Emergency Surgery

Question 1

Treatment for mesenteric paniculitis

Answer 1

Oral steroids if symptomatic

Question 2

Risk of malignant transformation in oral caustic injury

Answer 2

1000x from baseline
15-16%

In grade 3 (extensive necrosis) 80% will develop structures

Question 3

Neutropenic enterocolitis

Answer 3

Typholitis is inflammation of caecum - usually in patients on tx for haem cancer

Usually present with bloody diarrhoea and abdo pain

In fulminant cases right hemi

Less severe - NG, IV Abx and sometimes consider closing perf and defunction

Question 4

Size cut off for pancreatic necrosis

Answer 4

3 cm or greater

Question 5

MYH associated polyposis

Answer 5

MYH associated polyposis may phenotypically resemble FAP. However, the APC mutation is absent and it is due to a recessive genetic defect (the only colonic polyposis syndrome to have this feature) of mut Y human homologue gene on chromosome 1p.

Question 6

Volume of blood needed for malaena to be present

Answer 6

60ml

Question 7

Risks for re bleeding

Answer 7

Question 8

Causes of colo-vesical fistula

Answer 8

commonest cause of colovesical fistula (in order) are; diverticular disease, cancer, n’s, radiotherapy, foreign bodies. CT scanning is the investigation of choice. One e resectional surgery is the treatment of choice.

Question 9

Amount of traction applied to gastric ballon in S-B tube

Answer 9

1kg

Question 10

What pressure should S-B tube oesophageal ballon be inflated to

Answer 10

35-45mmHg isf bleeding persists

Once bleeding stops reduce by 5mmHg every 3 hours and maintain at 25mmHg for 24hrs

The ballon should be deflated every 6 hours to prevent necrosis

Question 11

Causes of pancreatitis

Answer 11

Gallstones = 50%
Alcohol = 25%
Remainder (including idiopathic) = 25%

Question 12

Predicting severe attack of pancreatitis

Answer 12

An APACHE score of >8 and obesity are strongly predictive of a severe attack.

Question 13

Mechanism of action of TXA

Answer 13

Tanexamic acid inhibits plasmin and this prevents fibrin degradation.

Question 14

Acute tubular necrosis

Answer 14

In acute tubular necrosis there is no response to intravenous fluids because the damage occurs from within the renal system rather than as a result of volume depletion.

Question 15

Children with appendicitis

Answer 15

Children have a high incidence of appendiceal perforation and early surgery should be the norm, this is particularly true when the diagnosis is beyond doubt.

Question 16

Low flow priaprism

Answer 16

Low flow priaprism is a urological emergency. Aspiration of bright red blood is more reassuring and may indicate high flow priaprism that may be actively monitored. Low flow priaprism should be decompressed with aspiration of blood from the corpus caveronsum.

Question 17

Priapism

Answer 17

Prolonged unwanted erection, in the absence of sexual desire, lasting more than 4

Question 18

Ionotropic agents

Answer 18

Question 19

Dopamine

Answer 19

Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.

Question 20

Dopamine

Answer 20

Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.

Question 21

Haemorrhagic gastritis

Answer 21

Often diffuse bleeding
Targeted haemostatic therapy if specific focal bleeding point
Argon plasma coagulation if diffuse bleeding
Consider anti fibrinolytic (tranexamic acid)
Total gastrectomy if in extremis and endoscopic therapy fails
All should have PPI

Question 22

Bleeding gastric ulcer

Answer 22

Dual therapy (e.g. endoclip and adrenaline)
PPI infusion post procedure
Biopsy to exclude cancer
If endoscopic therapy fails may require gastrotomy and over sewing of bleeding point
Distally sited large ulcers may require distal gastrectomy

Question 23

Bleeding gastric cancer

Answer 23

Attempt conventional methods to stop bleeding, definitive cancer surgery best performed electively

Question 24

Duodenal ulcers

Answer 24

Dual endoscopic therapy (e.g. adrenaline and clip)
High dose PPI infusion
Ulcer under-running may be required if endoscopy fails

Question 25

Dopamine

Answer 25

Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.