Intestine

Question 1

Top 3 Causes of SBO (in order)

Answer 1

ABC
Adhesions
Bulge (hernias)
Cancer (neoplasms)

Question 2

SBO
most useful indicator

Answer 2

inability to pass fatus

Question 3

AXR (3 views): triad

Answer 3

triad of dilated small bowel (>3 cm in diameter), air-fuid levels on upright flm,
paucity of air in colon (high sensitivity, low specifcity as ileus and LBO can present similarly)

Question 4

SBO
CT scan findings of ischemic bowel/strangulation

Answer 4

pneumatosis intestinalis (free
air in bowel wall)
and thickened bowel wall,
air in portal vein, free intraperitoneal fuid,
and
diferential wall enhancements (poor uptake of IV contrast into the wall of the afected
bowel)

Question 5

partial SBO/Crohn’s/Carcinomatosis
MNGT

Answer 5

onservative management with fuid resuscitation and NG
tube decompression

Question 6

for partial SBO/Crohn’s/Carcinomatosis
hours of observation prior to deciding for surgery

Answer 6

48 hrs

Question 7

for early postoperative SBO
- days of observation prior to deciding for surgery

Answer 7

3-5 days

Question 8

postoperative:
hours/days before motility return
1. gastric and small bowel
2. colonic motility

Answer 8

1. 24-48 h
2. 3-5 days

Question 9

diagnosis:
Pain “out of keeping with physical
fndings”

Answer 9

Intestial ischemia

Question 10

Gold standard investigation
Acute Intestinal Ischemia

Answer 10

Ct angiogram

Question 11

Hernia is more common in male or female

Answer 11

male

Question 12

Most common hernia

Answer 12

Indirect inguinal hernia

Question 13

What type of hernias requires UTZ with or without CT scan

Answer 13

obturator hernias
internal abdominal hernias
Spigelian
femoral hernias in obese patients

Question 14

name the Hernia
- combined indirect and direct hernia

Answer 14

Pantaloon

Question 15

name the hernia
-contains Meckels diverticulum

Answer 15

littres

Question 16

name the hernia
-contains appendix

Answer 16

Amyand

Question 17

name the hernia
-ventral hernia through linea semilunaris

Answer 17

Spingelian

Question 18

Stangulation of hernia is most common in what type?

Answer 18

femoral> indirect>direct

Question 19

Most common post operative complication of hernia

Answer 19

recurrence

Question 20

Pre operative antibiotics Appendix

Answer 20

cefazolin + metronidazole

Question 21

Most common complication of diverticulosis

Answer 21

Diverticulitis

Question 22

Most common fistula formation in Diverticulitis

Answer 22

Colovesical

Question 23

Rectal bleeding from diverticulitis painful or painless

Answer 23

Painless

Question 24

Is Colonoscopy done in diverticular disease?

Answer 24

Yes, after acute episodes

Question 25

Outpatient treatment of diverticulitis

Answer 25

antibiotics 7-10 days cipro+metro

Question 26

when to hospitalize patients with diverticulitis?

Answer 26

if severe presentation, inability to tolerate oral intake, signifcant comorbidities, or fail to
improve with outpatient management

Question 27

Indications for surgery diverticulitis

Answer 27

◆ unstable patient with peritonitis
◆ Hinchey stage 3-4 (see Table 19)
◆ afer 1 attack if immunosuppressed
◆ consider if recurrent episodes of diverticulitis (≥3); recent trend is toward conservative
management of recurrent mild/moderate attacks

Question 28

Surgery for diverticulitis
- if unstable patient

Answer 28

hartmanns

Question 29

Stages of diverticulitis describe and management
hinchey 1

Answer 29

phlegmon/small pericolic abscess -> medical

Question 30

Stages of diverticulitis describe and management
hinchey 2

Answer 30

Large abscess/fistula -> medical, abscess drainage +/- resection with primary anastomosis

Question 31

Stages of diverticulitis describe and management
hinchey 3

Answer 31

purulent peritonitis (ruptured abscess) -> resection or hartmanns procedure

Question 32

Stages of diverticulitis describe and management
hinchey 4

Answer 32

feculent peritonitis -> hartmanns procedure