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ABS > ALIMENTARY > Flashcards

ALIMENTARY Flashcards

1
Q

Greatest RF for bleeding peptic ulcer

A

NSAID use

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2
Q

Current recommendations for antibiotic prophylaxis in clean-contaminated cases where there is preceding biliary colic within 30 days

A

Ancef x 1

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3
Q

In POEM which muscle layer is divided

A

After creating a longitudinal mucosal incision and creating a submucosal tunnel into the proximal stomach, the endoscopist divides the circular muscle layer of the esophagus, leaving the longitudinal layer intact

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4
Q

volume of fluid produced by stomach

A

1500 mL daily

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5
Q

volume of fluid produced by pancreas

A

1000 mL daily

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6
Q

volume of fluid produced by biliary system

A

1000 mL daily

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7
Q

volume of fluid produced from small bowel

A

2000 mL

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8
Q

RF assoc with poorer prognosis/increased recurrence with SCC of the anus

A
  • tumor size > 5 cm
  • > 2/3 involvement of anal canal circumference Additional identified predictors of decreased survival include male sex, presence of nodal disease, and hemoglobin less than 13 g/dL.
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9
Q

what type of calcium deposits should prompt you to consider prophylactic cholecystectomy in pts with porcelain gallbladder

A

More extensive intramural deposits cause mucosal sloughing, which reduces the rate of adenocarcinoma while the selective calcification yields to a continued inflammatory stimulus. Thus, a stronger recommendation for prophylactic cholecystectomy is made for the selective mucosal calcification pattern in an asymptomatic patient.

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10
Q

best predictor of local recurrence in rectal cancer

A

Initial t stage

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11
Q

Lateral anal fissure should raise concern for

A

Crohn disease, syphilis, anal carcinoma, or tuberculosis.

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12
Q

Nuclear scintigraphy detects acute bleeding at a rate of

A

0.04 mL/minute

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13
Q

Mesenteric angio requires bleeding rate of

A

0.5 mL/minute

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14
Q

An esophageal stricture is refractory if

A

diameter of 14 mm cannot be achieved over 5 sessions at 2-week intervals

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15
Q

An esophageal stricture is recurrent if

A

satisfactory diameter cannot be maintained for 4 weeks once the target diameter of 14 mm has been achieved.

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16
Q

CT angiography can detect bleeding at rates of

A

as low as 0.3 mL/minute, which is better than angiography and only slightly worse than tagged red cell scans.

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17
Q

tagged RBC scan detection rates

A

This method will identify bleeding rates as low as 0.1 mL/minute.

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18
Q

mgmt of “mini GISTs”

A

Tumors that are 1 cm in size are referred to as mini GISTS. These tumors have very low malignant potential and are managed by endoscopic ultrasound surveillance.

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19
Q

High risk features of “mini GIST”

A

High-risk features include the presence of echogenic foci, irregular borders, or ulceration.

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20
Q

Gastric carcinoids occur due to

A

Gastric carcinoids are tumors of the stomach that occur due to hypergastrinemia that occurs with achlorhydria due to proton pump inhibitors.

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21
Q

Mgmt of gastric carcinoid

A

These tumors can be managed by stopping proton pump inhibitors.

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22
Q

Imatinib is used in tx of GIST and what else

A

CML

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23
Q

MC site of internal hernia after Roux en Y

A

Mesojejunal mesenteric window (56%) followed by Petersen defect

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24
Q

Petersen defect

A

mesenteric defect posterior to the roux jejunal limb

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25
Q

surveillance after complete resection of a cancerous polyp with a margin greater than 2 mm.

A

cscope at 1 year

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26
Q

what structure is used to guide the dissection of levator ani muscles from perineum into pelvis

A

coccyx

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27
Q

if pt has previous gastric surgery but requires anti reflux surgery (inadequate fundus for fundoplication)

A

Hill esophagogastropexy

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28
Q

What is hill esophagogastropexy

A

plication of lesser gastric curvature around right side of esophagus with esophagogastropexy to median arcuate ligaemnt
-intraop manometry required

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29
Q

slow transit constipation who have failed medical mgmt

A

total abdominal colectomy with ileorectal anastomosis

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30
Q

more than 95% perirectal abscesses arise from

A

anal glands

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31
Q

what is major reason left sided approach is preferred in approach to ecervical esophagus

A

right RLN has more variable course thus more prone to inadvertent injury

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32
Q

bland spindle cells with elongated nuclei

A

GIST

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33
Q

zenkers diverticulum - true or false

A

false (mucosa and submucosa only)

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34
Q

where does zenkers diverticulum occur

A

area of weakness just superior to cricopharyngeus

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35
Q

MC short term complication after roux en y gastric bypass

A

dehydration (also MC overall)

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36
Q

function of secretory IgA

A

blocks absorption of antigens from the gut

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37
Q

nutcracker esophagus - typical amplitude pressures

A

> 180-400 mmHg with long (>6 sec) duration contraction wave

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38
Q

high risk GIST

A

> 5 mitosis per HPF or >3 cm

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39
Q

what structure should surgeons be cognizant of when dividing gastrohepatic ligament

A

hepatic breanch of vagus nerve (ligament runs superior to it)
also aberrant left hepatic artery

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40
Q

cornerstone of initial GOO mgmt

A

endoscopic dilation and potential H pylori eradiction

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41
Q

most excess weight loss procedure

A

duodenal switch with biliopancreatic diversion

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42
Q

selenium deficiency can lead to

A

cardiomyopathy and weakness

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43
Q

vitamin E deficiency

A

hemolytic anemia

neurologic abnormalities

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44
Q

Initial therapy for bowen disease

A

Topical x like imiquimod

45
Q

Surgical excision for bowen disease - what margins

A

4 mm low risk

6 mm high risk

46
Q

corkscrew esophagus on UGI

A

DES

47
Q

most consistent predictor of good prognosis after hepatic resection in metastatic colon CA

A

positive response to preop chemotherapy

48
Q

RF that predict poor survival after hepatic resection in metastatic colon CA

A 
node positive primary tumor
disesase free interval <12 months
multiple liver mets
largest liver met >5 cm
serum CEA >200
49
Q

stenosis of GJ after roux en y most typically occurs after what kind of anastomosis

A

circular end to end

50
Q

greatest risk of met in GI carcinoid

A

tumor size
<1 cm fewer than 5% will have mets
>2 cm most will have mets

51
Q

tx of horseshoe abscess

A

modified Hanley procedure
small incision between tip of coccyx and anal verge, tissues of external sphincter gently separted using a hemostat tto get into the postanal space, abscess is drained, seton placed around sphincter complex and two lateral counterdrainage incisions are made with setons placed in each

52
Q

primary transthoracic operation used to treat GERD

A

Belsey Mark IV

53
Q

Belsey Mark IV

A

transthoracic anterior 240 degree plication of fundus buttressed by diaphragmatic crura

54
Q

excess weight loss at 2 years after gastric band

A

50%

55
Q

truncal vagotomy - what is ligated? pyloric drainage procedure needed?

A

main trunk of vagus including celiac and hepatic branches

pylorus is denervated –> needs drainage procedure

56
Q

selective vagotomy - what is ligated? pyloric drainage procedure needed?

A

anterior and posterior gastric nn of Laterjet

pyloric drainage procedure needed

57
Q

highly selective vagotomy aka

A

parietal cell vagotomy, proximal cell vagotomy

58
Q

tx of pharmacobezoar

A

activated charcoal

59
Q

tx of phytobezoar

A

initial try chemical dissolution

60
Q

factors assoc with regression of Barretts

A

short segment, smoking cessation and PPI use

61
Q

mgmt of low grade dysplasia Barretts

A

radiofrequency ablation

62
Q

what feature distinguishes IPMN from mucinous cystic neoplasm

A

communication with pancreatic duct

63
Q

which complications of hemorrhoidectomy are more common in stapled hemorrhoidectomy vs others

A

tensemus and septic complications and rectal prolapse

64
Q

what is tenesmus s/p hemorrhoidectomy from

A

likely presence of low rectal suture

65
Q

most common complication of stapled hemorrhoidopexy

A

early bleeding

66
Q

predictors of response to tx in MALT lymphoma

A

depth of penetration of gastric wall (deep to mucosa is less responive)
absence of AP-12-MALT 1 translocation
gastric site (proximal is more worrisome)
microsatellite instability
advanced age

67
Q

tx for MALT lymphoma after failed response to H pylori tx

A

XRT with chemo as salvage for XRT failure

68
Q

why are multiple biopsies required in gastric NETs

A

larger tumors >1 cm can be a/w synchronous gastric adenoCA

69
Q

serum gastrin > what is sensitive and specific for gastric carcinoid

A

120 pg/mL

70
Q

Choledocho is most likely with bili greater than what level

A

4 mg/dL

71
Q

surveillance for GB polyp <5 mm

A

may not be necessary

72
Q

MC site of aortoenteric fistula

A

duodenum

73
Q

diagnostic modality of choice in hemodynamically abnormal pts with suspected AEF

A

CTA (sensitivity approaches 94%)

74
Q

chemo for carcinoid and when do you give it

A

streptozocin and 5FU

unresectable disease

75
Q

tx of flushing in carcinoid syndrome

A

alpha bl;ockers like phenothiazine

76
Q

what can give false elevation in 5 HIAA

A

fruits

77
Q

if you perform liver resxn for carcinoid met what else should you do

A

cholecystectomy in case of future embolization

78
Q

highest sensitivity for detecting carcinoid tumor

A

chromogranin A level

79
Q

hallmark sx of carcinoid syndrome

A

intermittent flushing (kallikrein) and diarrhea (serotonin)

80
Q

serotonin produced by

A

Kulchitsky cells (Enterochromaffin cell or argentaffin cell)

81
Q

Endoscopic classification after esophageal injury with ulcers

A

2A or B (siperficial vs deep)

82
Q

Endoscopic classification after esophageal injury with necrosis

A

3A-B

A (focal) B (extensive)

83
Q

next step after noting grade 3 esophageal injury

A

CT to identify injuries that are nt transmural (camndidates for esophageal preservation)

84
Q

characteristics of high risk malignant polyp

A 
poor differentiation
lymphovascular invasion
submucosal invasion >1 mm
margin <1 mm
resection in pieces making margin assessment ddifficult
85
Q

polyps in stomach that are dome shaped 0.5-1.5 cm

A

hyperplastic

86
Q

polyps in stomach that are sessile and occur exclusively in the gastric fundus (0.1-0.8 cm)

A

fundic

87
Q

presence of fundic gland polyps a/w

A

PPI use
hypergastrinemia
FAP

88
Q

adenomatous polyps in stomach

A

may be sessile or polypoid in shape
usually <2 cm and solitary
can occur spont or as part of familial syndromes such as FAP

89
Q

Tx for esophageal dysmotility in scleroderma

A

PPI + Reglan

90
Q

Long term CA risk after caustic ingestion

A

Increased risk of SCC

91
Q

Inner layer of esophagus is what direction and an extension of what

A

circular inner layer
extension of cricopharynxgeus

92
Q

cervical esophagus blood suppl

A

thyrocervical trunk off subclavian artery (inferior thyroid artery)

93
Q

branches of thyrocervical trunk

A

STAT
Suprascapular artery
Transverse cervical artery
Ascending cervical artery
Inferior thyroid artery

94
Q

Thoracic esophagus arterial supply

A

branches directly off aorta and branches of bronchial aa

95
Q

ASPECT trial demonstrated that

A

high dose PPI and ASA chemo prevention therapy especially in combo reduces rate of cancer progression in pts with Barretss

96
Q

Abnormal resting pressure of LES

A

<6 mmHg

97
Q

Abnormal LES overall length

A

<2 cm

98
Q

abdominal esophagus blood supply

A

branches of left gastric nd left inferior phrenic, Belseys, sometimes splenic

99
Q

classic manometry findings for nutcracker esophagus

A

amplitude pressure >200 mm with long duration (>6 sec) contraction waves

100
Q

Sx of vagal nerve injury after nissen

A

gastroparesis, delayed gastric emptying, recurrent reflux, diarrhea

101
Q

Killian’s triangle

A

inferior to thyropharyngeus/inferior pharyngeal constrictor and superior to cricopharynxgeus

102
Q

inadequate fundus due to previous gastric surgery

A

Hill esophagogastropexy
Plication of lesser gastric curve around R side of esophagus with an esophagogastropexy to the median arcuate ligament

103
Q

Modified LA Classifcication of Esophagitis: 1+ mucosal break <5 mm in length that does not extend between tops of 2 mucosal folds

A

Class A

104
Q

Modified LA Classification of Esophagitis: 1+ mucosal break >5 mm that does not extend between the tops of 2 mucosal folds

A

Class B

105
Q

Modified LA Classification of Esophagitis: 1+ mucosal break that is continuous between tops of 2+ mucosal folds but involves <75% of circumference

A

Class C

106
Q

Modified LA classification of Esophagitis: 1+ mucosal break that involves at least 75% of circumference

A

Class D

107
Q

Manometry findings in scleroderma

A

absent peristaltic contractions with normal or decreased LES

108
Q

T stage of esophageal adenocarcinoma which invades the muscular propria

A

T2

109
Q

Surgical mgmt for refractory DES

A

Laparoscopic Heller-for OR a long esophagomyotomy

ABS (23 decks)

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