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Written Boards - Final > Abdomen > Flashcards

Abdomen Flashcards

1
Q

inheritance patterns of :
Thalessemias
Her sphero
G6PD
SSD

A

AD
AD
XLR
AR

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2
Q

What is your dg of exclusion for isolated thrombocytopenia?
7 others to evaluate for

A

ITP

Viral, autoimm, preg/preecl,TTP, HIT, hypersplenism, cirrhosis

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3
Q

When to transfuse for ITP patients

MC bleeding occurrences

Common non bleeding feature that may be severe

A

less than 20K or active bleeding

Petechia
Epistaxis
Purpura

fatigue

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4
Q

Recent hx questions for suspected ITP

A

Recent infection, quinine, medications

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5
Q

Lab difference for TTP vs ITP

special lab for either?

A

microangiopathic hemolytic anemia vs usually normal

AdamTS13 deficiency

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6
Q

Post op care for splenectomy timing

A

abx at 14 days

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7
Q

Initial tx for ITP

later?

A

steroids and IVIG

Splenectomy

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8
Q

Tx for TTP

A

therapeutic plasma exchange

steroids
rituxumab

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9
Q

Reasoning for splenectomy in ITP

A

for refractory cases where extended steroid use is problematic

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10
Q

2 genetic syndromes associated with desmoids

what other similarity do these share

A

fap and Gardners

polyps

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11
Q

intra-abdominal desmoid txs

first best step in management

A

radiation; negative margin resection

watch and wait

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12
Q

What is the PE for femoral hernia

A

below inguinal ligament

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13
Q

4 borders of femoral canal

A

sup - iliopubic
inf - cooper
med - lacunar
lat - fem vein

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14
Q

risk of incarceration per year for aysmpt or min sympt inguinal hernia

A

.3%

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15
Q

For splenectomy, when are platelets given

A

if needed and after taking artery

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16
Q

inguinal nerves and sensory distribution

A
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17
Q

overall parastomal hernia rate

A

50%

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18
Q

Groin anatomical hernia sites

A
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19
Q

typical symptoms for obturator hernia

A

medial thigh pain or paraesthesias due to obturator n compression

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20
Q

what percent of obturator hernias present with sbo

A

50

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21
Q

Why is there pain with hernia?

A

These are often sites where n and vessels penetrate the abdominal wall

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22
Q

When does umbilical defect usually close

A

5

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23
Q

medial umbilical ligaments are remnants of…

round ligament is a remnant of ….. also known as…..

A

left and right umbilical arteries

umb vein; lig teres

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24
Q

falciform anatomy

A
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25
Q

perks to laparoscopic hernia repair

A

better healing, easier for obeses patients, multiple defects, better recurrent hernia operation

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26
Q

Go to open hernia repair type and mesh to be used

A

rives stoppa with uncoated polypropylene

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27
Q

first step for obese patients with non urgent hernias

A

weight loss

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28
Q

blood supply of lateral abdominal wall

medial?

A

lumbars intercostals, deep circumflex ilac

epigastrics

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29
Q

below the arcuate line the rectus lies directly anterior to the ….

A

transversalis fascia

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30
Q

risk factors for incisional hernia development - 4

A

smoking, steroids, rads, wound infection

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31
Q

main benefit of lap vs open for hernia

A

lower infection

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32
Q

incisional hernia staging system

A

Table 2. Incisional Hernia Staging System
Stage I <10 cm, clean
Risk: low recurrence, low SSO
Stage II <10 cm, contaminated
Risk: moderate recurrence, moderate SSO 10-20 cm, clean
Stage III ≥10 cm, contaminated
Risk: high recurrence, high SSO Any ≥20 cm
SSO, surgical site occurrence.

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33
Q

size cutoff for hernia primary repair – ventral

A

2 cm

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34
Q

2 congenital diaphragmatic hernias and their positioning

what anatomical features failed in each

A

Bochdalek — post lat —pleuroperitoneal membrane closure

Morgagni — ant med – fusion of septum transversum

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35
Q

elevated diaphragm after diaphragm repair means…

usual treatment

if refractory or severe

A

phrenic nerve injury

obs

plication or pacing

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36
Q

preferred diaphragm repair approach according to east trauma

lap or open

A

abdominal due to concomitant injuries

lap if stable

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37
Q

when to use mesh for diaphragm repair?

A

10cm CHRONIC

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38
Q

2 hard indications for lap over open inguinal repair

A

bilateral and prior open recurrence

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39
Q

peritoneal sac location relative to cord structures

A

ant med

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40
Q

chronic pain post inguinal repair initial tx

refractory tx

A

nsaids, blocks

mesh removal or neurectomy

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41
Q

recurrence rate for inguinal

A

5-10%

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42
Q

what type of mesh gives best recurrence rate

A

permanent prosthetic

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43
Q

Relative cx to ventral hernia repair (4)

A

obesity
preg
smoking
multiple comorbids

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44
Q

anterior abdominal wall perforator relative positions

A
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45
Q

Describe anterior component separation

A
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46
Q

pathophys for choledochal cysts

A

pancreaticobiliary anomalous junction — pancreatic reflux into biliary tress

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47
Q

Mirizzi Types

A

1 A - patent CD
1 B - obliterated CD

2 - 1/3
3 - 2/3
4 - 2/3+

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48
Q

How likely is Mirizzi dg on pre op w/u

A

not likely

49
Q

At what level of bili do sclera and skin become jaundiced

A

2.5
5

50
Q

Charcots triad

A

fever, RUQ, jaundice

51
Q

Reynolds pentad

A

Charcot hypotension, AMS

52
Q

acholic stools, dark urine, RUQ pain

A

biliary obstruction

53
Q

2 labs indicating cholestasis

A

bili and alp

54
Q

what does hida stand for

good for identifying 2 things

A

leaks and CD obstruction

55
Q

Types of choledochal cysts and their treatments

A

1 - excison followed by HJ or HD
2 - diverticulectomy
3 - sphincterotomy v trans duodenal excision
4 - HJ possible limited lob resection
5 - transplant

56
Q

What is Carolis disease

A

type 5 choledochal cysts all intrahepatics

57
Q

2 disease processes that may stem from choledochal cysts

A

Obstruction from cyst debris

Malignancy

58
Q

Timing if prenatal testing finds choledochal cyst and why

A

early to prevent hepatic fibrosis

59
Q

4 pharm interventions that will affect sphincter of ODdi

A

Morphine - cx
Glucagon - relax
CCK - relax
Secretin - relax

60
Q

who gets biliary dykinesia

A

20-50 women

61
Q

DDX for biliary colic

A

chronic panc, PUD, GED

62
Q

Most definitive way to dg SOO disorder

A

Oddi manometry greater than 40

63
Q

3 SOO dg criteria

A

Criteria for biliary pain*
Elevated liver enzymes or dilated bile duct, but not both
Absence of bile duct stones or other structural abnormalities

64
Q

incidence of CBD injury in lap

A

.5%

65
Q

size of biliary duct that can be ligated for leak

circumference of injury that can be amenable to T tube

end to end repair defect length

all others?

A

3mm

50

1cm

HJ

66
Q

CBD stricture initial treatment

success rate

A

dilation

75%

67
Q

biliary injury repair success rates for surg, IR, GI

A

88
50
75

68
Q

solitary hyperplastic mucosal lesion in the gallbladder? management?

A

adenomyomatosis

nothing

69
Q

Percent of GB cancer from a distant met?

A

2%

70
Q

How to classify cholangioca

A
71
Q

what are peripheral cholangioca’s? what is their incidence relative to CCA overall

A

intra hepatic
5-10%

72
Q

6 big risk factors for GB cancer

A

GS >3cm
PSC
Anomalous PBJ
segmental mucosal calc
Polyps> 1cm
Obesity

73
Q

CCA risk factors

A

Parasite(opisthorchis
hepatolithiasis
Hep c
PSC
choledochal cysts

74
Q

staging for GB cancer

A

CT CAP
CA 19-9

75
Q

When is tissue required for CCA

A

non op managment or unclear imaging

76
Q

4 negative porgnosticator for GB CA

A

perineural invasion
LV invasion
inability to get R0 resection
T2b(hepatic perimusc side) vs a

77
Q

GB CA staging

A
78
Q

recommendations on incidental polyps on US

A

Polyps greater than 2.0 cm should be considered malignant, and appropriate workup is warranted to assess for cancer (see Learning Objective 4b), followed by resection.
Polyps 1.0 to 1.9 cm have increased risk of being malignant, and simple cholecystectomy should be recommended.
Polyps less than 1.0 cm that are detected on CT scan are more likely to represent cholesterol polyps.
Polyps 0.6 to 0.9 cm should be followed with yearly ultrasounds (American Society for Gastrointestinal Endoscopy [ASGE] guidelines).

79
Q

2 requirements for chole as definitive treatment for GB CA

A

T1a(lamina propria) and neg cyst duct margin

80
Q

Causes of primary biliary stricture? 3 for secondary?

A

PSC

Neoplasm, infection, ischemia

81
Q

Up to 90% of patients with PSC also have____

A

UC

82
Q

Elevated labs in PSC

PE exam findings

A

ALP and bili

Excoriations, enlarged liver or spleen, jaundice

83
Q

Test of choice for suspected PSC

Alternative

A

ERCP

PTHC

84
Q

When does PSC patient get transplant

A

Cirrhosis

85
Q

MELD number for transplant

MELD components

A

15

INR, Na, Cr, bili, dialysis twice per week?

86
Q

Tx for PSC with meld under 15

Success rate at 5 years

Success of reconstruction

A

balloon dilation

89%

35%

87
Q

only medical treatment for PSC and what does it actually help with

A

ursodeoxycholic acid

helps minimally with symptoms

88
Q

Screening with PSC diagnosis

A

Gallbladder/CCA
Colonoscopy for UC
CA 19-9
U/s

89
Q

Components of CHILD score

A

Total bilirubin: 1 point for less than 2, 2 points for 2 to 3, and 3 points greater than 3
Serum albumin: 1 point for greater than 3.5, 2 points for 2.8 to 3.5, and 3 points for less than 2.8
INR: 1 point for less than 1.7, 2 for 1.7 to 2.3, and 3 points for greater than 2.3
Ascites: 1 point for none, 2 points for mild or suppressed with medication, and 3 for moderate to severe.
Hepatic encephalopathy: 1 point for none, 2 points for grade I to II, and 3 for grade III to IV
Grade I: trivial lack of awareness; euphoria or anxiety; shortened attention span; impaired performance of addition or subtraction
Grade II: lethargy or apathy; minimal disorientation for time or place; subtle personality change; inappropriate behavior
Grade III: somnolence to semistupor but responsive to verbal stimuli; confusion; gross disorientation
Grade IV: coma

90
Q

One year survival per Child class

A
91
Q

Treatment for small esoph varices

large?

A

Propanalol – splanchnic vasoconstriction

Add banding or sclerotherapy, repeat q 6 weeks

92
Q

PPx for portal htn and GI bleeding

A

Octreotide or somatostatin – mesenteric or splanchnic VCX

93
Q

Tx for cirrhotic SBT? Recurrence rate?

A

Cefotaxime

40-70

94
Q

epidemiology of hepatic abscesses?

East v west type predominance?

A

1% pop in 5th decade, sick folks

Pyogenic v entamoaba histolytica

95
Q

pyogenic hepatic abscess bugs

A

strep, kleb, e coli

96
Q

3 big sources for hepatic abscess

A

portal

arterial

biliary

97
Q

blood work for hepatic abscess concerns

A

cbc, cmp, crp, cultures, echinococcus and Entamoeba histolytica

98
Q

Gold standard imaging for hepatic abscesses?

Appearance: pyogenic v ameobic v ecinocochal

A

CT IV

multiple

single sub diaphragm

Septated cyst - multiple daughter cysts

99
Q

Initial tx of pyogenic hep abscess?

size cut off for drainage?

Role for surg

A

BS abx

3cm

5cm plus, multiples, underlying cause needing resection

100
Q

Testing for ameobic abscess?

Tx?

A

serology

flagyl/tinidazole(10d v 5 d)
then
paromycin/iodoquinol(7-20d)

101
Q

What is echinococcus?

Single cyst tx? surg size?

Multi cyst treatment

A

helminth

albendozole; cm

PAIR - puncture, aspirate, inject, reaspirate —-28 d albend

102
Q

underlying causes of hepatic abscesses that need follow up(3)

A

Diverticulitis
Cholecystitis
Biliary/colon malign

103
Q

What landmark divide liver in two

A

Cantlie’s - gallbladder fossa to IVC

104
Q

What segment drains directly into IVC

A

Segment 1

105
Q

3 categories of liver mets

A

CR
NE
non above

106
Q

synchronus vs metachronous liver lesions

A

biology is more aggressive in synch, harder surgery

107
Q

non chemo, chemo, and cirrhotic FLR %s preferred

A

25,35,40

108
Q

option if FLR is not large enough

A

portal vein embolization

109
Q

CRC stage 4 % at dg

A

20-25%

110
Q

% mets at dg for GI NET

A

40-95 mostly in liver, strong prognosticator

111
Q

surveillance for liver mets after CRC

A

CEA and imaging

112
Q

CT appearance of liver mets?

A

hypoattenuating, portal filling with washout in delayed phase

113
Q

When to bx liver mets

A

unknown primary or chemo info needed

114
Q

Hepatectomy mortality and morbidity?

A

2% ; 30-50%

114
Q

Acalculous cholecystitis tx in sick patient?
When would this need to be deviated?

A

Chole tube

In case of perforation or clinical deterioration

114
Q

Anatomical side for Mattox vs Cattell

A

right

left

115
Q
A
116
Q
A

Written Boards - Final (21 decks)

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