Signs and Symptoms IV

Question 1

Which of the following is a subcostal incision used to gain access to the gall bladder?
A) Midline
B) Thoracotomy
C) Pfannenstiel
D) Kocher

Answer 1

D) Kocher

Question 2

Which surgical incision is made in an appendicectomy?

Answer 2

Lanz incision

Question 3

What are the routinely used incisions in abdominal surgery?

Answer 3

Midline and paramedian incisions, Lanz incision and the Kocher incision.

Question 4

What is a laparotomy?

Answer 4

A laparotomy is a large surgical incision through the abdominal wall to gain access into the abdominal cavity.

Question 5

Where is the lower border of the liver on full inspiration?

Answer 5

At the costal margin in the mid-clavicular line.

Question 6

What is the difference between diverticulosis and diverticulitis?

Answer 6

Diverticulosis refers to pouches in the large intestines.

If these pouches are inflamed, it is known as diverticulitis.

Question 7

What are the signs and symptoms of diverticulitis and what is a differential diagnosis of diverticulitis?

Answer 7

Diverticulitis typically presents with left quadrant abdominal pain of sudden onset. There may be fever, nausea, diarrhoea or constipation, and blood in the stools. Irritable Bowel Syndrome

Question 8

What is Mallory-Weiss Syndrome? What is the most common cause of this syndrome?

Answer 8

Mallory-Weiss syndrome is a gastro-esophageal laceration syndrome commonly caused by violent or prolonged vomiting due to alcoholism or bulimia.

Question 9

What are the 2 important signs that Mallory-Weiss Syndrome patients may present with?

Answer 9

Malaena or Haematemesis

Question 10

Describe the pain presented by patients with pancreatitis.

What other symptoms are there?

Answer 10

Epigastric pain that radiates to the back.

Nausea and vomiting

Question 11

Describe the pain in appendicitis.

What are the other symptoms?

Answer 11

Umbilical or Hypogastric pain that shifts to the right iliac fossa.
Fever, vomiting, anorexia, Guarding or rebound tenderness
Rovsing’s positive

Question 12

Describe the pain in sigmoid diverticulitis.

Answer 12

Hypogastric pain that radiates to the Left iliac fossa

Fever, nausea and vomiting, altered bowel habits and a history of constipation

Question 13

Describe the pain of bowel ischaemia/necrosis

Answer 13

Central abdominal tenderness and global abdominal pain

Question 14

Describe the pain in cholecystitis.

What other symptoms are there?

Answer 14

Epigastric pain that moves to the right hypochondrium, pain may radiate to the shoulder tip
Fever, vomiting and anorexia
Fat intolerance

Question 15

With pancreatitis, what are the results of blood tests?

Answer 15

High serum amylase (>1000u/mL or a 3-fold increase) and high protein
Raised serum lipase

Question 16

What is the most common cause of pancreatitis?

Answer 16

Alcoholism

Question 17

What is tested for if serum amylase levels are requested?

What is the other test conducted, which is more sensitive and specific than serum amylase?

Answer 17

Acute pancreatitis

Serum lipase is also tested, it is more sensitive and specific than serum amylase.

Question 18

What is the definition of AAA?

Answer 18

Localised, abnormal dilatation of the abdominal aorta to more than 1.5 its normal diameter.

Question 19

Are males or females more likely to have AAA?

Answer 19

Males, with a ratio of M:F = 6:1

Question 20

Where does AAA commonly occurs at?

Answer 20

Infrarenal, below the renal arteries

Question 21

What is a possible treatment of AAA?

Answer 21

1. Endovascular surgery where a stent graft is inserted into an artery at the groin and then carefully passed up into the aorta.
2. Open surgery where a graft is placed in the aorta with a cut in the patient’s abdomen

Question 22

Usually, what is the size of a large AAA?

Answer 22

more than 5.5cm across

Question 23

What is Cullen’s sign and Grey-Turner’s sign?

What are these findings indicative of?

Answer 23

Cullen’s sign is periumbilical bruising. Grey-Turner’s sign is bruising to the flanks.
They are indicative of retroperitoneal haemorrhage or autodigestion of blood vessels by pancreatic enzymes - complications in acute pancreatitis.

Question 24

What are the complications of acute pancreatitis? Give explanations for each.

Answer 24

Peritonitis - from spread of infection throughout the peritoneal cavity.

Diabetes - from autodigestion of beta-cells of Islets of Langerhans by pancreatic enzymes

Acute Renal Failure - from hypovolaemia

Abscess or fistula formation, haemorrhage.

Question 25

What can be seen on abdominal X-ray in a patient with pancreatitis?

Answer 25

Loss of Psoas shadow, which indicate inflammation around the psoas muscle, or shift of fluid to the retroperitoneum.

Question 26

What is the phrase used to describe pancreatitis management? Describe.

Answer 26

‘Drip and Suck’.
Drip refers to IV therapy - giving IV fluids and IV analgesia. Insertion of urinary catheter to monitor fluid balance (aim urine output for >30mL/hour)

Suck refers to an NG tube.
Insertion of a wide bore NG tube to drain gastric contents. This ensures the bowel is rested and can help with symptoms of nausea and vomiting through relief of stomach distension.

Question 27

Is this statement true or false: IV fluids and IV antibiotics are the first line management of acute pancreatitis.

Answer 27

False.
Only IV fluids for fluid resuscitation is needed. IV antibiotics is NOT needed as pancreatitis is not due to a bacterial infection.