Lower GI surgery

Question 1

Pathogen of appendicitis

Answer 1

Obstruction - faecolith, lymphoid hyperplasia, tumour, worms
Infection
Oedema –> ischaemia

Question 2

Special signs in appendicitis

Answer 2

Rovsings sign - pressure in LIF = more pain in RIF
Psoas sign - pain on extending hip = retrocaecal appendix
Cope sign - flexion + internal rotation of r hip = pain

Question 3

Mx appendicitis

Answer 3

Cef+met
Analgesia
Appendicectomy

Question 4

Complications of appendicitis

Answer 4

Appendix mass
Abscess
Perforation

Question 5

Epi of diverticulosis

Answer 5

30% of Westerner’s have diverticulosis by 60

F>M

Question 6

Mx diverticular disease

Answer 6

High fibre diet, mebeverine may help

Question 7

Ix diverticulitis

Answer 7

Bloods, endoscopy

Question 8

Grading diverticulitis

Answer 8

Hinchey Grading 1-4

Question 9

Mx diverticulitis

Answer 9

Mild - NMB + augmentin
Admit if unwell/pain not controlled/fluids not tolerated
Medical - IV fluids, analgesia, cef+met
Surgery - Hartmann’s

Question 10

Complications of diverticulitis

Answer 10

Perforation
Haemorrhage
Abscess
Stricture, fistula

Question 11

Bowel obstruction medical management management

Answer 11

NMB, IV fluids, NGT, catheter

Analgesia, antibiotics

Question 12

Presentation of colonic adenoma

Answer 12

Large polyps bleed –> IDA

Villous adenoma –> low K= and hypoproteinaemia

Question 13

Locations of colorectal cancers

Answer 13

Rectum 35%, sigmoid 25%, caecum/ascending 20%

Question 14

Risk factors for colorectal cancer

Answer 14

Diet - low fibre 
IBD 
Familial - FAP (AD), HNPCC (AD), Peutz-Jegher (AD, sin pigmentation)
Smoking 
NSAIDS/aspirin protective

Question 15

Left sided colon cancer features

Answer 15

Altered bowel habit
PR mass
Obstruction
Bleeding/mucus, tenesmus

Question 16

Right sided colon cancer features

Answer 16

ANAEMIA
Weight loss
Abdo pain

Question 17

Tumour marker for colorectal cancer

Answer 17

CEA

Question 18

Screening for bowel cancer

Answer 18

FOB every 2 years for 60-75

Question 19

Causes of mesenteric ischaemia

Answer 19

Arterial thrombus/embolus

Non-occlusive

Question 20

Present/features of mesenteric ischaemia

Answer 20

Triad - acute severe abdo pain+/-PR bleeding, shock, no abdo signs
Degree of illness > clinical signs
May be in AF

Question 21

Ix in mesenteric ischaemia

Answer 21

Raised lactate, metabolic acidosis

AXR - gasless abdo

Question 22

Minor anal conditions

Answer 22

Perianal haematoma 
Proctalgia fugax - young anxious men, crampy anorectal pain worse at night 
Perineal warts - MSM 
Pruritis ani 
Pilonidal sinus

Question 23

Position of haemorrhoids

Answer 23

3, 7, 11 o’clock

Question 24

Classification of haemorrhoids

Answer 24

1st - never prolapse
2 - prolapse of defecation and spontaneouslt reduce
3 - prolpase on defecation and need digital reduction
4 - remain permanent prolapsed

Question 25

Mx haemorrhoids

Answer 25

Conservative - fibre + fluids, stop straining
Medical - topical analgesia, hydrocortisone + laxatives
Interventional - Inject sclerosant, banding, cryotherapy
Surgical - haemorrhoidectomy

Question 26

Fissure in ano associated with

Answer 26

sentile pile/mucosal tag at 6 o’clock

Question 27

Mx fissure in ano

Answer 27

Soak in warm bath, increase fibre/fluids

Medical - laxatives, topical lidnocaine, GTN, botulinum injection

Question 28

Location of anorectal abscess

Answer 28

Perianal 45%

ischiorectal, intersphincteric, supralevator

Question 29

Pathology, cause + presentation of anal cancer

Answer 29

80% SCC
HPV 16, 18, 31, 33 - MSM/warts
Faecal incontinence

Question 30

Type of rectal prolapse

Answer 30

1 - mucosal prolapse

2 - full thickness prolapse

Question 31

Causes of inguinal hernia

Answer 31

Chronic cough
Constipation
Severe muscular effort
Ascites/obesity