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 inguinal canal

Answer 2

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

Question 3

Hesselbach’s triangle

Answer 3

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

Question 4

Classification of inguinal hernia

Answer 4

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 5

Laparoscopic techniques for inguinal hernia

Answer 5

TEP: totally extra peritoneal

TAPP: transabdominal pre- peritoneal

Question 6

Complications of inguinal hernia repair

Answer 6

Early
 - urinary retention
 - haematoma/ seroma formation
 - infection
 - intrabdominal Injury 
Late - reoccurrence

Question 7

Borders of the femoral canal

Answer 7

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

Question 8

Operative management of a femoral hernia

Answer 8

Elective: Lockwood low approach
Emergency: McEvedy high approach

Question 9

Definition of an inguinal hernia

Answer 9

Extrusion of peritoneum and abdominal contents through a previously acquired defect

Question 10

Risk factors for incscional hernias

Answer 10

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 11

Cause of a paraumbilcal hernia

Answer 11

Acquired defect in linea Alba just above or below the umbilicus

Question 12

Definition of a hernia

Answer 12

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

Question 13

Risk factor for umbilical hernias

Answer 13

Afro-Caribbean
Trisomy 21
Congenital hypothyroidism

Question 14

Definition of a hydroele

Answer 14

Accumulation of fluid within the tunica vaginalis

Tunica vaginalis is a rememant of the processus vaginalis

Question 15

Cause of hydroceles

Answer 15

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

Question 16

Surgical treatment of hydrocele

Answer 16

Lords repair: plication of the tunica vaignalisJaboulay’s repair: eversion of the sac

Question 17

Definition of a varicocele

Answer 17

Dilated viens of the pampinifrom plexus

Question 18

Operation for varicocele

Answer 18

Palomo operation

Question 19

Risk factor for testicular cancer

Answer 19

Undescended testis Infant hernia Infertility

Question 20

Royal marsden classification of testicualr cancer

Answer 20

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 21

No scars and stoma =

Answer 21

Colonoscopy assisted trephine colostomy

Question 22

Definition of a stoma

Answer 22

Artificial union between conduits or between a conduit and the outside

Question 23

Fistula definition

Answer 23

Abnormal connection between two hollow epithelial surface

Question 24

Indication for a stoma

Answer 24

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 25

How to site a stoma

Answer 25

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 26

Complication of a stoma

Answer 26

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 27

Layers of tissues around abdomen

Answer 27

Skin Campers fascia Scarpas fascia Linea Alba Transversalis fascia Pre-peritoneal fat Preitoneum Some catholic sluts like to practise phallactio

Question 28

Jenkins rule

Answer 28

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

Question 29

Indication for midline Laparotomy

Answer 29

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

Question 30

Indications for a roof top incscion

Answer 30

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

Question 31

Lateral layers of the abdominal wall

Answer 31

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

Question 32

Nerves at risk in appendicetomy

Answer 32

Ilioinguinal Iliohypogastric

Question 33

Cause of post op jaundice

Answer 33

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

Question 34

Cause of gynecomastia

Answer 34

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 35

Risk factors for oesophageal cancer

Answer 35

``` GORD EtOH Smoking Achalasia Plummer Vinson syndrome ```

Question 36

What's is a pharyngeal pouch

Answer 36

Outpouching between crico and thyro pharyngeal components of the inferior pharyngeal constrictiors Pulsion diverticulum Area of weakness is called killians dehiscnse

Question 37

Riglers triad

Answer 37

Small bowel obstruction Pneumobillia Gallstone in right iliac fossa