Surgery

Question 1

What is a perianal abscess?

Answer 1

A collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter?

Question 2

What causes perianal abscesses?

Answer 2

• E Coli (from gut)
• Staph aureus (from skin)

Question 3

What conditions are associated with perianal abscesses?

Answer 3

• IBD especially Crohns
• DM due to poor wound healing
• Underlying malignancy

Question 4

What is the management of perianal abscesses?

Answer 4

• Surgery - I+D under LA
• Abx - only if systemic upset secondary to the abscess

Question 5

How does acute mesenteric ischaemia present?

Answer 5

• Severe abdo pain
• Pain is sudden onset
• Pain is out of keeping with physical exam

Question 6

What typically causes acute mesenteric ischaemia?

Answer 6

• Embolism -> occlusion of an artery which supplies the small bowel e.g. superior mesenteric artery
• Classically pts have AF

Question 7

How do you investigate acute mesenteric ischaemia?

Answer 7

• Contrats CT - diagnostic test of choice, can assess bowel and blood supply
• BG - metabolic acidosis and raised lactate due to ischaemia

Question 8

What is the management of acute mesenteric ischaemia?

Answer 8

Surgery
- Remove necrotic bowel
- Remove or bypass thrombus

Question 9

What is chronic mesenteric ischaemia aka? What causes it?

Answer 9

• Intestinal angina
• Narrowing of mesenteric blood vessels by atherosclerosis

Question 10

How does chronic mesenteric ischaemia present?

Answer 10

Triad of:
- Central colicky abdo pain after eating (lasts 1-2 hrs)
- Wt loss (due to food avoidance)
- Abdo bruit (heard on auscultation)

Question 11

How do you diagnose chronic mesenteric ischaemia?

Answer 11

CT angiography

Question 12

What is the management of chronic mesenteric ischaemia?

Answer 12

• Reducing modifiable RF
• Secondary prevention (statins, anti-platlets)
• Revascularisation (to improve blood flow)

Question 13

What is the prognosis for acute mesenteric ischaemia?

Answer 13

High mortality (>50%)

Question 14

What branches of the abdominal aorta supply the abdo organs?

Answer 14

1. Coeliac artery
   - Foregut (stomach -> duodenum, liver, biliary system, pancreas, spleen)
2. Superior mesenteric artery
   - Midgut (duodenum -> 1st 1/2 transverse colon)
3. Inferior mesenteric artery
   - Hindgut (2nd 1/2 transverse colon -> rectum)