Surgical and medical abdomen

Question 1

What are the extra-intestinal manifestations of Crohn’s disease?

Answer 1

Liver - steatosis, abscess, granulomatous hepatitis

Biliary - stones, PSC

Joint - arthropathy

Eye - inflammation

Skin - erythema nodosum, pyoderma gangrenosum

Question 2

What are the extra-intestinal manifestations of ulcerative colitis?

Answer 2

Biliary - PSC

Skin - Pyoderma gangrenosum

Question 3

Signs associated with chronic stable liver disease

Answer 3

• Palmar erythema
• Dupuytren’s contracture
• > 5 spider naevi
• Gynaecosmastia

Question 4

Signs associated with portal hypertension

Answer 4

• Ascites
• Caput medusae
• Enlarged abdominal veins
• Splenomegaly

Question 5

Signs associated with liver failure

Answer 5

• Asterixis
• Foetor hepaticus (musty breath)
• Bruising
• Ascites/ oedema
• Low JVP

Question 6

Management of diverticular disease

Answer 6

Conservative
- Increase dietary fibre
Medical
- Diverticulitis: IV fluid and
abx, bowel rest
Surgical
- Para-colonic abscess (Hinchey I): Drainage
- Hinchey II, III - Laparascopic washout and drain insertion
- Hinchey IV - laparotomy, semgental resection and stoma (Hartmann’s), HDU admission
- Reccurrent diverticulitis - segmental resection

Question 7

Surgical management of carcinoma of the ceacal, ascending or proximal transverse colon

Answer 7

Right hemicolectomy with colo-colon anastomosis

Question 8

Surgical management of carcinoma of distal transverse or descending colon

Answer 8

Left/ extended right hemicolectomy

ERH thought by some to be better as anastomosis between small and large bowel better than large to large - less chance of leak

Question 9

Surgical management of carcinoma of sigmoid colon

Answer 9

High anterior resection with colo-rectal anastomosis

Question 10

Surgical management of carcinoma of rectum

Answer 10

Anterior resection (TME) with colo-rectal anastomosis

Question 11

Surgical management of carcinoma of anal verge

Answer 11

Abdomino-perineal excision of rectum (APER)

Question 12

What grade is a haemorrhoid that is reducible with pressure?

Answer 12

A. Grade III

Grade I - remains in rectum
Grade II - prolapse on defecation, spontaneous reduction
Grade III - reducible with pressure
Grade IV - irreducible

Question 13

Management of haemorrhoids

Answer 13

Conservative

• Increase dietary fibre and fluid intake to soften stools
• Fibre shown to be as effective as injection sclerotherapy

Medical

• Topical local anaesthetics
• Steroids
• Rubber band ligation superior to injection sclerotherapy

Surgical

• Reserved for large symptomatic and refractory haemorrhoids
• Novel – doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy