Surgery -common

Question 1

What is appendicitis?

Answer 1

Acute inflammation of the appendix most likely due to obstruction of the lumben

Question 2

What is the presentation of appendicitis?

Answer 2

*Abdominal pain mid abdomen to RIF
*Anorexia
*Nausea and vomiting
*RLQ tenderness - McBurney’s point
*Low grade pyrexia

Question 3

Examination in appendicits

Answer 3

*Rovsing’s sign: palpation of LIF causes pain in the right
*Guarding
*Rebound tenderness in RIF
*Percussion tenderness

Question 4

What does rebound tenderness suggest in the case of appendicitis?

Answer 4

That there is peritonitis due to rupture

Question 5

What investigations should be carried out in appendicitis?

Answer 5

*FBC
*CRP
*Ultrasound scan if imaging is required, or CT
*Urinalysis to rule out a UTI
*Pregnancy test in women

Question 6

What are the differentials for appendicitis?

Answer 6

*UTI
*Ectopic pregnancy
*Ovarian cysts
*Meckel’s diverticulum

Question 7

What is the management of appendicitis?

Answer 7

Supportive care and appendectomy

Question 8

What are the complications of appendicitis?

Answer 8

*Gangrene
*Rupture leading to peritonitis

Question 9

What are the complications of an appendectomy?

Answer 9

• Bleeding
  *Infection
  *Scar
  *Thromboembolic event
  *Damage to the bowel or bladder
  *Complciations relating to anaesthesia

Question 10

What is Cholecystitis?

Answer 10

Inflammation of the gallbladder caused by blockage of the cystic duct

Question 11

What is the presentation of cholecystitis?

Answer 11

*RUQ pain which may radiate to the shoulder
*Nausea and vomiting
*tachycardia and tachypnoea
*raised inflammatory markers

Question 12

Murphy’s sign

Answer 12

Palpation of the RUQ causes arrest of inspiration - cholecystitis

Question 13

What investigations should be carried out in cholecystitis?

Answer 13

*FBC
*CRP
*Abdominal USS - thick gallbladder Wal, stones/sludge, fluid around the gallbladder

Question 14

What are the complications of cholecystitis?

Answer 14

*Sepsis
*Gallbladder empyema
*Gangrenous gallbladder
*Perforation

Question 15

What is the management of cholecystitis?

Answer 15

*Conservative: will by mouth, IV fluids, antibiotics, NG tube if vomiting
*ERCP can be used to remove the stones in the common bile duct
*Cholecystectomy within 72 hours of symptoms onset or if inflamed then can wait 6-8 weeks for the infection to settle

Question 16

What are the causes of acute pancreatitis?

Answer 16

*Idiopathic
*Gallstone
*Alcohol
*Trauma
* Steroids
*Mumps
*Autoimmune
* Scorpion bite
*Hyperlipidaemia
*ERCP
*Drugs (furosemide, thiazide like diuretics, azathioprine)

Question 17

What is the presentation of acute pancreatitis?

Answer 17

*Severe epigastric pain which may radiate to the back
*Nausea and vomiting
*Systemically unwell (tachycardia, hypotension, hypovolaemia, low grade fever)
*Dyspnoea (due to diaphragmatic splinting)
*Jaundice may present if gallstones

Question 18

What investigations should be carried out for acute pancreatitis?

Answer 18

*Lipase or amylase
*FBC
*CRP
*U+Es
*LFTs: if ALT >3x normal then suggests gallstones
*Calcium: hypercalcaemia is a rare cause
*Consider a transabdominal USS to look for biliary pathology

Question 19

What is the management of acute pancreatitis?

Answer 19

*Glasgow score to assess severity: 0/1 is mild, 2 is moderate, 3+ is severe
*ABCDE and resuscitation and IV fluids
*Nil by mouth in severe pancreatitis
*Analgesia
*ERCP or cholecystectomy if gallstone pancreatitis
* Treatment of complications

Question 20

What are the complications of acute pancreatitis?

Answer 20

*Necrosis
*Infection in necrotic area
*Abscess Formation
*Acute peripancreatic fluid collections
*Pseudocysts
*Chronic pancreatitis
*Sepsis

Question 21

What is the prognosis of pancreatitis?

Answer 21

*80% mild and will resolve in 3-7 days
*mortality overall is around 5% but rises to 25-30% in severe cases

Question 22

What is the presentation of peritonitis?

Answer 22

*Abdominal pain/tenderness
*Signs of ascites
*Fever
*nausea and vomiting
*Diarrhoea
*Altered mental status

Question 23

What investigations should be carried out in peritonitis?

Answer 23

*FBC
*Serum creatinine
*Ascitic fluid: check appearance, neutrophil count, culture
*Blood cultures
*LFTs: raised bilirubin and liver enzymes, low albumin

Question 24

What is the management of peritonitis?

Answer 24

*IV cefotaxime

Question 25

What is diverticulitis?

Answer 25

Inflammation and infection of the diverticula

Question 26

What is the presentation of diverticulitis?

Answer 26

* Pain and tenderness in the LIF * Fever * Diarrhoea * Nausea and vomiting * Rectal bleeding * Palpable abdominal mass * Raised inflammatory markers and white blood cells

Question 27

What is the management of diverticulitis?

Answer 27

* At least 5 days oral co-amoxiclav * Analgeisia (avoid NSAIDs and opiates) * Clear liquids only - no solid food until symptoms improve

Question 28

What are the complications of diverticulitis

Answer 28

* Perforation * Peritonitis * Peridiverticular abscess * large haemorrhage * Fistula e.g. between colon and bladder * Ileus/obstruction

Question 29

What are the risk factors of an aortic aneurysm?

Answer 29

* Smoking * Sedentery lifestyle * Hypertension * Diabetes * Hyperlipidaemia

Question 30

What is the presentaiton of a ruptured aortic aneurysm?

Answer 30

* Severe abdominal pain radiating to the back * Haemodynamic instability * Pulsatile and expansile mass in the abdomen * Collpase * Loss of consciousness

Question 31

What is the management of ruptured aortic aneurysm?

Answer 31

* Surgical emergency * If haemodynamically stable, CT angiogrpahy can be used to diagnose or exclude

Question 32

What are the features of acute limb ischaemia?

Answer 32

* Pallor * Pulselessness * Perishingly cold * Paraesthesia * Painful * Paralysed

Question 33

What investigations should be carried out in acute limb ischaemia

Answer 33

* Doppler * ABPI * Investigate to determine thrombus or embolus

Question 34

What is the management of acute limb ischaemia?

Answer 34

* Endovascular thrombolysis * Endovascular thrombectomy * Bypass surgery * Amputaiton if unable to restore blood flow * surgical embolectomy * ABCDE approach, IV opioids, vascualr review, unfractionated heparin