Surgery

Question 1

What are the findings of small bowel obstruction on X-ray?

Answer 1

Dilated loops >3cm
Valvular conniventes across width of bowel
Centrally located

Question 2

What are the X-ray findings of large bowel obstruction?

Answer 2

Dilated loops >6cm, caecum >9cm
Haustra partially cross the width of the bowel
Peripherally located

Question 3

The inverted comma shaped is pathopneumonic for what on AXR?

Answer 3

Caecal volvulus
- caecum rotates causing a twist in the terminal ileum and ascending colon.

Question 4

The coffee bean shape on X-ray is pathopneumonic for what pathology?

Answer 4

Sigmoid volvulus
- chronic constipation causes large redundant loop of sigmoid colon. Can twist when heavily loaded. Causes ischaemic obstruction leading to perforation.

Question 5

What makes up Charcot’s triad?

And Reynold’s pentad?

Answer 5

Fever
RUQ pain
Jaundice

Shock
Altered mental status

Question 6

What are the indications for AAA repair?

Answer 6

Symptomatic
Asymptomatic, >4cm and grown >1cm in 1 year.
Asymptomatic and 5.5cm+

Question 7

What is the management of acute diverticulitis?

Answer 7

If systemically well:
- no Abx
- simple analgesia
- return if st persist/worse

Offer abx if systemically unwell, immunosuppressed, or sig comorbidity.