Surgery

Question 1

What is the investigation of choice for Meckels Diverticulum and what does it do?

Answer 1

99m Technetium pertechnetate scan for ectopic gastric mucosa

• Sensitivity of the scan is reduced with lower GI bleeding + a Hb <110
• Sensitivity improved by ranitidine
• Laparoscopy has become the investigation of choice

NOT all Meckels have gastric mucosa but those that don’t usually don’t bleed

Question 2

What are the rule of 2’s in Meckels?

Answer 2

• Most common in children <2yrs
• 2 x more common in males
• Contains 2 types of tissue: pancreatic + gastric
• 2 inches long
• Found within 2 feet of the ileocaecal valve
• 2% of the population

Question 3

What can cause red currant jelly stool?

Answer 3

• Meckels diverticulum
• Intussusception

Question 4

What are the midline neck lumps?

Answer 4

• Thyroglossal cyst
• Dermoid cyst
• Submental lymph node
• Ectopic thyroid

Question 5

Which of the following best describes the normal rotation of the bowel that occurs during embryogenesis?

Answer 5

Counterclockwise 270 degrees

Begins the 5th week, complete by 12 weeks

Superior mesenteric artery acts as the axis

• The gut tube undergoes a PRIMARY rotation of 90 degrees counterclockwise (if you were looking at the embryo) such that the lower loop (which has the appendix) is on the embryo’s left side.
• As the embryo grows the abdominal cavity expands thus drawing the gut tube back into the abdomen, during which time the gut tube further rotates another 180 degrees such that the appendix ends up in the upper right quadrant.

Question 6

What is the blood supply to the;

• Foregut
• Midgut
• Hindgut