Abdominal Flashcards
Earliest complication of ileostomy
Necrosis
Lienorenal ligament
Posterior to the spleen
Splenic artery+vein
Tail of the pancreas
Acute mesenteric embolus
Set an onset abdominal pain followed by profused diarrhoea
May be associated with vomiting
Rapid clinical deterioration and
Test high white cell count lactate amylase may all be abnormal particularly in established disease. These can be normal in the early phases
Acute in chronic mesenteric ischaemia
Usually longer prodromal history
Post prandial abnormal discomfort and weight loss
Low flow mesenteric infarction
This occurs in patients with multiple comorbidities in profusion significantly compromised by overuse of inotropes with background cardiovascular compromise
The end result is that the ball is not in adequately profused any forwards occur from the mucosa outwards
Which anatomical element will be least likely encountered when transverse incision is made 2/3 -umbilicus-symphysis
Posterior lamina of the recrus sheath
Accessory adrenal tissue frequent location
Mostly firmed only from vortex
Broad ligament or spermatic cord
However it can be found anywhere, even intracranial
Bilious vomiting in neonates
Think intestinal malrotation, volvulus
Necrotising entérocolites
Prematurity is the main risk
Early features abdominal distension and passage of bloody stools
X-ray pneumatics is intestinales and evidence of free air
Increased risk when empirical antibiotics are given to infants beyond 5 days
Treatment total gut rest and TPN
Laparotomy
Recommandation for ER thoracotomy
Penetrating thoracic trauma that is followed by cardiac arrest
Paget vs Eczema of the breast
Paget will affect the nipple first and then spread to the areolar area
The most important structure involved in supporting the uterus
Central perineal tendon
If this is injured->uterus prolapse
Lymphoedema primary
Congenital -milroy’s disease
1-35 years: meige’s disease
> 35 years Tarda
Malignant hyperthermia arterioles
Fibrinoid necrosis
Spigelian hernia
Arcuate line
Lumbar hernia
Crest of ilium inferiorly
External oblique laterally
Latissimus dorsi medially
Obturator hernia
Herniation through the obturator canal
Commoner in females
Lies behind pectineus muscle
Will present with obstruction
Richter hernia
Small bowel is strangulated within hernia
May present with obstruction
Where vomiting is prominent -paralytic ileus from peritonitis( these hernias can perforate)
Littres hernia
Hernia containing Meckel’s diverticulum
E colo symptoms
Enterohepathogenic
Enteroinvasive: dysentery, large bowel necrosis/ulcer
Enterotoxic:small intestine, travels diarrhoea
Enterohaemorrhagic:0157, cause a haemorrhagic colitis, haemolytic uraemic syndrome and thrombocytopaenic purpura
Yesenia enterocolitica
Gram negative, coccobacili
Typically produces a protracted terminal ileitis that may mimic Crohns
DD appendicitis
May progress to septicaemia in susceptible individuals
Usually sensitive to quinolone or tetracyclines
Exploration of CBD drain tube
Latex T tube- form fibrosis
CNS drain
Low suction drain
/ free drainage- sub dural haematoma
CVS drain
Underwater seal drain
Most frequent abdominal emergency in children under 1
Intussuseption
Carcinoid syndrome tests
5-HIAA -urine
Somatostatin receptor scintigraphy
CT scan
Chromogranin A
Structures passing through the diaphragm
Aorta+ thoracic duct -aortic hiatus
Vagal trunks accompany the oesophagus- muscle part R
R Frenic+ iVC -caval opening
L frenic- anterior to central tendon on the left
Spleen structure
Réticuloendothélial organ
Red pulp-venous sinuses
Réticuloendothélial cords-white pulp
Hernia repair
Open/ laparoscopic
Open Lichtenstein repair
Shouldice - acceptable
Dercums
Multiple lipomas
Adipose is dolorosa
Segmental resection for pts with polyps
Incomplete excision if malignant polyps Malignant sessile polyps Malignant pedunculated polyp with submucosal invasion Polyps with poorly diff. Carcinoma Familial polyposis
Acute pseudo-obstruction medical treatment
If supportive treatment doesn’t work- neostigmine
Treatment Barrett
Long term PPI
Consider ph and manometry studies
Regular endoscopic monitoring. Quadratic biopsies
Total vs sub total gastrectomie
If <5 cm from from the OD- total
If 5-20 from the OF - subtotal
Origin of most pancreatic carcinoma
Ductal
