General Surgery

Question 1

Give types of abdominal incisions

Answer 1

Midline incision

Paramedian incision

Battle

Kocher’s

Lanz

Gridrion

Gable

Pfannenstiel’s

McEvedy’s

Rutherford Morrison

Question 2

How is abdominal wound dehiscence managed?

Answer 2

Coverage of the wound with saline impregnated gauze, on the ward

IV broad-spectrum antibiotics

Analgesia

IV fluids

Arrangements made for a return to theatre

Question 3

What is shock?

Answer 3

Insufficient tissue perfusion

Question 4

What are the causes of shock?

Answer 4

Septic

Haemorrhagic

Neurogenic

Cardiogenic

Anaphylactic

Question 5

What is anaphylactic shock?

Answer 5

Severe, life-threatening, generalised or systemic hypersensitivity reaction

Question 6

How is anaphylaxis managed?

Answer 6

IM adrenaline, can be repeated every 5 minutes

Question 7

What is neurogenic shock?

Answer 7

Occurs most often following a spinal cord transection, usually at a high level, causing resultant interruption of the autonomic nervous system, therefore causing either decreased sympathetic tone or increased parasympathetic tone, the effect of which is a decrease in peripheral vascular resistance mediated by marked vasodilation

Question 8

How does neurogenic shock present?

Answer 8

Bradycardia

Hypotension

Post-trauma

Warm flushed peripheries

Question 9

How does haemorrhagic shock present?

Answer 9

Post-trauma

Tachycardia

Question 10

How does cardiogenic shock present?

Answer 10

Post MI

Peripherally poorly perfused

Question 11

How does septic shock present?

Answer 11

Increased temperature

Tachycardia

Question 12

Give types of stomas

Answer 12

Gastrostomy

Loop jejunostomy

Percutaneous jejunostomy

Loop ileostomy

End ilestomy

End colostomy

Loop colostomy

Caecostomy

Mucous fistula

Question 13

Describe a loop ileostomy

Answer 13

Right iliac fossa

Typically temporary

Used to protect distal anastomoses by temporarily defunctioning the bowel

Question 14

Describe an end ileostomy

Answer 14

Right iliac fossa

Permanent or temporary, although reversile is more difficult than loop

Used following complete excision of colon or where ileocolic anastomosis is not planned

Question 15

Describe a loop colostomy

Answer 15

Any region of abdomen

Typically temporary

Used to protect distal anastomoses and defunction a distal segment of colon

Question 16

Describe an end colostomy

Answer 16

Either left or right iliac fossa

Typically permanent

Used when anastomosis is not primarily achievable or desirable

Question 17

What is the difference between ileostomy and colostomy bag contents?

Answer 17

In ileostomy, there is liquid

In colostomy, there is faeculant matter as bowel has had more time to thicken

Question 18

What is the difference between ileostomy and colostomy appearance?

Answer 18

Ileostomy is pink and spouted to prevent the surrounding skin coming into contact with alkaline enzymes of the small intestine

Colostomy is flat

Question 19

Give ileostomy complications

Answer 19

Volume depletion

Metabolic acidosis due to increased ileostomy output

Question 20

What investigation is used to ensure anastamosis healing before ileostomy reversal?

Answer 20

Gastrografin emema

Question 21

Give features of anastomatic leak

Answer 21

AF

Feculent or purulent material in the wound drain

Distended and rigid abdomen

Fever, tachycardia

Question 22

How is anastomatic leak managed

Answer 22

CT abdomen and pelvis with rectal contrast for diagnosis and location

Question 23

Give features of chyle leak

Answer 23

Pale opalescent liquid within drain

Question 24

Give features of air leak

Answer 24

Persistent pneumothorax despite chest drainage

Bubbling when suction is applied to chest drainage

Question 25

Give features of post operative ileus present

Answer 25

Occurs in the few days following surgery Loss of electrolytes N&V Abdominal distention and tenderness

Question 26

How is post operative ileus managed?

Answer 26

Nil by mouth NG tube

Question 27

Give features of wound dehiscence

Answer 27

Open wound site with discharge and fat protruding through it

Question 28

How is wound dehiscence managed?

Answer 28

Apply sterile wet gauze and sutute in theatre

Question 29

What are early causes of post operative pyrexia (less than 5 days)?

Answer 29

Blood transfusion Cellulitis Urinary tract infection Physiological systemic inflammatory reaction, usually within a day following the operation Pulmonary atelectasis

Question 30

What are late causes of post operative pyrexia (more than 5 days)?

Answer 30

Venous thromboembolism Pneumonia Wound infection Anastomotic leak

Question 31

Give examples of iatrogenic nerve injury and their associated surgery

Answer 31

Posterior triangle lymph node biopsy and accessory nerve lesion Lloyd Davies stirrups and common peroneal nerve Thyroidectomy and laryngeal nerve Anterior resection of rectum and hypogastric autonomic nerves Axillary node clearance; long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve. Inguinal hernia surgery and ilioinguinal nerve Varicose vein surgery and sural and saphenous nerves. Posterior approach to the hip and sciatic nerve Carotid endarterectomy and ipsilateral hypoglossal nerve

Question 32

Give complications of massive haemorrhage

Answer 32

Hypothermia Hypocalcaemia Hyperkalaemia Transfusion related lung injury Coagulopathy Delayed type transfusion reactions

Question 33

Why is epidural analgesia used in abdominal surgery?

Answer 33

Accelerates the return of normal bowel function after abdominal surgery

Question 34

Describe the enteral feeding pathway

Answer 34

Stomach can function * Short term, NG tube * Long term, PEG Stomach cannot function * TPN

Question 35

Describe the different types of surgicla transplants

Answer 35

Allograft, non identical donor Isograft, identical donor Autograft, same individual Xenograft, another species