General Surgery

Question 1

Surgical Causes of RUQ

Answer 1

• cholecystitis
• biliary colic
• ascending cholangitis

Question 2

epigastric pain

Answer 2

duodenal ulcers
pancreatitis
gastritis

Question 3

RIF pain causes

Answer 3

appendicitis
ovary

Question 4

LIQ pain - causes

Answer 4

constipation
diverticulitis

Question 5

Cholecystitis- presentation

Answer 5

RUQ pain
fever
previous sx of biliary colic
Murphy’s sign (palpate RUQ, get pt to breathe, if painful indicative of cholecytisis_

Question 6

bloods in ?cholecystitis

Answer 6

LFTs
IFM
Surgical bloods (clotting etc)

Question 7

Ix for ?cholecystitis

Answer 7

Bloods
USS gallbladder
MRCP (if +ve, can do ERCP which can also be therapeutic)

Question 8

Mx of cholecystitis

Answer 8

fluids
abx
analgesia

Hot GB list for first 48h, then on elective list

Question 9

ascending cholangitis presentation

Answer 9

RUQ pain + fever + jaundice (Charcots triad)

previous gallstone disease or hx suggestive of malignancy

Question 10

o/e in ascending cholangitis

Answer 10

tender RUQ, jaundiced, may be septic

Charcot triad, which consists of RUQ pain, fever, and jaundice, is the classical clinical manifestation of acute cholangitis though not all patients manifest with the triad

Question 11

ix

Answer 11

bloods
USS GBS -> CBD dilatation -> ?MRCP

Question 12

mx ascending cholangitis

Answer 12

empirical abx (broad spectrum) - Piperacillin / tazobactam (or gentamicin + metronidazole in penicillin-allergic patients)

supportive management

urgent biliary drainage

Sepsis 6

analgesia

Question 13

Bowel obstruction causese

Answer 13

adhesions (e.g. from previous surgery)
mass e.g. malignancy
inflammatory stricture (IBD, diverticulitis etc)

Question 14

mx of bowel obstruction

Answer 14

drip and suck -> NGT, IVF, NBM

analgesia
gastrograffin
Surgery
may be terminal event in palliative patients

Question 15

ix in bowel obstruction

Answer 15

bloods
CTAP
gastrograffin + CTAP / AXR - d/w radiologist (can also be therapeutic)

Question 16

sx in appendicitis

Answer 16

initially central pain migrates to RIF
+/- RUQ / subrapubic
diarrhoea
vomiting
tachypnoea
fever

O/E
tender RLQ
Rosving’s sign
rebound tenderness

Question 17

mx of appendicitis

Answer 17

analgesia
abx
lap or open appendicectomy

Question 18

ix for pancreatitis

Answer 18

bloods
ABG
amylase
lipase
US to look for gallstones
CT if deteriorating ?necrotising pancreatitis

Question 19

Mx of pancreatitis

Answer 19

IV fluids (input/output monitoring)
analgesia
if gallstone related -> ERCP, cholecystectomy
Abx if needed
IR drain / necrosectomy if infected necrosis (abx are also indicated if it becomes necrotising)

maintain good lung function because of risk of ARDS

Question 20

opioid to use when worried about a patients renal function

Question 21

What is sigmoid volvulus associated with?

Answer 21

• older patients
• chronic constipation
• Chagas disease
• neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
• psychiatric conditions e.g. schizophrenia

Question 22

Coffee bean sign

Answer 22

indicates sigmoid volvulus

seen on plain abdo film

Question 23

What is volvulus

Answer 23

Volvulus may be defined as torsion of the colon around it’s mesenteric axis resulting in compromised blood flow and closed loop obstruction.

Question 24

What is catcall volvulus associated with?

Answer 24

all ages
adhesions
pregnancy