surgery

Question 1

what can cause acute abdominal pain

Answer 1

appendicitis most common. lower lobe pneum may cause pain referred to abdomen, primary peritonitis in nephrotic syndrome, DKA, UTI

Question 2

symptoms appendicitis

Answer 2

anorexia, vomiting, abdominal pain- initially central then localises to RIF

Question 3

signs appendicitis

Answer 3

tenderness with guarding RIF, flushed face, oral fetor, fever, abdominal pain aggravated by movement, Rovings sign

Question 4

what is rovsings sign

Answer 4

if palpate left lower quadrant and it produces pain in the right lower quadrant

Question 5

complications of appendicitis

Answer 5

abscess, perforation

Question 6

what is complicated appendicitis

Answer 6

presence of appendix mass, abscess, perforation

Question 7

if there is generalised guarding consistent with perforation what is the management

Answer 7

fluid resus, IV antibiotics, laparotomy

Question 8

if there is a palpable RIF mass but no signs peritonitis what is the management

Answer 8

conservative- IV antibiotics

Question 9

when is an appendicetomy done

Answer 9

after several weeks. if symptoms progress- laparotomy

Question 10

what is intussusception

Answer 10

invagination of proximal bowel into distal segment. ileum passes through ileocaecal valve to the caecum

Question 11

what is the commonest cause of intestinal obstruction in neonates

Answer 11

intussusception

Question 12

age intussusception

Answer 12

3m-2y

Question 13

complications intussusception

Answer 13

stretching and constriction of the mesentery, venous obstruction- engorgement and bleeding from bowel mucosa, fluid loss- perforation, peritonitis, gut necrosis

Question 14

presentation intussusception

Answer 14

paroxysmal colicky pain which can recover in between but becoming more lethargic, vomiting, refusing feeds, sausage shaped mass, redcurrant jelly like stools, abdominal distension and shock

Question 15

what may AXR show in intussusception

Answer 15

distended small bowel, absence of gas in distal colon

Question 16

investigations in intussusception

Answer 16

AXR, abdominal US

Question 17

management intussusception

Answer 17

reduction by rectal air enema- by radiologist. if fails- laparoscopy or laparotomy

Question 18

how recurrent is intussusception

Answer 18

5%

Question 19

what is meckel diverticulum

Answer 19

in 2% there is an ileal remnant of vitello intestinal duct containing ectopic gastric mucosa or pancreatic tissue

Question 20

presentation meckel diverticulum

Answer 20

most asymptomatic. can present with severe rectal bleeding. neither bright red or true malaena.

Question 21

investigation in meckel diverticulum

Answer 21

technetium scan

Question 22

management meckel

Answer 22

surgical resection.

Question 23

what happens in malrotation

Answer 23

during rotation of small bowel in fetal life if the mesentery is not fixed at the duodenojejunal flexure or in ileocaecal region base is shorter than normal and predisposed to volvulus

Question 24

presentation malrotation

Answer 24

obstruction (due to Ladd bands) or with compromised blood supply (ischaemic bowel)

Question 25

presentation malrotation

Answer 25

obstruction with bilious vomiting in first few days of life, or later on - volvulus. dark green vomiting

Question 26

management malrotation

Answer 26

upper GI contrast, laparotomy if vascular compromise. operate- volvulus untwisted, mobilise duodenum, bowel placed in non rotated position.

Question 27

what type of inguinal hernia is it almost always

Answer 27

indirect- due to patent processus vaginalis. more freq in boys

Question 28

what type of infant is inguinal hernia common in

Answer 28

premature

Question 29

presentation inguinal hernia

Answer 29

swelling in groin, scrotum, crying, straining. may be an irreducible lump in groin or scrotum. firm and tender lump.

Question 30

when would the groin swelling become more visible

Answer 30

increase intra abdominal pressure- press on abdomen or ask them to cough

Question 31

if the lump cant be reduced what happens (inguinal hernia)

Answer 31

emergency surgery as can lead to bowel strangulation and damage to testes

Question 32

why would surgery be delayed by 24-48 hours

Answer 32

allow resolution of oedema

Question 33

what is a hydrocele

Answer 33

patent processus vaginalis allows peritoneal fluid to track down and around the testis

Question 34

features hydrocele

Answer 34

scrotal swelling, bilateral sometimes bluish discoloration, non tender, transilluminates

Question 35

when is surgery necessary hydrocele

Answer 35

most resolve spontaneously. but if it is persistent past 18-24 months then need surgery

Question 36

what is varicocele

Answer 36

varicosities of testicular veins - abnormal enlargement of pampiniform plexus

Question 37

what is varicocele associated with

Answer 37

subfertility

Question 38

symptoms varicocele

Answer 38

visible or enlarged palpable vein, aching sensation within scrotum, feeling of heaviness

Question 39

management varicocele

Answer 39

obliteration testicular vein, surgery, laparoscopic

Question 40

what happens in testicular torsion

Answer 40

spermatic cord twists cutting off blood supply

Question 41

presentation testicular torsion

Answer 41

pain may be in scrotum, groin or lower abdomen. examine all young males with inguinal or lower abdominal pain

Question 42

management testicular torsion

Answer 42

must be relieved within 6-12h for testicular viability. Doppler US to look at flow, surgery

Question 43

why is fixation of contralat testicle in torsion surgery necessary

Answer 43

as may be predisposition to torsion eg bell clapper deformity

Question 44

what is a risk factor for torsion

Answer 44

undescended testes

Question 45

what is an undescended testis

Answer 45

has been arrested along its normal pathway of descent. present in 4% term births.

Question 46

what is the term for bilateral undescended testes

Answer 46

cryptorchidism

Question 47

in who is undescended testes more common

Answer 47

prem- as testicular descent occurs in 3rd trimester

Question 48

in examination of undescended testis what is done

Answer 48

gently massage the contents of the inguinal canal to bring the testes down to a palpable position

Question 49

classification undescended testis

Answer 49

retractile, palpable, impalpable

Question 50

what is a retractile undescended testis

Answer 50

can be massaged down into bottom of scrotum but retracts back into inguinal region due to the cremasteric muscle

Question 51

what is a palpable and impalpable testis

Answer 51

palpable- testis can be felt in the inguinal region but cant be manipulated into scrotum. impalpable- cant be felt- in the inguinal canal, intra abdominal or absent

Question 52

investigations in undescended testis

Answer 52

ultrasound, hormonal- watch for rise in testosterone when inject HCG if bilateral impalpable, laparoscopy

Question 53

what is the surgery for undescended testis

Answer 53

orchidopexy- move testis into scrotum and permanently fix it there

Question 54

indications orchidopexy

Answer 54

fertility, malignancy, cosmetic, psychological

Question 55

what is fertility reduced to in bilateral orchidopexy

Answer 55

50%

Question 56

when is the risk of malignancy higher in undescended

Answer 56

if bilateral and intra abdominal