Upper GI Surgery

Question 1

What is the clinical significance of the Ligament of Treitz?

Answer 1

Marks the duodenojejunal junction

melaena is thought to arise proximally to it

Question 2

What are the layers of the anterior abdominal wall?

Answer 2

Skin
Subcutaneous tissue
External oblique
Internal oblique
Transverse abdominis
Extraperitoneal fat
Peritoneum

Question 3

What is the 5-year prognosis of gastric carcinoma?

Answer 3

10%

Question 4

What causes a succussion splash?

Answer 4

Obstruction of antrum (e.g. gastric cancer)

Question 5

What are the risk factors for gallstones?

Answer 5

Female
Fertile (OCP, HRT)
Forty (although most common >50)
Fat (obesity)
Hyperlipidaemia
Haemolytic anaemia
Chron's disease

Question 6

What is Courvoisier’s Law?

Answer 6

Jaundice + palpable gallbladder is unlikely to be due to gallstones

Question 7

Which carcinoma of the pancreas has the worst prognosis?

Answer 7

Ductal adenocarcinoma

Question 8

What are the two most common causes of acute pancreatitis?

Answer 8

Gallstones (60%)

Alcohol (20%)

Question 9

What is Charcot’s Triad and what does it indicate?

Answer 9

Fever/rigors + abdominal pain + jaundice

= ascending cholangitis

Question 10

What is Reynaud’s Pentad and what does it indicate?

Answer 10

Fever + abdominal pain + jaundice + hypotension + confusion = severe ascending cholangitis

Question 11

What is Trosier’s sign?

Answer 11

Hard, enlarged left supraclavicular LN (Virchow’s node), suggesting gastric carcinoma spread

Question 12

What are the types of groin hernias and which is most common?

Answer 12

Inguinal hernias most common overall
Femoral hernias more common in females
Inguinal hernias more common in males

Question 13

What is the surface anatomy of the femoral artery?

Answer 13

Inferior to midpoint of the inguinal ligament which runs from ASIS to pubic tubercle

Question 14

What is the difference between a direct and indirect hernia?

Answer 14

Both emerge through superficial inguinal ring
Direct = through weakness in posterior wall of inguinal canal (medial to inferior epigastric artery)
Indirect = through deep inguinal ring (lateral to medial epigastric artery)

Question 15

Which hernias may be associated with a congenital persistence of the processus vaginalis?

Answer 15

Indirect inguinal hernia

Question 16

What are the most common causes of small and large bowel obstruction?

Answer 16

Small: adhesions, hernias
Large: colorectal carcinoma, diverticulitis, volvulus

Question 17

What percentage of patients taking NSAIDs develop PUD?

Answer 17

15-20%

Question 18

What is the most common small intestine malignancy?

Answer 18

Metastasis from malignant melanoma

Question 19

What serum marker may be useful in determining whether bleeding is coming from the upper or lower GI system?

Answer 19

Urate may be elevated in an upper GI bleed

absorption of RBC breakdown products

Question 20

At which serum level of total bilirubin is jaundice usually clinically detectable?

Answer 20

85-120umol/L

Question 21

Give 5 differential diagnoses for acute cholecystitis.

Answer 21

Perforated peptic ulcer
Acute pancreatitis
Acute hepatitis
Subphrenic abscess
Perforation of the hepatic flexure of the colon (e.g. cancer, diverticular disease)
Myocardial infarction
Right lower lobe pneumonia