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Backup Gen > Abdomen, Oesphagus and Stomach > Flashcards

Abdomen, Oesphagus and Stomach Flashcards

1
Q

Most common cause of mesenteric infarction

A

superior mesenteric artery

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2
Q

2 week diffuse abdominal pain, contraceptive pill, -ve pregnancy -

A

Mesenteric venous thrombosis

Increased P() with intrabdominal sepsis

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3
Q

Appendicular artery

A

ileocolic

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4
Q

Median arcuate ligament syndrome

A

post prandial epigastric prain + bruit

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5
Q

Greater omentum contains both

A

Greater omentum contains both gastroepiploic arteries

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6
Q

Brisk bleed – posterior duodenal ulcer – perforation of…

A

gastroduodenal artery perf – branch of common hepatic

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7
Q

3 week hx post prandial, intermittent diarrhoea and PR bleeding

A

mesenteric vascular disease. CT Angio or US Duplex if renal impairment

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8
Q

Management of bleeding inferior splenic pole?

A

Argos plasma coag

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9
Q

Cervical oesophagus supplied by

A

inferior thyroid artery

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10
Q

mucinous adenocarcinoma within abdomen - name and management

A

Pseudomxyoma peritonei – geltanious – sugar baker procedure + peritoneal chemo

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11
Q

Superior mesenteric vein – drains into

A

Superior mesenteric vein – drains into portal vein

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12
Q

Management of splenic vein thrombosis

A

Splenectomy

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13
Q

The medial edge of Hassalbach’s triangle =

A

rectus abdominus

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14
Q

Middle Sacral artery is

A

posterior to rectum

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15
Q

Normal intraabdominal pressure =

A

Normal intra abdominal pressure = 5-7mmHg

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16
Q

Laparoscopic insufflation pressure

A

12- 15mmHg

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17
Q

Abdominal compartment syndrome - sustained >…

A

Abdominal compartment syndrome - sustained >20mmHg + new organ dysfunction / failure

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18
Q

X% acute cholecystectomy – stone in the common bile duct

A

10% acute cholecystectomy – stone in the common bile duct

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19
Q

Renal stones in IBD

A

Calcium Oxalate

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20
Q

Drugs in UC

A

Steriods • 5 MA (Mesalazine) Immunosupressants (Cyclosporin)
Monoclonal antibody against TNF-a (Infliximab)

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21
Q

Drugs in UC

A

Steroids 5 ASA (Mesalazine)
Immunosupressants (Azothioprine/Mercaptopurine)
Methotrexate
Monoclonal antibody against TNF-a (Infliximab)

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22
Q

Transverse incision two thirds of the way between umbilicus and the symphysis pubis - Last likely to come across

A

Posterior lamina of the rectus sheath

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23
Q

stoma with a Low anterior resection + colorectal anastomosis

A

loop ileostomy

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24
Q

what stoma with a Low anterior resection + colorectal anastomosis

A

loop ileostomy

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25
Q

Rovsings pressing LIF – negative if

A

Rovsings pressing LIF – negative if appendicitis is retroceacal

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26
Q

Divide X to access coeliac axis for gastrectomy

A

Divide lesser omentum to access coeliac axis for gastrectomy

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27
Q

Duodenal Ferrous Fe2+ absorption – bound as

A

Duodenal Ferrous Fe2+ absorption – bound as ferritin

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28
Q

Crohn’s stricture – terminal ileal/ileocecal – , surgical management after IV Steroid trial

A

Crohn’s stricture – terminal ileal/ileocecal – right hemicolectomy after IV steroid trial

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29
Q

Colonic polyps – which has highest P() malignant transformation

A

villous adenoma

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30
Q

Colonic polyps – which has highest P() malignant transformation

A

villous adenoma

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31
Q

Folate – small intestine absorption not dependant on

A

jejnum - not pancreas dependant

b12 in terminal ileum

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32
Q

Ileostomy sodium content

A

120mmol/L Na+

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33
Q

Inflammation, bleeding + mucous from stump post Hartmann’s

A

Diversion proctitis

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34
Q

Level of blockage for blockade for inguinal hernia repair

A

T12 blockade for inguinal hernia repair

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35
Q

Short hx (2/52) nocturnal incontinence, diarrhoea + rectal bleeding

A

IBD

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36
Q

Management of Incarcerated femoral hernia

A

McEvedy’s>Lothessian (above, not through)

Lockwood inappropriate. Especially with SBO

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37
Q

Management of emergency presentation of low anal cancers

A

defunction with loop colostomy – then formal staging

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38
Q

Right obstructing colon carcinoma you perform..

A

rt hemicolectomy + ilocolic anastomosis

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39
Q

Post inguinal hernia repair groin pain…

A

ilioinguinal nerve entrapment

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40
Q

Coeliac autonomic plexus relative to aorta

A

Coeliac autonomic plexus – anterolateral to aorta

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41
Q

High output ureterosigmoidostomy will result in

A

High output ureterosigmoidostomy – acidosis

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42
Q

Devision of what ligament in splenectomy

A

Division of gastrosplenic ligament containing short gastric arteries in splenectomy

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43
Q

Hernia containing Meckel’s diverticulum known as…and management…

A

Litter’s hernia, resect before mesh repair.

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44
Q

Open Lichtenstein repair is a…

A

open hernia repair with mesh

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45
Q

Splenic Immune reticuloendothelial cells are in found in the…

A

Splenic Immune reticuloendothelial cells are in white pulp

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46
Q

For right adrenalectomy you need tomobilise

A

Mobilise right colonic flexure for right adrenalectomy

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47
Q

Resected colon cancer with nodal disease - you give…

A

Resected colon cancer with nodal disease – chemotherapy!

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48
Q

Right hemicolectomy puts at risk

A

Right hemicolectomy - Gonadal vessels + ureter at risk

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49
Q

Splenic flexure obstruction –

A

extended rt hemicolectomy

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50
Q

Massive splenomegaly

A

CGL (chronic granulocytic leukemia)

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51
Q

chronic inflammation resulting in obliteration of calots triangle

A

Mirizzi syndrome

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52
Q

Fe deficiency, postprandial pain most likely to be

A

Meckels with gastric>IBD

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53
Q

Annular pancreas will obstruct the

A

Annular pancreas will obstruct the second part of duodenum

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54
Q

Ca+ - most absorbed in

A

small bowel

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55
Q

Colorectal screen starts at

A

Colorectal screen starts at 60

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56
Q

Midgut

A

Second part of duodenum to 2/3 transverse colon

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57
Q

Hindgut-

A

Distal 1/3 transverse colon to anus

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58
Q

Divide which attachments of the caecum for retrocaecal appendix

A

Divide lateral peritoneal attachments of the caecum for retrocaecal appendix

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59
Q

Duke’s survival A/B/C/D

A

Duke’s survival A/B/C/D 95/75/50/25

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60
Q

What vessel disease will result in splenic atrophy

A

Coeliac disease – splenic atrophy

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61
Q

small appendiceal carcinoid tumours <2cm

A

Discharge small appendiceal carcinoid tumours <2cm

Liver mets for carcinoid syndrome diagnosis

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62
Q

Intermittent diarrhoea + RIF pain + weight loss

A

IBD

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63
Q

Colonic polyp on a stalk termed as..

A

Colonic polyp on a stalk – dysplasia

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64
Q

For a Serrated not malignant polyp

A

polypectomy!

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65
Q

1st new kidney? Attach to

A

1st new kidney? Attach to external iliac!

66
Q

Prev repair or bilateral hernia?

A

Lapracopic/TEP

67
Q

Deep ring – medial and lateral walls

A

Deep ring – Tranversalis facia lateral wall

inf epigastric vessels medial wall

68
Q

Rosethorn Ulcers found in….

69
Q

Rosethorn Ulcers found in….

A

Crohn’s

Chrohn’s, crown, crown of thorns,

70
Q

What drain do you put in after a Hartmann’s

A

Wallace Robinson Drain, no suction

71
Q

Post low anterior resection impotence

A

damage to nervi erigentes

72
Q

Colonoic-pseudoobstruction you can give..

A

neostigmine

73
Q

ankolosing spondylitis related to

74
Q

Adrenal mass with lipid rich core

A

Lipid rich core – benign adrenal adenoma

75
Q

Foul smelling pus after difficult appendicectomy

A

Bacteroides fragilis

76
Q

Burst abdomen most common at

A

Burst abdomen most common at 15 days

77
Q

Peri-anal chrohn’s disease, you give

A

Peri-anal chrohn’s disease, infliximab

78
Q

colonic pseudoobstruction also known as…

A

Ogilvie syndrome

79
Q

10% of fissures are…

A

10% of fissures are anterior

80
Q

Water mostly absorbed in the

A

Water mostly absorbed in the jejunum

81
Q

Xml of Bile in Duodenum in 24h

A

500ml of Bile in Duodenum in 24h

82
Q

Gastrinomas – most commonly found in the

A

Gastrinomas – most commonly found in the duodenum

83
Q

would infection rate in Hartmann’s for perforated disease

A

35% would infection rate in Hartmann’s for perforated disease

84
Q

What Rib lie’s behind the right kidney?

A

12th Rib lies behind right kidney not 10th

85
Q

sign – most often seen in ruptured ectopic pregnancy

A

Cullen’s sign – most often seen in ruptured ectopic pregnancy

CU..

86
Q

Pancreas - embryology

A

Ventral and dorsal endodermal outgrowths of the duodenum

87
Q

most posterior splenic structure

A

Lienorenal ligament – most posterior splenic structure

88
Q

Most of the gut is derived endodermally except for the

A

the spleen which is from mesenchymal tissue.

89
Q

zinc is absorbed in the..

A

Jejunum absorbs zinc

90
Q

You don’t need to measure X with home TPN

A

You don’t need to measure thyroid function with home TPN

91
Q

Accessory spleens are not found in the

A

Accessory spleens are not found in the ureter

92
Q

before flexi sig you give a…

A

Phosphate enema 30 minutes before flexi sig

93
Q

What % Synchronous bowel cancer

A

Synchronous bowel cancer – 5% of all cases

94
Q

Laparoscopic choelcystectomy for uncomplicated biliary colic – % wound infection rate

A

Laparoscopic choelcystectomy for uncomplicated biliary colic – 5% wound infection rate

95
Q

right scapular – acute cholecystitis, name of Sign

A

Boas’ sign – right scapular – acute cholecystitis

96
Q

Operate acute cholecystectomy within

A

Operate acute cholecystectomy within 72 hours

97
Q

Recurrent gallstone cholecytitis results in

A

Achoff-Rotinsky Sinuses

98
Q

Pancreatic lipase - digestion of fat, Proteases facilitate

A

protein and B12 absorption

99
Q

Pancreas output and pH

A

Pancreas 1000-1500ml/day pH 8

100
Q

Pancreatic necrosectomy – only when

A

only when infection proven after FNAC

101
Q

Carcinoma of the pancreatic head- failed ERCP – go to

102
Q

Klatskin Tumour

A

hilar tumour at left and right bile duct confluence.

103
Q

Klatskin Tumour

A

hilar tumour at left and right bile duct confluence.

104
Q

Liver Cell Adenoma – non encapsulated, mixed echoity and heterogeneous texture, normal AFP and LFTs, RUQ pain, On MR

A

Resect! Malignancy M>F

105
Q

Colorectal liver mets what do you do first?

A

chemotherapy then resection

106
Q

UC patients - biliary condition

A

UC patients - Primary sclerosing cholangitis (inflammation)

107
Q

UC patients - biliary condition

A

UC patients - Primary sclerosing cholangitis (inflammation)

108
Q

ileal resection – higher incidence of

A

higher incidence of cholesterol stones

109
Q

Cystic artery – from

A

Cystic artery – from right hepatic artery

110
Q

most common infection cholangitis

A

E Coli – most common in cholangitis

111
Q

To access the abdominal oesophagus you need to mobilise

A

Mobilise left lobe – for abdominal oesophagus

112
Q

Pancreatic pseudocyst >4 weeks

A

Pancreatic pseudocyst - >4 weeks, a/w raised amylase

113
Q

Rectal prolapse in the young…

A

Rectopexy for the young – lowest recurrence rate for rectal prolapse

114
Q

Willsons disease, solid mass liver mass.

A

easure AFP (+chronic inflame = HPCC)

115
Q

to diagnose carcinoid syndrome check for

A

Liver mets to diagnose carcinoid syndrome

116
Q

hormones that increases and suppresses appetite

A

Grehlin increases appetite, leptin decreases

117
Q

ERCP sphincterotomy – electric setting

A

ERCP sphincterotomy – cutting monpolar

118
Q

SMV + Splenic vein @ L1 = Hepatic Portal vein – runs in

A

hepatoduodenal ligament (free edge of lesser omentum)

119
Q

Hepatic Vein – exits liver…and drains…

A

Hepatic Vein – exits liver posteriorly draining directly into IVC

120
Q

Cystic vein into right branch of…

A

Cystic vein into right branch of portal vein

121
Q

Right gastric vein drains

A

Right gastric vein drains lesser curvature of stomach

122
Q

Oesophagus – no

A

Oesophagus – no serosa, loose connective tissue only

123
Q

Achalasia = increased P()

A

Achalasia = increased P() SCC

124
Q

Oesophagectomy Prox>Distal:

A

Oesophagectomy Prox>Distal: McKwon>Ivor>Transhiatal

125
Q

division for lower third oesophagectomy

A

Ayzgos vein division for lower third oesophagectomy

126
Q

Parietal cells: secrete

A

Parietal cells: secrete HCl, Ca, Na, Mg and intrinsic factor

127
Q

Chief cells: secrete

A

Chief cells: secrete pepsinogen- PEPSI CHIEF

128
Q

Surface mucosal cells:

A

Surface mucosal cells: secrete mucus and bicarbonate

129
Q

Cardia tumour, no distal mets -

A

Cardia tumour, no distal mets - Total gastrectomy and Roux en Y reconstruction

130
Q

8 month post distal gastrectomy – normal Ix – jaundice secondary to

A

8 month post distal gastrectomy – normal Ix – jaundice 2ry peri hilar lymphandenopathy

131
Q

Post gastrectomy – dumping:

A

diarrhoea, hypoglycaemia. Fe + B12 malabsorption.

Eat high protein and low carbs.

132
Q

Gastrin stimulates

A

enterochromaffin histamine release.

133
Q

single large arteriole in submucosa – a bleeder!

A

Dieulafoy lesion – single large arteriole in submucosa – a bleeder!

134
Q

organism causing terminal ileitis + mesenteric lymphadenitis

A

Yersinia enterolitica

135
Q

Mackler triad for Boerhaave syndrome/ Oesophageal perf:

A

Mackler triad for Boerhaave syndrome/ Oesophageal perf: vomiting, thoracic pain, subcutaneous emphysema

136
Q

Carcinoma of greater curvature with no mets:

A

Carcinoma of greater curvature with no mets: subtotal gastrectomy, D2 lymphadenectomy + rou en y

137
Q

Upper 1/3rd oesophagus:

A

Combined radical radiotherapy and chemotherapy

138
Q

GI Ulcer secondary to thermal injury

A

GI Ulcer – 2ry thermal injury = Curling’s Ulcer

139
Q

Direct inguinal hernia - suture ?mesh

A

Direct inguinal hernia - Nylon sutured repair + placement of prolene mesh posterior to cord structures.

140
Q

No hyperamylasemia in

A

No hyperamylasemia in pancreatic CA

141
Q

Barrettes’ –

A

Barrettes’ – Goblet Cells + intestinal metaplasia

o High risk of adenocarcinoma

142
Q

Pernicious anaemia - Abs and malabsoption of…

A

Pernicious anaemia -Parietal Cell Abs – no IF to absorb B12

143
Q

hx of straining, painless bleeding

A

Solitary rectal ulcer –

144
Q

Oesophageal Constrictions:

A 
Oesophageal Constrictions: ABCD
o   A- Arch of the Aorta
o   B- Left main Bronchus
o   C- Cricoid Cartilage
o   D- Diaphragmatic Hiatus
145
Q

signet rings, leather bottle stomach, unable to distend on the scope

A

Linitis plastica

adenocarcinoma and accounts for 3-19% of gastric adenocarcinoma - not associated with H pylori

146
Q

GIST’s are derived from the

A

GIST’s are derived from the interstitial pacemaker cells of Cajal.

147
Q

Longitudinal oesophageal muscles

A

Longitudinal oesophageal muscles propels food

148
Q

Post oesophagectomy –

A

Post oesophagectomy – feeding jejunostomy

149
Q

McKown procedure –

A

McKown procedure – total oesophagectomy

150
Q

Cardiooesophageal junction level =

A

Cardiooesophageal junction level = T11

151
Q

Anterior gastrojejunostomy – most associated with

A

Anterior gastrojejunostomy – most associated with delayed gastric emptying

152
Q

Pudendal canal is a fascial canal located on the lateral wall of the..

at inferior border of…

A

Pudendal canal is a fascial canal located on the lateral wall of the ischioanal fossa

inferior border of obturator internus

153
Q

Fascial layers surrounding the rectum:

Anteriorly

A

Anteriorly lies the fascia of Denonvilliers

154
Q

Fascial layers surrounding the rectum:

Posteriorly lies

A

Waldeyers fascia – divided to separate mesorectum from sacrum in low anterior resection
Suprior rectal artery+vein.

155
Q

rectum: Above dentate line – nodes..

A

Above dentate line – mesorecal lymph nodes, Below = inguinal.

156
Q

Chrohns for even low fissures

A

Chrohns – seton for even low fissures – poor healing if laid open!

157
Q

K+ secretion highest in…

A

Rectal K+ secretion highest!

158
Q

Placenta percreta –

A

Placenta percreta – brisk frank haematuria!

159
Q

Genital branch of the genitofemoral nerve exits via

A

Genital branch of the genitofemoral nerve exits via deep inguinal ring

160
Q

AP resection impotence

A

AP resection impotence – hypogastric plexus damage during IMA mobilisation

161
Q

Excision haemorrhoidectomy analgesia:

A

caudal block > pudenal block

162
Q

Ischiorectal space – medial to

A

Ischiorectal space – medial to pudendal canal

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