Podcast
Questions and Answers
What condition is characteristic of males with a high level of anomaly?
What condition is characteristic of males with a high level of anomaly?
- Rectovaginal fistula
- Rectovesical fistula (correct)
- Anal atresia
- Anal stenosis
Females with a low anomaly commonly present with anorectal malformation.
Females with a low anomaly commonly present with anorectal malformation.
False (B)
What is the first surgical step for managing a high anomaly in males?
What is the first surgical step for managing a high anomaly in males?
Diverting colostomy
The surgery known as _____ is used to create an opening for the anal canal.
The surgery known as _____ is used to create an opening for the anal canal.
Match the following anomalies with their corresponding level:
Match the following anomalies with their corresponding level:
What is a primary advantage of using a cutting seton in the treatment of high fistula?
What is a primary advantage of using a cutting seton in the treatment of high fistula?
Complete prolapse is more commonly seen in children than in adults.
Complete prolapse is more commonly seen in children than in adults.
Which arteries provide blood supply to the liver, and in what percentage?
Which arteries provide blood supply to the liver, and in what percentage?
What is the primary treatment method for the first episode of partial mucosal prolapse in children?
What is the primary treatment method for the first episode of partial mucosal prolapse in children?
Left Trisectorectomy involves segments 5 and 8.
Left Trisectorectomy involves segments 5 and 8.
A perforation through the rectal wall and epithelium seen in Crohn's disease is primarily treated with a ______ seton.
A perforation through the rectal wall and epithelium seen in Crohn's disease is primarily treated with a ______ seton.
What is the primary function of the liver related to clotting factors?
What is the primary function of the liver related to clotting factors?
Match the type of prolapse with its characteristic:
Match the type of prolapse with its characteristic:
The primary imaging technique used to differentiate between HCC and metastases is ______.
The primary imaging technique used to differentiate between HCC and metastases is ______.
Match the types of liver resections with their respective segments involved:
Match the types of liver resections with their respective segments involved:
What is the initial treatment for an amoebic liver abscess?
What is the initial treatment for an amoebic liver abscess?
A pyogenic liver abscess is commonly treated with metronidazole.
A pyogenic liver abscess is commonly treated with metronidazole.
Name two indications for aspiration of a liver abscess.
Name two indications for aspiration of a liver abscess.
The common complication of an amoebic liver abscess includes _____ in the sub-diaphragmatic space.
The common complication of an amoebic liver abscess includes _____ in the sub-diaphragmatic space.
Match the treatments with the type of liver abscess:
Match the treatments with the type of liver abscess:
Which of the following organisms is primarily responsible for Hydatid Disease of the liver?
Which of the following organisms is primarily responsible for Hydatid Disease of the liver?
The liver is the least commonly affected organ in Hydatid Disease.
The liver is the least commonly affected organ in Hydatid Disease.
What clinical feature is commonly associated with Hydatid Disease of the liver?
What clinical feature is commonly associated with Hydatid Disease of the liver?
In the life cycle of Echinococcus granulosus, the definitive host is the ______.
In the life cycle of Echinococcus granulosus, the definitive host is the ______.
What is the maximum score for severe encephalopathy in the Child-Turcotte-Pugh score?
What is the maximum score for severe encephalopathy in the Child-Turcotte-Pugh score?
Bilirubin levels of 3.5 mg/dL receive a higher point score than levels between 2.8–3.5 mg/dL in the Child-Turcotte-Pugh score.
Bilirubin levels of 3.5 mg/dL receive a higher point score than levels between 2.8–3.5 mg/dL in the Child-Turcotte-Pugh score.
Match the WHO-IWGE classification with its corresponding description:
Match the WHO-IWGE classification with its corresponding description:
What does the Child-Turcotte-Pugh score evaluate?
What does the Child-Turcotte-Pugh score evaluate?
In the Child-Turcotte-Pugh score, ascites with a severe presentation is assigned _____ points.
In the Child-Turcotte-Pugh score, ascites with a severe presentation is assigned _____ points.
Match the following criteria with their corresponding points in the Child-Turcotte-Pugh score:
Match the following criteria with their corresponding points in the Child-Turcotte-Pugh score:
What is the most common organism responsible for pyogenic liver abscess?
What is the most common organism responsible for pyogenic liver abscess?
Amoebic liver abscess typically results in neutrophil-rich pus.
Amoebic liver abscess typically results in neutrophil-rich pus.
Which imaging technique is typically used for the evaluation of liver abscess?
Which imaging technique is typically used for the evaluation of liver abscess?
The predominant clinical feature of both amoebic and pyogenic liver abscess is _____ and fever.
The predominant clinical feature of both amoebic and pyogenic liver abscess is _____ and fever.
Match the type of liver abscess with its characteristic:
Match the type of liver abscess with its characteristic:
What is the most common complication after surgery related to the rectum and anal canal?
What is the most common complication after surgery related to the rectum and anal canal?
Solitary Rectal Ulcer Syndrome (SRUS) typically presents with an ulcer located on the posterior wall of the rectum.
Solitary Rectal Ulcer Syndrome (SRUS) typically presents with an ulcer located on the posterior wall of the rectum.
What investigation is considered the best for delineating anatomy in cases of anorectal malformation?
What investigation is considered the best for delineating anatomy in cases of anorectal malformation?
In an invertogram, the presence of a gas shadow indicating a low anorectal malformation occurs when the distance between the metallic coin and gas shadow is less than _____ cm.
In an invertogram, the presence of a gas shadow indicating a low anorectal malformation occurs when the distance between the metallic coin and gas shadow is less than _____ cm.
Match the following associated abnormalities with the VACTERL syndrome:
Match the following associated abnormalities with the VACTERL syndrome:
Which segment of the liver is independent and drains bile into both the left and right lobes?
Which segment of the liver is independent and drains bile into both the left and right lobes?
Which of the following is an advantage of perineal procedures for complete prolapse?
Which of the following is an advantage of perineal procedures for complete prolapse?
Segment 1 undergoes hypertrophy in Budd Chiari syndrome.
Segment 1 undergoes hypertrophy in Budd Chiari syndrome.
What are the three major fissures of the liver?
What are the three major fissures of the liver?
Abdominal procedures for complete prolapse are more likely to result in recurrence than perineal procedures.
Abdominal procedures for complete prolapse are more likely to result in recurrence than perineal procedures.
The liver is divided into _____ functional segments.
The liver is divided into _____ functional segments.
Name one example of a perineal procedure used for complete prolapse.
Name one example of a perineal procedure used for complete prolapse.
Match the following segments with their respective characteristics:
Match the following segments with their respective characteristics:
The surgical technique that involves placing mesh between the rectum and sacrum is known as _____ .
The surgical technique that involves placing mesh between the rectum and sacrum is known as _____ .
Match the surgical procedures with their correct descriptions:
Match the surgical procedures with their correct descriptions:
Flashcards are hidden until you start studying
Study Notes
Anorectal Malformations
- Males: Fecal matter passed during urination, recurrent UTI.
- Females: Anorectal malformation.
- Anomaly Levels:
- High (Males): Anorectal agenesis, rectovesical fistula.
- High (Females): Rectovaginal fistula.
- Intermediate (Males): Rectourethral fistula.
- Intermediate (Females): Rectovestibular fistula, Rectovaginal fistula.
- Low/Miscellaneous (Females): Anal atresia, anal stenosis, persistent cloacal anomaly.
- Management:
- Low Anomaly: Definitive surgery.
- High Anomaly: Diverting colostomy followed by definitive surgery.
- Definitive Surgery: Posterior Sagittal Anorectoplasty (PSARP)- creating an anal canal opening.
Brisbane Classification of Liver Resection
- Left Hepatectomy: Segments 4A, 4B, 2, 3.
- Right Hepatectomy: Segments 5, 6, 7, 8.
- Left Trisectorectomy (Extended Left Hepatectomy): Segments 4A, 4B, 2, 3 + 5, 8.
- Right Trisectorectomy (Extended Right Hepatectomy): Segments 5, 6, 7, 8 + 4A, 4B.
Liver Anatomy and Blood Supply
- Dual Blood Supply: Portal vein (80%), Hepatic artery (20%).
- Right Hepatic Artery: Larger, supplies majority of the liver.
- Liver Pedicle: Portal vein (posterior), Common Bile Duct (right), Hepatic Artery (left). This arrangement resembles "Mickey Mouse Sign".
Liver Functions
- Maintaining core body temperature.
- pH balance and correction of acidosis.
- Synthesis of clotting factors.
- Glucose metabolism.
- Bilirubin formation from Hb degradation.
- Drug & hormone metabolism and excretion.
- Removal of endotoxins and foreign antigens.
Liver Dysfunction and Investigations
- Causes of Encephalopathy: Liver Dysfunction.
- Investigations:
- Liver Function Tests (LFT)
- Liver Enzymes
- Clotting Factor Tests
- Ultrasound (USG) abdomen
- Triple Phase CT (IOC)
- Differentiate between Hepatocellular Carcinoma (HCC) and Metastases (mets).
- Liver Function Tests (LFT)
Rectal Prolapse
-
High Fistula Treatment: Seton - Thread inserted, tightened over intervals.
- Draining Seton: Crohn's disease.
- Cutting Seton: High fistula.
-
Rectal Prolapse Types:
- Partial Mucosal Prolapse (Children): Mucosal layer prolapses, incomplete sacral curve.
- Complete Prolapse (Adults): All layers prolapse, weak pelvic floor.
- Complete Prolapse in Children: Different diagnosis (Intussusception).
-
Management of Prolapse:
- Partial: Digital repositioning for first episode, Thiersch wiring/sclerotherapy if recurrent.
- Complete: Requires specific surgical interventions (e.g., rectopexy).
Liver Abscess Treatment
- Amoebic Liver Abscess Treatment:
- Tissue Amoebicide: Metronidazole (Double Strength)
- Duration: 4-5 days.
- If not responding: Aspiration of pus using USG/CT guidance.
- Other indications for Aspiration: Abscess cavity > 5 cm, pregnant patient, impending rupture, left lobe abscess.
- Continue medication for 2-3 weeks: Luminal Amoebicide (Diloxanide furoate).
- Pigtail Catheter: Used for aspiration of pus in abdominal cavity (USG/CT guidance).
- Pyogenic Liver Abscess Treatment:
- IV Antibiotics: Broad spectrum.
- Aspiration: Low threshold (If patient not responding, aspirate quickly).
- Complications of Amoebic Liver Abscess:
- Rupture: Sub-diaphragmatic space (most common), pleural cavity, peritoneal cavity, pericardial cavity.
- Secondary Infection
Liver Dysfunction Scores
- Child-Turcotte-Pugh Score (CTP Score): Evaluates liver dysfunction.
- Encephalopathy: None, 3 (Mild/Moderate).
- Ascites: None, 3 (Mild/Moderate).
- Bilirubin (mg/dL): <2.8, 2.8-3.5, >3.5.
- Prothrombin Time (s) or INR:
Liver Abscess: Types and Clinical Features
- Amoebic Liver Abscess
- Organism: Entamoeba histolytica.
- Route of Spread: Flask-shaped ulcers in the gut -> portal vein -> Bare area (segment 7).
- Number of Abscesses: Usually solitary.
- Labs: Increased PT/INR, positive serology for Entamoeba.
- Clinical features: Pain, fever, severe illness, jaundice.
- Epidemiology: Males > Females.
- Pus: "Anchovy sauce pus" (lacks neutrophils).
- Pyogenic Liver Abscess
- Organism: Polymicrobial (40%), most common: E. coli, Klebsiella (Asia), S. aureus (children with CGD).
- Number of Abscesses: Solitary or multiple
- Labs: Increased ALP, PT/INR, bilirubin.
- Clinical Features: Pain, fever, severe illness, jaundice.
- Epidemiology: Males > Females, immunocompromised individuals.
- Pus: Neutrophil-rich.
- Management and Complications
- IOC: CECT abdomen.
- Features: Abscess cavity with hypoechoic liquefied pus.
- Resolution: Radiological resolution takes months post-treatment.
Hydatid Disease of the Liver
- Organism: Echinococcus granulosus, E. multilocularis (malignant hydatid).
- Definitive host: Dog.
- Intermediate host: Sheep.
- Accidental intermediate host: Man, male = female.
- Organs affected: Liver (most common), lungs, kidneys, spleen.
- Clinical features: Asymptomatic (majority), Right hypochondrial pain, hepatomegaly.
- Gross anatomy: Pearly white cyst.
- Classification:
- WHO-IWGE 2001: CEI, CEA.
- Gharbi 1981: Type I, Type III.
- Stage: Active.
- CT Image: Differentiate between unilocular and multiseptate cysts.
Rectum and Anal Canal
- Complication of Surgery: Constipation (most common), hemorrhage, recurrence, nerve injury, fistula, bladder dysfunction, retrograde ejaculation.
Solitary Rectal Ulcer Syndrome (SRUS)
- Location: Ulcer in anterior wall of rectum, 3-10 cm from anal verge.
- Pathology: Ulcer → Intussusception/Prolapse.
- Histopathology: Fibromuscular obliteration of lamina propria.
- Management: STARR (Stapled Transanal Rectal Resection of Intussusception).
Anorectal Malformation
- Definition: Absence of normal anal opening.
- Associated Abnormalities: VACTERL (Vertebral defects, Tracheo-esophageal atresia/fistula, Anorectal malformations, Renal, Cardiac abnormalities, Limb abnormalities).
- Investigation:
- MRI: Best for delineating anatomy.
- Invertogram: Done after 24 hours, metallic coin placed at proposed site of anal opening.
- Low Anorectal Malformation: < 2 cm between coin and gas shadow.
- High Anorectal Malformation: > 2 cm between coin and gas shadow.
Liver - Part 1
- Functional Anatomy (Couinaud): Divided into 8 functional segments based on portal vein and hepatic vein.
- Sectors: Right posterior, right anterior, left medial, left lateral.
- Major Fissures: Right hepatic vein, left hepatic vein, middle hepatic vein.
- Minor Fissures: Right portal vein, left portal vein, fissure of Ganz.
- Segment 1: Caudate lobe (posterior to left of IVC), independent segment, drains bile into both lobes, receives blood from both lobes, direct venous drainage into IVC, undergoes hypertrophy in Budd Chiari Syndrome.
- Subdivisions: Spigelian lobe and segment 9.
Surgical Management of Complete Prolapse
- Perineal Procedures: Easier, less complications, less recurrence, suitable for frail patients.
- Thiersch Wiring: Digitally reduce prolapse, close with purse-string suture.
- Delorme Repair: Repair of mucosa and prolapse.
- Altemeier Repair (Perineal rectosigmoidectomy): Redundant sigmoid cut to prevent recurrence.
- Abdominal Procedures: More difficult, more operative complications, more recurrence, suitable for young, fit patients.
- Rectopexy: Mesh placed between rectum and sacrum.
- Well's Repair: Ripstein Repair, Frykman Goldberg Resection.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
