acute GI

Question 1

What are key decision of bowel obstruction?

Answer 1

Is it obstruction of the small or large bowel?

Small bowel obstruction: early vomiting, less distension, pain is higher in the abdomen

Large bowel obstruction: pain is more constant.

REALITY: check AXR

Is there an ileus or mechanical obstruction?

IF Ileus (lower bowel motility - functional obstruction)- absent bowel sounds, less pain

Is the obstructed bowel simple/closed loop/strangulated?

Simple: one obstructing point and no vascular compromise.

Closed loop: two obstruction points (eg sigmoid volvulus), loop of grossly distended bowel at risk of perforation

Strangulated: compromised blood supply- patient iller than expected. (harper, more constant, and localized pain) Peritonism and fever + high WCC

Question 2

Fill out the table for causes of bowel obstruction

Answer 2

Question 3

What are the miscellaneus other hernias? and what are their definitions

Answer 3

1. Paraumbilical hernias
2. Epigastric
3. Incisional hernias
4. Spigelian hernias
5. Lumbar hernias
6. Richter’s hernias
7. Maydl’s hernias
8. Littré’s hernias
9. Obturator hernias
10. Sciatic hernias
11. Sliding hernias
12. Paediatric hernias:

• Umbilical hernias:
• Indirect inguinal hernias
• Gastroschisis:
• Exomphalos

Question 4

Fill out the table

Answer 4

Question 5

Fill out the table

Answer 5

Question 6

What dies this diagrma show?

What re causes of this?

Answer 6

Pneumoperitoneum:

CAUSES

• Bowel perforation (visible only in 75%)
• Gas-forming infection, eg C. perfringens.
• Iatrogenic, eg laparoscopic surgery
• Per vaginam (eg sexual activity) (WHO KNEW)

Question 7

Fill out the table

Answer 7

Question 8

What does this CT show?

Answer 8

rolling diaphragmatic hernia

Question 9

What does this diagram show’?

Answer 9

rolling diaphramtic hernia

Question 10

What does this diagram show’?

Answer 10

sliding diaphramtic hernia

Hernia hiatus

Question 11

Label this diagram

Answer 11

Question 12

What does this CT show?

Answer 12

coffee bean volvulus

Question 13

Label this diagram

Answer 13

Question 14

Label this diagram

Answer 14

Question 15

What does this CT show

Answer 15

large bowel obstruction

Question 16

Label this diagram

Answer 16

small bowel obstruction

LOOK at the the valvulae conviventes going all the way through

Question 17

A 16 year year old college students attends the local A & E with her boyfriend, comlaining of an episode of sudden onset right sided pain in her abdomen.

Physical examination of the patient is unremarkable except from a small scar in her right lower quadrant.

What is the most appropriate first line investigation

A. USS of abdomen

B. ß-hCG test

C. FBC

D. CT of abdomen

E. no investigation, immediate surgery

Answer 17

B. ß-hCG test

Question 18

A 26 year old proffesional rugby player presents to a& E with abdominal pain in the umbelical region. On inspection he is feverish wiht a temperature of 38°C and BP of 115/90. THe admitting doctors suspect appendicitis and performs abdominal examination.

extension of right hip elicits pain

WHat sing is this?

A. Cope’s , means retrocaecal appendix

B. Psoas sign, means retrocaecal appendix

C. Psoas sign an d appendix located next to obbsturator externus

D. Rovsing’s sign and a retrocaecal appendix

E. Rovsing’s sign and located next to obbsturator externus

Answer 18

A. Cope’s , means retrocaecal appendix

B. Psoas sign, means retrocaecal appendix

C. Psoas sign an d appendix located next to obbsturator externus

D. Rovsing’s sign and a retrocaecal appendix

E. Rovsing’s sign and located next to obbsturator externus

Question 19

What is the difference between diverticular disease, diverticulosis, and diverticulitis?

Answer 19

Diverticulosis= oresence of diverticular outpouchings of teh colonic mucosa throughout the large bowel

Diverticular disease= the complication from diverticulosis

Diverticulitis= acute inflammation and infection of diverticulae

Question 20

What surgical procedure would you do on someone with diverticular disease?

Answer 20

Hartmann’s - if acute

Primary anastomosis - if chronic

Question 21

What is hartmann’s procedure?

Answer 21

removal of the diseased bowel and an end colostomy formation with an anorectal stump

This is used when primary anastomosis is not possible

ACUTE scenario -too much inflammation

Question 22

a 56 year old feverish woman attends her GP complaining of a sudden appearance of blloody stools. She adds that she has experienced a few episodes of bloody stolls beofre but has not seeked medical attention and apart rfom a fever, she has had no other constituinal symtpoms. the Gp notes that the pateietns diet is particularylow in fibre and on physical examination, tenderness is found on pressure to the LIF. A DRE shows fresh blood upon removal of a gloved finger. WHat is the most likely diagnosis?

A. Angiodysplasia

B. Diverticulosis

C. Diverticulitis

D. Mallory Weiss tear

E. Gastroenteritis

Answer 22

C. Diverticulitis

Question 23

A feverish 65 year old is brought to A& E departemnt by her daughter . she complains about nausea, LIF pain and vomiting. Attending doctor takes a full histroy and performs an abdominal examination and subsequently makes he diagnosis of actue diverticulitis with some signs of peritonism. A erect AXR taken which shows some air under teh diaphragm. What is the most appropriate surgical procedure

A. Hartmann’s procedure

B. primary anastomosis

C. Colectomy and end -Ileostomy formation

D. delorme procedure

E. Whipple procedure

Answer 23

A. Hartmann’s procedure

Question 24

What are the borders of Hasselbach’s triangle?

Answer 24

rectus abdominus, inguinal ligament and inferior epogastric artery

Question 25

A 26 year old bodybuidler attends the local day surgery upon referrral of his GP due to a groin lump. the genral surgical registrar suspects a hernia and so performs a simple test to ascertain the type the type of hernia to determine the most appropriate management. The doctor reduces the hernia and then places their finger over the deep inguinal ring. the patient is asked to cough and the hernia does not reappear. What hernia is this? A. Femoral hernia B. direct inguinal hernia C. indirect inguinal hernia D. Spigelian hernia E. hiatus hernia

Answer 25

C. indirect inguinal hernia

Question 26

What does get smashed stand for?

Answer 26

Gallstones Ethanol Trauma steroid Mumps, malignancy Autoimmune Scorpion Hypercalcaemia, HYperlipidaemia, Hyperparathyrodism ERCP Drugs

Question 27

What is the score for pancreatitis? What does it consist of?

Answer 27

PaO2 Aage Neutrophils Calcium Renal function Enzyme Albumin Sugar

Question 28

What is the eponymous sign of bowel perforation?

Answer 28

Rigler sign

Question 29

an overweight 65 year old woman visits her general practitioner with discomfort in her right groin. On examination, the suggestion of a reducible groin lump is noted. She is routinely referred to the surgical outpatient clinic with a possible diagnosis of inguinal hernia. However two weeks later and before her surgical appointemnet, she again viits her general practioner, this time with vomiting, diarrhoea and colicky abdominal pain. What is the next most apporpriate management step? A. Administer antibiotics B. Give IV fluids C. Insert an NG tube D. Give Iv fluids and insert an NG tube E. Administer an enema

Answer 29

. Give Iv fluids and insert an NG tube

Question 30

A 70 year old gentleman presents to the A& E departement with sudden onset severe diffuse abdominal pain. Observations are taken in the ambulance which show an irregularly irregular pulse rate 130 and a BP pf 76/60. An abdominal X ray is performed as asoonas possible whic shows rigler sign and the physician diagnoses acute form of mesenteric ischaemia with perforation. What is the most likely cause for the acute onset of the mesenteric ischaemia? A. Athrosclerotic disease B. Embolism C. Thrombosis D. Polycythaemia vera E. Idiopathic

Answer 30

B. Embolism