SURGERY Passmed

Question 1

Acute pancreatitis: complications

Answer 1

1. Peri-pancreatic fluid collections
–> aspiration + drainage AVOID , risk of infection
–> most resolve

2. Pseudocysts
–> most spony resolve
–> tx: endoscopic or surgical cystagastrostomy

3. Pancreatic necrosis
–> avoid surgery unless needed

4. Pancreatic abscess
–> tx transgastric drainage

5. Haemorrhage

6. Acute respiratory distress syndrome

Question 2

Signs of Diverticulitis

Answer 2

• Low-grade pyrexia
• Tachycardia
• Tender LIF
• tender palpable mass
  ——> 20% patients
  ——> due to inflammation or an abscess
• Possibly reduced bowel sounds
• Guarding, rigidity and rebound tenderness may suggest complicated diverticulitis with perforation

Question 3

Investigations for diverticulitis

Answer 3

1. FBC: raised WCC
2. CRP: raised
3. Erect CXR:
   —-> may show pneumoperitoneum in cases of perforation
4. AXR:
   —-> may show dilated bowel loops, obstruction or abscesses
5. CT: this is the best modality in suspected abscesses
6. Colonoscopy: should be avoided initially due to the increased risk of perforation in diverticulitis

Question 4

Diverticulitis: management

Answer 4

1. Mild cases
   —> oral abx
   —> liquid diet
   —> analgesia
2. No improvement after 72hrs
   —> admitted to hospital for IV abx

Question 5

The following features are characteristic of what condition:
- pain worse 15-30 mins post meal
- steatorrhoea
- diabetes mellitus

Answer 5

CHRONIC PANCREATITIS
NOTES
- pancreatic insufficiency usually develops between 5-25 years after onset of pain
- DM occurs more than 25 years post symptoms

Question 6

Key investigations for suspected chronic pancreatitis

Answer 6

1. Abdominal X-RAY
   –> pancreatic calcification
2. Functional tests
   –> faecal elastase
   —–> for pancreatic exocrine function

Question 7

Management of chronic pancreatitis

Answer 7

1. Pancreatic enzyme supplements
2. analgesia
3. Anti-oxidants