__Y6 Abdo

Question 1

Skip lesions

Crohn’s or UC?

Answer 1

Crohn’s

Question 2

No inflammation past sub-mucosa

Crohn’s or UC?

Answer 2

UC

Question 3

‘Cobblestone’ mucosa

Crohn’s or UC?

Answer 3

Crohn’s

Question 4

Pseudopolyps

Crohn’s or UC?

Answer 4

UC

Question 5

Rose thorn ulcers

Crohn’s or UC?

Answer 5

Crohn’s

Question 6

Granulomas

Crohn’s or UC?

Answer 6

Crohn’s

Question 7

Decreased goblet cells

Answer 7

UC

Question 8

Increased Goblet cells

Answer 8

Crohn’s

Question 9

Kantor’s string sign (strictures on Ba enema)

Answer 9

Crohn’s

Question 10

Extra-intestinal manifestations of IBD

Answer 10

Erythema nordosum

Arthritis

Question 11

Dermatitis herpatiformis

Intensely itchy, chronic papulovesicular blistering eruptions, usually distributed symmetrically on extensor surfaces

Answer 11

Coeliac disease

Question 12

Hypersplenism vs splenomegaly

Answer 12

Hypersplenism is about function, not necessarily large, just hyper-functioning, +++ sequestration of cells

Question 13

Causes of portal HTN

Answer 13

Pre-hepatic – portal vein thrombosis (↑risk in prothrombotic states)
Hepatic – cirrhosis (most common)
Post-hepatic – Budd-Chiari, R heart failure

Question 14

What is Budd Chiari syndrome?

Answer 14

Occlusion of hepatic veins by thrombosis

Question 15

Signs of liver decompensation

x5

Answer 15

Ascites
Encephalopathy 
Hepatorenal syndrome (biochem sign)
Variceal bleeding
(Acute onset jaundice)

Question 16

Child Pugh Score for cirrhosis mortality

Includes:
x5

Answer 16

Bilirubin
Albumin 
INR
Ascites
Encephalopathy

Question 17

Common causes of ESRF

Answer 17

PKD, diabetes, glomerulonephritis

Question 18

Pfannenstiel incision

Answer 18

Transverse, convex, suprapubic

for C-sectons, abdo hysterectomy

Question 19

Rutherford-Morrison incision

Answer 19

Hockey stick
Oblique, flank

Renal transplant

Question 20

Lanz incision

Answer 20

Horizontal incision in IF
variation of Mc Burneys

open appendectomy

Question 21

McBurney incision

Answer 21

Oblique, right iliac fossa

Open appendectomy

Question 22

Kocher incision

Answer 22

Oblique, Right upper quadrant

For hepatobiliary surgery eg. open cholecystectomy

Question 23

Abdo wall muscles and orientation

Answer 23

External oblique - hands on pockets

Internal oblique - perpendicular to ext ob

Transverse abdominal - horizontal/transverse

Question 24

Why is the Arcuate line important?

Answer 24

Below arcuate line (just below umbilicus) there is no posterior rectus sheath

Enables immediate access to peritoneum

Question 25

Transpyloric plane of Addison

Answer 25

1/2way between jugular notch and symphysis pubis

Question 26

Supercristal plane

Answer 26

L4/5, bifurcation of aorta, umbilicus in lean pts

Question 27

Discoloration of skin in pt with chronic pain due to prolonged exposure to hot water bottle?

Answer 27

Erythema ab igne

Question 28

GI causes of clubbing (x5)

Answer 28

CUMPF ``` Chronic liver disease UC/Crohns Malignancy PBC Familial ```

Question 29

Paramedian inscision

Answer 29

Historical Vertical incision, next to midline Wrongly thought it might be better than midline lap

Question 30

Rooftop incision

Answer 30

Subcostal For HPB and oesophageal-gastric cancers Mercedes Benz added vertical scar (liver transplant and allows access to chest)

Question 31

Indications for oblique and vertical inguinal incisions

Answer 31

Oblique bilateral inguinal incisions – hernias Vertical inguinal vascular access scars – access arteries/veins

Question 32

Laparostomy

Answer 32

Unable to close abdo as too ill | Once healed forms a permanent incisional hernia

Question 33

HBsAg Anti-HBs Anti-HBc HbeAg

Answer 33

HBsAg - implies current acute disease Anti-HBs - implies immunity Anti-HBc - implies previous infection (negative if vaccinated) HBeAg - a marker of infectivity (results from breakdown of core ag)

Question 34

Histology - villous atrophy, crypt hyperplasia, raised intraepithelial lymphocytes

Answer 34

Coeliac disease

Question 35

Coeliac disease histology

Answer 35

Histology - villous atrophy, crypt hyperplasia, raised intraepithelial lymphocytes

Question 36

Embryology of gut

Answer 36

Foregut - coeliac trunk Midgut - supplied by the sup mesenteric artery Hindgut - inf mesenteric artery

Question 37

Branches of coeliac trunk

Answer 37

Splenic artery, hepatic artery, left gastric

Question 38

Branches of superior mesenteric artery

Answer 38

Ileocolic artery, right colic, middle colic

Question 39

Branches of inferior mesenteric artery

Answer 39

Left colic artery, sigmoid artery, superior rectal

Question 40

What makes a healthy anastamosis?

Answer 40

Good technique (complete join, no holes), no tension, no sepsis, no cancer

Question 41

Anterior resection vs APER

Answer 41

Based on how close pathology is to anal sphincter If sphincter infiltrated or <1cm then sphincter must be sacrificed - do APER (with colostomy) IF >1cm can make a join with a low anterior resection

Question 42

How to examine spider naevi?

Answer 42

Found in distribution of the SVC Blanch and watch them fill from the CENTER >5 significant

Question 43

Signs of portal HTN

Answer 43

Splenomegaly Ascites Dilated veins on abdo (haematemesis, malaena)

Question 44

Causes of obstructive jaundice

Answer 44

Malignancy (liver, pancreas) Gallstones PBC

Question 45

Cause of ascites (x6)

Answer 45

``` Portal HTN IVC/hepatic vein obstruction Constrictive pericarditis Ovarian malignancy Peritoneal secondaties Hypo-proteinaemia states - nephrotic syndrome, liver failure, malabsorption ```

Question 46

Large mass in LUQ How do you prove it's spleen rather than kidney? (x4)

Answer 46

Spleen has a notch Cannot palpate above spleen Spleen dull to percusion, kidney resonant due to overlying bowel Kidney ballotable Spleen moves to RIF, kidney moves down towards LIF

Question 47

d

Answer 47

d