Surgery

Question 1

What is the surgical procedure for diverticulitis?

Question 2

How do you score severity of IBD?

Answer 2

Truelove-Witts

Mild: <4 bowel motions/day

Moderate:

Severe:

Question 3

What causes haemorrhoids?

Answer 3

dilated veins in lower rectum

Question 3

are haemorrhoids painful?

Answer 3

can be (if they are, they may be thrombosed)

Answer 4

3, 7 and 11 o’clock

Question 5

Mx of haaemorrhooiuds

Answer 5

1. Conservative: laxatives, analgesia, ice-packs, topical lidocaine/GTN ointment
2. Rubber band ligation: done as an outpatient
3. Haemorrhoiodextomy

Question 6

Mx of haemorrhoids depending on grade/severoty?

Answer 6

1 - conservative
2 + 3: rubber band
4: surgical

Question 7

Anal fissure commonest position

Answer 7

6 o’clock (90%)

or 12 o’clock

Question 8

Mx of anal fissure

Answer 8

1. high fibre and fluid intake
2. bulk forming laxatives (e.g. ispaghula hulk)
3. topical GTN or dilatezam cream

Question 9

Do you need a stoma for right/left hemicolectomy?

Answer 9

no

because there is good blood supply in the area

Question 10

Is Hartmann’s only used in emergencies?

Answer 10

generally yes

you would rarely have an elective procedure that ends with a Hartmann’s

Question 11

What is the surgical procedure for GORD?

Answer 11

fundoplication

(full or partial)

Nissen - total posterior
partial has less wind related symptoms

standard is laparoscopic, not open

Question 12

What

Question 13

sx of oesophageal cancer

Answer 13

dysphagia
haematemesis
weight loss
anaemia
non-specific

sometimes can get pain with dysphagia

Question 14

sx of gastric cancer

Answer 14

vomiting
haematemesis
weight loss
anaemia
pain
non-specific

Question 15

Ix for ?upper GI cancer

Answer 15

bloods
endoscopy (gold standard, needed for dx)
CT (for staging)
PET
EUS

Question 16

Late post-op complications for upper GI surgery

Answer 16

• dumping (fluid influx, faint)
• chronic diarrhoea (b/c vagus is disrupted)
• weight loss
• anaemia

Question 16

Mx of deumpitn

Answer 16

avoid sugar
solids and liquids separately
lie down after food
small but frequent meals

Surgical: Roux-en-Y gastroenterostomy jejunal interposition graft

Question 17

What predisposes people to pathological fractures?

Answer 17

• metastasis in bones (lung, breast, thyroid, renal, prostate)
• metabolic bone disease
• Paget’s disease
• osteogenesis imperfecta
• osteoporosis
• local benign conditions (Chronic osteomyelitis,
  Solitary bone cyst)
• Primary malignant tumours (Chondrosarcoma
  Osteosarcoma
  Ewing’s tumour)