General Surgery Crash Course

Question 1

What sign?

Answer 1

Coffee bean sign

AXR - diagnosis is Sigmoid volvulus

Question 2

coffee bean sign - means..

Answer 2

Sigmoid volvulus

Question 3

… accounts for approx 5% of cases of large bowel obstruction

Answer 3

Volvulus
Sigmoid most common, can be caecum also
Sigmoid volvulus may be treated with decompression +/- surgery
Caecum volvulus - surgical only

Question 4

62 YO accountant - LLQ pain, general malaise and intermittent fevers
Suspect diverticulitis - which part of intestines does this most commonly effect?

Answer 4

Sigmoid colon

Question 5

Diverticula are …

Answer 5

Sac like protrusions of the mucosa through the muscular wall

Question 6

Diverticulitis refers to

Answer 6

Symptomatic acute inflammation and infection of diverticula
Common with advancing age
Most commonly in sigmoid colon
4025% lifetime risk of diverticulitis if diverticulosis

Question 7

Management of diverticulitis

Answer 7

ABs, supportive care or surgical intervention (drainage, surgical washout or hartmann’s procedure)

Question 8

Acute mesenteric ischaemia -

Answer 8

Collection of conditions causing acute intestinal hypoperfusion
Occlusive arterial AMI - usually embolic disease
Risk factors - AF, MI and IE
Necrosis necessitates intervention or palliation, typically via laparotomy

Question 9

Abdo pain and constipation - change in bowel habit, 4kg of weight loss
HTN - previous surgeries
Low HB, low MCV, CRP up and lactate up
Large bowel on AXR - finding on X-ray?

Answer 9

Haustra - large bowel

Question 10

AXR small vs large bowel

Answer 10

AXR - smalll bowel has valvulae conniventes, white lines which cross the entire lumen
Large bowel has haustra - white lines which do not cross the lumen of the large bowel
3,6,9 cm rule can be used to identify dilated bowel

Question 11

Bowel dilatation -

Answer 11

3,6,9cm rule

Question 12

Bowel obstruction is the presenting symptom in up to … of cases of colorectal cancer

Answer 12

1/3rd

Question 13

What is the most common cause of large bowel obstruction

Answer 13

Colorectal cancer

Question 14

Surgical options for colorectal cancer

Answer 14

Defunctioning stoma or resection with anastomosis

Non surgical - endoscopic stenting

Question 15

Small bowel obstruction causes - post appendectomy

Answer 15

Adhesions

Question 16

Adhesional SBO

Answer 16

May resolve with conservative measures , may need surgery
NG tube and IV fluid = conservative
Gastrografin is often given therapeutically if uncomplicated
Emergency surgery may be indicated if persistent or risk of complications

Question 17

Positive cough impulse, dragging in right groin

Question 18

What describes the surface landmarks for the deep inguinal ring?

Answer 18

6cm oblique passage through the abdominal wall
Transmits the spermatic cord in men and round ligament in women
Deep ring - mid point between the asis and pubic tubercle (mid point of inguinal ligament)
The superficial ring - triangular opening in external oblique aponeurosis

Question 19

During laparoscopic surgery a direct inguinal hernia does what in relation to the inferior epigastric vessels?

Answer 19

Passes medically - inguinal hernias are either direct or indirect (60%(
Direct protrude directly through the posterior wall of the inguinal canal

Question 20

Indirect hernias

Answer 20

Protrude through the deep ring and into the inguinal canal

Question 21

Inguinal hernias

Answer 21

Symptomatic - operative management

Question 22

Inguinal hernia open vs laparoscopic

Answer 22

Question 23

Complication of inguinal hernia repair

Answer 23

Chronic pain, infection, recurrence

Ilioinguinal nerve damage possible during surgery - relates to chronic pain