Postoperative complications

1. Recurrence of the hernia after repair is estimated to occur in 3–10% of patients.

2. Temporary urinary retention with difficulty urinating is common.

3. Wound infection occurs in 1–3% of patients postoperatively.

4. Injury:

• to the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerves rarely occurs and may result in paresthesias in their distribution of innervation;

• to the structures of the spermatic cord rarely occurs.

5. Seroma and haematoma.

Tests for control Chapter 1. Acute appendicitis

Tests (one answer is correct)

1.Acute appendicitis is:

1. inflammation of the appendix;

2. inflammation of the appendix with its perforation;

3. nonspecific inflammation of the inner lining of the vermiform appendix that spreads to its other parts;

4. purulent inflammation of the inner lining of the vermiform appendix that spreads to its other parts.

2. Kolesov’s classification of acute appendicitis:

1. oedematous stage, purulent stage, gangrenous stage;

2. appendicular colic, destructive appendicitis (phlegmonous, gangrenous, perforated), complicated;

3. no complicated and complicated;

4. phlegmonous, gangrenous, perforated.

3. Abdominal pain in patients with acute appendicitis:

1. sudden, intensive, localized in the right part of abdomen;

2. often begins gradually in the right lower quadrant of the abdomen;

3. usually begins as periumbilical or epigastric pain migrating to the right lower quadrant of the abdomen;

4. often begins as periumbilical or epigastric pain, accompanies with vomiting, nausea high temperature.

4. Describe Rovsign’s sign:

1. passive internal rotation of flexed right thigh with the patient in supine position causes pain;

2. light percussion on McBurney’s point will elicit pain;

3. pain in the right lower quadrant is complained of when palpation pressure is exerted in the left lower quadrant;

4. strengthening pain in the right lover square in the position of patient on the left side.

5. Describe Sitkoysky’s sign:

1. passive internal rotation of flexed right thigh with the patient in supine position causes pain;

2. light percussion on McBurney’s point elicits pain;

3. pain in the right lower quadrant is complained of when palpation pressure is exerted in the left lower quadrant;

4. strengthening pain in the right lover square in the position of patient on the left side.

6. Main method in diagnostic procedure is:

1. X-ray examination;

2. ultrasonic;

3. laboratory studies;

4. anamnestic and clinical examination.

7. Peculiarities of trends of acute appendicitis in elderly patients:

1. often retrocaecal position of appendix;

2. often pain accompanies with vomiting, nausea;

3. no evident clinical picture + rapid destructive changes in appendix;

4. often spontaneous regression of inflammation.

8. Patient 20 years old has pain in upper part of abdominal cavity with vomiting, nausea during last 2 hours. Optimal tactic is:

1. urgent operation;

2. antibiotics;

3. hospitalization and observation at surgical department;

4. observation at home by family doctor.

9. Optimal final method of differential diagnostic of acute appendicitis is:

1. laparoscopy;

2. ultrasonic;

3. laboratory studies;

4. anamnestic and clinical examination.

10. In preoperative preparation in patients with acute appendicitis we use:

1. analgetics;

2. spasmolitics;

3. antibiotics;

4. all answers are not correct.

11. In patients with acute appendicitis and clinical manifestation of local peritonitis surgeons use:

1. McBurney’s incision of abdominal wall;

2. Shprengel’s incision of abdominal wall;

3. Koher´s incision of abdominal wall;

4. middle line laparotomy.

12. In patients with acute appendicitis and clinical manifestation of general peritonitis surgeons use:

1. McBurney’s incision of abdominal wall;

2. pararectal incision of abdominal wall;

3. Koher’s incision of abdominal wall;

4. middle line laparotomy.

13. Differential diagnostic of appendicular mass:

1. colonic cancer;

2. appendicular abscess;

3. ovarium tumor;

4. all answers are correct.

14. Final method of differential diagnosis between colonic cancer and appendicular mass is:

1. laparoscopy;

2. ultrasonic;

3. colonoscopy + biopsy;

4. X-ray examination.

15. Final method of differential diagnostic between appendicular abscess and appendicular mass is:

1. laparoscopy;

2. ultrasonic;

3. colonoscopy + biopsy;

4. laboratory studies.

16. Clinical manifestation of appendicular abscess:

1. temperature of body rises to 38.0–39.0ºС;

2. increasing of the size of the mass;

3. increasing abdominal pain – suggesting spreading peritonitis;

4. all answers are correct.

17. Ultrasonic examination helps in differential diagnosis between colonic cancer and appendicular mass by:

1. detecting of adhesions between mass and bowels;

2. absence of adhesions between mass and bowels;

3. increasing of mass during 2 weeks;

4. revealing of metastasis.

18. Treatment of the intra-abdominal bleeding from mesoappendix after appendectomy:

1. laparotomy and arrest of bleeding;

2. conservative;

3. surgical in young patients, conservative in elderly;

4. laparoscopy drainage.

19. Treatment of the appendicular mass:

1. surgical;

2. conservative;

3. surgical in young patients, conservative in elderly;

4. laparoscopy drainage.

20. Treatment of the pelvic abscess in man:

1. laparotomy or laparoscopy drainage;

2. conservative;

3. surgical in young patients, conservative in elderly;

4. rectal drainage.