Variants of Surgical Diseases Flashcards
1
Q
.What is the definition of “Richter’s hernia’?
A
Hernia that contains part of the circumference of the bowel wall, which can cause strangulation without obstruction.
2
Q
What does “Morgagni hernia” mean?
A
Morgagni hernia is a type of diaphragmatic hernia that occurs through sternocostal triangle.
- Morgagni hernias are most often right-sided, probably because left-sided defects are covered by the heart and pericardium, and are often associated with obesity.
- The hernia sac usually contains omentum but may contain transverse colon or, rarely, stomach, small bowel, or liver.
3
Q
Which are the complications of ulcerative colitis?
A
- Toxic megacolon (acute dilatation),
- massive haemorrhage,
- malignant degeneration.
4
Q
What is the gross pathology appearance in ulcerative colitis?
A
Ulcerative colitis is a disease largely limited to the mucosa and submucosa of the colorectum.
- The rectum is always involved, and the disease presents from this point proximally.
- There are numerous ulcers with areas of regenerating mucosa, called pseudopolyps and superficial fissures are seen.
5
Q
. What is the definition of ‘‘blunt abdominal trauma”?
A
Blunt abdominal trauma (non- penetrating) is a trauma in which traumatic object does not break the skin and doesn not pierce the parietal peritoneum.
- Blunt trauma can result in the laceration of solid organs usually causing bleeding, which in its most severe form manifests as hemorrhagic shock or as visceral perforation of the gastrointestinal tract
6
Q
Which classification is used to determine the endoscopic severity of stomach and duodenal ulcer bleeding?
A
Forrest classification is used to determine the endoscopic severity of stomach and duodenal ulcer bleeding.
7
Q
What is the definition of “toxic adenoma”?
A
It is a benign single thyroid nodule consisting of hyperplastic epithelium with overproduction of thyroid hormones.
- This nodule is autonomous in its overproduction of thyroid hormones and is surrounded by acini in the resting phase [due to the negative feedback loop regulation of TSH secretion].
- Women are more likely than men to be affected with this type of hyperthyroidism, and its maximum prevalence occurs between the ages of 40 and 60 years, although children may also be affected.
8
Q
What is the classic triad of presenting symptoms in achalasia?
A
The classic triad of presenting symptoms in achalasia consists of: dysphagia, regurgitation, and weight loss.
9
Q
What does “hypersplenism” mean?
A
Hypersplenism is increased splenic function that is manifested clinically by the decrease in one or more of the circulating blood elements
10
Q
What is the usual clinical presentation of liver microabscesses?
A
Patients with microscopic liver abscesses usually have an acutely septic clinical presentation, with
- fever, rigors,
- as well as right upper quadrant pain that can be quite severe
11
Q
What does “caput medusae” mean?
A
“Caput medusae” means recanalized umbilical vein from the left portal vein to the epigastric venous system due to the portal hypertension.
12
Q
There are defined three stages (phases) of empyema. Which are they?
A
The American Thoracic Society, in 1962, divided the formation of an empyema into three distinct stages (phases), indicative of disease progression in the pleural space:
- Exudative phase (stage I)
- Fibrinopurulent phase (stage II)
- Phase of Organization (stage III)
13
Q
- What is the definition of “advanced gastric cancer”?
A
“Advanced gastric cancer” is tumor with deeper invasion than stomach mucosa and submucosa
14
Q
When does tension pneumothorax develop?
A
A tension pneumothorax develops when a ‘oneway-valve’ air leak occurs, either from the lung or through the chest wall.
- Air is forced into the thoracic cavity without any means of escape, completely collapsing the affected lung.
- The mediastinum gets displaced to the opposite side, decreasing venous return and compressing the opposite lung
15
Q
What is the definition of “pancreatic pseudocyst”?
A
Pancreatic pseudocyst is a formation of the retroperitoneal space due to its inflammatory process causes by acute pancreatitis. In up to 10% of patients with acute pancreatitis, retroperitoneal acute fluid collections progress to develop a wall of fibrous granulation tissue, at which point they are classified as pseudocysts.
16
Q
What is the definition of “spigelian hernia”?
A
Spigelian hernia is an interparietal hernia in the line of the linea semilunaris (the lateral margin of the rectus sheath, running from the tip of the ninth costal cartilage to the pubic crest)
17
Q
Which are the nonsurgical treatment options of achalasia?
A
The nonsurgical treatment options of achalasia are medications and endoscopic intervention pneumatic (balloon) dilatation.
Medical treatment with
- sublingual nitroglycerin,
- nitrates,
- calcium channel blockers may offer hours of relief of chest pressure before or after a meal.
Pneumatic dilatation is the most effective nonsurgical therapy for achalasia.
18
Q
Three types of hiatal hernia have been described. Which are they?
A
The classic sliding hiatal hernia (type I) is the passage of the gastroesophageal junction and variable amounts of the cardia above the diaphragm.
paraesophageal or rolling hernia(type II) , the gastroesophageal junction remains below the diaphragm but the fundus rolls up, generally in an anterior location, next to the esophagus.
The type III hiatal hernia Is a combination of a sliding and paraesophageal hernia.
19
Q
. What does “superior sulcus tumor” mean?
A
Superior sulcus tumor is a peripheral lung cancer that is localized in superior pulmonary sulcus.
Anatomically, the pulmonary sulcus comprises
- the costovertebral gutter extending from the first rib to the diaphragm.
- The superior pulmonary sulcus lies at the uppermost extent of this recess.
20
Q
What is the clinical presentation of carcinoid syndrome?
A
The carcinoid syndrome is characterized by flushing, diarrhoea and wheezing,
- occurs when carcinoid tumour metabolites are secreted directly into the systemic circulation from hepatic metastases or from a primary lesion
21
Q
. What is the definition of “intussusceptum” and “intussuscipiens”?
A
intussusceptum segment invaginates into the intussuscipiens
resulting in obstruction and ischemic injury to the intussuscepting segment.
22
Q
What is the definition of “sentinel lymph node”?
A
A sentinel lymph node is defined as the first lymph node that receives drainage from a cancer
23
Q
What is the definition and clinical features of “de Quervain’s thyroiditis”?
A
De Quervain’s thyroiditis is subacute thyroiditis
- a history of an upper respiratory infection before the onset of thyroiditis can be elicited.
- Patients have diffuse swelling in the cervical area and a sudden increase in pain.
- Approximately two thirds of patients demonstrate fever, weight loss, and severe fatigue
24
Q
What is the clinical presentation of noninfected thyroglossal cyst?
A
- Presentation of thyroglossal cyst is commonly during the second or third decades of life.
- The mass is usually midline, between the thyroid notch and hyoid bone, and moves upwards on protrusion of the tongue
25
Primary liver cancer includes two main histological types. Which are they?
Primary liver cancer includes two major types: **hepatocellular carcinoma** (more than 90 %) and **cholangio-carcinoma** (intrahepatic bile duct cancer).
26
. What is the treatment of the open pneumothorax during the primary survey?
The treatment of the open pneumothorax during primary survey is aimed at returning normal ventilation and closing the chest wound.
* The first step is place an **occlusive dressing** over the chest wound to promote normal ventilation
* A standard method involves placing a **nonporous dressing over the wound and taping it on 3 sides**.
* This acts as a _1-way valve_, allowing air to escape during expiration but becomes occlusive during inspiration
27
Which are the most common mediastinal neurogenic tumors in adults?
The most common mediastinal neurogenic tumors in adults are **_neurofibromas_**. They arise from the nerve sheath
28
. What is the definition of "colon diverticulosis"
and definition of "colon diverticulitis"?
* "_diverticulosis_" is used to describe **colonic diverticula with no associated inflammation,**
* "Diverticulitis" indicates **associated inflammation**.
29
30
Why are Pancreatic injuries are serious problem, in abdominal trauma, resulting in high mortality
High mortality rates in pancreatic injuries can frequently be attributed to **delays in their diagnosis and treatment**.
Because of the caustic nature of pancreatic enzymes, delays in managing pancreatic injuries result in **massive systemic inflammation -\> SIRS -\> MODS**
31
. What is the primary goal of prophylactic treatment of splenectomized patients?
The primary goal of this prophylaxis is to prevent overwhelming postsplenectomy infection.
Done with Pneumococcal vaccine weeks before surgery
32
What does the term "taxis" mean?
Taxis is non-operative treatment of intestinal obstruction = manual repositioning
33
What is the definition of "acute abdomen"?
The term "acute abdomen" refers to **signs and symptoms** of _abdominal pain_ and _tenderness_, a clinical presentation that often **requires emergency surgical therapy**
34
. What does the term "functional obstruction" mean?
There are **neurogenic** or functional obstructions in which _luminal contents_ are prevented from passing because of **disturbances in gut motility** that **prevent coordinated peristalsis** from on region of the gut to the next
35
What is the definition of Hashimoto's thyroiditis?
Hashimoto's thyroiditis is a **chronic**, **autoimmune** disease, also known as ***_lymphocytic thyroiditis_***.
This condition was described by Hashimoto in 1912 as struma lymphomatosa based on the histologic findings.
36
What does "Courvoisier's sign" mean?
**_Palpable_ enlarged gallbladder**.
* Two-thirds of patients with pancreatic cancer and obstructive jaundice exemplify **Courvoisier's law**, which states that this finding in the abscence of pain indicates a malignant & distal biliary obstruction.
37
. What is the definition of "mastitis"?
Mastitis is _infection of the breast_ that fall into two general categories:
1. **Lactational** infections
2. **chronic Subareolar infections** associated with duct ectasia.
* Lactational infections are thought to arise from e*ntry of bacteria through the nipple into the duct system* and are characterized by fever, leukocytosis, erythema, and tenderness.
* Infections are most often caused by **Staphylococcus aureus** and may be manifested as cellulitis with breast parenchymal inflammation and swelling.
* Acute mastitis in the lactating women usually is presented as **cellulitis** with fever, pain, redness, and swelling of the affected breast.
38
What is the definition of "achalasia"?
Achalasia is a **motility disorder of the esophagus** characterized by
* **failure** of the **lower esophageal sphincter** **to relax** in response to swallowing and by an **absence of peristalsis** in the esophageal body.
* The disease is most often progressive, leading to **gradual dilatation of the esophagus** above the sphincter.
39
What does "_superior vena cava syndrome_" mean?
The superior vena cava syndrome constitutes a _constellation of signs and symptoms_ resulting from either **extrinsic** or **intrinsic** obstruction of the **superior vena cava** and causing ***congestion of venous outflow*** from the head, neck, and upper extremities.
A resulting increase in venous pressure leads to dramatic signs and symptoms
40
What does "Ludwig's angina" mean?
Ludwig's angina is a subtype of **_severe deep neck infection_**.
It is a **diffuse cellulitis**, involving the _bilateral_ sub**mental**, sub**mandibular**, and sub**lingual** _spaces_.
41
What is the definition of "false diverticulum"?
False diverticulum is acquired **herniation of mucosa through the muscle layer** and occurs most frequently in the **_colon_**
42
. When does tension pneumothorax develop?
A tension pneumothorax develops when a **'oneway-valve' air leak occurs,** either from the **lung** or through the **chest wall**. Air is forced into the thoracic cavity without any means of escape, **completely collapsing the affected lung**. The _mediastinum gets displaced to the opposite side_, decreasing venous return and **compressing the opposite lung.**
43
Which is the most common complication of the left-sided colon cancer?
_Complete obstruction_ of the _large bowel_ (**ileus**)
44
. What is the definition of "portal hypertension"?
Portal hypertension is defined by a portal pressure **higher than _5 mmHg._**
45
What is the definition of "haematochesia"?
"Haematochesia" means "**defecation of the blood".** Synonym of haematochesia is "**rectorrhagia**
".Haematochesia is typical for intestinal bleeding, with localization of the source of bleeding more **_distally than flexura coli hepatica._**
46
Rectorrhagia is a symptom of hemorrhoids. What is the typical character of bleeding?
**Fresh blood not mixed with stool** during the defecation or immediately after defecation -
**bright red** into the pan and/or on the toilet paper.
47
Which are the types of inguinal hernias and what is the difference between them (from anatomical point of view)?
**Indirect** and **direct** inguinal hernias.
* in _indirect_ hernia the sac protrudes **through the inguinal canal from deep to superficial ring**.
* In _direct_ hernia the sac doesn't protrude through the inguinal canal but from the **posterior abdominal wall**.
48
What does "Mallory-Weiss syndrome" mean?
Mallory-Weiss syndrome denotes "**linear tearing** of esophaeal **mucosa**, caused by _repeatedly vomiting_"
49
What is the definition of "Graves' disease"?
Graves' disease is a **toxic diffuse goiter** associated with **exophthalmos** and **palpitations**.
* It is an **autoimmune disorder** with a genetic predisposition and a **female predominance** (_five to seven_ times higher than the incidence in males).
* It is characterized by the presence of ***_thyroid-stimulating antibodies_***.
* These antibodies **bind** to _Thyroid Stimulating Hormone_ (TSH) receptor on follicular cells and **stimulate thyroid hormone** release.
50
The lung cancer is divided in two major types, based on histology, treatment and prognosis. Which are they?
The lung cancer is divided in two types, based on histology, treatment and prognosis: **Small cell** lung cancer **Non-small cell** lung cancer
51
What does "flail chest" mean?
A "flail chest" is a segment of the chest wall that does not have bony continuity with-the rest of the thoracic cage. This condition usually results from b**lunt - traum**a associated with **multiple rib fractures**, i.e. **three or more** ribs _fractured_ in **two or more places**
52
What is the definition of "linitis plastica" carcinoma?
"Linitis plastica" stomach carcinoma is a subgroup of **diffusely infiltrative cancer**, characterized by extensive infiltration of the **submucosa** and **muscular layers** with a marked **fibroblastic**/desmoplastic **reaction** around columns of malignant cells.
53
What is the definition of "true diverticulum"?
True diverticulum, such as a Meckel's diverticulum, contains **all layers of the bowel wall** and represents a _congenital abnormality_.
54
What is the definition of Meckel's diverticulum?
Meckel's diverticulum is a **true** diverticulum of variable size derived from the intestinal remnant of the yolk stalk (**omphalomesenteric duct).**
55
What does the term "closed-loop obstruction" mean?
A closed-loop obstruction means that **inflow** to the loop of bowel and **outflow** from the loop are **both blocked**. This obstruction permits gas and secretions to _accumulate in the loop without a means of decompression,_ **proximally** or **distally**.
56
What does "gynecomastia" mean?
Gynecomastia means **enlarged breast in the male**.
Physiologic gynecomastia usually occurs during three phases of life: the **neonatal** period, **adolescence**, and **senescence**.
57
What is the definition of "Hydatid disease"?
Hydatid disease is a **parasitic infection** caused by the larval stage of the cestode **Echinococcus granulosus**.
58
Which are the most common complaints and clinical features in patients with _deep neck 'infections_?
Any patient with a _recent history_ of tonsillitis, pharyngitis, an odontogenic infection, or recent **dental work** with onset of **neck swelling** and **pain**, and severe **general malaise** must be _assumed to have a deep neck infection_.
Other common findings include odynophagia, trismus, and respiratory compromise.
59
. What is the definition of "bronchiectasis"?
Bronchiectasis is defined as a **permanent** and **abnormal** **dilation** of **bronchi** caused by _destruction of the elastic and muscular components_ of the bronchial wall.
The distribution pattern can be either localized or diffuse.
60
What is the definition of "acute pancreatitis"
Acute pancreatitis is an **acute process** of **enzymatic autodigestion** of the pancreas with variable involvement of other **regional tissues** or **remote organ systems.**
61
There are two main types of liver abscesses (based on the etiology). Which are they?
**Pyogenic** and **amebic liver abscesses**
Pyogenic liver abscesses are of bacterial origin and amebic liver abscesses are caused by _Entamoeba histolytica_.
62
. What is the definition of "Littre's hernia"?
Hernia containing a **Meckel's** diverticulum
63
Which are two most common causes of acute pancreatitis?
A wide range of etiologies (triggers) of acute pancreatitis are identified. More than 75% of cases are attributable to either **gallstones** or **alcohol**
64
What is definition of "macrascopic liver abscess"?
Macroscopic liver abscess is usually restricted to **one lobe** of the liver, **single or confluent**, and requires some form of _primary drainage._
65
What does "Bochdalek hernia" mean?
Bochdalek hernia is a type of **diaphragmatic** hernia that occurs occurs through **posterolateral defects** in the diaphragm (**trigonum lumbocostale**).
* These hernias are seen more commonly on the **left** than on the right (_earlier closure of the right pleuroperitoneal membrane_ and the protection of right-sided defects by the **liver**).
* In a small hernial defect the hernia may contain only **retroperitoneal fat,** whereas in larger defects hernia can contain abdominal viscera such as **stomach**, intestine, **spleen**, kidney, or liver.
66
What is the definition of "Graves' disease"?
Graves' disease is a **toxic diffuse goiter** associated with **exophthalmos** and **palpitations**. It is an **autoimmune disorder** with a genetic predisposition and a _female predominance_ (five to seven times higher than the incidence in males).
* It is characterized by the presence of **_thyroid-stimulating antibodies_**. These antibodies bind to the Thyroid Stimulating Hormone (TSH) receptor on **follicular** cells and stimulate thyroid hormone release.
67
What does "periapppendicular infiltrate" mean?
Periapppendicular infiltrate is a _host defense reaction_ against **spreading** of the inflammation from appendix into the **peritoneal cavity.**
68
What is the definition of "intrathoracic goiter"?
Intrathoracic goiter is a **primary mediastinal goiters**, also referred to as _ectopic or aberrant_ goiters, **do not possess** any ***direct fibrous*** or ***parenchymal connections*** to the _cervical portion of the gland_, and its _vascular supply_ is derived from the **chest**.
Although usually intrathoracic goiters involve the _anterior 'mediastinum_, up to **10**% of them may be located within the _posterior mediastinum_.
69
. What does "Barrett's esophagus" mean?
Barrett's esophagus is the condition in which the normal **squamous epithelium** of the _distal_ esophagus is replaced with **columnar epithelium** in response to _chronic exposure to gastric juice_
70
What is the definition of "early gastric cancer"?
"Early gastric cancer" is the tumour that is confined to the gastric **mucosa and submucosa.**
71
In contrast to ulcerative colitis, what is the gross pathology appearance in Crohn's colitis?
Crohn's colitis is a **transmural**, predominantly _chronic submucosal_ inflammation characterized by a **thickened colonic wall**.
Ulcerative colitis is not transmural, and therefore **lacks thickening**, fibrosis, and **chronic inflammation.**
72
. What is the definition of acute upper gastro-intestinal bleedings?
This is gastro-intestinal bleeding with the source of haemorrhage **proximally from ligamentum Treitz** (duodenum — jejunum connection) from esophagus, stomach and duodenum.
73
3. What is the definition of "penetrating abdominal trauma"?
Penetrating abdominal trauma is an injury that occurs when an object **pierces the parietal peritoneum** and enters into peritoneal cavity. Penetrating trauma to the abdomen can result in **laceration of solid organs** and **perforation of hollow organs**, which must be discovered and repaired at the time of _laparotomy_
74
What does "Budd-Chiari syndrome" mean?
"Budd-Chiari syndrome" means **hepatic vein thrombosis**, which is one of the _posthepatic causes of portal hypertension_.
75
When does open pneumothorax develop?
Open pneumothorax develops as a result of a _large open defect_ in the chest ("sucking chest wound"), leading to **equilibration** between _intrathoracic and atmospheric pressure_.
Air accumulates in the hemithorax with each inspiration, leading to **profound hypoventilation** and **hypoxia**.
76
What does "solitary intraductal papilloma" mean?
Solitary intraductal papilloma is **true polyp** of **epithelial-lined breast ducts**. Solitary papillomas are most often _located close to the areola_ but may be present in peripheral locations. Most papillomas are **smaller than 1 cm** but can grow to as **large as 4 or 5 cm** in size.
77
What is the definition of "Beck's triad"?
Beck's triad is a complex of three associated symptoms that are classic to the diagnosis of _cardiac tamponade_. These signs include:
1. increased central venous pressures (**distended neck veins**),
2. arterial **hypotension** ,
3. **muffled heart tones**.
78
4. Small cell lung cancers are divided in two stages. Which are they
There are two stages of small cell lung cancers: **_limited_** and **_extensive_**.
* The traditional tumornode-metastasis (TNM) classification is less helpful in small cell lung cancer because most patients have _stage II or IV disease at diagnosis_, and **surgery is seldom performed.**
79
What is the origin of the _differentiated_ thyroid cancers?
Differentiated thyroid cancers are of
1. **_follicular cell origin_** (_papillary thyroid_ carcinoma and its variants, follicular thyroid carcinoma, and _Hurthle_ cell carcinoma) or
2. **_parafollicular_** (C-cell) origin (_medullary thyroid carcinoma)_
80
How can you distinguish femoral from inguinal hernia?
the _upper medial border_ of a femoral hernia is always **below** and **lateral** to the **pubic tubercle**.
81
What is the definition of "catamenial pneumothorax"?
Catamenial pneumothorax is _**pneumothorax** that occurs within **48 to 72** hours after the onset of **menstruation**._
* The pathogenesis of catamenial pneumothorax is still unclear.
* Most catamenial pneumothoraces are on the **right side**, and they may be recurrent over several years before being diagnosed.
* They are usually **small**, and patients present with **chest pain** and **dyspnea**.
82
Which are the indications for surgery in acute pancreatitis?
The indications for surgery in acute pancreatitis are:
1. abdominal pain where the **diagnosis is unclear** and they are found to have _acute pancreatitis_
2. **significant necrosis** of pancreas and peripancreatic retroperitoneal space
3. **infection** of pancreatic and parapancreatic necrosis;
4. **critically ill patients** with severe acute pancreatitis, without of effect of medical treatment;
5. **biliary pancreatitis** with stones in the common bile duct.
83
. Gastric outlet obstruction may be acute or chronic. What is the cause of acute obstruction?
Acute gastric outlet obstruction is caused by **edema** and **inflammation** _associated with ulcers_ in the **pyloric channel** and the first portion of the **duodenum**.
84
There are _three sites that are prone to caustic injury_ of the esophagus because of a relative delay in transit through the esophagus. Which are they?
The three sites that are prone to caustic injury of the esophagus correlate to the _anatomic narrowings of the organ_ and are:
* Proximal esophagus at the level of the upper _esophageal sphincter_
* Midesophagus where the aorta abuts the left mainstem bronchus
* Distal esophagus just proximal to the _lower esophageal sphincter_
85
With which other pathological condition intussusception is associated in adults?
About 90% of cases of intussusception in adults are associated with pathologic processes (tumors - benign or malignant). **Tumor** acts as the lead point of intussusception.
86
. What does the prophylactic treatment of splenectomized patients include?
Immunization with polyvalent pneumococcal vaccine and antibiotics.
87
. The hydatid cysts grow more rapidly in the lungs than in other organs. Why?
The hydatid cysts grow more **rapidly in the lungs** than in other organs, mainly because of the *_negative pressure_ and the _great elasticity_ of the pulmonary tissue*
88
. Four distinct pathophysiologic mechanisms can lead to acute mesenteric ischemia. Which are they?
1. arterial **embolus**,
2. arterial **thrombosis**,
3. **vasospasm** (nonocclusive mesenteric ischemia - NOMI)
4. **venous thrombosis**.
89
What does "Paget's disease" mean?
Paget's disease is usually a _presenting feature of breast cancer_ in the **elderly**, although it is occasionally seen in other age groups. It presents as an **_eczema-like_** condition of the _nipple' and areola_. It usually represents an underlying **_invasive ductal carcinoma_** that may be quite extensive in the breast.
* _Paget's disease of the nipple must be distinguished from eczema_!
* Eczema tends to occur in **younger** people who have signs of _eczema elsewhere_ (look at the **antecubital fossae)**
90
What is the treatment of the tension pneumothorax during the primary survey?
Treatment is aimed at **decompressing** the chest to release the trapped air from the pleural cavity: *_convert tension into open pneumothrax_* and after that try to place a **nonporous dressing** over the wound and taping it on 3 sides. This acts _as-a 1-way valve_, allowing air to escape during expiration but becomes occlusive during inspiration
91
Which are the most common mediastinal neurogenic tumors in pediatric populations?
The most common neurogenic tumors in pediatric populations are **ganglioneuromas** and **neuroblastomas**. The cells of origin are the _ganglia_.
92
What does "paraneoplastic syndrome" mean?
Paraneoplastic syndrome is **_complex of symptoms**_ or findings that are _**related to the primary tumor_** or its metastases by **_hormonal intermediates_**.
Paraneoplastic syndrome may accompany lung cancer (more frequently is associated with **small-cell cancer)**
93
What is the mechanism of caustic injuries of the esophagus caused by acid substances? .
_Acid_ substances cause **coagulative necrosis**, forming an *eschar that limits tissue penetration.*
* In some cases, acid burns result in fullthickness injury, although in most cases, it is limited.
* Within 48 hours, the extent to which the acid will injure the esophagus.
94
What does "thyrotoxic crisis" mean?
Thyrotoxic crisis is a rare presentation of **extreme signs of thyrotoxicosis and severe metabolic disturbances.**
Precipitated by nonthyroid surgery, major trauma, infection, imaging studies with iodinated contrast medium in patients with unrecognized thyrotoxicosis.
Features are **insomnia**, anorexia, vomiting, diarrhoea, **marked sweating**, fever, **marked tachycardia**.
Early clinical diagnosis of the condition and immediate treatment decrease the risk of fatal outcome.
95
Why you never have to try manual reposition in strangulated umbilical hernias in adults?
Manual reposition (taxis) in strangulated adult umbilical hernia may **shift strangulated bowel loop from one to other loculations** (loculated nature of the hernia sac) = _false-positive success_ of taxis!
96
Which is the most common type of hiatal hernia?
**_Sliding hiatal hernia_** (type I) is much more common than the paraesophageal hernia (type II) and hernia type III.
97
What is the main danger for the patients after splenectomy and which aged group is most commonly affected?
**Overwhelming post splenectomy sepsis** due to the changes in the immunologic responses.
**Infants or young children** are under the highest risk of post splenectomy sepsis
98
What does Zollinger-Ellison syndrome mean?
"Zollinger-Ellison syndrome" means _severe peptic ulceration_, often **multiple**, with a progressive and complicated course and sometimes found in the **distal** _rather than the proximal duodenum_.
The excess _secretion of **gastrin** by gastrinoma_ stimulates an excess production of gastric acid and leads to the development of the Zollinger-Ellison syndrome
99
. What is the definition of "Crohn''s colitis"?
Crohn's colitis means **_limitation of the Crohn's disease to the colon_**.
The inflammatory process may affect the entire colon (mimic ulcerative colitis), or may affect only segments of the colon
100
What is the definition of "haemobilia"?
Haemobilia is **gastrointestinal haemorrhage** caused by _bleeding into the biliary tree_ - sign of extensive *liver haematoma*.
101
. What is the management of thyroglossal cysts and sinuses?
The thyroglossal cysts and sinuses are _removed surgically_.
To avoid recurrence, which may be associated with a sinus, the **central portion of the hyoid bone (approx. 1 cm) is included in the excision** because the tract can run either deep or superficial to the bone.
102
