Bowel obstruction and herniae

Question 1

Bowel __ to obstruction dilates

Answer 1

proximal

Question 2

Presents within hrs of obstruction, vomit large volumes (___) =

Answer 2

small bowel obstruction

gut secretions

Question 3

present gradually with colicky abdo pain, distension and faeculent vomiting

Answer 3

distal small bowel/colon obstruction

Question 4

The more ___ the obstruction the earlier vomiting occurs

Answer 4

proximal

Question 5

vomiting of semi-digested food eaten 1/2 days ago (no bile) suggests

Answer 5

gastric outflow syndrome

Question 6

The ileocaecal valve being ___ delays onset of symptoms of obstruction

Answer 6

incompetent (50:50 whether comp/not)

Question 7

in a closed loop obstruction the ileocaecal valve is ___ results in ___

Answer 7

competent

distention and perforation of the caecum

Question 8

If tenderness is present in suspected bowel obstruction then ____ is occuring

Answer 8

strangulation

usually obstructions are relatively non-tender

Question 9

colicky episodes in incomplete bowel obstruction can be ___ prominent that in complete because

Answer 9

more

if chronic then proximal bowel hypertrophies

Question 10

Investigations for bowel obstruction =

Answer 10

supine AXR (shows gas and dilated loops)
then CT if needed

Question 11

Management of bowel obstruction =

Answer 11

nil by mouth
NG tube to decompress stomach
IV cannula for bloods, fluids and electrolytes

Question 12

small bowel dilations on supine AXR =

Answer 12

central and have valvulae coniventes

Question 13

colon dilations on supine AXR =

Answer 13

round periphery of abdomen and have haustra

Question 14

Mechanical causes of bowel obstruction =

Answer 14

strictures
volvulus
hernias
adhesions
tumours
bolus
intussusception

Question 15

Inflammatory strictures in Crohn’s/diverticula usually cause ___ obstruction

Answer 15

incomplete

Question 16

If bowel is strangulated venous/arterial flow is cut off first?

Answer 16

venous (then arterial backP => gangrene)

Question 17

In mechanical causes of obstruction can see ___

this is not true for adynamic causes

Answer 17

clear cut off between dilated and non-dilated bowel

Question 18

Risk factors for paralytic ileus =

Answer 18

recent GI surgery, inflammation with peritonitis, diabetic ketoacidosis

Question 19

Paraltic ileus present’s similarly to small bowel obstruction but __+__ not present

Answer 19

pain

tinkling

Question 20

Treatment of paralytic ileus =

Answer 20

drip and suck

wait for peristalsis to return

Question 21

Ogilvie’s syndrome =

Answer 21

Pseudo-obstruction of the colon

acute dilatation of colon wo an obstruction makes patient acutely unwell

Question 22

Pseudo-obstruction of the colon is associated with

Answer 22

hip replacement surgery
CABG
pneumonia
# of spine
frail and elderly

Question 23

Pseudo-obstruction mechanism behind it =

Answer 23

sympathetic overrides parasympathetic and colon distends with gas

Question 24

If pseudo-obstruction causes respiratory problems(diaphragm splinting)/pain then treatment =

Answer 24

colonoscopy to decompress

Question 25

Hernia =

Answer 25

abnormal protrusion of a viscus outwith its normal body cavity

Question 26

Commonest to least common 4 hernias

Answer 26

inguinal (80%) umbilical (8%) incisional(7%) femoral (5%)

Question 27

majority of abdominal hernias are from natural openings/weak areas

Answer 27

weak areas

Question 28

Risk factors for herniae is anything that ___

Answer 28

increases intra-abdo pressure

Question 29

reducible/ireducible hernia cause problems and need surgery?

Answer 29

irreducible

Question 30

Incarcerated irreducible hernia =

Answer 30

too big to fit back in

Question 31

obstructed irreducible hernia ->___ where __ is occluded

Answer 31

strangulation | venous drainage occluded first then arterial inflow back P => gangrene and friable

Question 32

Most important modifiable risk factor for incisional herniae

Answer 32

suture technique | to prevent use tension suture and mass closure of linea alba

Question 33

vertical/transverse incisions are morely to cause an incisional hernia

Answer 33

vertical

Question 34

True umbilical hernia only occur in ___

Answer 34

kids congenitally

Question 35

If true umbilical hernia don't resolve by age __ only then will you operate

Answer 35

3yrs

Question 36

Paediatric inguinal herniae are more common in M/F and ___ | High risk of strangulation in under 1yos so

Answer 36

M 9:1 low birth wt/prem babies operate within 24hrs

Question 37

hydrocele =

Answer 37

peritoneal fluid in the testis | can occur due to patent processus vaginalis

Question 38

hydrocele treatment =

Answer 38

not operated on unless large/aesthetics | usually recede by themselves

Question 39

Epigastric hernia are more common in ___ usually contain arise from

Answer 39

M3:1 extraperitoneal fat congenital linea albus weakness

Question 40

treatment of epigastric herniae =

Answer 40

sutures/mesh

Question 41

``` Femoral canal is made up of anteriorly= medially= laterally= posteriorly = ```

Answer 41

ant = inguinal ligament medial - lacunar lig lateral = femoral vein post = pectinate lig

Question 42

inferior and lateral to pubic tubercle and flatten groin crease =

Answer 42

femoral hernia

Question 43

Thin, elderly female hernia =

Answer 43

femoral hernia

Question 44

femoral hernia are more common in M/F

Answer 44

F 10:1 | however if see a groin hernia in a female is still more likely it will be inguinal, get me?

Question 45

superior and medial to pubic tubercle and increases groin crease =

Answer 45

inguinal hernia

Question 46

Inguino-scrotal herniae are most likely to be direct/indirect?

Answer 46

indirect

Question 47

deep ring of inguinal canal location =

Answer 47

mid inguinal point | more superior and lateral than superficial

Question 48

superficial ring of inguinal canal location =

Answer 48

above and medial to pubic tubercle

Question 49

anterior wall of inguinal canal =

Answer 49

external oblique aponeurosis

Question 50

floor of inguinal canal =

Answer 50

inguinal and lacunar lig

Question 51

roof of inguinal canal =

Answer 51

conjoint tendon

Question 52

posterior wall of inguinal canal =

Answer 52

transversalis fascia and conjoint tendon(medially)

Question 53

Hesselbach's triangle =

Answer 53

inguinal lig inferiorly inferior epigastric vessels laterally leteral border of rectus sheath medially

Question 54

__ inguinal herniae occur through Hesselbach's triangle

Answer 54

direct

Question 55

Inguinal herniae that go through posterior wall | are medial to inferior epigastric vessels

Answer 55

direct

Question 56

direct/indirect are often bilateral inguinal herniae

Answer 56

direct

Question 57

inguinal herniae that is poorly controlled by finger over deep ring - comes back out

Answer 57

direct

Question 58

inguinal herniae more common in old men = | don''t usually get surgery because ___

Answer 58

direct | low strangulation risk and are old

Question 59

Indirect inguinal herniae go through ___ | lie ___ to inferior epigastric vessels and go with the ___

Answer 59

deep inguinal ring lateral cord

Question 60

Congenital (eg. PPV) inguinal hernia are usually

Answer 60

indirect

Question 61

indirect inguinal herniae occur more commonly in ___

Answer 61

M 10:1 | younger males

Question 62

hernia controlled by digital P over deep ring = stays in =

Answer 62

indirect inguinal hernia

Question 63

indirect/direct inguinal herniae have more risk of complications and so are more likely to get ___

Answer 63

indirect | surgery

Question 64

Operations for inguinal herniae (more commonly for indirect)

Answer 64

suture (eg. Bassini), open mesh (Lichtenstein), TAPS/TEPS, herniotomy (for congenital), herniorraphy (repair wall defect)

Question 65

Post-op after hernia repair = 2 things

Answer 65

no driving for a wk | no heavy lifting for 1 month

Question 66

Testicular scrotal swelling indicates

Answer 66

testicular cancer

Question 67

scrotal swellings could be due to (4)

Answer 67

testicular cancer epidydymal cyst hydrocele inguino-scrotal hernia

Question 68

in scrotal swellings if can get above it then it is in the ___ and is not a ___

Answer 68

scrotum eg. a hydrocele | not a hernia

Question 69

If can feel scrotal swelling is separate to testiicles then it is a ___

Answer 69

epididymal cyst