The Surgical Abdomen

Question 1

Courvoisier’s Law

Answer 1

In the presence of Jaundice, if there is a palpable gall bladder in the right upper quadrant then this is unlikely to be due to gallstones.

Question 2

Causes of Bowel Obstruction

Answer 2

There are two types of bowel obstruction, small bowel and large bowel obstructions.

Small Bowel Obstructions are more common than large bowel.

The most common causes of small bowel obstruction are adhesions, hernias and cancers.

The most common causes of large bowel obstruction are cancers, diverticular disease or a volvulus.

However, there are many possible causes of bowel obstruction. I like to divide these into the mechanical causes and the non mechanical causes:

Mechanical causes can be further classified in accordance with their relation to the bowel wall: Luminal (in the lumen), Mural (in the wall) or Extra Mural (outside the wall)

Luminal causes include gallstones, intussesception and impacted faeces.

Mural casues include: strictures, inflammatory bowel disease, cancers and diverticulitis.

Extramural causes include: adhesions, hernias, cancers and volvuls.

Non-mechanical causes also known as paralytic ileus are due to postoperative abdominal surgery, mesenteric ischaemia and metabolic causes such as hypokalaemia, uraemia, hyperglycaemia and hypothyroidism.

Question 3

Causes of Clubbing

Answer 3

There are many causes of clubbing the most common of which is idiopathic.

However, clubbing can be pathological and these causes can be classified via system:

Gastrointestinal causes include IBD, PBC and Coeliac disease.

Respiratory causes include bronchial ca, suppurative lung disease, CF, mesothelioma and fibrosing alveolitis

Finally, cardiac causes include congenital cyanotic heard disease and endocarditis.