Abdomen

Question 1

Causes of intususseption?

Answer 1

lumenal pathologies such as polyps, lymphadenopathy and diseases such as cystic fibrosis

Question 2

Most common site of intususseption?

Answer 2

ileocaecal valve and terminal ileum

Question 3

Causes of groin masses?

Answer 3

Herniae
Lipomas
Lymph nodes
Undescended testis
Femoral aneurysm
Saphena varix (more a swelling than a mass!)

Question 4

Key questions for groin lumps?

Answer 4

Is there a cough impulse
Is it pulsatile AND is it expansile (to distinguish between false and true aneurysm)
Are both testes intra scrotal
Any lesions in the legs such as malignancy or infections (?lymph nodes)
Examine the ano rectum as anal cancer may metastasise to the groin
Is the lump soft, small and very superficial (?lipoma)

Question 5

What key investigations should patients presenting with large bowel obstruction have prior to surgery?

Answer 5

gastrograffin enema, sigmoidoscopy or CT scanning prior to surgery.

Question 6

Features of PID?

Answer 6

lower abdominal pain associated
vaginal discharge
dysuria
fever
dyspareunia
Peri-hepatic inflammation secondary to Chlamydia (Fitz Hugh Curtis Syndrome) may produce right upper quadrant discomfort

Question 7

Intestinal causes of malabsorption?

Answer 7

coeliac disease
Crohn’s disease
tropical sprue
Whipple’s disease
Giardiasis
brush border enzyme deficiencies (e.g. lactase insufficiency)

Question 8

Pancreatic causes of malabsorption?

Answer 8

chronic pancreatitis
cystic fibrosis
pancreatic cancer

Question 9

Biliary causes of malabsorption?

Answer 9

biliary obstruction
primary biliary cirrhosis

Question 10

Other causes of malabsorption?

Answer 10

bacterial overgrowth (e.g. systemic sclerosis, diverticulae, blind loop)
short bowel syndrome
lymphoma

Question 11

Which artery is responsible for blood supply to a meckels?

Answer 11

vitelline artery

Question 12

Management of Fitz-Hugh Curtis?

Answer 12

Usually medically managed- doxycycline or azithromycin

Question 13

What are cullens and grey turners sign?

Answer 13

Cullens sign- pancreatitis (other intraabdominal haemorrhage)
Grey-Turners sign- pancreatitis (or other retroperitoneal haemorrhage)

Question 14

What is a spigelian hernia?

Answer 14

-Interparietal hernia occurring at the level of the arcuate line
-May lie beneath internal oblique muscle. Usually between internal and external oblique
-lateral to rectus abdominis

Question 15

What is a lumbar hernia?

Answer 15

hernia in area bounded by the lumbar triangle?
Crest of ilium (inferiorly)
External oblique (laterally)
Latissimus dorsi (medially)
Primary lumbar herniae are rare, most are incisional hernias following renal surgery

Question 16

what is an obturator hernia?

Answer 16

-Herniation through the obturator canal
-Commoner in females
-Usually lies behind pectineus muscle
-most will present acutely with obstruction
When presenting acutely most cases with require laparotomy or laparoscopy (and small bowel resection if indicated)

Question 17

What is a Richters hernia?

Answer 17

condition in which part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type)

Question 18

What is a bochdalek hernia?

Answer 18

Typically congenital diaphragmatic hernia
85% cases are located in the left hemi diaphragm
Associated with lung hypoplasia on the affected side
More common in males
Associated with other birth defects
May contain stomach

Question 19

What is a morgagni hernia?

Answer 19

Rare type of diaphragmatic hernia (approx 2% cases)
Herniation through foramen of Morgagni
Usually located on the right and tend to be less symptomatic
More advanced cases may contain transverse colon
As defects are small pulmonary hypoplasia is less common
Direct anatomical repair is performed

Question 20

What is a paraumbilical hernia?

Answer 20

Usually a condition of adulthood
Defect is in the linea alba
More common in females
Multiparity and obesity are risk factors
Traditionally repaired using Mayos technique - overlapping repair,

Question 21

What is a Littres hernia?

Answer 21

ernia containing Meckels diverticulum
Resection of the diverticulum is usually required and this will preclude a mesh repair

Question 22

Borders of the femoral CANAL?

Answer 22

Laterally Femoral vein
Medially Lacunar ligament
Anteriorly Inguinal ligament
Posteriorly Pectineal ligament