surgery

Question 1

risk factors for gallstones

Answer 1

fat
forty
female
foetus

Question 2

mirizzi syndrome

Answer 2

large stone in the GB/cystic duct compressing on the CBD resulting in obstruction and jaundice

Question 3

presentation of ascending cholangitis

Answer 3

charcots triad (fever/rigors, RUQ pain, jaundice)

+ shock and confusion = reynaolds pentad

Question 4

complications of gallstones

Answer 4

mirizzi syndrome
ascending cholangitis
acute pancreatitis
gallstone ileus (due to erosion through GB forming a fistula and causing bowel obstruction )

Question 5

presentation of acute pancreatitis

Answer 5

epigastric pain radiating to back
N&V
fever
hypovolaemia
grey turners and cullens (indicates haemorrhagic pancreatitis)

Question 6

investigations for acute pancreatitis

Answer 6

serum lipase or amylase > 3x ULN
raised inflammatory markers
CXR (ARDS, pleural effusions)
MRCP
CT severity score and glasgow severity score

Question 7

management of acute pancreatitis

Answer 7

IV fluids
analgesia
antiemtic
ERCP if gallstone and cholangitis
Abx if pancreatic necrosis

Question 8

presentation of chronic pancreatitis

Answer 8

epigastric pain (dull, alleviated by leaning forward, radiates to back)
steatorrheoa
wt loss/malnutrition
diabetes

Question 9

management of chronic pancreatitis

Answer 9

NSAIDs if acute pain
smoking alcohol cessation
enzyme supplements
psudocyst decompression
pancreatic duct decompression
ESWL for calcifications

Question 10

presentation of haemorrhoids

Answer 10

fresh painless PR bleeding
pruritus ani
lumps in perianal area
thrombosis can cause severe pain

Question 11

management of haemorrhoids

Answer 11

high fibre and fluid diet
topical hydrocortisone
laxitives
rubber band ligation or injection sclerotherapy
haemorrhoidectomy

Question 12

hinchey classification

Answer 12

I - local abscess
II - pelvic abscess
III - purulent peritonitis
IV - feculent peritonitis

Question 13

causes of visceral perforation

Answer 13

ruptured peptic ulcer
perforated appendicitis, colitis, diverticulitis
iatrogenic - colonoscopy

Question 14

presentation of mesenteric ischaemia

Answer 14

acute severe abdo pain +/- PR bleeding (usually after eating)
hypovolaemia (tachycardia, hypotensive)
no abdominal signs
AF

Question 15

investigations of ischaemic bowel

Answer 15

FBC - raised WCC, low Hb
ABG - raised lactate, metabolic acidosis
raised amylase
AXR
CT/MR angiography

Question 16

types of inguinal hernias

Answer 16

indirect
younger patients, emerges through deep ring, has same 3 coverings as spermatic cord and descends into scrotum, can strangulate, urgent surgery required

direct
older patients, emerges through hasselbach’s triangle, rarely descends into scrotum and rarely strangulates