Abdo Part 1

Question 1

What is in the inguinal canal?

Answer 1

3 arteries
- Cremasteric
- To testicle
- To Vas deferens

3 nerves
- Cremasteric
- Ilioinguinal
- Autonomic

3 structures
- Vas deferens
- Pampiniform plexus
- Lymphatics

Question 2

Direct vs Indirect Hernia

Answer 2

Indirect
- patent Processus Vaginalis
- no cough impulse
- Lateral to Inferior epigastric vessel
- travels with scrotum

Direct
- Weak posterior wall of inguinal canal
- YES cough impulse
- Medial to inferior epigastric vessel
- No travel
- Bulges

Question 3

Differential of lump in groin

Answer 3

Lymph node
Skin lesion / Sapheno varix
Hernia
Aneurysm
Psoas abscess
Ectopic / Undescended testicle

Question 4

Contraindications to inguinal repair

Answer 4

Pain
Haematoma
Urinary retention
Recurrence
Bleeding
Infection
Ischaemic colitis

Question 5

Specific complications of stoma

Answer 5

Retraction
Prolapse
Parastomal hernia
Stenosis
Skin Excoriation
Ischaemia
Haematoma

Question 6

General complications of Stoma

Answer 6

Stomal diarrhoea
Stones
Nutritional deficiency
Psychosexual
Residual Disease

Question 7

O/e for Hepatomegaly + Splenomegaly

Answer 7

S: Site of enlargement
P: Percussion (dull)
R: Dec Resp Movements
U: unable to get above it
E: edges (smooth / irregular

Question 8

Causes of Hepatomegaly

Answer 8

Physio
Metabolic
Alcohol
Infection
Infiltrative - Mal
Cardiac
Biliary

Question 9

Causes of Massive Splenomeg

Answer 9

Chronic Myeloid Leukaemia
Myelofibrosis
Malaria
Tropical Splenomegaly
Visceral Leischmaniasis

Question 10

What is jaundice?

Answer 10

Dark urine
Pale stool
Itchiness

Question 11

Classify Jaundice

Answer 11

Post hepatic: biliary injury
Hepatic: hepatitis + infectious
- decompensated chronic liver disease
- post-op HT
Pre-hepatic: Haemolysis, Hereditary

Question 12

Courvoisier’s Law

Answer 12

Mass + Jaundice = NOT A GALL STONE

Question 13

Investigations for Jaundice

Answer 13

FBC
U+E
LFT (GGT, AP, ALT, AST, Bilirubin)
Coombs
Renal function (creatinine) hepatorenal syndrome
INR / APTT / PTT

CT
ERCP
MRCP

Question 14

DD Hepatomeg

Answer 14

Congestive: CHF, Budd-chiari
Haematological: lymp, leukaemia, myeloproliferative
Infection: viral, bacterial, protozoa
Amyloid
Storage disorders: Wilson’s haemachromatic
Masses: primary / secondary
Autoimmune / alcohol: fatty liver , cirrhosis

Question 15

DD Splenomegaly

Answer 15

Congestive: Portal HT, hepatic vein obstruction
Haematological: haemolytic anaemia / lymph / leukaemia / myelofibrosis / sickle cell
Infection
Amyloid
Storage disorders: Gaucher’s
Masses
Autoimmune / Alcohol: Felty’s

Question 16

Indications for Splenectomy

Answer 16

Trauma
Hypersplenism
Splenic rupture
Neoplasia

Question 17

Complications post-splenectomy

Answer 17

Thrombocytosis
Infection

Question 18

Causes of bowel obstruction

Answer 18

Small: adhesions, herniae
Large: Mal, diverticular disease, volvulus

Intraluminal: Gallstone, Injested FB, Faecal impaction
Mural: Meckel’s, Inflammatory strictures, Diverticular strictures , Intususception, Lymphoma, Ca
Extra mural: Hernia, Adhesions, Pertional mets, Volvulus

Question 19

Indications for Sx in Intestinal Obstruction

Answer 19

Failure of Mx mng
Ischaemic colitis
Tumour
Peritonitis
Closed-loop bowel obstruction