Abdomen, Oesphagus and Stomach Flashcards
(162 cards)
1
Q
Most common cause of mesenteric infarction
A
superior mesenteric artery
2
Q
2 week diffuse abdominal pain, contraceptive pill, -ve pregnancy -
A
Mesenteric venous thrombosis
Increased P() with intrabdominal sepsis
3
Q
Appendicular artery
A
ileocolic
4
Q
Median arcuate ligament syndrome
A
post prandial epigastric prain + bruit
5
Q
Greater omentum contains both
A
Greater omentum contains both gastroepiploic arteries
6
Q
Brisk bleed – posterior duodenal ulcer – perforation of…
A
gastroduodenal artery perf – branch of common hepatic
7
Q
3 week hx post prandial, intermittent diarrhoea and PR bleeding
A
mesenteric vascular disease. CT Angio or US Duplex if renal impairment
8
Q
Management of bleeding inferior splenic pole?
A
Argos plasma coag
9
Q
Cervical oesophagus supplied by
A
inferior thyroid artery
10
Q
mucinous adenocarcinoma within abdomen - name and management
A
Pseudomxyoma peritonei – geltanious – sugar baker procedure + peritoneal chemo
11
Q
Superior mesenteric vein – drains into
A
Superior mesenteric vein – drains into portal vein
12
Q
Management of splenic vein thrombosis
A
Splenectomy
13
Q
The medial edge of Hassalbach’s triangle =
A
rectus abdominus
14
Q
Middle Sacral artery is
A
posterior to rectum
15
Q
Normal intraabdominal pressure =
A
Normal intra abdominal pressure = 5-7mmHg
16
Q
Laparoscopic insufflation pressure
A
12- 15mmHg
17
Q
Abdominal compartment syndrome - sustained >…
A
Abdominal compartment syndrome - sustained >20mmHg + new organ dysfunction / failure
18
Q
X% acute cholecystectomy – stone in the common bile duct
A
10% acute cholecystectomy – stone in the common bile duct
19
Q
Renal stones in IBD
A
Calcium Oxalate
20
Q
Drugs in UC
A
Steriods • 5 MA (Mesalazine) Immunosupressants (Cyclosporin)
Monoclonal antibody against TNF-a (Infliximab)
21
Q
Drugs in UC
A
Steroids 5 ASA (Mesalazine)
Immunosupressants (Azothioprine/Mercaptopurine)
Methotrexate
Monoclonal antibody against TNF-a (Infliximab)
22
Q
Transverse incision two thirds of the way between umbilicus and the symphysis pubis - Last likely to come across
A
Posterior lamina of the rectus sheath
23
Q
stoma with a Low anterior resection + colorectal anastomosis
A
loop ileostomy
24
Q
what stoma with a Low anterior resection + colorectal anastomosis
A
loop ileostomy
25
Rovsings pressing LIF – negative if
Rovsings pressing LIF – negative if appendicitis is retroceacal
26
Divide X to access coeliac axis for gastrectomy
Divide lesser omentum to access coeliac axis for gastrectomy
27
Duodenal Ferrous Fe2+ absorption – bound as
Duodenal Ferrous Fe2+ absorption – bound as ferritin
28
Crohn's stricture – terminal ileal/ileocecal – , surgical management after IV Steroid trial
Crohn's stricture – terminal ileal/ileocecal – right hemicolectomy after IV steroid trial
29
Colonic polyps – which has highest P() malignant transformation
villous adenoma
30
Colonic polyps – which has highest P() malignant transformation
villous adenoma
31
Folate – small intestine absorption not dependant on
jejnum - not pancreas dependant
| b12 in terminal ileum
32
Ileostomy sodium content
120mmol/L Na+
33
Inflammation, bleeding + mucous from stump post Hartmann’s
Diversion proctitis
34
Level of blockage for blockade for inguinal hernia repair
T12 blockade for inguinal hernia repair
35
Short hx (2/52) nocturnal incontinence, diarrhoea + rectal bleeding
IBD
36
Management of Incarcerated femoral hernia
McEvedy’s>Lothessian (above, not through)
Lockwood inappropriate. Especially with SBO
37
Management of emergency presentation of low anal cancers
defunction with loop colostomy – then formal staging
38
Right obstructing colon carcinoma you perform..
rt hemicolectomy + ilocolic anastomosis
39
Post inguinal hernia repair groin pain...
ilioinguinal nerve entrapment
40
Coeliac autonomic plexus relative to aorta
Coeliac autonomic plexus – anterolateral to aorta
41
High output ureterosigmoidostomy will result in
High output ureterosigmoidostomy – acidosis
42
Devision of what ligament in splenectomy
Division of gastrosplenic ligament containing short gastric arteries in splenectomy
43
Hernia containing Meckel’s diverticulum known as...and management...
Litter’s hernia, resect before mesh repair.
44
Open Lichtenstein repair is a...
open hernia repair with mesh
45
Splenic Immune reticuloendothelial cells are in found in the...
Splenic Immune reticuloendothelial cells are in white pulp
46
For right adrenalectomy you need tomobilise
Mobilise right colonic flexure for right adrenalectomy
47
Resected colon cancer with nodal disease - you give...
Resected colon cancer with nodal disease – chemotherapy!
48
Right hemicolectomy puts at risk
Right hemicolectomy - Gonadal vessels + ureter at risk
49
Splenic flexure obstruction –
extended rt hemicolectomy
50
Massive splenomegaly
CGL (chronic granulocytic leukemia)
51
chronic inflammation resulting in obliteration of calots triangle
Mirizzi syndrome
52
Fe deficiency, postprandial pain most likely to be
Meckels with gastric>IBD
53
Annular pancreas will obstruct the
Annular pancreas will obstruct the second part of duodenum
54
Ca+ - most absorbed in
small bowel
55
Colorectal screen starts at
Colorectal screen starts at 60
56
Midgut
Second part of duodenum to 2/3 transverse colon
57
Hindgut-
Distal 1/3 transverse colon to anus
58
Divide which attachments of the caecum for retrocaecal appendix
Divide lateral peritoneal attachments of the caecum for retrocaecal appendix
59
Duke’s survival A/B/C/D
Duke’s survival A/B/C/D 95/75/50/25
60
What vessel disease will result in splenic atrophy
Coeliac disease – splenic atrophy
61
small appendiceal carcinoid tumours <2cm
Discharge small appendiceal carcinoid tumours <2cm
Liver mets for carcinoid syndrome diagnosis
62
Intermittent diarrhoea + RIF pain + weight loss
IBD
63
Colonic polyp on a stalk termed as..
Colonic polyp on a stalk – dysplasia
64
For a Serrated not malignant polyp
polypectomy!
65
1st new kidney? Attach to
1st new kidney? Attach to external iliac!
66
Prev repair or bilateral hernia?
Lapracopic/TEP
67
Deep ring – medial and lateral walls
Deep ring – Tranversalis facia lateral wall
| inf epigastric vessels medial wall
68
Rosethorn Ulcers found in....
Crohn's
69
Rosethorn Ulcers found in....
Crohn's
Chrohn's, crown, crown of thorns,
70
What drain do you put in after a Hartmann's
Wallace Robinson Drain, no suction
71
Post low anterior resection impotence
damage to nervi erigentes
72
Colonoic-pseudoobstruction you can give..
neostigmine
73
ankolosing spondylitis related to
UC
74
Adrenal mass with lipid rich core
Lipid rich core – benign adrenal adenoma
75
Foul smelling pus after difficult appendicectomy
Bacteroides fragilis
76
Burst abdomen most common at
Burst abdomen most common at 15 days
77
Peri-anal chrohn’s disease, you give
Peri-anal chrohn’s disease, infliximab
78
colonic pseudoobstruction also known as...
Ogilvie syndrome
79
10% of fissures are...
10% of fissures are anterior
80
Water mostly absorbed in the
Water mostly absorbed in the jejunum
81
Xml of Bile in Duodenum in 24h
500ml of Bile in Duodenum in 24h
82
Gastrinomas – most commonly found in the
Gastrinomas – most commonly found in the duodenum
83
would infection rate in Hartmann’s for perforated disease
35% would infection rate in Hartmann’s for perforated disease
84
What Rib lie's behind the right kidney?
12th Rib lies behind right kidney not 10th
85
sign – most often seen in ruptured ectopic pregnancy
Cullen’s sign – most often seen in ruptured ectopic pregnancy
CU..
86
Pancreas - embryology
Ventral and dorsal endodermal outgrowths of the duodenum
87
most posterior splenic structure
Lienorenal ligament – most posterior splenic structure
88
Most of the gut is derived endodermally except for the
the spleen which is from mesenchymal tissue.
89
zinc is absorbed in the..
Jejunum absorbs zinc
90
You don’t need to measure X with home TPN
You don’t need to measure thyroid function with home TPN
91
Accessory spleens are not found in the
Accessory spleens are not found in the ureter
92
before flexi sig you give a...
Phosphate enema 30 minutes before flexi sig
93
What % Synchronous bowel cancer
Synchronous bowel cancer – 5% of all cases
94
Laparoscopic choelcystectomy for uncomplicated biliary colic – % wound infection rate
Laparoscopic choelcystectomy for uncomplicated biliary colic – 5% wound infection rate
95
right scapular – acute cholecystitis, name of Sign
Boas' sign – right scapular – acute cholecystitis
96
Operate acute cholecystectomy within
Operate acute cholecystectomy within 72 hours
97
Recurrent gallstone cholecytitis results in
Achoff-Rotinsky Sinuses
98
Pancreatic lipase - digestion of fat, Proteases facilitate
protein and B12 absorption
99
Pancreas output and pH
Pancreas 1000-1500ml/day pH 8
100
Pancreatic necrosectomy – only when
only when infection proven after FNAC
101
Carcinoma of the pancreatic head- failed ERCP – go to
PTCP
102
Klatskin Tumour
hilar tumour at left and right bile duct confluence.
103
Klatskin Tumour
hilar tumour at left and right bile duct confluence.
104
Liver Cell Adenoma – non encapsulated, mixed echoity and heterogeneous texture, normal AFP and LFTs, RUQ pain, On MR
Resect! Malignancy M>F
105
Colorectal liver mets what do you do first?
chemotherapy then resection
106
UC patients - biliary condition
UC patients - Primary sclerosing cholangitis (inflammation)
107
UC patients - biliary condition
UC patients - Primary sclerosing cholangitis (inflammation)
108
ileal resection – higher incidence of
higher incidence of cholesterol stones
109
Cystic artery – from
Cystic artery – from right hepatic artery
110
most common infection cholangitis
E Coli – most common in cholangitis
111
To access the abdominal oesophagus you need to mobilise
Mobilise left lobe – for abdominal oesophagus
112
Pancreatic pseudocyst >4 weeks
Pancreatic pseudocyst - >4 weeks, a/w raised amylase
113
Rectal prolapse in the young...
Rectopexy for the young – lowest recurrence rate for rectal prolapse
114
Willsons disease, solid mass liver mass.
easure AFP (+chronic inflame = HPCC)
115
to diagnose carcinoid syndrome check for
Liver mets to diagnose carcinoid syndrome
116
hormones that increases and suppresses appetite
Grehlin increases appetite, leptin decreases
117
ERCP sphincterotomy – electric setting
ERCP sphincterotomy – cutting monpolar
118
SMV + Splenic vein @ L1 = Hepatic Portal vein – runs in
hepatoduodenal ligament (free edge of lesser omentum)
119
Hepatic Vein – exits liver...and drains...
Hepatic Vein – exits liver posteriorly draining directly into IVC
120
Cystic vein into right branch of...
Cystic vein into right branch of portal vein
121
Right gastric vein drains
Right gastric vein drains lesser curvature of stomach
122
Oesophagus – no
Oesophagus – no serosa, loose connective tissue only
123
Achalasia = increased P()
Achalasia = increased P() SCC
124
Oesophagectomy Prox>Distal:
Oesophagectomy Prox>Distal: McKwon>Ivor>Transhiatal
125
division for lower third oesophagectomy
Ayzgos vein division for lower third oesophagectomy
126
Parietal cells: secrete
Parietal cells: secrete HCl, Ca, Na, Mg and intrinsic factor
127
Chief cells: secrete
Chief cells: secrete pepsinogen- PEPSI CHIEF
128
Surface mucosal cells:
Surface mucosal cells: secrete mucus and bicarbonate
129
Cardia tumour, no distal mets -
Cardia tumour, no distal mets - Total gastrectomy and Roux en Y reconstruction
130
8 month post distal gastrectomy – normal Ix – jaundice secondary to
8 month post distal gastrectomy – normal Ix – jaundice 2ry peri hilar lymphandenopathy
131
Post gastrectomy – dumping:
diarrhoea, hypoglycaemia. Fe + B12 malabsorption.
| Eat high protein and low carbs.
132
Gastrin stimulates
enterochromaffin histamine release.
133
single large arteriole in submucosa – a bleeder!
Dieulafoy lesion – single large arteriole in submucosa – a bleeder!
134
organism causing terminal ileitis + mesenteric lymphadenitis
Yersinia enterolitica
135
Mackler triad for Boerhaave syndrome/ Oesophageal perf:
Mackler triad for Boerhaave syndrome/ Oesophageal perf: vomiting, thoracic pain, subcutaneous emphysema
136
Carcinoma of greater curvature with no mets:
Carcinoma of greater curvature with no mets: subtotal gastrectomy, D2 lymphadenectomy + rou en y
137
Upper 1/3rd oesophagus:
Combined radical radiotherapy and chemotherapy
138
GI Ulcer secondary to thermal injury
GI Ulcer – 2ry thermal injury = Curling’s Ulcer
139
Direct inguinal hernia - suture ?mesh
Direct inguinal hernia - Nylon sutured repair + placement of prolene mesh posterior to cord structures.
140
No hyperamylasemia in
No hyperamylasemia in pancreatic CA
141
Barrettes’ –
Barrettes’ – Goblet Cells + intestinal metaplasia
| o High risk of adenocarcinoma
142
Pernicious anaemia - Abs and malabsoption of...
Pernicious anaemia -Parietal Cell Abs – no IF to absorb B12
143
hx of straining, painless bleeding
Solitary rectal ulcer –
144
Oesophageal Constrictions:
```
Oesophageal Constrictions: ABCD
o A- Arch of the Aorta
o B- Left main Bronchus
o C- Cricoid Cartilage
o D- Diaphragmatic Hiatus
```
145
signet rings, leather bottle stomach, unable to distend on the scope
Linitis plastica
| adenocarcinoma and accounts for 3-19% of gastric adenocarcinoma - not associated with H pylori
146
GIST's are derived from the
GIST's are derived from the interstitial pacemaker cells of Cajal.
147
Longitudinal oesophageal muscles
Longitudinal oesophageal muscles propels food
148
Post oesophagectomy –
Post oesophagectomy – feeding jejunostomy
149
McKown procedure –
McKown procedure – total oesophagectomy
150
Cardiooesophageal junction level =
Cardiooesophageal junction level = T11
151
Anterior gastrojejunostomy – most associated with
Anterior gastrojejunostomy – most associated with delayed gastric emptying
152
Pudendal canal is a fascial canal located on the lateral wall of the..
at inferior border of...
Pudendal canal is a fascial canal located on the lateral wall of the ischioanal fossa
inferior border of obturator internus
153
Fascial layers surrounding the rectum:
| Anteriorly
Anteriorly lies the fascia of Denonvilliers
154
Fascial layers surrounding the rectum:
| Posteriorly lies
Waldeyers fascia – divided to separate mesorectum from sacrum in low anterior resection
Suprior rectal artery+vein.
155
rectum: Above dentate line – nodes..
Above dentate line – mesorecal lymph nodes, Below = inguinal.
156
Chrohns for even low fissures
Chrohns – seton for even low fissures – poor healing if laid open!
157
K+ secretion highest in...
Rectal K+ secretion highest!
158
Placenta percreta –
Placenta percreta – brisk frank haematuria!
159
Genital branch of the genitofemoral nerve exits via
Genital branch of the genitofemoral nerve exits via deep inguinal ring
160
AP resection impotence
AP resection impotence – hypogastric plexus damage during IMA mobilisation
161
Excision haemorrhoidectomy analgesia:
caudal block > pudenal block
162
Ischiorectal space – medial to
Ischiorectal space – medial to pudendal canal
