SURGERY REVISION SESSION QUESTIONS
1. A 30 year old man, who is known alcoholic presents to you in accident and emergency
department with complaints of severe haematemesis:
a) Define haematemesis ✔✔refers to vomiting blood.
b) List 4 possible causes of haematemesis in the above patient
✔✔pud,
✔✔Gastroduodenal erosions,
✔✔Oesophagitis
✔✔Oesophageal varices
✔✔'Mallory-Weiss' tears
✔✔Upper gastrointestinal malignancy
✔✔Vascular malformations
c) List 5 investigations which are useful in confirming the diagnosis
✔✔Labs – CBC, LFTs, UEC, Coagulation studies
✔✔OGD
✔✔CXR:
• May identify aspiration pneumonia
• Pleural effusion
• Perforated oesophagus
✔✔Erect and supine abdominal X ray to exclude perforated viscus and ileus
✔✔CT scan and ultrasound can identify:
• Liver disease
• Cholecystitis with haemorrhage
• Pancreatitis with haemorrhage and pseudocyst
• Aortoenteric fistulae
2. Question: Kelvin, a 35 years old male presents to you in the outpatient department
complaining of acute abdominal pain, vomiting, abdominal distention and constipation.
On examination, He was sick looking, febrile and dehydrated. He has abdominal
guarding, rebound tenderness and reduced bowel sounds on auscultation.
a) What is the most likely diagnosis ✔✔Most likely diagnosis – Acute peritonitis with
adynamic intestinal obstruction (paralytic ileus)
b) Classify intestinal obstruction ✔✔Intestinal obstruction is classified as Mechanical or
Paralytic ileus :
✔✔ Mechanical intestinal obstruction (Dynamic) – due to blockage of passage by a
structural barrier
✔✔Small bowel obstruction – Partial or total; acute or chronic – usually due to
adhesions, volvulus, intussusception, obstructed hernia
✔✔Large bowel obstruction – Partial or total; acute or chronic – usually due to
malignancies, fecal impaction, volvulus
, ✔✔Paralytic ileus (adynamic) – Due to temporally impairment of peristalsis – usually due
to peritonitis, hypokalaemia, bowel ischaemia, drugs like opiods, anticholinergics,
antidepressants, pseudo-obstruction
c)List three causes of dynamic intestinal obstruction
✔✔adhesions,
✔✔hernias,
✔✔ tumors, and
✔✔ inflammatory conditions.
d) List three investigations to confirm diagnosis
Imaging –
✔✔ Plain abd-Xray (AP & Lat decubitus),
✔✔Abd Ultra sound scan,
✔✔ CT scan in difficulty diagnosis
Labs –
✔✔UEC,
✔✔ CBC,
✔✔RBS,
✔✔ LFTs,
✔✔serum amylase/lipase
d) Describe the management of Kelvin’s disease
✔✔Supportive (conservative)
NBM
NGT
IV fluids
Enema
Parenteral Anaelgesic, antispasmodics
Antibiotic cover
✔✔Surgery – Exploratory laparotomy – Intra-op management dependent on cause: in
peritonitis – peritoneal lavage and repair of the perforation or removal of infected
material/appendix
3. A 75 year old male presents to you with complaints of progressive dysphagia for 6
months. The dysphagia is associated with regurgitation of the food a few minutes after
eating. On physical examination, he is wasted, dehydrated, mildly pale, has no
lymphadenopathy, not jaundice, abdomen is scaphoid and has no organomegally.
a) What is the most likely diagnosis
✔✔Ca Esophagus-
1. A 30 year old man, who is known alcoholic presents to you in accident and emergency
department with complaints of severe haematemesis:
a) Define haematemesis ✔✔refers to vomiting blood.
b) List 4 possible causes of haematemesis in the above patient
✔✔pud,
✔✔Gastroduodenal erosions,
✔✔Oesophagitis
✔✔Oesophageal varices
✔✔'Mallory-Weiss' tears
✔✔Upper gastrointestinal malignancy
✔✔Vascular malformations
c) List 5 investigations which are useful in confirming the diagnosis
✔✔Labs – CBC, LFTs, UEC, Coagulation studies
✔✔OGD
✔✔CXR:
• May identify aspiration pneumonia
• Pleural effusion
• Perforated oesophagus
✔✔Erect and supine abdominal X ray to exclude perforated viscus and ileus
✔✔CT scan and ultrasound can identify:
• Liver disease
• Cholecystitis with haemorrhage
• Pancreatitis with haemorrhage and pseudocyst
• Aortoenteric fistulae
2. Question: Kelvin, a 35 years old male presents to you in the outpatient department
complaining of acute abdominal pain, vomiting, abdominal distention and constipation.
On examination, He was sick looking, febrile and dehydrated. He has abdominal
guarding, rebound tenderness and reduced bowel sounds on auscultation.
a) What is the most likely diagnosis ✔✔Most likely diagnosis – Acute peritonitis with
adynamic intestinal obstruction (paralytic ileus)
b) Classify intestinal obstruction ✔✔Intestinal obstruction is classified as Mechanical or
Paralytic ileus :
✔✔ Mechanical intestinal obstruction (Dynamic) – due to blockage of passage by a
structural barrier
✔✔Small bowel obstruction – Partial or total; acute or chronic – usually due to
adhesions, volvulus, intussusception, obstructed hernia
✔✔Large bowel obstruction – Partial or total; acute or chronic – usually due to
malignancies, fecal impaction, volvulus
, ✔✔Paralytic ileus (adynamic) – Due to temporally impairment of peristalsis – usually due
to peritonitis, hypokalaemia, bowel ischaemia, drugs like opiods, anticholinergics,
antidepressants, pseudo-obstruction
c)List three causes of dynamic intestinal obstruction
✔✔adhesions,
✔✔hernias,
✔✔ tumors, and
✔✔ inflammatory conditions.
d) List three investigations to confirm diagnosis
Imaging –
✔✔ Plain abd-Xray (AP & Lat decubitus),
✔✔Abd Ultra sound scan,
✔✔ CT scan in difficulty diagnosis
Labs –
✔✔UEC,
✔✔ CBC,
✔✔RBS,
✔✔ LFTs,
✔✔serum amylase/lipase
d) Describe the management of Kelvin’s disease
✔✔Supportive (conservative)
NBM
NGT
IV fluids
Enema
Parenteral Anaelgesic, antispasmodics
Antibiotic cover
✔✔Surgery – Exploratory laparotomy – Intra-op management dependent on cause: in
peritonitis – peritoneal lavage and repair of the perforation or removal of infected
material/appendix
3. A 75 year old male presents to you with complaints of progressive dysphagia for 6
months. The dysphagia is associated with regurgitation of the food a few minutes after
eating. On physical examination, he is wasted, dehydrated, mildly pale, has no
lymphadenopathy, not jaundice, abdomen is scaphoid and has no organomegally.
a) What is the most likely diagnosis
✔✔Ca Esophagus-
