Surgery Concepts

Question 1

Hinchey classification for diverticulitis

Answer 1

stage 1: pericolic or mesenteric abscess
stage 2: walled-off pelvic abscess
stage 3: generalized purulent peritonitis
stage 4: generalized fecal peritonitis

Question 2

whirpool/whirl sign

Answer 2

seen when the bowel rotates around its mesentery leading to whirls of the mesenteric vessels. can be seen in volvulus, closed bowel loop obstruction, enteritis, omental torsion.

Question 3

contrast-induced nephropathy (CIN)

Answer 3

> 25% increase baseline creatinine or mild proteinuria with brown casts

Question 4

residuals >200-300

Answer 4

stop tube feeds because may have obstruction or overfeeding

Question 5

bouveret’s syndrome

Answer 5

uncommon form of gallstone ileus that is characterized by gastric outlet obstruction caused by impaction of gallstone in the pylorus or proximal duodenum after its passage through cholecystoduodenal fistula.

Question 6

howship-romberg sign

Answer 6

inner thigh pain with internal rotation, used to identify obturator hernia

Question 7

Fothergill’s sign

Answer 7

if a mass in the abdominal wall does not cross midline and does not change with flexion of the rectus muscles, this is a positive sign for rectus sheath hematoma

Question 8

morgagni hernia

Answer 8

anteromedial diaphragmatic defect, 2/2 congenital defects in anterior diaphragm. hernia sac frequently contains transverse colon with momentum.

Question 9

bochdalek hernia

Answer 9

congenital diaphragmatic defects resulting from failure of posterolateral diaphragmatic foramina to fuse in utero. retroperitoneal structures may prolapse through defect

Question 10

space of retzius

Answer 10

= retropubic space = prevesical space. extraperitoneal space located posterior to pubic symphysis and anterior to urinary bladder. separated from anterior abd wall by transversalis fascia and extends to the level of the umbilicus.