GI / Gen Surg

Question 1

When are pseudocysts unlikely to be present after an attack of acute pancreatitis?

Answer 1

< 4 weeks

Question 2

Local complications of AP

Answer 2

Peripancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Pancreatic abscess
Haemorrhage

Question 3

What % of AP get peripancreatic fluid collections?

Answer 3

25%

Question 4

Describe peripancreatic fluid collections

Answer 4

Located in or near the pancreas and a lack of granulation or fibrous tissue

Question 5

What may happen to peripancreatic fluid collections?

Answer 5

May resolve
May turn into abscess
May turn into pseudocysts

Question 6

Describe pseudocysts

Answer 6

In AP result from organisation of peripancreatic fluid collection
The collection is walled by fibrous or granulation tissue and typically occurs > 4 weeks after an attack of AP

Question 7

Where are most pseudocysts due to AP found?

Answer 7

Retrogastric

Question 8

What are 75% of pseudocysts associated with?

Answer 8

Elevation of amylase

Question 9

Investigation of pseudocysts due to AP

Answer 9

CT
ERCP
MRI
Endoscopic USS

Question 10

Management of pseudocysts due to AP

Answer 10

Symptomatic cases may be observed for 12 weeks as up to 50% resolve
Endoscopic or surgical cystogastrostomy or aspiration

Question 11

Describe pancreatic necrosis

Answer 11

May involve both the pancreatic parenchyma and the surrounding fat

Question 12

What are complications of pancreatic necrosis linked to?

Answer 12

Extent of parenchymal necrosis

Extent of necrosis overall

Question 13

Treatment of pancreatic necrosis

Answer 13

If sterile necrosis - manage conservatively 
Early necrosectomy (although high mortality rate so try to avoid)

Question 14

What is a pancreatic abscess?

Answer 14

Intraabdominal collection of pus associated with the pancreas in the abscess of necrosis

Question 15

What do pancreatic abscesses generally occur due to?

Answer 15

As a result of an infected pseudocyst

Question 16

Treatment of a pancreatic abscess

Answer 16

Antibiotics
Transgastric drainage
Endoscopic drainage

Question 17

How may haemorrhage occur in terms of AP?

Answer 17

Infected necrosis may involve vascular structures which result in haemorrhage may occur de novo or as a result of surgical necrosectomy

Question 18

What sign may be present if retroperitoneal haemorrhage may occur?

Answer 18

Grey turners sign

Question 19

Preferred diagnostic test for chronic pancreatitis - what are you looking for?

Answer 19

CT pancreas with intravenous contrast

Looking for pancreatic calcification

Question 20

3 criteria for aneurysm surgery

Answer 20

An asymptomatic aneurysm > 5.5cm in diameter
An asymptomatic aneurysm which is enlarging more than 1cm per year
A symptomatic aneurysm

Question 21

Criteria for emergency repair of aneurysm

Answer 21

Symptomatic aneurysm

Rupture

Question 22

Most common causes of ascending cholangitis

Answer 22

1. E coli

2. Klebsiella

Question 23

Another name for hartmans procedure

Answer 23

Proctosigmoidectomy

Question 24

What is hartmans procedure?

Answer 24

The surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

Question 25

What reduces the risk of intra abdominal adhesions?

Answer 25

Use of laparoscopic approach over open approach

Question 26

What is used to monitor the response to treatment of colon cancer?

Answer 26

CEA

Question 27

Is there a screening programmme for aortic aneurysm? If so for who?

Answer 27

Yes Men aged 65 y/o Single AUSS

Question 28

Indications for surgical treatment of a sigmoid volvulus

Answer 28

Repeated failed attempts at decompression Necrotic bowel noted on endoscopy Suspected or proven perforation Peritonitis

Question 29

1st line investigation for SBO

Answer 29

CT abdo

Question 30

Two most common causes of SBO

Answer 30

Intraabdominal adhesions | Hernias

Question 31

What is a defunctioning stoma?

Answer 31

The name given to any stoma which prevents the passage of bowel contents in the distal segment of the bowel

Question 32

Are end stomas reversible?

Answer 32

No

Question 33

What are intramural calcifications of the gallbladder a strong risk factor for?

Answer 33

Gallbladder cancer

Question 34

What is Reynolds pentad?

Answer 34

Charcots triad + Hypotension + Confusion

Question 35

Associations of sigmoid volvulus

Answer 35

``` Older patients Chronic constipation Chagas disease Neurological conditions e.g. PD, Duchennes Psych conditions e.g. schizophrenia ```

Question 36

Assosiations of caecal volvulus

Answer 36

All ages Adhesions Pregnancy

Question 37

What is used to assess the severity of an upper GI bleed?

Answer 37

Blatchford score

Question 38

What may an enterovesical fistula cause?

Answer 38

Frothy urine

Question 39

What is a common cause of enterovesical fistula?

Answer 39

Colorectal malignancy

Question 40

Features of post op ileus

Answer 40

Occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting become apparent

Question 41

What is the rule for eating and drinking before general anaesthesias?

Answer 41

No eating for 6 hours before operation | No clear fluids for 2 hours before operation

Question 42

Definition of upper GI bleed

Answer 42

GI haemorrhage with an origin proximal to the ligament of Treitz

Question 43

What is the ligament of Trietz?

Answer 43

Suspensory muscle of the duodenum

Question 44

Describe richters hernia

Answer 44

Can present with strangulation without obstruction | Bowel lumen is patent whilst bowel wall is compromised

Question 45

Is an anal fissure is present anteriorly what is it usually due to? And posteriorly?

Answer 45

Anteriorly - Underlying organic disorder (merit endoscopy) | Posteriorly - Passage of hard stool

Question 46

What does the modified Glasgow criteria for severe pancreatitis involve?

Answer 46

``` P - PaO2 < 8 A - Age > 55 N - Neutrophilia C - calcium < 2 R - renal function - urea > 16 E - enzymes - LDH > 400, AST > 200 A - Albumin < 32 (serum) S - Sugar - BG > 10 ```

Question 47

What is an (odd) risk factor for acute limb ischaemia?

Answer 47

AF