General Surgery

Question 1

Diagnosis?
Why?

Answer 1

SBO

1. dilated loops of bowel
2. multiple fluid levels
3. small bowel - central/3mm/valvular coneventes

Question 2

what are the common causes of SBO obstruction and their examination findings?

Answer 2

• adhesions - old scars
• hernias - hernia on exam
• malignancy - systemic sx

Question 3

what are the metabolic complications of SBO and why?

Answer 3

• metabolic alkalosis - loss of HCL from vomming
• hypoK - vomiting
• hypoNa - 3rd spacing to gut
• lactic acidosis - from iscahemia and hypoperfusion

Question 4

abdo pain and guarding:
What ate the abnormalities?

Diagnosis?

Answer 4

IP free fluid
IP free air
fat stranding around stomach
gallstones
thick walled stomach

diagnosis
Perforated peptic ulcer

Question 5

what is the initial management of perforated abdominal viscous?

Answer 5

IV fluid - bolus and aim over 100
Anagelsea eg fent
IV abx
urgent surgical input

Question 6

diagnosis?

3 positive and two neg findings

Answer 6

gastric volvulus

Pos:
* hiatus hernia
* multiple bowel loops in intrathoraic region
* air fluid in lower loop suggesting obstruciton
* mediastinal shift

Neg
* no pneumothorax
* no free air under diaphragm

Question 7

what clinical features of history and exam make appendicitis more likely in a child?

Answer 7

RIF pain
pain migrating to RIF
pain less than 3 days
anorexia
pain on coughing/moving/hopping

Question 8

with suspected appendicits in child what tests could you do to rule out other things?

Answer 8

urine - UTI
US - mesenteric adenitis
CXR - LRTI
lipase - pancreatitis
glucose - DM

Question 9

what is the maintennce fluid for kids?

Answer 9

normal saline plus 5% dextrose

4:2:1

• For the first 10 kilograms (3-10 kg) — 4 ml/kg/h.
• For the next 10 kilograms (11-20 kg) — 2 ml/kg/h.
• For weights above 20 kilograms — 1 ml/kg/h

Question 10

what are the management options for sigmoid volvulus?

Answer 10

1. PR deflation eg sigmoidoscope
2. percutaneous deflation
3. laparatomy

Question 10

interpretation of wound

Answer 10

midline laparatomy wound with significant dehiscence

Question 11

list three patient and surgical factors that could contribute to post op wound dehiscence

Answer 11

Patient
* Smoker
* steroid use
* obesity
* immunocompromised
* diabetic
* poor self care
* over 65
* anaemia

Surgical
too much wound tension
inappropriate sutures
inappropriate technique
haematoma at site
FB
non sterile procedure

Question 12

what are the advantages and disadvantages of common methods of wound closure in ED

Answer 12

Question 13

what are the two most common causes of pancreatitis

Answer 13

GS
Alcohol

GETSMASHED

Question 14

what are the local and systemic compliations of pancreatitis?

Answer 14

Local
* pancreatic pseudocyst
* abscess
* ileus
* splenic vein thrombosis
* chronic pancreatitis
* duodenal obstruction

Systemic
* Shock
* ARDS
* hypocalcaemia
* metaolic acidosis
* pleural effusion
* multi organ failure

Question 15

what CT featues of pancreatitis are associated with severe disease?

Answer 15

focal or diffuse enlargement
fat stranding
single or multiple fluid collections
necrosis

Question 16

1. Diagnosis?
2. Imprtant investigations?
3. Management

Answer 16

1. Ascending cholangitis
2. LFTs,lipase, cultures, US
3. IV abx (cef 1g BD), fluid(NaCl 1l 4/24), surgical opinion, analgesia( paracetamol, fentanul or bupe)

Question 17

two positives and two negatives?

Answer 17

Positives
* dilated small bowel loops
* thumbprinting

Negatives
* no fecal loading
* no free air
* no rigleers sign

Question 18

What is this?

Answer 18

Pneumatosis intestinalis (presence of gas within wall of bowel)

Question 19

what can cause pneumatosis intestinalis?

Answer 19

submucosal cysts
infective enteritis
coeliac
COPD
AIDS
sarcoid
post chemo

Question 20

what could indicate a bad prognosis in mesenteric infarct/bowel ischaemia

Answer 20

metabolic acidosis
bloody diarrheoa
portal venous gas
thickened bowel wall on imaging

Question 21

if a patient is NBM what are the analgesia options in ED?

Answer 21

ketamine 0.2mg/kg
fentanyl 25mcg aliquts
IV panadol
PR indomethacin

Question 22

what are the complications of SBO with management principles?

Answer 22

perforation - abx and surgery
hypovoaemia - fluid replacement
hypok - replacement
aspiration - cxr

Question 23

3 year old in abdo pain
describe abnormalities and diagnosis

Answer 23

dilated bowel loop with telescoping

Intersusscpetion

Question 24

what is the management of intersussception?

Answer 24

* Analgesia - IV morphine 1mg aliquots or fentanyl * IV fluid - 20ml/kg aiming for pulse under 120 * urgent surgical paeds referral

Question 25

what are the mangement options for intersusscpetion and when would you use them?

Answer 25

gas insufflation PR - first line when uncomplicated Surgical - if first line fails or complicated eg perforation

Question 26

what are the complications of intersussception?

Answer 26

perforation sepsis intestinal ischaemia