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General Surgery > 10/4 > Flashcards

10/4 Flashcards

1
Q

What is in the spermatic cord?

A
  • Cremasteric muscle fibers
  • Vas deferens
  • Testicular artery
  • Pampiniform venous plexus
  • +/- hernia sac
  • genital branch of gen-fem nerve
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2
Q

Causes of Hypercalcemia

A

(CHIMPANZEES)

Calcium supplementation, Hyperparathyroidism, Immobility/ Iatrogenic. Mets, Paget disease, Addison’s disease/ Acromegaly, Neoplasm, ZE, Excess Vit D, Excess Vit A, Sarcoid

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3
Q

tests to perform in small bowel obstruction

A

electrolytes, CBC, type & screen, urinalysis

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4
Q

Left Sided Colon Cancer

A
  • change in bowel habits (smaller stools)
  • colicky pain
  • signs of obstruction
  • abdominal mass
  • heme(+) or gross red blood in stool
  • n/v
  • constipation
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5
Q

Lynch Syndrome

A

Hereditary non-polyposis colon cancer

AD inheritance

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6
Q

Plicae Circularis

A

circular folds of mucosa in small bowel

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7
Q

Right Sided Colon cancer

A
  • right side of bowel has large lumen so cancer can get large before Sx develop
  • Microcytic anemia, occult/ melena
  • post-prandial discomfort
  • fatigue
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8
Q

Treatment of Small Bowel Obstruction

A

Initial: NPO, NGT, IVF, Foley

Complete: laparotomy & lysis of adhesions

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9
Q

Colorectal Carcinoma

A
  • Adenocarcinoma
  • 2nd most common cancer in US
  • Peaks 70-80yo, incidece increases from 40yo
  • lifetime risk of 6%
  • equally common in men & women
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10
Q

Daily Secretions of gastric, bile, & small bowel

A

BGS 123

Bile: 1L

Gastric: 2L

Small bowel: 3L

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11
Q

Terminal Ileum

A

absorbs B12, fatty acids, bile salts

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12
Q

Types of hiatal hernias

A

Type 1: sliding; stomach & GE junction herniate into thorax

Type 2: paraesophageal; herniation of stomach w/o herniation of GE junction

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13
Q

Meckel’s Diverticulum

A

remnant of omphalomesenteric duct/ vitelline duct which connects yolk sac to primitive midgut in embryo

located within 2’ of ileocecal valve

true diverticulum (all layers of intestine)

2x more common in men

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14
Q

Borders of Femoral Canal

A

Cooper’s ligament posteriorly

Inguinal ligament anteriorly

Femoral Vein laterally

Lacunar ligament medially

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15
Q

How many LNs should be resected in colon cancer

A

12 minimum

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16
Q

Polyp size to cancer risk

A

>2cm = high risk of cancer

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17
Q

NG Tube Acid Base status

A

metabolic alkalosis w/ hypokalemia (gets rid of HCl so K+ goes into cells) & hypochloremia

Tx: NS w/ KCl

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18
Q

Littre’s Hernia

A

hernia involving Meckle’s diverticulum

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19
Q

Risks for Colorectal CA

A
  • Dietary: low fiber, high fat diets
  • Genetic (family histroy)
  • IBD: UC > Crohn’s
  • Previous Colon cancer
  • increasing age
20
Q

Who should have incidental Meckel’s removed?

A

all kids

adults with ectopic tissue or mesodiverticular bleed

21
Q

Common Adult Maintenance Fluid

A

D5 ½NS w/ 20 mEq KCl/L

(dextrose added to prevent muscle breakdown)

22
Q

Femoral Hernia

A

hernia medial to femoral vessels (under inguinal ligament)

23
Q

Differential Dx of Colon Mass

A

Adenocarcinoma, Carcinoid tumor, lipoma, leiomyosarcoma, lymphoma, diverticular disease, UC, Crohn’s, polyps

24
Q

Indirect vs Direct Inguinal Hernia

A

Direct- hernia within Hesselbach’s Triangle (does not go through internal ring)

Indirect- hernia lateral to Hesselbach’s Triangle (does go through internal ring)

25
Q

Anatomic DIfferences of Small Bowel & Colon

A

Colon has teniae coli, haustra, & appendices epoploicae (fat appendages)

small intestine is smooth

26
Q

chemo for stage 3 colon cancer

A

5-FU & leucovorin

27
Q

Types of Neoplastic Polyps

A
  • tubular adenoma
  • tubulovillous adenoma
  • villous adenoma
    • highest potential for CA
28
Q

Ilioinguinal Nerve

A

sensation to inner thigh or lateral scrotum

if cut, sensation returns in 6mo

travels on spermatic cord

29
Q

Causes of Small Bowel Obstruction

A
  • adhesions (most common cause in adults), hernia (Bulge), Cancer/ tumors
30
Q

Layers of abdominal wall

A

skin, SQ fat, Scarpa’s fascia, external oblique, internal oblique, transversus abdominus, transversalis fascia, peritoneal fat, peritoneum

31
Q

Where is Cremaster muscle from

A

internal oblique muscle

32
Q

What electrolyte should you replace before K+?

A

Magnesium

33
Q

Tumors of small intestine

A
  • Benign: leiomyoma (most common), lipoma, lymphangioma, fibroma, adenomas, hemangiomas
  • Malignant: adenocarcinoma, carcinoid, lymphoma, sarcoma
34
Q

Stages of Colorectal Cancer

A
  • Stage 1: invades submucosa or muscularis propria
  • Stage 2: invades through muscularis propria but (-) LNs
  • Stage 3: (+) nodes, no distant mets
  • Stage 4: (+) distant mets
35
Q

Complete SBO

A

complete obstrution of lumen

danger of closed loop strangulation of bowel → bowel necrosis

36
Q

What is inguinal ligament derived from?

A

External Oblique Aponeurosis

37
Q

Duodenum

A
  • 12” long
  • ends at Ligament of Treitz
38
Q

Signs of Strangulated Bowel with Small Bowel Obstruction

A

fever, severe pain, hematemesis, shock, gas in bowel wall, abd free air, peritoneal signs, acidosis

39
Q

How fast can you change Na+ concentration?

A

<12 mEq/L per day

40
Q

Hesselbach’s Triangle Borders

A

inferior epigastric vessels

inguinal ligament

lateral border of rectus sheath

Floor: internal oblique and transversus abdominis

41
Q

Pre-op Abx in colon surgery

A

cefoxitin or carbepenem

42
Q

Peterson’s Hernia

A

herniation of small bowel through defect in mesentary after gastric bypass

43
Q

Most common hernia

A

indirect inguinal hernia (in both men and women)

44
Q

First Identifiable Subcutaneous Layer in Inguinal Hernia Repair

A

Scarpa’s fascia

45
Q

Small Bowel Obstruction

A
  • abd discomfort, cramping, nausea, abd distention, emesis, high-pitched bowel sounds
  • Labs: electrolytes, CBC, type & screen, urinalysis
  • must rule out incarcerated hernia
  • X-Ray Finding: distended loops of small bowel, air fluid levels
46
Q

Complications w/ Meckel’s diverticulum

A
  • Intestinal Hemorrhage- painless; ½ of all lower GI bleeds in kids <2; d/t ectopic gastric mucosa that secretes acid
  • Intestinal Obstruction- most common complication in adults; volvus and intussusception
  • inflammation +/- perforation
47
Q

Most common causes of colonic obstruction in adults

A

colon cancer, diverticular disease, colonic volvulus

General Surgery (6 decks)

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