Acute Surgery

Question 1

Following removal of the spleen, what things should the patient be advised?

Answer 1

Pneumococcal vaccination

Meningococcal vaccination

H. Influenzas vaccination

Long term Penicillin V

Higher risk of malaria
- caution when traveling

Question 2

What are the four main investigations you want to conduct into someone presenting with symptoms of peritonitis without a definitive diagnosis?

Answer 2

Serum amylase

Erect chest x-ray

US of abdomen

CT scan of Abdomen

Question 3

What other conditions can raise your amylase slightly? and why might someone have moderate amylase in pancreatitis?

Answer 3

Amylase can rise with:

• acute cholecystitis
• Mesenteric infarction
• Duodenal perforation

A cause for a low amylase that is due to pancreatitis may be because the initial attack happened a few days ago

Question 4

What additional examination out with an abdominal examination would you want to conduct into a child presenting with suspected appendicitis and why?

Answer 4

ENT examination

One of the major differentials is mesenteric adenitis which may present following URTI

Question 5

What is the most common cause for pneumoperitoneum following surgery?

Answer 5

Normal finding after surgery

Question 6

How should someone be fed if they have >48 hours ileus and list some important monitoring required for it:

Answer 6

TPN

Monitoring:

• Blood glucose
• Daily electrolytes
• Accurate fluid balance recording
• 4 hourly checks on temperature and observations
• daily check of line for infection

Delivered:
- Peripherally Inserted Central Venous Catheter (PICC)

Question 7

What important vitamin substitute must be given prior to starting someone on TPN and why?

Answer 7

Pabrinex

- to ensure thiamine is on board in preparation for reintroducing the food

Question 8

If there is a mass felt in the RUQ in a patient with pancreatic carcinoma, what is it likely to be?

Answer 8

Distended gallbladder

Question 9

What is the name of the x-ray finding where the large bowel is seen in front of the liver and is it normal?

Answer 9

Chilaiditi’s finding

it is normal

Question 10

Outline the signs and symptoms of emphysematous gallbladder?

Answer 10

More common in diabetics

often signs and symptoms are minor to begin with but develop and can lead to overwhelming sepsis

Question 11

What may cause a mass to be felt in the LLQ in symptoms in keeping with diverticular disease and how is a non-serious version of this treated?

Answer 11

Pelvic abscess due to diverticular disease.

Simple abcess formation can be managed with:

• IV fluids
• IV antibiotics
• NIL by mouth

*CT follow up is needed. if not resolved CT drainage may be needed

Question 12

In the setting of someone you suspect may have fistula formation into the bladder from diverticulitis - what investigations do you want?

Answer 12

CT Abdomen

Cystoscopy

Flexible Sigmoidoscopy

Question 13

What are the advantages of laproscopic surgery for cholysectomy?

Answer 13

Reduced hospital time

Quicker recovery time

Question 14

If someone comes in with an object inserted in their backside, what important other condition must you consider and how would you test for this?

Answer 14

Bowel perforation

Erext chest xray

Question 15

What is an important symptom to be aware on in acute urinary retention?

Answer 15

Delirium

Question 16

How is acute urinary retention diagnosed and what is the management?

Answer 16

Bloods:

• FBC
• U&Es - assess for obstruction to kidney (abnormal U&Es demonstrates abnormality)
• CRP for infection

*PSA levels shouldn’t routinely be done in acute retention because it is likely they will be high due to the obstruction

Orifices:
- Digital rectal examination

X-rays:

• Bladder US - >300cc is diagnostic
• Kidney US - assess for dilation

Treatment:

• catheterise
• 3 way catheter may need to be used if you suspect clots.
• Suprapubic catheter if unable to pass catheter
• take urine sample of urine to assess for UTI

Question 17

Following urinary tract obstruction what should be done?

Answer 17

Monitoring of the U&Es closely
Monitoring of weight

Trial without catheter following days

Question 18

What are some of the complications following relieving a patient with urinary retention?

Answer 18

Post obstructive diuresis

Metabolic acidosis

UTI
- urine should always be sent for analysis

Question 19

What are the types of priapism and how are they investigated and treated?

Answer 19

Ischemic and non-ischemic

Corpus cavernous blood Gas

Management:

• aspiration of the blood
• surgical management

Question 20

What advice would you give to someone post TURP?

Answer 20

Avoid driving for 2 weeks
Avoid sex for 2 weeks 
Expect blood to pass for 2 weeks 
Will pass more urine to begin with - stay hydrated 
If feverish contact dr

Question 21

How is prostate cancer staged?

Answer 21

MRI