Surgical cases

Question 1

1st line investigation for suspecting gallstones

Answer 1

USS abdomen (sensitive)

Question 2

Why might USS not pick up gallstones

Answer 2

If they are very small….. because the big ones are actually not a problem because they can’t get into the cystic duct. It is the smaller ones that can often get into the duct and cause acute pancreatitis. You’d have to rely on the blood tests

Question 3

What would you do after a USS

Answer 3

MRCP??

Question 4

What are the indications for MRCP?

Answer 4

…..

Question 5

What if LFTs fail to spontaneously resolve

Answer 5

ERCP- the LFTs are not resolving spontaneously because you have stones there

Question 6

Outline the modified glasgow criteria for pancreas

Answer 6

P
A
N
C
R
E
A
S

Question 7

What is the difference between biliary colic and cholecystitis

Answer 7

…..

Question 8

What is riglers sign

Answer 8

Air insi

Question 9

most common perforated organ

Answer 9

Sudden pain –> duodenum
Appendix –> typical pain presentation
Sigmoid diverticular –> left lower quadrant
Stomach rare to perforate (gastric c?)

Question 10

What is primary peritonitis causes

Answer 10

Bacterial origin, but no visceral perforation

• Spontaneous
• TB
• Peritoneal dialysis catheterisation

Question 11

What is secondary peritonitis causes

Answer 11

Bacerial origin with visceral performation

-perforated ulcer, perforated appendicitis

Question 12

What is teritary peritonitis

Answer 12

Persistence/recurrence of