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MRCS A(My Own) > THE ABDOMEN > Flashcards

THE ABDOMEN Flashcards

1
Q

Things to reduce intra abd adhesion

A

Laparoscopy over open procedure

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2
Q

Things which promote intra abdominal adhesions?

A

open procedures
Talc usage on gloves
Anastomotic leak

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3
Q

Which artery ismostly affected by laproscopic ports and surgical draine

A

Inferior epigastric artery

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3
Q

Which artery ismostly affected by laproscopic ports and surgical draine

A

Inferior epigastric artery

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4
Q

Use of Verres Needle to establish pneumoperitoneum causes which complication

A

Bowel perforation

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5
Q

During re-do open hernia surgery what structure can be damaged

A

Testicular vessels

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6
Q

Hepatic veins can be damaged due to

A

Liver mobilization

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7
Q

Neurosurgical electrolyte disturbance

A

SIADH following cranial surgery causing hyponatraemia

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8
Q

Meckels diverticulum is a derivative of

A

The Meckels divertic ulum is a persistence of the vitello-intestinal duct.

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9
Q

Rule of 2 of Meckels diverticulum

A

2% of population
2 inches (5cm) long
2 feet (60 cm) from the ileocaecal valve
2 x’s more common in men
2 tissue types involved

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10
Q

Arterial supply of Meckel

A

omphalomesenteric artery

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11
Q

Mucosa of Meckel

A

ileal mucosa mostly
sometimes gastric
rarely Pancreatic and jejunal

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12
Q

Surgical opt for Meckel if symptomatic

A

wedge excision or formal small bowel resection and anastomosis.

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13
Q

Right iliac fossa pain

causes

A

Appendicitis
Crohn’s disease
Mesenteric adenitis
Diverticulitis
Perforated peptic ulcer
Meckel’s diverticulitis
Thread worms infection

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14
Q

Causes of Mesenteric adenitis

A

Adenoviruses, Epstein Barr Virus, beta-haemolyticStreptococcus,Staphylococcusspp.,Escherichia coli,Streptococcusviridansand Yersinia spp

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15
Q

Rx of ileo ileal intussuscaption vSileo-colic varian

A

Ileo-ileal intussusception are far less common than the ileo-colic variant. However, where they occur, they require surgery and are not amenable to pneumatic reduction

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16
Q

Causes of Intussusception

A

polyps, lymphadenopathy and diseases such as cystic fibrosis

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17
Q

most common variant of Intussusception

A

ileocaecal valve and terminal ileum is the most common variant and typically affects young children and toddlers.

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18
Q

Intussusception diagnosis by

A

U/S

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19
Q

When pneumatic reduction of Intussusception shouldn’t occur

A

Impending perforation
Small bowel intussusception.

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20
Q

commonest cause of acute abdominal pain in acute unselected surgical ‘take’?

A

Non specific abdominal pain is a commonly recorded diagnosis for patients presenting with acute abdominal pain.

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21
Q

In suspected large bowel obstruction a key investigation is

A

either a water soluble contrast enema or CT scan.

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22
Q

Plain film radiology usually cannot detect

A

<1mm free air

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23
Q

Boas sign is in

A

Acute cholecystitis
hyperesthesia felt by the patient to light touch in the right lower scapular region or the right upper quadrant of the abdomen.

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24
Q

weight loss and intermittent diarrhea

A

inflammatory bowel disease the most likely diagnosis.

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25
Q

Oral contraceptive pills

A

Mesenteric venous thrombosis

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26
Q

Fitz-Hugh-Curtis occurs exclusively in

A

Females

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27
Q

Fitz-Hugh Curtis syndrome Rx

A

Usually medically managed- doxycycline or azithromycin

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28
Q

Mid cycle pain
Usually occurs two weeks after last menstrual period
Pain usually has a supra-pubic location

A

Mittelschmerz

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29
Q

pain is typically greater than the physical signs

A

Mesenteric infarction

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30
Q

Mesenteric infarction most sensitive test

A

Arterial phase CT scanning

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31
Q

Severe and pain with acidemic and raised lactate

A

Bowel ischemia

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32
Q

Key points of ischemic bowel

A

Pain out pf proportion of symptoms
Acidaemic and raised lactate

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33
Q

How much raised amylase levels in pancreatitis

A

3x the normal limit

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34
Q

tender swelling that lies below and lateral to the pubic tubercle.

A

Femoral hernia : if +ve cough impulse
Saphena varix: if -ve cough impulse

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35
Q

positive Howship-Romberg sig

A

hip and knee pain exacerbated by thigh extension, medial rotation, and abduction).

36
Q

Keypints of obturator hernia

A

More common in females and elderly
More in people who has lost weight very fast
Positive Howship-Romberg sig

37
Q

abdominal hernia, whereby there is herniation of a Meckel’s diverticulum

A

Littre’s Hernia

38
Q

Richter hernia

A

can occur at any of the above sites and is a partial herniation of bowel, whereby the anti-mesenteric border becomes strangulated

39
Q

Surgery of umbilical hernia ais performed after

A

Third birthday

40
Q

Bochdalek hernia vs Morgagni Hernia

A

B: more common, on left and posterior side, lung hypoplasia, contains stomach
M: less common, on right and anterior side, rarely lung hypoplasia, contains transverse colon

41
Q

Intestinal causes of malabsorption

A

coeliac disease

Crohn’s disease

tropical sprue

Whipple’s disease

Giardiasis

brush border enzyme deficiencies (e.g. lactase insufficiency)

42
Q

Bllod supply of Meckels diverticulum

A

Vitelline artery/ Omphalosmesenteric artery a branch of SMA’

43
Q

an attachment between the vitello-intestinal duct and the yolk sac disappears at

A

6 weeks gestation

44
Q

evidence of pelvic inflammatory disease together with peri-hepatic inflammation

A

Fitz-Hugh Curtis syndrome

45
Q

Cullens sign is seen with

A

intra peritoneal haemorrhage

46
Q

Is suspected ileus secondary to anastomotic l3ak

A

CT with contrast

47
Q

If excessive discharge in drain due after cholecystectomy then what to do

A

Perform ERCP

48
Q

Infant with high pitched scream and draws up her legs.
3 to 4 days hx of being unwell

A

Intussusception

49
Q

The history of varicose veins with positive cough impulse

A

Saphena varix

50
Q

M3ckel is distal or proximal to ileocaecal valve?

A

They are typically found 2 feet proximal to the ileocaecal valve (or approximately 60cm).

51
Q

Gro in mass with red streaks onthigh

A

Lymphadenitis

52
Q

retroperitoneal VS anterior abdominal aorta rupture

A

(anterior ones generally don’t survive to hospital

53
Q

when to do immediate Ioprotomy in suspected Abd aorta aneurysm rupture

A

systolic BP of <100mmHg at presentation mandates immediate laparotomy.

54
Q

abdominal aortic aneurysm (AAA) is defined as

A

dilatation of the abdominal aorta greater than 3cm

55
Q

ROME III diagnostic criteria of IBS

A

Recurrent abdominal pain or discomfort at 3 days per month for the past 3 months associated with two or more of the following:
•Improvement with defecation.
•Onset associated with a change in the frequency of stool.
•Onset associated with a change in the form of the stool.

56
Q

Pain Rx in IBS

A

low dose tricyclic antidepressants

57
Q

Mesenteric cysts can cause

A

Volvulrs or infarct
Not Intussusception

58
Q

Causes of Intussusception

A

•Cystic fibrosis
•Mucosal polyps
•Meckel
•Inflammation of Peyer Patches

59
Q

Which GIT part shouldn’t show fluid levels on a plain abdominal film?

A

Descending colon

60
Q

Features which are usually abnormal on abdominal x ray

A

Large amounts of free air (colonic perforation), smaller volumes seen with more proximal perforations.

A positive Riglers sign (gas on both sides of the bowel wall).

Caecal diameter of >8cm

Fluid levels in the colon

Ground glass appearance to film (usually due to large amounts of free fluid).

Sentinel loop in patients with inflammation of other organs (e.g. pancreatitis

61
Q

Riglers sign

A

(gas on both sides of the bowel wall)

62
Q

Chiladitis sign

A

loop of bowel may be interposed between the liver and diaphragm,

63
Q

Features which should be expected/ or occur without pathology

A

In Chiladitis sign, a loop of bowel may be interposed between the liver and diaphragm, giving the mistaken impression that free air is present.

Following ERCP (and sphincterotomy) air may be identified in the biliary tree.

Free intra abdominal air following laparoscopy / laparotomy, although usually dissipates after 48-72 hours.

64
Q

In which appendicitis does Rousing sign is absent

A

retrocaecal appendicitis

65
Q

Mesenteric cysts usually occur in

A

•young children before 15
•Smooth
•Incidental finding

66
Q

If suspected perforated abdominal visCus in pregnant 🤰 then what test to confirm it

A

Abd CT Scan as it’s suspected

67
Q

Obese patients with ileus following major abdominal surgery with mesh repair ddevelops anuria and increase nasogastric aspirates

A

Abd compartment syndrome

68
Q

Abdominal compartment syndrome

A

sustained intra abdominal pressure >20mmHg coupled with new organ dysfunction / failure

69
Q

Operative Rx of Abdominal compartment syndrome

A

Bogota bag or VAC techniques

70
Q

Non operative management of Abdominal compartment syndrome

A

Gastric decompressionImprove abdominal wall compliance e.g. muscle relaxants/ sedationDrain abdominal fluid collections.Consider fluid restriction/ diuretics if clinically indicated.

71
Q

Intra abdominal hypertension

A

12-25 mm Hg

72
Q

If suspected fluid leakage in child then

A

Perform USS to confirm itnot CT Like in adults

73
Q

sudden onset of deep seated colicky abdominal pain with adenexal tendernes

A

Ovarian torsion

74
Q

Pelvic inflammatory disease tests

A

High vaginal and urethral swabs

75
Q

Bilateral lower abdominal pain associated with vaginal discharge.
Dysuria

A

PID

76
Q

menstrual irregularity, infertility, pain and deep dyspareunia

A

Endometriosis

77
Q

Endometriosis affect on bowel

A

May result in adhesion formation ,obstruction,localised inflammation

78
Q

Positive psoas sign

A

Pain in his extension

79
Q

Tests to do in bowel obstruction

A

•Gastrograffin enema, •Sigmoidoscopy or
• CT scanning prior to surgery.

80
Q

If flu-like Symptoms in children then Severe abdominal Pain and no abd sign on examination then mostprobably it is

A

Mesenteric adenitis

81
Q

If severe mid cyclic pain in females with normal inflmamatpry markers

A

Mittelschmerz

82
Q

Pale opalescent liquid discharge poat surgery

A

Chyle leak

83
Q

Howsurgeons mark lymphatics to chk for iatrogenic injury to lymphs

A

some surgeons administer a lipid rich material immediately prior to surgery to facilitate its identification in the event of iatrogenic damage.

84
Q

Risk factors for the development of post operative incisional hernias

A

post operative wound infections, long term steroid use, obesity and chronic cough

85
Q

Bowel obstruction or tenderness at the hernia sit

A

mandate early surgical intervention

86
Q

Mature incisional hernias with a wide neck, and no symptoms
Rx

A

may be either left or listed for elective repair

87
Q

Diverticular abscess Rx

A

If <5cm …Antibiotics
If >5 cm …. Radiological drainage

88
Q

If a young boy with Fe defi anemia and post Prandial pain with normal gastroscopy and colonoscopy
Dx?

A

Meckels not crohn

MRCS A(My Own) (28 decks)

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