Abdo

Question 1

Anatomy of the inguinal canal

Answer 1

Anterior: external oblique and internal oblique for the lateral third
Posterior: transversalis fascia and conjoint tendon for medial third
Floor: inguinal ligament
Roof: arching fibre of transversus and internal oblique

Question 2

Contents of the spermatic cord

Answer 2

Three layers of fascia:
1. External spermatic fascia 
2. Cremestatic fascia
3. Internal spermatic 
Three ateries and three viens 
1. Testicular
2. Cresmenteric 
3. Vas 
Two nerves
1. Sympathetic 
2. Gential branch of gen fem nerve 
Lymphatic 
Vas 
Process vaginalis

Question 3

Contents of inguinal canal

Answer 3

M: spermatic cord and illoinguinal nerve
F: round ligament, illoinguinal nerve , gen branch of gen fem nerve

Question 4

Hesselbach’s triangle

Answer 4

Medial: rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament

Question 5

Classification of inguinal hernia

Answer 5

Indirect - 80% 
- patent processus vaginalis 
- arise lateral to inferior epigastric artery 
Direct -20% 
- emerge through hesselbach's triangle 
- due to acquired weak wall of canal

Question 6

Laparoscopic techniques for inguinal hernia

Answer 6

TEP: totally extra peritoneal
TAPP: transabdominal pre- peritoneal

Question 7

Complications of inguinal hernia repair

Answer 7

Early 
- urinary retention 
- haematoma/ seroma formation - 10% 
- infection - 1% 
- intrabdominal Injury - lap 
Late 
- reoccurrence

Question 8

Borders of the femoral canal

Answer 8

Medial: lacunar ligament
Lateral: femoral vien
Anterior: inguinal ligament
Posterior: pectineal ligament of cooper

Question 9

Operative management of a femoral hernia

Answer 9

Elective: Lockwood low approach
Emergency: McEvedy high approach

Question 10

Definition of an inguinal hernia

Answer 10

Extrusion of peritoneum and abdominal contents through a previously acquired defect

Question 11

Risk factors for incscional hernias

Answer 11

Pre-op: increased age, co-mobrdities ( malignancy and obesity )
Intra - op: surgical technique ( width of suture bites, suture material, midline, placing drain through wounds )
Post op: incensed IAP, infection, heamatoma

Question 12

Cause of a paraumbilcal hernia

Answer 12

Acquired defect in linea Alba just above or below the umbilicus

Question 13

Definition of a hernia

Answer 13

Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity

Question 14

Risk factor for umbilical hernias

Answer 14

Afro-carribean
Trisomy 21
Congenital hypothyroidism

Question 15

Definition of a hydroele

Answer 15

Accumulation of fluid within the tunica vaginalis

Tunica vaginalis is a rememant of the processus vaginalis

Question 16

Anatomical classification of hydroele

Answer 16

Vaginal: accumulation in the tunica vaginalis that does not extend up the cord
Congenital: proximal part of the processus has not obliterated and sac communicates directly with preitoneum
Infantile: processus is obliterated at the deep ring but still extend up the cord
Hydroele of the cord: fluid accumulate around the ductus deferens

Question 17

Cause of hydroceles

Answer 17

Primary: patent processus vaginalis
Secondary: testicualr tumours, epidymo-orchitis, trauma, torsion

Question 18

Surgical treatment of hydrocele

Answer 18

Lords repair: plication of the tunica vaignalis

Jaboulay’s repair: eversion of the sac

Question 19

Definition of a varicocele

Answer 19

Dilated viens of the pampinifrom plexus

Question 20

Operation for varicocele

Answer 20

Palomo operation

Question 21

Risk factor for testicualr cancer

Answer 21

Undescended testis
Infant hernia
Infertility

Question 22

Royal marsden classification of testicualr cancer

Answer 22

1. Disease only in testis
2. Sub diaphragmatic para-aortic node involvement
3. Supra and infra diaphragmatic lymph nodes involved
4. Extra lymphatic spread - lungs liver

Question 23

No scars and stoma =

Answer 23

Colonoscopy assisted trephine colostomy

Question 24

Definition of a stoma

Answer 24

Artificial union between conduits or between a conduit and the outside

Question 25

Fistula definition

Answer 25

Abnormal connection between two hollow epithelial surface

Question 26

Indication for a stoma

Answer 26

Exteriorisation 
- perforated or contaminated bowel 
- permenant 
Diversion
- protection of distal anastomosis
- acute chrons 
- urinary diversion following cystectomy 
Decompression: bypass of distal obstructing lesion 
Feeding: gastrostomy/ jejunostomy 
Laveage: appendecictomy

Question 27

How to site a stoma

Answer 27

Avoid: bony prominences, skin folds/creases, waistline, old wounds, umbilicus
Chose
- a site that is easily accessible to the patient
- ideally below the belt line for concealment
- within the rectus: decreased risk of hernia or prolapse

Question 28

Complication of a stoma

Answer 28

Early 
- haemorrhage 
- ischemia 
- hight out put leading to electrolyte disturbances 
- parastomal abscess 
- stoma retraction 
Delayed 
- parastomal hernia - more common on the lateral side 
-obstruction: adhesion or herniation through lateral space around stoma 
- dermatitis 
- stoma prolapse 
- stenosis or stricture 
- fistula 
- psychosexual dysfunction

Question 29

Layers of tissues around abdomen

Answer 29

Skin 
Campers fascia 
Scarpas fascia 
Linea Alba 
Transversalis fascia 
Pre-peritoneal fat 
Preitoneum 

Some catholic sluts like to practise phallactio

Question 30

Jenkins rule

Answer 30

Length of suture should be 4 times the length of the incscion

Question 31

Indication for midline stenotomy

Answer 31

Trauma
Vascular: AAA, Vascualr bypass
Gastro: perforated Dueodenal ulcer, Hartmann, colectomy

Question 32

Indications for a roof top incscion

Answer 32

Hepatobillary: 
- liver transplant 
- whipples 
- liver resection 
Gastric surgery

Question 33

Lateral layers of the abdominal wall

Answer 33

Skin 
Campers fascia 
Scarpas fascia 
External oblique 
Internal oblique 
Transversus 
Transversalis fascia 
Pre-peritoneal fat 
Preitoneum

Question 34

Nerves at risk in appendicetomy

Answer 34

Ilioinguinal

Iliohypogastric

Question 35

Cause of post op jaundice

Answer 35

Pre-hepatic: heamolysis after a transfusion
Hepatic: halogenated anaesthetic, sepsis, intra-post operative hypotension
Post hepatic: billary injury in lap Chloe

Question 36

Cause of gynecomastia

Answer 36

Drugs
- recreational: marijuana, diazepam, anabolic steroid
- prescription: spirolactone, digoxin, catopril, verapamil, ranitidine
Physiological
- puberty resolve by adulthood
Pathological
- decreased androgen production: hypogoandism: hyperprolactinemia, renal failure, testicualr atrophy, post-orchitis, bilateral torsion, klienfelter XXY
- increased oestrogen
- increased production: sex-cord stromal tumours, lung ca
- increased peripheral aromatisation: CLD, thyrotoxicosis

Question 37

Risk factors for oesophageal cancer

Answer 37

GORD
EtOH 
Smoking 
Achalasia 
Plummer Vinson syndrome

Question 38

What’s is a pharyngeal pouch

Answer 38

Outpouching between crico and thyro pharyngeal components of the inferior pharyngeal constrictiors

Pulsion diverticulum

Area of weakness is called killians dehiscnse

Question 39

Riglers triad

Answer 39

Small bowel obstruction
Pneumobillia
Gallstone in right iliac fossa