Surgery and pathologyOnline version After reading the Sometimes things go wrong section, try this quiz! Don't worry if you make a mistake, make notes on where you went wrong and try again. by Douglas Christie 1 A symptom of gallstones (cholelithiasis) is a localised pain in the centre of the abdomen. Referred pain is also felt in which area of the upper body? a Down the arm on both sides b Lower back c Subscapular d Right hemithorax 2 True or false: portal hypertension is rarely caused by cirrhosis of the liver? a False b True c False 3 When blood is diverted to systemic drainage, what can be the result of the extra flow through these veins? a Varices b Lymphodema c Peripheral neuropathy d Atherosclerosis 4 Greater than, or equal to which pressure value (mmHg) is considered clinically significant during portal hypertension? a 5 mmHg b 7 mmHg c 10 mmHg d 14mmHg 5 True or false: Radiography is used to establish the anatomy of the biliary tree? a False b True Feedback 1 Referred pain from the gallbladder may present in the sub-scapular region. 2 False! Cirrhosis (scarring) of the liver can be a cause of portal hypertension, which places strain on the vessels. 3 Varices (varix sin.) - trauma to the collateral vessels - can be a result of the extra flow through these veins. It can cause pain and can be highly distressing for the individual. 4 Above 10mmHg is clinically significant, as it places strain on the vasculature of the portal system, and collateral vessels. 5 True! Radiography, usually pre-operative ultrasonography is used to determine the anatomical structure of the biliary tract, and any variations that may exist. This prepares the surgical team for the operation, and gives the patient the best outlook for post-operative recovery.
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