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Surgery > Surgery ( Adynamic Bowel Obstruction) > Flashcards

Surgery ( Adynamic Bowel Obstruction) Flashcards

1
Q

Congenital megacolon/ Hirschsprung disease

A

Loss of ganglion cells in both aurebach & mesissner’s plexus of variable portion of the rectum and colon

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2
Q

Mc site of hirschsprung disease

A

Rectum

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3
Q

Hirschsprung disease a/w

A

Down syndrome

Men 2A

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4
Q

Factor implicated in the hirschsprung diseases

A

GLial derived neurotrophic factor

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5
Q

Squirt sign

A

Hirschsprung disease

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6
Q

IOC for hirschsprung disease

A

Full thickness rectal biopsy

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7
Q

IHC for hirschsprung disease

A

Acetylcholinesterase

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8
Q

Name of the surgery for the Hirschsprung diseases

A

Swenson
Suave
Duhamel

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9
Q

IOC of mesenteric ischemia

A

Ct angiography

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10
Q

MC cause of the Mesenteric ischemia

A

Acute mesenteric artery embolism

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11
Q

Mc source of the embolism

A

Atrial fibrillation

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12
Q

Embolectomy done by

A

Fogarty catheter

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13
Q

Thumb print sign on x ray suggestive of

A

Bowel ischemia/ ischemic colitis

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14
Q

Mc cause of paralytic ileus

A

Post operative

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15
Q

Mc cause of prolonged paralytic ileus

A

Hypokalemia

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16
Q

Which part firstregains motility after the bowel surgery

A

Jejunum / small instestine

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17
Q

Ogilvie syndrome/ primary colonic psudeo obstruction mx

A

Catchpole regimens - Iv neostigmine

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18
Q

Higher chances if skin excoriation seen with

A

Ileostomy> colostomy

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19
Q

Pouts like

A

Ileostomy

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20
Q

Same level as that of skin

A

Colostomy

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21
Q

Placement of the stoma ?

A

Outer border of the rectus abdominus
Away from the bony landmarks
Along the spinoumbilical line

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22
Q

Earliest complications of the stoma

A

Necrosis of stoma

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23
Q

Overall most common complication of stoma

A

Skin excoriation

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24
Q

Mc long term complication of colostomy

A

Para stomal herniation

Loop colostomy > end colostomy

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25
Q

Short bowel syndrome

A

< 200 cm of small intestine

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26
Q

Mc cause of short bowel syndrome

A

Superior mesenteric artery embolism

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27
Q

Mx of short bowel syndrome

A

Total parental nutrition
Drugs - gastic empty inhibitor- Teduglutide

Bile acids - cholestyramine

Anti motility- Loperamide

Sx - Bianchi & step procedure

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28
Q

Mc site involve in the Crohn disease

A

Terminal ileum

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29
Q

Mc gene involve in the Chron’s disease

A

NOD2/Card 15 gene

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30
Q

Hallmark feature of crohn disease

A

Anorectal fistula formation

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31
Q

Creeping fat is feature of

A

Crohn disease

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32
Q

All the layer of bowel ( Transmural) involved in

A

Crohn disease

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33
Q

Type of granuloma present in the crohn disease

A

Non- caseating granuloma

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34
Q

Earliest manifestation of Crohn’s disease!?

A

Apthous ulcer

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35
Q

String sign of kantor present in!?

A

Crohn’s disease

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36
Q

Marker of the Crohn’s disease !?

A

Stool calprotectin

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37
Q

Antibody present in the Crohn’s disease

A

ASCA ( Anti saccharomyces cerevisiae antibody)

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38
Q

Cobble stone mucosa appearance is feature of

A

Crohn’s disease

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39
Q

IOC of Crohn’s disease

A

Colonoscopy + biopsy

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40
Q

Mx of the Crohn’s disease

A

Steroids (Doc)
Azathioprine
Mycophenolate
Infliximab ( TNF alpha antagonist)

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41
Q

Risk factor for the Crohn’s disease

A

Smoking

Increased consumption of refined diet

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42
Q

Crohn’s disease and ulcerative colitis are a/w increase……..

A

Risk of cancer

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43
Q

Smoking is protective in

A

Ulcerative colitis’s

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44
Q

Mc site of ulcerative colitis

A

Rectum

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45
Q

Pseudo polyp is feature of

A

Ulcerative colitis

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46
Q

35 year old female comes with colicky pain , she told that she notice fresh bleeding in the stool and has fever , chills & Rigors and she is trying to conceives the baby but not able to do it what is the dx !?

A

Crohn’s disease

C/f - colicky pain
Hematochezia
Intra abdominal abscess fever , chills , Rigors
Adhesions with fallopian tube decreases the motility of fallopian tube : infertility or ectopic pregnancy

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47
Q

38 yr male comes with complain of painless bloody diarrhea 10-15 times /day on examination he has puffy eyes , pedal edema what is the dx!?

A

Ulcerative colitis

C/f - painless bloody diarrhea + Hypoprotinemia

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48
Q

Antibody found in the ulcerative colitis’s

A

P-ANCA ( Peri - nuclear anti cytoplasmic antibody)

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49
Q

Ba enema - lead pipe appearance is feature of !?

A

Ulcerative colitis

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50
Q

Earliest radiological feature of UC !?

A

Mucosal granulation (mc)

Other -
Loss of haustration
Lead pipe colon

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51
Q

IOC Of UC !?

A

BIOPSY

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52
Q

Doc of UC!?

A

Sulphasalazine.

Sulphasalazine is prodrug converted into 5 ASA ( Amino salicylic acid)

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53
Q

Definitive treatment of UC!?

A

Total proctocolectomy

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54
Q

Mc complication of sx in the UC!?

A

Pouchitis

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55
Q

Mc complication a/w mortality in the case ulcerative colitis!?

A

Small bowel obstruction

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56
Q

All extra intestinal manifestation resolve after surgery in UC except !?

A

1) primary sclerosing cholangitis

2) ankylosing spondylitis

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57
Q

To called TOXIC MEGACOLON dilated loops of bowel should be

A

> 6 cm

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58
Q

MC part of the colon involve in the case of toxic megacolon!?

A

Transverse colon

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59
Q

How to define Pseudomembranous colitis !?

A

Received antibiotics in previous 3 months

Or hospitalized patient > 48 hours admission

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60
Q

Mc antibiotics a/w with pseudomembranous colitis’s!?

A

Cephalosporins > clindamycin

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61
Q

Toxin responsible for PMC!?

A

Clostridium difficile toxin A/B

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62
Q

Dx test for the PMC!?

A

Enzyme immune assay - glutamate dehydrogenase

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63
Q

Ideal test for the PMC !?

A

PCR for cl. Difficle gene

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64
Q

DOC for the PMC!?

A

Vancomycine

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65
Q

TOC for the psudeomembranous colitis!?

A

Fecal transplantation

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66
Q

Most common extra intestinal manifestation of IBD !?

A

Arthritis

CD> UC

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67
Q

Most common site of diverticular disease!?

A

Sigmoid colon

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68
Q

IOC of Diverticulosis!?

A

Barium enema ( saw tooth appearance)

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69
Q

MCC of bleeding per rectum !?

A

Hemmorhoids

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70
Q

MCC or bleeding per rectum in neonate!?

A

Intussusception

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71
Q

MCC of bleeding per rectum in elderly patients

A

Ca of colon

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72
Q

Hinchey classification used for !?

A

Diverticulitis

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73
Q

Hinchey classification!?

A

1 - pericolic absecss
2- pelvic abscess
3- purulent peritonitis
4- fecal peritonitis

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74
Q

IOC for the diverticulitis is !?

A

CECT

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75
Q

LONG term complication of diverticulitis!?

A

Colovesical > colovaginal fistula

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76
Q

MCC of Massive lower GI hemorrhage!?

A

Diverticulitis

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77
Q

Angiodysplasia !?

A

Dilated submucosal vein

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78
Q

Most common site of Angiodysplasia !?

A

Caecum

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79
Q

Dx & mx for the Angiodysplasia!?

A

Colonoscopy / capsule endoscopy & cauterisation

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80
Q

Angiodysplasia + Aotic stenosis

A

Heyde syndrome

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81
Q

Angiodysplasia + von willebrand factor gene involve!?

A

ADAMTS 13 gene

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82
Q

Horizontaal ulcer causes strictures lead to Bowel obstruction in case of !?

A

BOWEL TB

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83
Q

Longitudinal ulcer in the Bowel causes perforation in case of !?

A

TYPHOID

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84
Q

Most site of TB infection in BOWEL !?

A

Terminal ileum

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85
Q

Crohn’s stricture mx !?

A

Stricturoplasty

Heinke mikulicz
Finney

86
Q

Goose neck deformity found in !?

A

Bowel TB

87
Q

Sterlen & fleischner / inverted umberlla sign is feature of !?

A

Bowel TB

88
Q

Most common site of Appendix !?

A

Retrocecal

89
Q

2nd most common site of Appendix !?

A

Pelvic

90
Q

Mcc cause of acute appendicitis!?

A

Obstruction

91
Q

Most common cause of obstruction!?

A

Faecolith ( capo4)

92
Q

Max incidence of the acute appendicitis are seen in !?

A

Teenagers ( male > female)

93
Q

Scoring system used in the appendicitis

A

MANTRELS scoring / ALVARADO score

94
Q

2 points to which in the MANTRELS SCORING system !?

A

LT -2

Migration of pain  - 1
Anorexia.                -1
Nausea & vomiting- 1 
Tenderness.           -2
Rebound pain.      -1
Elevated temperature- 1
Leuckocytosis -  2
Shift of white blood cell count to left -1
95
Q

McBurney’s point tenderness is feature of !?

A

Acute appendicitis

Mc burney’s point - 2/3 rd from the umbilicus to 1/3 rd ASIS

96
Q

Rovsing sign

A

Pressure on left iliac fossa - pain in right iliac fossa

97
Q

Psoas sign / cope psoas sign!?

A

Pain on hyperextension of right hip or flexion of right hip against resistance

98
Q

Obturator sign !?

A

Flexion & internal rotation of right hip

99
Q

Non specific sign of appendicitis!?

A

Dunphy sign - pain on coughing
Ten horn sign - pain on pulling right testis
Aaron sign - pressure on right iliac fossa - pain in epigastrium

100
Q

IOC OF appendicitis in adults !?

A

CECT

101
Q

IOC OF appendicitis in children!?

A

USG

102
Q

Base of the appendix

A

Junction of the 3 taenia coil

103
Q

Perforated appendix incision!?

A

Lower midline incision

104
Q

Most common complication on appendicectomy !?

A

Wound infection

105
Q

Most common long term complication of the appendicectomy !?

A

Adhesive intestinal obstruction

106
Q

Injury to illiohypogastric nerve during the appendicectomy increase the risk of ………. !?

A

Right inguinal hernia

107
Q

Most common extrauterine abdominal emergency in pregnancy!?

A

Appendicitis

108
Q

Mx of appendicular lump !?

A

Ochsner sherren regimen

Treatment - NPO
IV fluids
IV antibiotics
Painkillers

Monitor - vital signs
Temperature
Size of lump
Tenderness

109
Q

Most common site of carcinoid tumor

A

Appendix

110
Q

Most common malignant appendicular tumor of the appendix !?

A

Mucinous adenocarcinoma

111
Q

Dx of mucinous adenocarcinoma

A

Imaging & HPE

112
Q

Mx of mucinous adenocarcinoma of appendix !?

A

Right hemicolectomy followed by chemotherapy

113
Q

Mc of appendicular carcinoid !?

A

< 2 cm size & > 2 cm from base - simple appendicectomy

> 2cm & < 2 cm from base - Right hemicolectomy

114
Q

Jelly like deposition in peritoneal cavity !?

A

Pseudomyxoma peritonei

115
Q

Tumors that can give rise to pseudomyxoma peritonei !?

A

Primary peritoneal tumor
2 ‘ to mucinous adenocarcinoma of appendix
2’ to mucinous adenocarcinoma of ovary

116
Q

Earliest symptoms in a patient with acute appendicitis

A

Periumbilical pain

117
Q

Organisms is most commonly isolated in patient presenting with perforated appendicitis!?

A

Bacteroids fragilis

118
Q

Maximum stump size that you can leave behind in order to prevent stump appendicitis??

A

5mm

119
Q

Most common differential diagnosis of acute appendicitis!?

A

Yersinia enterocoilitica infection

120
Q

Psuedomyxoma peritonei mx !?

A

Cytoreductive surgery + hyperthermic intraperitoneal chemotherapy ( paclitaxel + mitomycin c )

121
Q

Most common type of colorectal polyps !?

A

Hyperplastic colorectal polyps ( not premalignant)

122
Q

Juvenile polyposis syndrome

A

SMAD4 gene mutation
AD condition
Multiple polyps (3-100)
Increased risk of cancer

Mc site - rectum

123
Q

Perioral melanosis is pathognomonic feature of ……….

A

Peutz jeghers syndrome

124
Q

Gene involved in the case of peutz jeghers syndrome !?

A

STK-11/ LKB-1 gene on chromosome 19

Autosomal doMinant condition

125
Q

Most common presentation of peutz jeghers syndrome!?

A

Bowel obstruction

126
Q

Most common site of peutz jeghers syndrome

A

Jejunum

127
Q

100 times in increase risk of cancer……… jn peutz jeghers syndrome

A

Pancreatic cancer

128
Q

Type of Polyps which has the highest risk of cancer !?

A

Villous > tubular > sessile > pedunculate polyps

129
Q

Haggit classification is for !?

A

Pedunculate polyps

130
Q

Gardener syndrome

A

FAP + soft tissue sarcoma [ desmoid, osteomas, sebaceous cyst)

131
Q

Turcot syndrome!?

A

FAP + brain tumor

M/c - Glioblastoma

M/c in children- medullablastoma

132
Q

Dx and surgery for FAP & its complication ?,

A

Colonoscopy + biospy

Total proctocolectomy + ileoanal pouch

Mc complication- pouchitis

Mcc of death following surgery- small intestine obstruction

133
Q

Mc site of FAP !?

A

Rectum

134
Q

FAP A/w with 100 % risk of ………. Cancer

A

Colorectal cancer

135
Q

Hallmark feature of FAP !?

A

> 100 adenomatous polyps

136
Q

Most common gene involve in the HNPCC/ LYNCH syndrome !?

A

MSH2 > MLH1 gene

137
Q

HNPCC detected by the ………..

A

Bethesda classification

138
Q

Lynch syndrome 1 ?

A

Most common

Risk of colorectal cancer is increased by 70-80 %

139
Q

Lynch 2 syndrome !?

A

Extra colonic cancer

Uterine cancer (MC )
Ovarian cancer
Pancreatic cancer
140
Q

Modified Amsterdam criteria used for !?

A

HNPCC

141
Q

Muir Torre syndrome!?

A

Variant of HNPCC
Benign & malignant tumors of sebaceous glands
Keratocanthomas

142
Q

Most common malignancy of GI tract !?

A

Colorectal cancer

143
Q

Most site of colorectal cancer !?

A

Rectum

144
Q

Most common colonic site for the colorectal cancer !?

A

Sigmoid colon

145
Q

Best modality for the screening the colorectal cancer !?

A

Colonoscopy

146
Q

Anemia is feature of which side of the colorectal cancer

A

Right sided

147
Q

Constipation is feature of which sided colorectal cancer !?

A

Left sided lesion

148
Q

Apple core deformity on barium enema is feature of

A

Colorectal ca

149
Q

Distant metastasis for the colorectal ca

A

Liver

150
Q

…………. 100 times risk for the colorectal cancer

A

Ueterosigmoid anastomosis

151
Q

IOC for staging colorectal ca !?

A

Pet -ct

152
Q

IOC for T & N rectal cancer

A

MRI

153
Q

Duke staging / modified Astler coller classification is for !?

A

Colorectal cancer

Duke A - mucosa + submucosa
B- into muscle layer
B2- Beyond the muscle layer
C1- into muscle layer + lymph node involvement
C2 - beyond muscle layer + lymph node involved
D - distant metastasis

5 year survival for Duke A - 90 %

154
Q

Mc site for the ischemic colitis!?

A

Splenic flexure aka Griffith point

155
Q

If tumour is in cecum !?

A

Right hemicolectomy

156
Q

If cancer is in ascending colon / hepatic flexure / transverse colon

A

An extended right hemicolectomy ( ileum + ileocecal junction + ascending colon/hepatic flexure/ transverse colon + MCA + right and ileocolic artery

157
Q

If the cancer is in the splenic flexure/ descending colon

A

Left hemicolectomy

158
Q

If tumour is in sigmoid colon !?

A

LOW anterior resection ( sigmoid + rectum ) + total mesorectal excision

159
Q

If tumor is within 5 cm from the anal verge !?

A

Abdominoperineal resection & permanent end colostomy + total mesorectal excision ( to prevent recurrence rate )

160
Q

Chemotherapy used for colorectal in advanced stage !?

A

FOLFOX- 5 FU , folinic acid , oxaliplatin
FOLFIRI- 5 FU , folinic acid , irinotecan

CAPEOX - Capecitabine , oxaliplatin

161
Q

Mc prognostic factor for colorectal CA !?

A

Lymph node status

162
Q

Colorectal cancer tum our marker !?

A

CEA ( carcinoembryonic antigen)

163
Q

Mc Anal carcinoma!?

A

Squamous cell carcinoma

164
Q

To determine the extent of disease in anal carcinoma !?

A

MRI

165
Q

TOC for anal canal carcinoma !?

A

NIGRO’s carcinoma

1 month chemoradiotherapy ( 5 FU + mitomycin/ cisplatin )

Fails - APR SECTION

166
Q

Most common position of DRE !?

A

Left lateral/ sims position

167
Q

Contraindications for DRE !?

A

Acute anal fissure

168
Q

Mucosal fold present in the rectum’!?

A

Houston valve

169
Q

Pain can be felt on DRE !?

A

Below the dentate line

170
Q

Children + H/o of bouts of diarrhea what is the dx & tx !?

A

Partial thickness prolapse

Mucosal prolapse

1st episode - digital reposition

Recurrent- sclerotherapy , Thiersch wiring

171
Q

Full thickness prolapse involve !?

A

Anterior wall

172
Q

Frail + elderly patient comes with full thickness prolapse !?

A

Perineal approach

  • Thiersch wiring
  • Delorme repair
  • Altemier repair
173
Q

Young + fit patient comes with full thickness prolapse !?

A

Abdominal approach

Well’s & Ripstein Rectopex
Frykman Goldberg - Resection rectopexy

174
Q

IOC IN ANORECTAL MALFORMATION

A

MRI

175
Q

Most common anorectal abnormality in male !?

A

Rectobulbar

176
Q

MC anorectal abnormality in female !?

A

Vestibular fistula

177
Q

Mx of the anorectal malformation!?

A

PSARP ( posterior saggital Anorectoplasty

178
Q

Pilonidal sinus

A

Aka jeep driver disease

179
Q

Most common site of pilonidal sinus !?

A

Natal cleft

180
Q

Definite surgery for the Pilonidal sinus !?

A

Rhomboid/ Limberg flap

Kardyakis surgery

Bascom procedure

181
Q

Mcc of bleeding per rectum !?

A

Hemorrhoids aka piles

182
Q

Piles is d/t !?

A

Bleeding from dilated vascular channels

Pathology- Loss of elasticity of anal cushions

183
Q

Sites of primary hemorrhoids!?

A

11 o clock , 3 O’ clock , 7 o’ clock

184
Q

Thrombosed pile !?

A

Aka melgney 5 day self healing lesion

Painful reddish / bluish nodule

185
Q

…… only hemorrhoids felt on DRE !?

A

Thrombosed piles

186
Q

IOC for hemorrhoids!?

A

Proctoscopy

187
Q

Grades for the hemorrhoids!?

A

Grade 1- only bleeding no prolapse
Grade 2 - prolapse but spontaneously pushed inside
Grade 3 - have to pushed inside
Grade 4 - Remained prolapsed

188
Q

Grade 1 hemorrhoids mx !?

A

Lifestyle modification

Avoid fried, fatty food , high fiber diet & increased liquid intake

Laxative
Sitz bath

189
Q

Grade 2 hemorrhoids mx !?

A

Lifestyle + banding > sclerotherapy

190
Q

Mc agent used in sclerotherapy is !?

A

Sodium tetradecyl so4

191
Q

Grade 3 piles mx !?

A

Grade 2 + surgery

192
Q

Grade 4 piles mx !?

A

Surgery

193
Q

Procedure of choice in the hemorrhoids!?

A

Stapled haemorrhoidopexy

194
Q

Milligan Morgan hemorrhoidectomy !?

A

Open hemorrhoidectomy

195
Q

Ferguson hemorrhoidectomy !?

A

Closed

196
Q

Mc complication of haemorrhoidectomy !?

A

Urinary retention

197
Q

Anal fissure !?

A

Breach in continunity of anal epithelium

198
Q

Mc site of anal fissure

A

6 o clock posterior midline

199
Q

Mc anal fissure after vaginal delivery!?

A

12 o clock anterior midline

200
Q

Mx of anal fissure

A

Lifestyle modification + local applications of 2 % xylocaine jelly
Dilitazem cream and nitrate gel

201
Q

Surgery if choice in anal fissure !?

A

Lateral anal sphincterotomy

202
Q

Mcc of perianal abscess !?

A

Infection of the anal gland

203
Q

Mx perianal abscess !?

A

I & D

Incisin - cruciate ( diamond shaped )

204
Q

Water can perineum ( mutliple perianal fistula ) cause !?

A 
Crohn disease ( KRohn’s)
Trauma ( krush)
TB ( koch)
Cancer ( kancer)
Immunocompromised
205
Q

Goodsall’s rule

A

For the identification of the internal opening of the ana fistula

206
Q

IOC of anal fistula !?

A

MR Fistulogram

207
Q

Most common perianal fistula acc to park’s classification!!?

A

Intersphincteric

208
Q

Mx of high anal fistula!?

A

Seton treatment

209
Q

Low anal fistula mx !?

A

Fistulotomy , fistulectomy , LIF & VAFS

210
Q

Fistulotomy & fistulectomy not done for …….,

A

Inter sphincter & trans sphincteric fistulae

211
Q

Strawberry lesion of recto sigmoid is d/t !?

A

Infection by spirochetes or B fusiformis

212
Q

Meconium ileus is a presentation seen in with !?

A

Mucoviscidosis

Surgery (8 decks)

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