac disease

Small bowel enema and CT

Resection

153
Q

Duodenal adenocarcioma tx

A

Pancreaticoduodenectomy

154
Q

Effects of jejunum resection

A

Reduced absorption of ADEK, Ca, Mg, Folate
Amino acids, mono, lipids

Results in diarrhoea

Most recover
Folic acid never recovers- give supplements

155
Q

Effects of ileum resection

A

B12 def - if >1m - B12 injection to prevent meg anaemia

Reduced bile salt respiration - gallstones, ADEK

Diarrhoea- increased fats and Bile salts

156
Q

Short bowel syndrome

A

Resection of >80%less than 200cm

Parenteral nutrition for 3m

157
Q

Pathology of short bowel syndrome

A

Few days- dilates, lengthens and thickens
Interstitial villi hypertrophy
Hyperplasia

158
Q

Reason for resecting >80% of small bowel

A

Mesenteric ischameia
Crohns
NEC

159
Q

Mx of short bowel syndrome

A

Initial
Fluid and elec replacement
TPM

Long term
Glutamine and GH Supplementation
Low fat, high carb, high fibre diet

160
Q

Cell types with crohns and UC

A

Th17- crohns
Th2- UC

161
Q

Most specific finding in Crohns

A

Granulomas
(aggregation of macrophages)

162
Q

Features that point more towards Crohns on examination

A

Erythema nodosum
Mass in RIF
Fistula
Fissure
Amyloidosis

163
Q

Ix of IBD

A

Sigmoidosocpy
Barium enema- cobblestone
Blood tests- hosepipe

164
Q

What to test for when giving azathioprine

A

TPMT level
If deficient- bone marrow suppression

165
Q

Major Complications of IBD

A

Crohns- stricutres, obstruction
Fistula
Perianal sepsis
Perf

UC
Toxic megacolon
Perf
Haemorrhage
Malignancy

166
Q

Coeliac variant allele

A

HLA DQ2

167
Q

Extrainterstinal symptoms of coeliac

A

Anaemia
Osteopenia
Motor weakness
Amenorrheoa
Dermatitis herpetiformis

168
Q

Dx of coeliac

A

IgA TTG
Biopsy of duodenum
Villous atrophy, crypt hyperplasia, increased intra-epithelial lymphocytes
○ Villous:crypt ratio should be 3-5:1 - this increases / reverses
○ >20 IEL / 100 enterocytes

169
Q

Types of adenoma of bowel

A

Tubular- multiple, lower malignant potential

Villous - large, sensile, shaggy, resctum- malignant potential

Tubulovillous

170
Q

Types of FAP

A

FAP- most severe
Attenuated FAP- APC gene , late onset
AR FAP- MUTYH

171
Q

Ix of FAP

A

Colonoscopy- favour right side common polyps
Genetic testing

172
Q

When to suspect pout jaggers

A

2 or motor harmatomotous polyps in GI tract

Mucocutaneous pigmentation

173
Q

Hereditary haemorrhgaic telangiectasia

A

Small AV malformations

Nose bleeds

Bleeding in GI tract

Telengectasia

Olser Weber rendu

174
Q

Findings on CT of diverticulitis

A

Pericolic fat stranding
Wall thickeneing
Diverticula

175
Q

Mx of fistula

A

Sepsis
Nutrition- high output- swap oral fluids to IV, fluid balance
Anatomy
Plan- conservative or surgical

176
Q

Most posterior structure of aorta hepatis

A

Portal vein

CBD right, CHA left ant

177
Q

Level where oesophagus starts, pierces diaphragm and ends

A

Starts at C6
Pierces diaphragm at T10
Ends at T11

178
Q

Normal cells of oesophagus

A

Non keratinised Strat Squamous

179
Q

Greater omentum
In children
Contains?
Attaches?

A

Less developed in children under 5
Contains gastroepiploic arteries
Attaches to stomach and transverse colomn

180
Q

Difficult splenectomy
Drain has clear fluid with what biochem

A

Elevated amylase

181
Q

Renal hilum structure order

A

Vein anterior - remember has to be divided in some aortic surgery

Artery post

Ureter- inferior

182
Q

Which vein is the varicose in oesophageal varies

A

Hemiazygous

183
Q

Embryological origin of ureter

A

Mesonephric duct

184
Q

Route of ureter

A

Posterior to gonadal
Anterior to iliac vessels

Posterior to vas deferens

185
Q

Small yellow nodule found in inguinal canal of term baby

A

Adrenal Rest

Benign tumour that regress

186
Q

What is the round ligament of liver and what is a remnant of

A

Ligamentum teres
Forms part of free edge of falciform ligament
Remnant of left umbilical vein

187
Q

What are the medial and median arcuate ligaments

A

Median- remnant of urachus where urine would leave fetus

Medial- remnants of umbilical arteries
From internal iliac

188
Q

Hernia management

A

First time- open with mesh in adults, herniotomy in children

Recurrent or bilateral- laparoscopic TEP

189
Q

Stoma after sub total colectomy

A

End ileostomy and rectal stump

190
Q

Which ligaments contain splenic and short gastric arteries

A

Splenic- splenorenal
Shorts gastric-gastrosplenic

191
Q

Staging of colon cancer vs rectal

A

Colon- CT chest abdo pelvis
Rectum- MRI rectum with CT chest abdo pelvis

192
Q

Patient has a >2cm adrenal mass, tests and CT otherwise normal, mx?

A

Adrenalectomy

193
Q

Which structures can be damaged posteriorly with caecal mobilisation

A

Ureters and Gonadal vessels

194
Q

Which vessels cause significant bleeding in aortic repair

A

Lumbar arteries
As EVAR does not include them

195
Q

Which artery requires high ligation in right hemicolectomy for removal of caecum

A

Ileo colic

Middle usually preserved

196
Q

Mobilisation of the left lobe of the liver will facilitate surgical access to which of the following?

A

Oesophagus

197
Q

Unpaired abdo aortic branches

A

Coeliac
SMA
IMA
Median sacral

198
Q

What is the quadrate lobe functionally

A

Left

199
Q

Where is the bare area of liver, which lobe is more affected

A

Posterior
Right more affected

200
Q

Drainage of right adrenal

A

IVC

201
Q

Blood supply of bile duct

A

Hepatic artery

202
Q

Oesophagectomy and an oesophagogastric anastomosis is constructed. The arterial supply to the gastric component is mainly provided by which of these vessels?

A

Right gastro epiploic

203
Q

How far is the gap between coeliac and SMA

A

1cm

204
Q

What has to be divided in splenectomy

A

Short gastric artery as in gastrosplenic ligament

205
Q

where do pancreaticoduodenal veins drain

A

SMV

206
Q

Location of kidney hilum, lower border and upper border

A

Left L1, right L-2
Lower L3
Upper 11th rib

207
Q

Ectopic kidney, where is adrenal found

A

Usual position

208
Q

Ant to posterior gastrosplenic, lienorenal , splenic artery vein

A

Gastrosplenic
Splenic artery
Vein
Lienorenal

209
Q

What is a strong indicator of IBD

A

Incontinence and nocturnal diarrhoea

210
Q

What appendicitis can be Rovsig Sign negative

A

Retrocaecal

211
Q

Mx of gallstone ileus causing SBO

A

Remove gallstone via proximal enterotomy
Decompress bowel
Leave gallbladder in situ

212
Q

Management of splenic vein thrombosis

A

Splenectomy

213
Q

Pregnant with ?perf, what investigations

A

CT abdo

214
Q

Hepatocellular adenoma in male

A

Should be resected as greater risk of malignant transformation

215
Q

Carcinoma resected, 8 months later has jaundice with intra hepatic duct dilation, dx?

A

Peri hilar lymphadenopathy

216
Q

Mx of pseudocyst from pancreatitis

A

Elective cystogastrostomy

Where stomach and cyst connected- so cyst drains

217
Q

Mx of acute cholagntitis, with empyema and mirizzi syndrome

A

Cholecystostomy and T tube

218
Q

On lap for choles, calot triangle hard to determine, dx

A

Mirizzi

219
Q

Loop colostomy, become swollen, tender

A

Obstructed incisional hernia

Loop colostomy reversals are at high risk of this complication as the operative site is at increased risk of the development of post operative wound infections.

220
Q

What is useful to mobilsie when trying to do open adrenal surgery

A

Mobilisation of the hepatic flexure and right colon

221
Q

Annular pancreas where will it obstruct

A

2nd part of duodeunum

222
Q

left side of colon is pulled and there is bleeding in parabolic gutters what is damaged

A

Spleen

The spleen is commonly torn by traction injuries in colonic surgery. The other structures are associated with bleeding during colonic surgery but would not manifest themselves as blood in the paracolic gutter prior to incision of the paracolonic peritoneal edge.

223
Q

Dermatome area for blockade for inguinal hernia repair

A

T12

224
Q

Campers and scarpers fasciae

A

Campers superficial fatty
Scarpers deep membranous

225
Q

Which plane inferior epigastric vessel lie

A

Between TA and peritoneum

Medial to deep ring

226
Q

Pseudo obstruction vs constipation

A

Constipation- LIF pain, no distended loops, faecal loading

PO- illness, post surgery
Dilated bowel, electrolytes disturbance

227
Q

Patient with ileostomy and hypocalcaemia cause

A

Hypomagnesium due to high output stoma

228
Q

What communicates freely with hepatorenal space

A

Right paracolic gutter

229
Q

Ligament cut to give greater mobility for poster access to kidney

A

Costoverterbal

L1-2 body to 12th rib

230
Q

Which part of the duodenum does the IVC pass posterior to

A

First and Third

230
Q

Right renal artery relation to IVC

A

Posterior

231
Q

Attachment and relation of pyrimidalis

A

Anterior to RA

Originates pubis and symph to linea alba

232
Q

Linea semilunari and what crosses it

A

Lateral margin of rectus

Inferior epigastric and medial umbilical cross posteriorly below arcuate

233
Q

Borders of lesser sac

A

Anterior- visceral peritoneum of posterior stomach
Lesser omentum
Gastrocolic omentum

Posterior- transverse mesocolon, peritoneum covering pancreas, left kidney, duodenum and diaphragm

Superiorly by the peritoneum covering the caudate lobe of the liver and laterally on the left side by the gastrosplenic and splenorenal ligaments

234
Q

Location of bare area of liver

A

Between coronary ligament
Triangle

235
Q

Portal vein relation to hepatic artery and bile duct

A

Posterior

Artery left of bile duct

236
Q

Jejunum vs ileum

A

Jejunum longer
Thicker walls
Less prominent arcades
Longer VR
Less fat
Less payers patches
More prominent plicae circulars

Jejunum more prominent valvular conniventes
Bigger lumen

237
Q

Ligament of Trietz connects

A

Originates from the duodenojejunal flexure/4th part of duodenum to right crus

238
Q

Which artery is clamped in lesser omentum

A

Hepatic proper

239
Q

Cause of annular pancreas, week occurring and syndrome associated

A

Failure of ventral bud to rotate around the duodenum

Happens in 7th week

Downs

240
Q

Gerotas fasciae in nephrectomy

A

Incised in simple nephrectomy

Excised in radical

241
Q

Where does the transverse mesocolon attach to in pancreas and which artery it contains

A

Head, neck and body

Middle colic arteries

242
Q

SMV, IMV relations to duodenum and pancreas

A

SMV runs anterior to third part of duodenum
Then Uncinate process lies posterior to SMV
SMV then passes behind neck of pancreas to from portal vein

IMV lies behind body of pancreas where it joins splenic vein

Portal vein formed behind neck of pancreas and anterior to IVC
Passes posterior to 1st duodenum to liver

243
Q

What does a femoral hernia compress

A

Goes through femoral canal
Can compress femoral vein which lies laterally

244
Q

Root of mesentery attachments

A

Left of L2 vertebrae at duodenojejunal junction to right of SI joint

245
Q

What structures cross root of mesentary

A

Aorta
IV
Third duodenum
Psoas
Right ureter
Right gonadal

246
Q

What cell lines ureters

A

Transitional

247
Q

What organ borders kidney without any fascia or peritoneum separating

A

Tail of pancreas

248
Q

Where is the duct of santorini

A

Accessory duct of pancreas

249
Q

SMA in relation to duodenum, IMA, SMV, splenic and left renal vein

A

Anterior to third duodenum- if compress Wilkie syndrome
Right of IMA
Left of SMV
Posteiro inferior to splenic
Anterior to left renal - nutcracker

250
Q

What lies anterior to right adrenal gland

A

IVC and right lobe of liver- bare area

251
Q

Ribs spleen is located at

A

Between 9 and 11

252
Q

Cystic duct in relation to right renal vein and hepatic artery

A

Right of hepatic artery

Anterior to renal vein

253
Q

Ureter and uterine artery relationship

A

Uterine artery initially lateral
Then cross over superiorly and anterior to it

254
Q

Local anaesthetic for appendectomy

A

On ilihypogastric T12-L1
2cm medial to ASIS

and ilioinguinal L1-2
1-2cm lateral to pubic tubercle

255
Q

Where is the mesh attached to in Lichtenstein repair

A

Reflected inguinal ligament

256
Q

Segments of liver supplied by which portal vein

A

2,3,4 (quadrate)- left portal vein
5,8- right anterior
6,7- right posterior

1 caudate- can be both

257
Q

What makes obturator hernias worse

A

Pain is worse with hip extension medial rotation and abduction

258
Q

Traction of what could cause splenic damage

A

Splenorenal and splenocoloic ligaments together

259
Q

Bleeding gin oesophageal varicose caused by which vessels

A

Superficial oesophageal - as drain in to left gastric

260
Q

Pancreatic lymphatic spread

A

Coeliac, paraduodenal, lesser greater curvature of stomach, hilum of spleen

261
Q

DIrect spread of pancreatic cancer

A

Stomach, duodenum, reotrperitoneum

262
Q

What splits the foregut and midgut

A

Major duodenal papilla

263
Q

What can be used to identify superficial ring

A

Intercrural fibres

Run across external oblique

264
Q

Surgery with major kidney bleed

A

Simple nephrectomy

Through midline incision

265
Q

Where does lesser omentum attach to liver

A

Ligamentum venosum

266
Q

Which arteries does lesser omentum contain

A

Right gastric

267
Q

Levels of kidney coverings

A

Kidney
Capsule
Perinephric Fat
Gerotas fascia
Pararenal fat

268
Q

Layer UC effects up to

A

Mucosa/submucosa

269
Q

Patient presents with distention, crohns and CT shows strictures what mx

A

IV HC and parenteral nutrition

If fails stricutroplasty

270
Q

Indications for proctocolectomy in UC

A

Elective- chronic steroid dependent or systemic SE from treatment, dysplasia

PSC- increased risk of cancer- more likely to require

271
Q

Pouchitis following protoceletomy repair

A

Cipro/met

272
Q

Absolute CI to restorative proctocolectomy pouch

A

Small bowel involvement and anal disease - Crohns or cancer

273
Q

Most common liver tumour

A

Haemangioma

274
Q

% of people with anomalies in biliary trees and what are the common ones

A

50%

Anomalies in duct- 12%

25% right hepatic crosses infant of common hepatic instead of behind it

275
Q

Chronic alcohol intake effect on haem

A

Macro anaemai
BM suppression
Thrombocytopaenia

Coagulopathies

276
Q

Stomach thickened, reduced distensibility, cells signet ring with mucin

A

Linitis plastica

277
Q

Normal size of small, large bowel and caecum

A

Upper limit of normal
3
6
9

278
Q

Hallmarks of toxic megacolon

A

Large than 6cm
Non obstructive
Signs of systemic toxicity

279
Q

Mx of toxic megacolon

A

Medical- fluid, abx, NG, bowel rest

If no- surgical

280
Q

Mx of colonicvesicle fistula

A

Surgical removal

281
Q

Glasgow scoring and mortality

A

PaO2<8
Age >55
Neuts >15
Ca <2
Renal >16
Enz LDH >600, AST >200
Albumin <32
Sugar >10

Mortality
3-4 20%
5-6 40%
>6- 100%

282
Q

Alvadro scoring

A

Migratory RIF
Anorexia
N+V
RIF tenderness-2
Rebound
Fever
Leucocytosis -2
Left shift

<5 unlikely
5-6 may require scan
>7 strong

283
Q

Meckels diverticulum presentation age, location

A

Ileum anti mesenteric border

60cm from valve

Usually present before 2

284
Q

% of gallstones that show on X ray

A

15%

285
Q

Most common gallstones

A

Cholestrol

286
Q

RF for HCC

A

Poorly controlled T2DM

Men
Hep B C
HIV

287
Q

FAP associated features

A

Hypertrophy of retinal pigment

Desmoid tumours

Osteoma jaw

Adenoma duodenum

Gardners with EIM

288
Q

Commonest complication of rectal prolapse

A

Incontinence

Also can cause incarceration, strangulation, ulceration

289
Q

Sign of amoebic liver abscess on CXR

A

Blunting of costophrenic angle

290
Q

Asymptomatic gallstone tx

A

None

291
Q

Biliary atresia sx

A

Hepatosplenomegaly
Pale stool
Dark urine
All this not usually present at birth

No tree dilation

292
Q

Mx of dumping syndrome

A

Several small meals
avoid simple sugars
High fibre
Ocreotide/PPI if conservative efails

293
Q

Dysphagia, raynauds, furrowing of lips and tapered fingers

A

CREST

294
Q

Screening of FAP

A

Chromosome 5

Opthalmoscopy

295
Q

Abx after spelenectomy

A

Usually just 2 years

Lifelong- invasive pneumococcal, splenic malignant, irradiation or gVHD

Infection most likely <16, >50 and first 2 years

296
Q

Vaccines in splenectomy

A

AT least 2 weeks before for elective

If emergency - 2 weeks after

One dose of Him/MenC MenB

1 month after MenB 1

297
Q

SAAG levels for exudative and causes

A

<1.1

Infection, malignancy
Hereditary angioeoedma

Nephrotic - low albumin

298
Q

Imaging for complex fistulas

A

MRI

299
Q

Haemorrhoid needing manual reduction, thromboses with sig bleeding tx

A

Stapled haemorrhoidopexy

300
Q

Cause of hypoclacaemia in pancreatitis

A

Fat saponification

301
Q

Location of pancreatic pseudocyst

A

Lesser sac

302
Q

pH monitoring of GORD

A

Probs placed in oesophagus and continuously reads oesophageal acidity

303
Q

Muscle of oesophagus

A

Inner circular and outer longitudinal muscular coat

Striated in upper
Smooth in lower

Overlap in middle

304
Q

Thick darkened axilla, warty lesions casques

A

GI cancers

DM

305
Q

Dermatitis herpatifemormis

A

Itchy blisters knee, elbows, scalp

306
Q

Highest sensitivity and spec for H pylori

A

Urea breath test

307
Q

How to assess exocrine function of pancreas

A

Lundh meal
Dex and milk pwder
Measure lipase

Faecal elestace better used

308
Q

Where does salmonella typhi collect

A

Peyer patches

Highest conc in ileum

309
Q

Intusspection gender and time of year

A

Male winter

310
Q

PBC bloods

A

High ALP, normal ish AST

High protein- Anti mito

High bilirubin

311
Q

Ramstedt pyloromyotomy division layers

A

Parietal and visceral peritoneum

Serosa
Longitudinal muscle
Circular muscle

Mucosa left in tact

312
Q

Peutz mutation and features

A

STK11 AD

Mainly polyp of SI

Intusspection

Demoid cyst

313
Q

Parastomal hernia rate, sx and mx

A

10% of colostomies
More common if not through RA

Asymptomatic

Rarely need mx

314
Q

Pigment laden Macrophages with peroidic acid shiff staining

A

Melonosis coli

315
Q

What do NSAIDs inhibits that causes ulceration

A

COX2
Covnerts arachnoid acid to PG H2 which protects

316
Q

Commonest cause of biliary strictures

A

Iatrogenic after surgery

317
Q

Most common cause of anal fistula

A

Anorectal abscess

318
Q

FAP surveillance

A

Relatives with 50% of inheritance
1-3 years 12-14 until 30

3-5 until 60

Upper GI at 25

319
Q

Child Purgh scoring

A

Albumin
Ascites
Bilirubin
Coagulopathy - PT
Encephalopathy

Score >10 decompensation
42% of 5YS

320
Q

RF gastric carcinoma

A

H pylori
Pernicious anaemia
Prev gastric surgery
Blood group A

321
Q

Signet ring , mucinouos tumour, appearance colon and associations

A

HNPCC

Endometrium and stomach

322
Q

Other blood test for coeliac disease

A

Endomysial AB

323
Q

Repair for umbilical hernia in child

A

Mayo repair

324
Q

Hoarse voice with oesophageal cancer

A

RLN involvement

325
Q

Alcoholic found to have TG of 26, what is the casue

A

Increased synthesis of TG for incorporation into VLDL in the liver

As alcohol favour fat synthesis

326
Q

Most common benign tumour in oesophagus

A

Leimyoma

Benign 1% of all tumours in oesophagus

327
Q

Extensive iliocolic resection effect on PTH

A

Secondary hyperparathyroid

328
Q

Persistent pain, fever, fullness in abdo after acute panc , ix

A

CT
Pseudo cyst

329
Q

BALTHAZAR scoring for pancreatitis

A

Uses CT to score severity

330
Q

Direction sigmoid volvulus occurs in and sign on AXR

A

Anticlockwise
Coffee bean

331
Q

Diverticulitis in elderly, perforated but absence peritonitis

A

IV ABx and monitor

332
Q

mx of sigmoid volvulus

A

Flatus tube flex sig

If any necrosis- laparotomy

333
Q

Glasgow score of 5 mortality

A

40%

334
Q

Hydatid vs amoebic infection

A

Amoebic causes dysentry

335
Q

Mesenteric adentiis features

A

After URTI
Mild peritonitis reaction - shifting tenderenss

336
Q

Large PR bleed post AAA repair

A

Aort enteric fistula

337
Q

Ix for pancreatitis

A

CT

338
Q

Triad of gastric volvulus

A

Epigastric pain
Retching without vomiting
Unable to pass NG tube

339
Q

Most common secondary generalised peritontiis

A

Small intestine perf

eMRCS questions (45 decks)

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