Abdomen

Question 1

Most likely conditions to cause Cullens

Answer 1

Pancreatitis
Ruptured ectopic

Question 2

Imaging if pregnant lady has abdominal signs

Answer 2

CT

Question 3

What appendicitis can cause negative rovsig sign

Answer 3

Retroceacal

Question 4

Painless massive GI bleed in paeds 1-2 years

Answer 4

Merckels Diverticulum

Question 5

Mesenteric ischaemia vs ischaemic colitis

Answer 5

MI- out of proportion to exam findings, bowel emptying (vomiting and diarrhea), and a potential embolic source

IC- bloody bowel movements, abdominal pain, and leukocytosis

Question 6

Stoma that is swollen and presenting with obstructive symptoms

Answer 6

Incisional hernia

Question 7

What part of GI tract should not show fluid filled level

Answer 7

Descending colon

Question 8

IBS symptoms

Answer 8

Improvement with defecation.
Onset associated with a change in the frequency of stool.
Onset associated with a change in the form of the stool.

Question 9

Blood test for IBD

Answer 9

Faecal calprotectin

Question 10

Ix if blood stained discharge and abdo tenderness

Answer 10

Abdo and pelvic USS and pregnancy test

Question 11

Spigelian hernia

Answer 11

hernia lateral to the rectus muscle at the level of the arcuate line

Question 12

Richters hernia

Answer 12

part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type)

Question 13

Bochdalek hernia

Answer 13

Of the posterolateral diaphragm

Question 14

Morgagni Hernia

Answer 14

Herniation through foramen of Morgagni- anterior
Usually located on the right and tend to be less symptomatic

Question 15

Littres hernia

Answer 15

Hernia containing Meckels diverticulum

Question 16

Intusseption sx

Answer 16

Screaming
Drawing legs up
The child may pass bloody mucus stool, which is a late sign. Examination of the abdomen is often normal as the sausage mass in the right upper quadrant is difficult to feel.

Question 17

Most commons smooth abdo lump in children

Answer 17

Mesenteric cyst

Question 18

commonest cause of acute abdominal pain in acute unselected surgical ‘take’

Answer 18

Non specific abdo pain

Question 19

Femoral canal borders

Answer 19

Laterally- Femoral vein
Medially - Lacunar ligament
Anteriorly- Inguinal ligament
Posteriorly- Pectineal ligament

Question 20

Pale opalescent liquid from chest drain

Answer 20

Damage to the lymphatic duct may occur during this procedure

Occurs in Ivor - Lewis oesophagogastrectomy

Question 21

A 5 year old boy develops a persistent fever following an open appendicectomy for gangrenous appendicitis. On examination, he has erythema of the wound and some abdominal distension. What is the most appropriate course of action?

Answer 21

USS

Question 22

Lining of meckel diverticulum

Answer 22

Most asymptomatic Meckels diverticulum will be lined by ileal mucosa. Those which present with bleeding are more likely to contain gastric type mucosa.

Question 23

Causes of intusseption

Answer 23

CF
Merkels diverticulum
Polyps and inflammation of Peyers patches

Question 24

After surgery, swinging fever and ileus investigation

Answer 24

CT with contrast

Question 25

Causes of intrabdominal compartment syndrome and how it presents

Answer 25

Obese patients with ileus following major abdominal surgery are at increased risk of intra abdominal compartment syndrome use of prosthetic meshes Nasogastric aspirates increase, urine output falls and metabolic acidosis.

Question 26

Blood supply of meckel diverticulum

Answer 26

Vitelline

Question 27

Location of meckels diverticulum and epidemeology

Answer 27

60cm proximal to ileocaecal valve 2% population and 2 inches long, 2x as common in men

Question 28

Pulsatile lump in groin in Hep C patent

Answer 28

False aneurysm Associated with IVDU

Question 29

Embryonic derivative of meckels diverticulum

Answer 29

vitello-intestinal duct.

Question 30

After cholecystectomy drain starts draining 200ml of bile per day- cause and ix?

Answer 30

Most likely clip has come loose in big duct ERCP and allows stent placement

Question 31

Intusseption tx

Answer 31

Resuscitation first - fluid and abx Then fluoroscopic reduction if ileocolic Ileo-ileal intussusception require laparotomy

Question 32

Why is a chest tube inserted after oesophagestomy

Answer 32

As lung is collapsed to access oesophagus

Question 33

Splenic vein thrombosis ix and tx

Answer 33

CT angio Causes gastric varies as shunts to them Splenectomy

Question 34

Child with facial oedema, abdo pain and fever

Answer 34

SBP - after nephrotic syndrome

Question 35

What structure lies under deep inguinal ring

Answer 35

Inferior epigastric

Question 36

Embryological origin of diaphragm

Answer 36

Septum transversum - Central tendon Pleuroperitoneal membranes - Parietal membranes surrounding viscera Cervical somites C3 to C5 - Muscular component of the diaphragm