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MRCS A - Dr Bishoy > 24- Upper GIT Explains > Flashcards

24- Upper GIT Explains Flashcards

1
Q

What is the prevalence of BPH in men over the age of 60?

A

BPH is present in 50% of men over the age of 60.

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2
Q

Where does hyperplasia occur in the prostate gland in BPH?

A

Hyperplasia occurs in the periurethral glands in the transitional zone of the prostate.

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3
Q

What role do androgens play in the development and progression of BPH?

A

Androgens, such as testosterone, stimulate the growth and proliferation of prostatic and stromal cells, leading to BPH.

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4
Q

What is the end result of androgen stimulation in prostatic stromal cells?

A

Androgen stimulation leads to proliferation and growth of these cells.

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5
Q

What are the clinical features used to diagnose BPH?

A

Clinical diagnosis of BPH involves lower urinary tract symptoms (LUTS), palpable prostatic enlargement, and evidence of impaired voiding on urodynamic assessment.

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6
Q

What are the two main groups of LUTS in BPH?

A

LUTS in BPH can be divided into obstructive symptoms (hesitancy, poor stream, straining) and irritation symptoms (pain during bladder filling, frequency, urgency, nocturia).

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7
Q

What are the conservative management options for BPH?

A

Conservative management options include alpha-adrenergic antagonists and 5-alpha reductase inhibitors.

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8
Q

What is the gold standard surgical treatment for BPH?

A

Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for BPH.

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9
Q

When might an open retropubic prostatectomy be considered for BPH?

A

An open retropubic prostatectomy may be considered for BPH in cases of a large gland.

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10
Q

What are the two main types of germ cell tumors in testicular cancer?

A

Seminoma and nonseminomatous germ cell tumors

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10
Q

What is the most common malignancy in men aged 20-30 years?

A

Testicular cancer

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11
Q

What percentage of testicular cancer cases are germ-cell tumors?

A

Around 95%

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12
Q

What are the key features of seminoma, the most common subtype of germ cell tumor?

A

Average age at diagnosis is 40, even advanced disease has a 5-year survival rate of 73%

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13
Q

What tumor markers are associated with seminomas?

A

HCG (elevated in 10% of cases) and lactate dehydrogenase (elevated in 10-20% of cases)

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14
Q

What tumor markers are commonly elevated in nonseminomatous germ cell tumors?

A

They include teratoma, yolk sac tumor, choriocarcinoma, and mixed germ cell tumors. They present at a younger age (20-30 years) and advanced disease has a worse prognosis (48% at 5 years).

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14
Q

What are the key features of nonseminomatous germ cell tumors?

A

They include teratoma, yolk sac tumor, choriocarcinoma, and mixed germ cell tumors. They present at a younger age (20-30 years) and advanced disease has a worse prognosis (48% at 5 years).

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15
Q

What tumor markers are commonly elevated in nonseminomatous germ cell tumors?

A

AFP (elevated in up to 70% of cases) and HCG (elevated in up to 40% of cases)

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16
Q

What is the characteristic texture of nonseminomatous germ cell tumors?

A

They have a heterogeneous texture with occasional ectopic tissue, such as hair.

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17
Q

What are the risk factors for testicular cancer?

A

Cryptorchidism, infertility, family history, Klinefelter’s syndrome, and mumps orchitis

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18
Q

What is the most common presenting symptom of testicular cancer?

A

A painless lump

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19
Q

What is the first-line diagnostic test for testicular cancer?

A

Ultrasound

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20
Q

What are other possible features of testicular cancer?

A

Pain (in a minority of men), hydrocele, and gynecomastia

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21
Q

What imaging is used for staging testicular cancer?

A

CT scanning of the chest, abdomen, and pelvis

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22
Q

What should be measured as tumor markers in testicular cancer?

A

HCG, AFP, and lactate dehydrogenase

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23
Q

What is the management for testicular cancer?

A

Orchidectomy (inguinal approach), chemotherapy, and radiotherapy (depending on staging)

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24
Q

What surgical procedure may be required for abdominal lesions following chemotherapy?

A

Retroperitoneal lymph node dissection

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25
Q

What is the 5-year survival rate for seminomas if Stage I?

A

Around 95%

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26
Q

What is the 5-year survival rate for teratomas if Stage I?

A

Around 85%

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27
Q

What is another name for epididymo-orchitis?

A

Acute epididymitis

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28
Q

What is the usual cause of epididymo-orchitis in men under 35 years of age?

A

Gonorrhea or chlamydia

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29
Q

What medication is a non-infective cause of epididymitis?

A

Amiodarone

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30
Q

What are the distinguishing features of epididymo-orchitis compared to testicular torsion?

A

Tenderness usually confined to the epididymis, pain does not affect the entire testis

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31
Q

What is testicular torsion?

A

Twist of the spermatic cord resulting in testicular ischemia and necrosis

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32
Q

What is the peak incidence of testicular torsion?

A

Males aged between 10 and 30, with a peak incidence at 13-15 years

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33
Q

What are the symptoms of testicular torsion?

A

Severe and sudden onset of pain, loss of cremasteric reflex, and elevation of the testis does not ease the pain

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34
Q

What is the treatment for testicular torsion?

A

Surgical exploration and fixation of both testes

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35
Q

What is a hydrocele?

A

A mass that transilluminates and can be examined above

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35
Q

How should a hydrocele in younger men be investigated?

A

With an ultrasound to exclude tumor

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36
Q

What is the treatment for hydrocele in children?

A

Transinguinal ligation of the patent processus vaginalis

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36
Q

With an ultrasound to exclude tumor

A

Lords or Jabouley procedure

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37
Q

What is the most common cause of bladder injuries?

A

Blunt trauma

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38
Q

What percentage of bladder injuries are associated with pelvic fractures?

A

85%

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39
Q

Why are bladder injuries easily overlooked during trauma assessment?

A

They can be easily missed or overshadowed by other injuries

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40
Q

What percentage of male pelvic fractures are associated with urethral or bladder injuries?

A

Up to 10%

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41
Q

What are the two types of urethral injury in males?

A

Bulbar rupture and membranous rupture

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42
Q

What is the most common cause of bulbar rupture?

A

Straddle-type injury, such as bicycles

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42
Q

What are the signs of bulbar rupture?

A

Urinary retention, perineal hematoma, and blood at the meatus

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43
Q

What are the signs of membranous rupture?

A

Penile or perineal edema/hematoma, displaced prostate on PR examination

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44
Q

What imaging is used to investigate urethral injuries?

A

Ascending urethrogram

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45
Q

What is the management for urethral injuries?

A

Suprapubic catheter (surgical placement, not percutaneously)

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46
Q

What are the causes of external genitalia injuries?

A

Penetration, blunt trauma, continence or sexual pleasure-enhancing devices, and mutilation

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47
Q

Is bladder injury rupture intra or extraperitoneal?

A

It can be either intra or extraperitoneal

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48
Q

How can bladder injury be indicated if a Foley catheter is used to irrigate the bladder?

A

Inability to retrieve all the fluid used for irrigation

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48
Q

What are the common presentations of bladder injury?

A

Hematuria or suprapubic pain, history of pelvic fracture, and inability to void

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49
Q

What imaging is used to investigate bladder injuries?

A

Intravenous urography or cystogram

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50
Q

What is the management for bladder injuries?

A

Laparotomy if intraperitoneal, conservative if extraperitoneal

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51
Q

Why do treatments for squamous cell carcinomas (SCC) and adenocarcinomas of the esophagus differ?

A

Positive outcomes observed with radical chemoradiotherapy for localized SCC, particularly in the proximal esophagus, make surgery unnecessary

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52
Q

Who should be considered for surgery in esophageal cancer?

A

Only patients with negative staging investigations for metastatic disease

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53
Q

What is the surgical option for early localized adenocarcinoma of the distal esophagus?

A

Endoscopic mucosal resection

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54
Q

Which surgical approach is commonly used for junctional (type II) tumors with limited thoracic resection required?

A

Transhiatal esophagectomy

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55
Q

What is the advantage of Ivor Lewis esophagectomy for middle and distal tumors?

A

Lower incidence of recurrent laryngeal nerve injury

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55
Q

Which surgical approach may be useful for proximal tumors and has a lower risk of anastomotic leakage?

A

McKeown esophagectomy

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56
Q

What is the disadvantage of McKeown esophagectomy compared to Ivor Lewis esophagectomy?

A

Higher incidence of recurrent laryngeal nerve injury

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57
Q

What is associated with a survival advantage in esophageal cancer?

A

Preoperative chemotherapy

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57
Q

What is the risk associated with anastomotic leakage in intrathoracic anastomosis?

A

The risk of mediastinitis

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58
Q

What is the benefit of neoadjuvant radiotherapy alone prior to resection?

A

It confers little benefit and is not routinely performed

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59
Q

In which type of tumors does perioperative chemotherapy confer a survival advantage?

A

Junctional tumors

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60
Q

Is postoperative chemotherapy generally recommended after esophageal resections?

A

No, it is not generally recommended outside of clinical trials

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61
Q

Which treatment may improve survival in patients with HER2 positive tumors?

A

Trastuzumab

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62
Q

What is the effect of combination chemotherapy in non-operable esophageal cancer?

A

It improves quality of life and survival

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63
Q

What is the preferred treatment for patients with occluding tumors >2cm from the cricopharyngeus?

A

Oesophageal intubation with self-expanding metal stents

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64
Q

When are covered metal stents useful?

A

In cases of malignant fistulas

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65
Q

Which therapies may be useful for tumor overgrowth and bleeding?

A

Laser therapy and argon plasma coagulation

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66
Q

Should photodynamic therapy and ethanol injections be routinely used in esophageal cancer?

A

No, they confer little benefit and should not be routinely used

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67
Q

What condition presents with inguinoscrotal swelling that cannot be ‘get above it’ on examination?

A

Inguinal hernia

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68
Q

What are the symptoms of testicular tumors?

A

Discrete testicular nodule, may have associated hydrocele, and symptoms of metastatic disease

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69
Q

What tests are required to evaluate testicular tumors?

A

USS scrotum and serum AFP and β HCG

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70
Q

What are the common symptoms associated with acute epididymo-orchitis?

A

History of dysuria and urethral discharge

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71
Q

What can ease the swelling in acute epididymo-orchitis?

A

Elevating the testis

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72
Q

What is the usual cause of most cases of acute epididymo-orchitis?

A

Chlamydia infection

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73
Q

At what age do epididymal cysts usually occur?

A

Over 40 years of age

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73
Q

What may be associated with epididymal cysts?

A

Single or multiple cysts that may contain clear or opalescent fluid (spermatoceles)

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74
Q

What is a characteristic feature of hydrocele?

A

Non-painful, soft fluctuant swelling that transilluminates

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75
Q

What condition should be considered if hydrocele is the presenting feature in young men?

A

Testicular cancer

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76
Q

What is a characteristic feature of testicular torsion?

A

Severe, sudden onset testicular pain

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77
Q

Which side do varicoceles typically occur on?

A

Left side (due to the testicular vein draining into the renal vein)

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78
Q

What condition may be associated with varicoceles and affect fertility?

A

Bilateral varicoceles, and it may be a presenting feature of renal cell carcinoma

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79
Q

What is the recommended treatment for testicular torsion?

A

Urgent surgery and fixation of the contralateral testis

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80
Q

What is the treatment for testicular malignancy?

A

Orchidectomy via an inguinal approach

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81
Q

Why is orchidectomy performed via an inguinal approach for testicular malignancy?

A

It allows high ligation of the testicular vessels and avoids exposing another lymphatic field to the tumor

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82
Q

What is the treatment for testicular torsion?

A

Prompt surgical exploration and testicular fixation, achieved through sutures or placement in a Dartos pouch

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83
Q

Which age group is most commonly affected by testicular torsion?

A

Young teenagers

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84
Q

How should varicoceles be managed?

A

Usually managed conservatively, but surgery or radiological management can be considered if there are concerns about testicular function or infertility

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85
Q

What is the recommended approach for excising epididymal cysts?

A

Scrotal approach

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86
Q

How are hydroceles managed in adults?

A

Scrotal approach, with excision or plication of the hydrocele sac

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87
Q

How are hydroceles managed in children?

A

Inguinal approach, ligating the underlying patent processus vaginalis

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88
Q

Which gender is most commonly affected by urinary incontinence?

A

Females (80% of cases)

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89
Q

What is the prevalence of urinary incontinence in those aged greater than 65 years?

A

11%

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90
Q

What are the common variants of urinary incontinence?

A

Stress urinary incontinence (50%), urge incontinence (15%), and mixed incontinence (35%)

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91
Q

What anatomical factors contribute to urinary incontinence in males?

A

Males have two powerful sphincters, one at the bladder neck and the other in the urethra. Damage to the bladder neck mechanism can occur following prostatectomy and may cause retrograde ejaculation. The segment of the urethra passing through the urogenital diaphragm has both striated and smooth muscle, with the latter maintaining continence after prostatectomy.

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92
Q

How is urinary incontinence in females different from males?

A

The sphincter complex at the level of the bladder neck is poorly developed in females. The external sphincter complex is functionally more important in females, similar to males.

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93
Q

How can obstetric events in females lead to stress urinary incontinence?

A

Obstetric events may cause neuropathy, compromising the innervation of the pudendal nerve, which can lead to stress urinary incontinence.

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94
Q

What is the most common type of urinary incontinence?

A

Stress urinary incontinence, especially in females (50% of cases)

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95
Q

What are the innervation pathways involved in bladder control?

A

Somatic innervation is via the pudendal, hypogastric, and pelvic nerves. Autonomic nerves also travel in these fibers. Sympathetic innervation leads to detrusor relaxation and sphincter contraction, while parasympathetic innervation causes detrusor contraction and sphincter relaxation.

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96
Q

What can cause stress urinary incontinence?

A

Damage to the supporting structures surrounding the bladder, often from obstetric events, can lead to urethral hypermobility. Other cases may be due to sphincter dysfunction, usually from neurological disorders such as pudendal neuropathy or multiple sclerosis.

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96
Q

What are the two mechanisms that can result in involuntary passage of urine in stress urinary incontinence?

A

Urethral mobility, where pressure is not transmitted appropriately to the urethra during episodes of raised intra-abdominal pressure, and sphincter dysfunction, where the sphincter fails to adapt to compress the urethra, resulting in involuntary passage of urine. Complete failure of the sphincter can lead to continuous passage of urine.

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97
Q

What is urge incontinence?

A

Involuntary passage of urine accompanied by a sense of urgency

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98
Q

What is the main characteristic of the detrusor muscle in patients with urge incontinence?

A

Unstable and overactive detrusor muscle

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99
Q

What can urodynamic investigation reveal in patients with urge incontinence?

A

Overactivity of the detrusor muscle at inappropriate times, such as during bladder filling

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100
Q

What are the possible causes of urge incontinence?

A

Both patients with overt neurological disorders and those without can experience urgency. The exact pathophysiology is not well understood, but poor coordination of events during bladder filling is thought to be the main process.

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101
Q

What is the recommended assessment for patients with urge incontinence?

A

Careful history and examination, including vaginal examination for cystocele. Bladder diary for at least 3 days. Consider flow cystometry if symptoms are unclear or if surgery is being considered and the diagnosis is unclear. Exclude other organic diseases such as stones, UTI, and cancer.

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102
Q

What is the initial management approach for urge incontinence?

A

Conservative measures should be tried first. Patients with stress urinary incontinence or mixed symptoms should undergo 3 months of pelvic floor exercises. Patients with an overactive bladder should undergo 6 weeks of bladder retraining.

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103
Q

What drug therapy can be offered to women with overactive bladder if conservative measures fail?

A

Oxybutynin (or solifenacin if elderly)

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104
Q

What treatment options are available for women with detrusor instability who fail non-operative therapy?

A

A trial of sacral neuromodulation may be considered, with conversion to a permanent implant if there is a good response. Alternatively, augmentation cystoplasty can be considered, but this will involve long-term intermittent self-catheterization.

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105
Q

What procedure may be undertaken for women with stress urinary incontinence?

A

A urethral sling-type procedure

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106
Q

What are the NICE guidelines for the assessment and management of urinary incontinence?

A

Initial assessment should classify urinary incontinence as stress/urge/mixed. At least 3 to 7 days of bladder diary should be used if classification is not easy. Conservative treatment should be started before urodynamic studies if the diagnosis is obvious from the history. Urodynamic studies should be considered if surgery is planned. Pelvic floor exercises should be offered to all women in their first pregnancy.

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107
Q

What percentage of the worldwide population is affected by urolithiasis?

A

Up to 15%

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108
Q

What are the classic features in the history of urolithiasis?

A

Sudden onset loin to groin pain that is colicky in nature, associated with haematuria (visible or detectable on urine dipstick testing)

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109
Q

What is the most sensitive and specific investigation for suspected renal stones?

A

Helical, non-contrast, computerised tomographic (CT) scanning

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110
Q

What is the typical management for renal stones measuring less than 5mm in maximum diameter?

A

They will typically pass within 4 weeks of symptom onset.

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111
Q

When is more urgent treatment indicated for renal stones?

A

In the presence of ureteric obstruction, renal developmental abnormalities (such as horseshoe kidney), and previous renal transplant.

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112
Q

What are the options for treating ureteric obstruction together with infection as a surgical emergency?

A

Nephrostomy tube placement or ureteric stent placement via cystoscopy

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113
Q

What are the preferred options for the non-emergency treatment of renal stones?

A

Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS)

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114
Q

What are the potential complications of extracorporeal shock wave lithotripsy (ESWL)?

A

Solid organ injury and fragmentation of larger stones resulting in ureteric obstruction.

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114
Q

What is the principle behind extracorporeal shock wave lithotripsy (ESWL)?

A

Shock waves generated externally lead to stone fragmentation through cavitation bubbles and mechanical stress.

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115
Q

When is extracorporeal shock wave lithotripsy (ESWL) contraindicated?

A

In pregnant females and patients with significant vascular calcification.

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116
Q

How is a ureteroscope passed during ureteroscopy?

A

Retrograde via the urethra, bladder, and into the ureter and renal pelvis

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117
Q

What methods are used for stone fragmentation during ureteroscopy?

A

Laser or pneumatic fragmentation (lithoclasty) using the ureteroscope

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118
Q

What is done with the stone fragments during ureteroscopy?

A

They are extracted

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119
Q

How is percutaneous access gained during percutaneous nephrolithotomy?

A

Through percutaneous access to the renal collecting system

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120
Q

What procedures are performed to fragment and remove stones during percutaneous nephrolithotomy?

A

Endoscopic intra-corporeal lithotripsy, lithoclasty, or laser stone fragmentation

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121
Q

What is the purpose of percutaneous nephrolithotomy?

A

To remove stone fragments

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122
Q

What is the first-line option for renal stones measuring less than 5mm and asymptomatic?

A

Watchful waiting

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123
Q

What is the first-line option for renal stones measuring less than 10mm?

A

Extracorporeal shock wave lithotripsy (ESWL)

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124
Q

What are the first-line options for renal stones measuring 10-20mm?

A

ESWL or ureteroscopy

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125
Q

What is the first-line option for renal stones measuring greater than 20mm (including staghorn calculi)?

A

Percutaneous nephrolithotomy (PCNL)

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126
Q

What is the first-line option for ureteric stones measuring 10-20mm?

A

Ureteroscopy

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126
Q

What is the first-line option for ureteric stones measuring less than 5mm?

A

Watchful waiting

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127
Q

What is the first-line option for ureteric stones measuring 5-10mm?

A

Extracorporeal shock wave lithotripsy (ESWL)

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128
Q

What is vasectomy?

A

A commonly performed technique for permanent sterilization

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129
Q

What is the failure rate of vasectomy?

A

1 in 2000

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130
Q

How is vasectomy typically performed?

A

Under local anesthesia

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131
Q

What are the success rates for vasectomy reversal within 10 years of the procedure?

A

Approximately 55%

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132
Q

Is vasectomy considered a permanent procedure?

A

Yes, for counseling purposes

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133
Q

What is the standard technique for vasectomy?

A

Small bilateral incisions and formal dissection of the vas

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134
Q

What is the ‘no scalpel’ technique for vasectomy?

A

A technique involving the use of haemostats for skin puncture

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135
Q

Is it necessary to routinely send the vas for histology after vasectomy?

A

No

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136
Q

Who should be cautious when considering vasectomy?

A

Childless, single men under the age of 30

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137
Q

What are the risks associated with vasectomy?

A

Chronic scrotal pain, haematomas, and sperm granulomas

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138
Q

When should clearance be granted after vasectomy?

A

After a negative sperm sample is available, usually taken 12-16 weeks post-procedure

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139
Q

Can recanalization occur after vasectomy?

A

Yes, in 0.04% of cases

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140
Q

What is the criteria for ‘special clearance’ to stop contraception after vasectomy?

A

Less than 10,000 non-motile sperm/mL found in a fresh specimen examined at least 7 months after vasectomy

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141
Q

Do the risks of sexually transmitted infections (STIs) change after vasectomy?

A

No, the risks of STIs remain unchanged

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142
Q

What is a Mallory-Weiss Tear?

A

A tear in the oesophagus usually caused by antecedent vomiting, followed by the vomiting of a small amount of blood

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143
Q

What are the features of a Mallory-Weiss Tear?

A

Little systemic disturbance or prior symptoms

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144
Q

What is a Hiatus Hernia of gastric cardia?

A

A longstanding condition associated with dyspepsia, often seen in overweight patients

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145
Q

Can uncomplicated hiatus hernias be associated with dysphagia or haematemesis?

A

No

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146
Q

What is Oesophageal Rupture?

A

A complete disruption of the oesophageal wall in the absence of pre-existing pathology, commonly occurring at the left postero-lateral oesophagus

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147
Q

What are the signs of Oesophageal Rupture?

A

Severe chest pain without cardiac diagnosis, signs suggestive of pneumonia without convincing history, history of vomiting

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148
Q

What is Squamous Cell Carcinoma of the oesophagus?

A

A type of oesophageal cancer characterized by progressive dysphagia and weight loss

149
Q

Is there a history of previous GORD symptoms in Squamous Cell Carcinoma of the oesophagus?

A

Usually little or no history of previous GORD symptoms

150
Q

What is Adenocarcinoma of the oesophagus?

A

Another type of oesophageal cancer characterized by progressive dysphagia, may have previous symptoms of GORD or Barrett’s oesophagus

151
Q

What is Dysmotility Disorder?

A

A condition characterized by episodic and non-progressive dysphagia, may be accompanied by retrosternal pain

152
Q

What are the features of Peptic Stricture?

A

Longer history of dysphagia, often not progressive, symptoms of GORD, lack systemic features seen with malignancy

153
Q

How can most oesophageal diseases be accurately diagnosed?

A

Through upper GI endoscopy, pH and manometry studies, and radiological contrast swallows

154
Q

How many types of metaplastic processes are recognized in Barrett’s oesophagus?

A

Three types: intestinal (high risk), cardiac, and fundic

155
Q

What is Barrett’s oesophagus characterized by?

A

The metaplastic transformation of squamous oesophageal epithelium to columnar gastric type epithelium

156
Q

What is the most concrete diagnosis for Barrett’s oesophagus?

A

Presence of endoscopic features of Barrett’s oesophagus and a deep biopsy demonstrating goblet cell metaplasia and oesophageal glands

157
Q

How is Barrett’s oesophagus classified based on the length of the affected segment?

A

Short (<3cm) and long (>3cm)

158
Q

What is the correlation between the length of the affected segment and the chances of identifying metaplasia?

A

Strong correlation

159
Q

What is the overall prevalence of Barrett’s oesophagus?

A

Difficult to determine, but may be around 1 in 20

160
Q

What proportion of patients with metaplasia may progress to dysplasia?

A

A proportion of patients

161
Q

How often should endoscopic surveillance be done for individuals with Barrett’s oesophagus?

A

Every 2-5 years

161
Q

Why should individuals with Barrett’s oesophagus undergo endoscopic surveillance?

A

To detect dysplasia

162
Q

What kind of biopsies should be taken during endoscopic surveillance?

A

Quadrantic biopsies taken at 2-3cm intervals

163
Q

What should be considered when mass lesions are present in Barrett’s oesophagus?

A

Endoscopic submucosal resection

164
Q

What is the recommended treatment for Barrett’s oesophagus?

A

Long-term proton pump inhibitor therapy

165
Q

In younger patients, what additional studies may be considered for treatment?

A

pH and manometry studies to consider anti-reflux procedures

166
Q

How frequently should endoscopic monitoring be done for individuals with moderate dysplasia?

A

More frequently

167
Q

What precaution should be taken when severe dysplasia is present in Barrett’s oesophagus?

A

To be wary of small foci of cancer

168
Q

What are the features of calcium oxalate stones?

A

Hypercalciuria, hyperoxaluria, hypocitraturia, radio-opaque

169
Q

What is a major risk factor for calcium oxalate stones?

A

Hypercalciuria

170
Q

Why are calcium oxalate stones radio-opaque?

A

Due to their composition

171
Q

What increases the risk of calcium oxalate stones?

A

Hyperoxaluria and hypocitraturia

172
Q

What can cause uric acid stones to form along with calcium oxalate?

A

Hyperuricosuria

173
Q

What is the percentage of all calculi accounted for by calcium oxalate stones?

A

85%

174
Q

What are the features of cystine stones?

A

Inherited recessive disorder, multiple stones, radiodense (contain sulfur)

175
Q

What causes cystine stones to form?

A

Decreased absorption of cystine due to transmembrane cystine transport disorder

176
Q

What is the percentage of all calculi accounted for by cystine stones?

A

1%

177
Q

What are the features of uric acid stones?

A

Formed from purine metabolism, precipitate in low urinary pH, more common in children with inborn errors of metabolism, radiolucent

178
Q

What is the percentage of all calculi accounted for by uric acid stones?

A

5-10%

179
Q

What is the percentage of all calculi accounted for by calcium phosphate stones?

A

10%

179
Q

What are the features of calcium phosphate stones?

A

Associated with renal tubular acidosis, high urinary pH increases supersaturation of urine with calcium and phosphate, radio-dense (composition similar to bone)

180
Q

What are the features of struvite stones?

A

Formed from magnesium, ammonium, and phosphate, associated with urease-producing bacteria and chronic infections, slightly radio-opaque

181
Q

What is the percentage of all calculi accounted for by struvite stones?

A

2-20%

182
Q

What is the mean urine pH for calcium phosphate stones?

A

Normal to alkaline (>5.5)

182
Q

How does urine pH affect stone formation?

A

Urine pH can vary from acidic to alkaline, and different stone types are associated with different urine pH levels

183
Q

What is the mean urine pH for calcium oxalate stones?

A

Variable (around 6)

184
Q

What is the mean urine pH for uric acid stones?

A

Acidic (around 5.5)

185
Q

What is the mean urine pH for struvite stones?

A

Alkaline (>7.2)

186
Q

What is the mean urine pH for cystine stones?

A

Normal (around 6.5)

187
Q

What is renal cell carcinoma?

A

An adenocarcinoma of the renal cortex believed to arise from the proximal convoluted tubule

188
Q

What are the characteristics of renal cell carcinoma?

A

Usually solid lesions, up to 20% may be multifocal, 20% may be calcified, and 20% may have a cystic component or be wholly cystic

189
Q

How are renal cell carcinomas often circumscribed?

A

By a pseudocapsule of compressed normal renal tissue

190
Q

How does renal cell carcinoma spread?

A

Direct extension into the adrenal gland, renal vein, or surrounding fascia, or via the haematogenous route to lung, bone, or brain

191
Q

What percentage of all renal malignancies does renal cell carcinoma comprise?

A

Up to 85%

192
Q

Who is more commonly affected by renal cell carcinoma?

A

Males (typically in their sixth decade)

193
Q

What are common symptoms of renal cell carcinoma?

A

Haematuria (50%), loin pain (40%), mass (30%), and symptoms of metastasis (up to 25%)

194
Q

What is the recommended imaging modality for investigating renal masses?

A

Multislice CT scanning

195
Q

What should be done to detect distant disease in renal cell carcinoma?

A

CT scanning of the chest and abdomen

196
Q

When should a biopsy be performed in renal cell carcinoma?

A

Before any ablative therapies are undertaken

197
Q

What is the management approach for T1 lesions in renal cell carcinoma?

A

Partial nephrectomy, which gives equivalent oncological results to total radical nephrectomy

198
Q

When is radical nephrectomy performed in renal cell carcinoma?

A

For T2 lesions and above

199
Q

What should be done during surgery for renal cell carcinoma?

A

Early venous control to avoid shedding of tumour cells into the circulation

200
Q

Do patients with completely resected renal cell carcinoma benefit from adjuvant therapy?

A

No, adjuvant therapy is not beneficial

201
Q

What is the recommended treatment for transitional cell cancer?

A

Nephroureterectomy with disconnection of the ureter at the bladder

202
Q

What is a DMSA scan?

A

A scintigraphy using dimercaptosuccinic acid (DMSA)

202
Q

Which part of the kidney does DMSA localize to?

A

Renal cortex

203
Q

How does DTPA provide information about glomerular filtration rate (GFR)?

A

It is filtered at the level of the glomerulus

203
Q

What can a DMSA scan help identify?

A

Cortical defects and ectopic or aberrant kidneys

204
Q

What is DTPA used for?

A

Assessing renal function

204
Q

Does a DMSA scan provide information on the ureter or collecting system?

A

No, it does not

205
Q

Can image quality be affected in patients with chronic renal impairment?

A

Yes, it may be degraded in such cases

206
Q

What is used for a MAG 3 renogram?

A

Mercaptoacetyle triglycine (MAG 3)

207
Q

How is MAG 3 primarily excreted?

A

By tubular cells instead of being filtered at the glomerulus

208
Q

In which patients is MAG 3 the preferred agent for kidney imaging?

A

Patients with existing renal impairment

209
Q

What does an MCUG scan provide information about?

A

Bladder reflux

210
Q

How is an MCUG scan performed?

A

By filling the bladder with contrast media and asking the child to void

211
Q

What can be calculated based on the images obtained during an MCUG scan?

A

The degree of reflux

212
Q

What can intravenous urography provide evidence of?

A

Renal stones or other structural lesions

212
Q

What is intravenous urography?

A

An examination using intravenous iodinated contrast media

213
Q

Is intravenous urography commonly used for assessing renal function?

A

No, it is now rarely used due to non-contrast CT scan protocols for detecting urinary tract calculi

214
Q

When is PET/CT used in renal imaging?

A

To evaluate structurally indeterminate lesions in the staging of malignancy

215
Q

What can be used to supplement oral intake?

A

Calorie-rich dietary supplements

216
Q

When may naso gastric feeding be safe to use?

A

In patients with impaired swallow

217
Q

When is naso gastric feeding often contraindicated?

A

Following head injury due to risks associated with tube insertion

218
Q

What problem does naso jejunal feeding avoid?

A

Feed pooling in the stomach and the risk of aspiration

219
Q

How is the feeding tube inserted for naso jejunal feeding?

A

More technically complicated, easiest if done intraoperatively

220
Q

When is naso jejunal feeding safe to use?

A

Following oesophagogastric surgery

221
Q

What is a feeding jejunostomy?

A

A surgically sited feeding tube

222
Q

How long can feeding jejunostomy be used for?

A

Long-term feeding

223
Q

What are the main risks associated with feeding jejunostomy?

A

Tube displacement and peritubal leakage immediately following insertion, which carries a risk of peritonitis

224
Q

How is percutaneous endoscopic gastrostomy performed?

A

Combined endoscopic and percutaneous tube insertion

225
Q

When may percutaneous endoscopic gastrostomy not be possible?

A

In patients who cannot undergo successful endoscopy

226
Q

How should total parenteral nutrition be administered?

A

Via a central vein

226
Q

What are the risks associated with percutaneous endoscopic gastrostomy?

A

Aspiration and leakage at the insertion site

227
Q

When is total parenteral nutrition used?

A

In patients in whom enteral feeding is contraindicated

228
Q

What is needed for total parenteral nutrition?

A

Individualized prescribing and monitoring

229
Q

Are resections offered to patients with distant metastasis or N2 disease?

A

No, in general, resections are not offered to those patients

229
Q

What are the long-term risks associated with total parenteral nutrition?

A

Fatty liver and deranged liver function tests

230
Q

Is local nodal involvement a contraindication to resection?

A

No, local nodal involvement is not a contraindication to resection

230
Q

What is the mainstay of treatment for esophageal cancer?

A

Surgical resection

231
Q

When is neoadjuvant chemotherapy given in the treatment of esophageal cancer?

A

In most cases, prior to surgery

232
Q

How may in situ disease be managed?

A

By endoscopic mucosal resection

233
Q

What type of procedure is commonly performed for lower third lesions of the esophagus?

A

Ivor-Lewis procedure

234
Q

What type of procedure is required for more proximal lesions of the esophagus?

A

Total esophagectomy (Mckeown type) with anastomosis to the cervical esophagus

235
Q

Why is a transhiatal procedure an attractive option for very distal tumors?

A

Because the penetration of two visceral cavities required for an Ivor-Lewis procedure increases the morbidity considerably

236
Q

What options are available for patients with unresectable esophageal cancer?

A

Local ablative procedures, palliative chemotherapy, or stent insertion

237
Q

What incision is made to access the stomach and duodenum in the Ivor-Lewis procedure?

A

A rooftop incision

238
Q

What is the first step in laparotomy to mobilize the stomach?

A

Incising the greater omentum along the greater curvature of the stomach

239
Q

What is done after incising the greater omentum?

A

Ligating and detaching the short gastric vessels from the spleen

240
Q

How is the lesser omentum incised?

A

How is the lesser omentum incised?

241
Q

What attachments of the duodenum are incised to allow the pylorus to reach the oesophageal hiatus?

A

Retroperitoneal attachments in the second and third portions

242
Q

What additional procedure may be performed to facilitate gastric emptying?

A

Pyloroplasty

243
Q

Where is the incision made for right thoracotomy?

A

Through the 5th intercostal space

244
Q

At what point is the dissection performed?

A

10cm above the tumor

245
Q

What is done after removing the oesophagus with the stomach?

A

Creating a gastric tube and performing an anastomosis

245
Q

What may be transected during the dissection?

A

The azygos vein

246
Q

Where do patients typically recover initially postoperatively?

A

In the Intensive Care Unit (ITU)

247
Q

What must remain in place during the early phases of recovery?

A

The nasogastric tube

248
Q

What is the risk of anastomotic leakage?

A

Relatively high, especially due to the devascularization of the stomach

249
Q

What are some potential complications postoperatively?

A

Atelectasis, anastomotic leakage, and delayed gastric emptying

250
Q

How is delayed gastric emptying often managed?

A

By performing a pyloroplasty

251
Q

How many men are diagnosed with prostate cancer each year?

A

Up to 30,000

252
Q

How many men die from prostate cancer in the UK per year?

A

Up to 9,000

252
Q

What are the possible presentations of metastatic prostate cancer?

A

Bone pain

253
Q

How does locally advanced prostate cancer present?

A

Pelvic pain or urinary symptoms

254
Q

What tests are used for the diagnosis of prostate cancer?

A

Prostate specific antigen measurement, digital rectal examination, transrectal ultrasound (with or without biopsy), MRI/CT and bone scan for staging

255
Q

What is the normal upper limit for prostate specific antigen (PSA)?

A

4ng/ml

256
Q

What can cause false positives in PSA tests?

A

Prostatitis, UTI, BPH, vigorous digital rectal examination (DRE)

257
Q

How can the percentage of free: total PSA help distinguish benign disease from cancer?

A

Values of <20% are suggestive of cancer and biopsy is advised

258
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma (95%)

259
Q

How is prostate cancer graded using the Gleason grading system?

A

Two grades are awarded, one for the most dominant grade and one for the second most dominant grade. The grades are added together to give the Gleason score

260
Q

Where does lymphatic spread occur first in prostate cancer?

A

To the obturator nodes

261
Q

What is the standard treatment for localized prostate cancer?

A

Radical prostatectomy (surgical removal of the prostate)

262
Q

What alternative treatment options are available for prostate cancer?

A

Watchful waiting, radiotherapy, hormonal therapy

263
Q

What is the preferred option for low-risk men according to NICE?

A

Active surveillance

264
Q

What are the criteria for candidates of active surveillance?

A

Clinical stage T1c, Gleason score 3+3, PSA density < 0.15 ng/ml/ml, cancer in less than 50% of biopsy cores, <10 mm of any core involved

264
Q

What should be offered if men on active surveillance show evidence of disease progression?

A

Radical treatment

265
Q

How should treatment decisions be made for prostate cancer?

A

In consultation with the patient, considering co-morbidities and life expectancy

266
Q

What is renal cell carcinoma?

A

An adenocarcinoma of the renal cortex believed to arise from the proximal convoluted tubule

267
Q

What are the characteristics of renal cell carcinoma?

A

Usually solid lesions, may be multifocal, calcified, or have a cystic component. Often circumscribed by a pseudocapsule of compressed normal renal tissue

268
Q

What percentage of renal malignancies do renal cell carcinomas comprise?

A

Up to 85%

269
Q

How does renal cell carcinoma spread?

A

Direct extension into the adrenal gland, renal vein, or surrounding fascia, and via the haematogenous route to lung, bone, or brain

270
Q

Who is more commonly affected by renal cell carcinoma?

A

Males

271
Q

What are the common symptoms of renal cell carcinoma?

A

Haematuria, loin pain, mass, symptoms of metastasis

272
Q

What imaging modality is used to investigate renal masses?

A

Multislice CT scanning

273
Q

What additional phases may be added to the CT scan for renal masses?

A

Arterial and venous phases to demonstrate vascularity and evidence of caval ingrowth

274
Q

Is routine bone scanning necessary for renal masses?

A

No, unless there are symptoms suggestive of bone involvement

274
Q

When is biopsy not performed for renal masses?

A

When a nephrectomy is planned

275
Q

What is the standard treatment for T1 renal lesions?

A

Partial nephrectomy

275
Q

What is the standard treatment for T2 renal lesions and above?

A

Radical nephrectomy

276
Q

How do calcium oxalate stones appear on x-ray?

A

Opaque

276
Q

Do patients with completely resected renal cell carcinoma benefit from adjuvant therapy?

A

No, adjuvant therapy is not beneficial unless part of a clinical trial

277
Q

What is the management approach for transitional cell cancer?

A

Nephroureterectomy with disconnection of the ureter at the bladder

278
Q

What is the frequency of calcium oxalate stones?

A

40%

279
Q

What is the frequency of mixed calcium oxalate/phosphate stones?

A

25%

280
Q

How do triple phosphate stones appear on x-ray?

A

Opaque

281
Q

How do mixed calcium oxalate/phosphate stones appear on x-ray?

A

Opaque

281
Q

What is the frequency of triple phosphate stones?

A

10%

282
Q

What is the frequency of calcium phosphate stones?

A

10%

282
Q

How do calcium phosphate stones appear on x-ray?

A

Opaque

283
Q

What is the frequency of urate stones?

A

5-10%

284
Q

How do urate stones appear on x-ray?

A

Radio-lucent

285
Q

What is the frequency of cystine stones?

A

1%

286
Q

How do cystine stones appear on x-ray?

A

Semi-opaque, ‘ground-glass’ appearance

287
Q

What is the frequency of xanthine stones?

A

<1%

288
Q

How do xanthine stones appear on x-ray?

A

Radio-lucent

289
Q

What are the causes of unilateral hydronephrosis?

A

Pelvic-ureteric obstruction (congenital or acquired), aberrant renal vessels, calculi, tumours of the renal pelvis

290
Q

What are the causes of bilateral hydronephrosis?

A

Stenosis of the urethra, urethral valve, prostatic enlargement, extensive bladder tumour, retro-peritoneal fibrosis

290
Q

What imaging modality can identify the presence of hydronephrosis and assess the kidneys?

A

USS (Ultrasound)

291
Q

What imaging modality can assess the position of the obstruction?

A

IVU (Intravenous Urogram)

292
Q

What type of pyelography allows for treatment?

A

Antegrade or retrograde pyelography

293
Q

What imaging modality is used if renal colic is suspected?

A

Non-contrast CT scan

294
Q

What is the management approach for acute upper urinary tract obstruction?

A

Nephrostomy tube placement

295
Q

What is the management approach for chronic upper urinary tract obstruction?

A

Ureteric stent or pyeloplasty

296
Q

What is the increased risk of bladder cancer for current or previous smokers?

A

2-5 fold

297
Q

What is the second most common urological cancer?

A

Bladder cancer

298
Q

What is a common cause of squamous cell carcinomas in regions where Schistosomiasis is endemic?

A

Chronic bladder inflammation arising from Schistosomiasis infection

299
Q

What is the most common type of bladder malignancy?

A

Transitional cell carcinoma (>90% of cases)

300
Q

Are benign tumours of the bladder common?

A

No, they are uncommon

301
Q

Who does bladder cancer most commonly affect?

A

Males aged between 50 and 80 years of age

302
Q

What is the prevalence of squamous cell carcinoma in regions affected by Schistosomiasis?

A

1-7%

303
Q

What growth patterns are seen in transitional cell carcinomas?

A

Papillary (up to 70% of cases), mixed papillary and solid, or pure solid growths

304
Q

Do superficial transitional cell carcinomas have a better prognosis?

A

Yes

305
Q

TNM Staging
Stage Description

A

T0 No evidence of tumour
Ta Non invasive papillary carcinoma
T1 Tumour invades sub epithelial connective tissue
T2a Tumor invades superficial muscularis propria (inner half)
T2b Tumor invades deep muscularis propria (outer half)
T3 Tumour extends to perivesical fat
T4 Tumor invades any of the following: prostatic stroma, seminal vesicles,
uterus, vagina
T4a Invasion of uterus, prostate or bowel
T4b Invasion of pelvic sidewall or abdominal wall
N0 No nodal disease
N1 Single regional lymph node metastasis in the true pelvis (hypogastric,
obturator, external iliac, or presacral lymph node)
N2 Multiple regional lymph node metastasis in the true pelvis (hypogastric,
obturator, external iliac, or presacral lymph node metastasis)
N3 Lymph node metastasis to the common iliac lymph nodes
M0 No distant metastasis
M1 Distant disease

305
Q

What is the most common presentation of bladder cancer?

A

Painless, macroscopic hematuria

306
Q

What percentage of females aged over 50 with incidental microscopic hematuria may have a malignancy?

A

Up to 10%

307
Q

What is the risk of regional or distant lymph node metastasis for T3 bladder cancer or worse?

A

30% or higher

308
Q

What increases the risk of bladder cancer?

A

Exposure to hydrocarbons such as 2-Naphthylamine

309
Q

What is the recommended diagnostic procedure for bladder cancer?

A

Cystoscopy and biopsies or TURBT (Transurethral Resection of Bladder Tumor)

309
Q

What imaging modalities are used to determine locoregional spread and distant disease?

A

Pelvic MRI and CT scanning

310
Q

What is the prevalence of adenocarcinoma in bladder malignancies?

A

2%

311
Q

How are nodes of uncertain significance investigated?

A

PET-CT (Positron Emission Tomography - Computed Tomography)

312
Q

What treatment option is available for superficial lesions?

A

TURBT (Transurethral Resection of Bladder Tumor)

313
Q

What treatment option is offered to those with recurrences or higher grade/risk on histology?

A

Intravesical chemotherapy

314
Q

What treatment options are available for T2 disease?

A

Surgery (radical cystectomy and ileal conduit) or radical radiotherapy

314
Q

What is the 5-year survival rate for T1 bladder cancer?

A

90%

315
Q

What is the 5-year survival rate for T2 bladder cancer?

A

60%

316
Q

What is the 5-year survival rate for T3 bladder cancer?

A

35%

317
Q

What is the 5-year survival rate for T4a bladder cancer?

A

10-25%

317
Q

What is the 5-year survival rate for any T stage with N1-N2 lymph node involvement?

A

30

318
Q

What is the major health problem in the Western world that bariatric surgery aims to address?

A

Obesity

318
Q

What have randomized controlled trials shown regarding weight loss after surgical interventions compared to standard medical therapy?

A

Dramatic weight loss can be achieved following surgical interventions

319
Q

Is weight loss more durable following surgical interventions or non-surgical interventions?

A

Weight loss is more durable following surgical interventions

320
Q

What are the case selection criteria for bariatric surgery?

A

BMI ≥ 40 kg/m² or between 35-40 kg/m² with other significant diseases that could be improved with weight loss

321
Q

What are the prerequisites for bariatric surgery according to NICE UK Guidelines?

A

Non-surgical measures have failed for at least 6 months, will receive intensive specialist management, fit for anesthesia and surgery, commit to long-term follow-up

321
Q

What is the surgical procedure of adjustable gastric band?

A

Laparoscopic placement of an adjustable band around the proximal stomach that can be filled or adjusted

322
Q

What is the first-line option for adults with a BMI > 40 kg/m² for whom surgical intervention is appropriate?

A

Adjustable gastric band or consider orlistat if there is a long waiting list

323
Q

What is the surgical procedure of gastric bypass?

A

Combines changes to reservoir size with a malabsorptive procedure for enduring weight loss

323
Q

What are the complications associated with adjustable gastric band surgery?

A

Rare complications include band erosion, slippage, or loss of efficacy

324
Q

What are the risks associated with gastric bypass surgery?

A

Technically more challenging with risks related to anastomoses, including a 2% leak rate. Up to 50% may become B12 deficient

325
Q

What is the surgical procedure of sleeve gastrectomy?

A

Resection of the stomach using stapling devices

325
Q

Why is sleeve gastrectomy less popular now?

A

Initial promising results have not been sustained

325
Q

What are some post gastrectomy syndromes that may occur?

A

Small capacity (early satiety), dumping syndrome, bile gastritis, afferent loop syndrome, efferent loop syndrome, anemia (B12 deficiency), metabolic bone disease

326
Q

Which reconstruction method generally provides the best functional outcomes?

A

Roux en Y reconstruction

327
Q

In reconstruction following distal gastrectomy, what can improve gastric emptying?

A

Tunneling the jejunal limbs in the retrocolic plane

328
Q

What is the characteristic symptom of small capacity post gastrectomy syndrome?

A

Early satiety

329
Q

What is dumping syndrome?

A

A syndrome characterized by rapid emptying of undigested food from the stomach into the small intestine, leading to symptoms such as diarrhea, nausea, and lightheadedness

330
Q

What is bile gastritis?

A

Inflammation of the stomach lining caused by the reflux of bile into the stomach

331
Q

What is efferent loop syndrome?

A

Obstruction or distention of the efferent loop, the portion of the small intestine that carries food from the stomach after a gastrectomy

332
Q

What is afferent loop syndrome?

A

Obstruction or distention of the afferent loop, the portion of the small intestine that carries bile and pancreatic juices to the stomach after a gastrectomy

333
Q

What deficiency may lead to anemia following gastrectomy?

A

B12 deficiency

334
Q

What is metabolic bone disease?

A

A condition characterized by the loss of bone density and increased risk of fractures due to malabsorption of nutrients after gastrectomy

335
Q

What are the functions of the stomach in relation to gastric emptying?

A

Mechanical function and immunological function

335
Q

What happens to solid and liquid material in the stomach during gastric emptying?

A

Repeated peristaltic activity against a closed pyloric sphincter causes fragmentation of food bolus material

336
Q

How does gastric acid contribute to gastric emptying?

A

Gastric acid helps neutralize any pathogens present

337
Q

What factors affect the amount of time material spends in the stomach?

A

Composition and volume of the material

338
Q

Give an example of how composition affects gastric emptying.

A

A glass of water will empty more quickly than a large meal. The presence of amino acids and fat will delay gastric emptying

338
Q

Which neuronal stimulation mediates gastric motility?

A

Vagus nerve (parasympathetic nervous system)

339
Q

Why do individuals who have undergone truncal vagotomy require pyloroplasty or gastro-enterostomy?

A

Truncal vagotomy causes delayed gastric emptying

340
Q

What hormonal factors are involved in gastric emptying?

A

Gastric inhibitory peptide (delays emptying), Gastrin (increases emptying), Cholecystokinin, Enteroglucagon

341
Q

How can diseases affecting gastric emptying impact the stomach?

A

They may result in bacterial overgrowth, retained food, formation of bezoars, dyspepsia, reflux, and foul-smelling belches of gas

342
Q

How can gastric surgery affect gastric emptying?

A

Gastric surgery, especially procedures that disrupt the vagus nerve, can cause delayed emptying. Procedures like vagotomy, oesophagectomy, and distal gastrectomy can impact gastric emptying

342
Q

In a gastro-enterostomy, which type of anastomosis empties better?

A

A posterior, retrocolic gastroenterostomy empties better than an anterior one

343
Q

What is the main cause of diabetic gastroparesis?

A

Neuropathy affecting the vagus nerve

344
Q

What is the characteristic symptom of diabetic gastroparesis?

A

Poor stomach emptying and episodes of repeated and protracted vomiting

345
Q

Why are drugs like metoclopramide less effective in treating diabetic gastroparesis?

A

They exert their effect via the vagus nerve, which is affected by neuropathy

345
Q

How is the diagnosis of diabetic gastroparesis made?

A

Upper GI endoscopy, contrast studies, and sometimes a radio nucleotide scan

346
Q

What is a prokinetic drug that can be used to treat diabetic gastroparesis?

A

Erythromycin, an antibiotic that works differently

347
Q

How can distal gastric cancer and pancreatic malignancies affect gastric emptying?

A

They can obstruct the pylorus or cause extrinsic compression of the duodenum, leading to delayed emptying

348
Q

What are the treatment options for gastric emptying delay caused by malignancies?

A

Gastric decompression using a wide bore nasogastric tube, insertion of a stent, or surgical gastroenterostomy

349
Q

At what age does congenital hypertrophic pyloric stenosis typically present?

A

Around 6 weeks of age

349
Q

What other procedure may be done in cases of malignant disease that is being palliated?

A

Roux en Y bypass, although the increased number of anastomoses is usually not justified

350
Q

Where are gastroenterostomies usually placed for bypassing malignancies, despite emptying less well?

A

On the anterior wall of the stomach

351
Q

How is the diagnosis of congenital hypertrophic pyloric stenosis usually made?

A

Careful history, examination, and ultrasound showing hypertrophied pylorus

352
Q

What is the characteristic symptom of congenital hypertrophic pyloric stenosis?

A

Projectile non bile stained vomiting

353
Q

What is the treatment for congenital hypertrophic pyloric stenosis?

A

Pyloromyotomy, either open or laparoscopic

354
Q

Are there any long-term sequelae after treating congenital hypertrophic pyloric stenosis?

A

No, there are no long-term complications or effects

MRCS A - Dr Bishoy (58 decks)

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