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Written Boards - Final > Alimentary > Flashcards

Alimentary Flashcards

1
Q

FAP screening recs

gene

A

APC

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2
Q

Lynch screening

A
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3
Q

MC area for FBs to impact

A

Esoph

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4
Q

What is the most common type of CBD injury

A

complete transection

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5
Q

When should stricturoplasty be performed for crohns

A

When concerned for short gut

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6
Q

Small bowel tumor with liver mets think…..

watch out for this during resection

Tx for 2nd line?

A

carcinoid

serotonin syndrome

octrotide

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7
Q
A
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8
Q

2 PE findings for obturator hernia

A

medial thigh paraesthesias and romberg—knees tucked

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9
Q

Ideal Wetzel location on small bowel

A

40 cm distal to LOT

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10
Q

Expected weight loss of excess weight at 2 years follow up?

What is excess weight calculated as

A

excess weight is current weight - IBW

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11
Q

First important SMA branch

Next?

A

pancreaticoduodenal

middle colic

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12
Q

3 possible origins of the right colic artery

A

SMA MCA, nothing

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13
Q

superior rectal artery collateralizes with …

A

hypogastric arteries

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14
Q

what is the collateral flow of the colon?

artery of Moskowitz?

A

Marginal artery

Arc of riolan

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15
Q

distal sma thrombus will show what effect pattern

A

jejunal sparing

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16
Q

3 types of mesenteric ischemia

A

arterial, venous and nomi

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17
Q

non emergent pneumatosis intestinalis

when is PI concerning

A

Nonemergent etiologies include asthma, chronic obstructive pulmonary disease, inflammatory bowel disease, peptic ulcer disease, bacterial and viral infections, immunosuppressive medications, collagen vascular disease, and iatrogenic causes

acute abdomen

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18
Q

3 findings in all mesenteric ischemia types

A

pain out of proportion, acute abdominal pain, metabolic acidosis

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19
Q

3 s/s of chronic mesenteric ischemia

A

food fear, postprandial pain, weight loss

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20
Q

Given critical CV patient, look for these 4 signs when considering NOMI

A

Diagnostic symptoms: high suspicion if three of four are present

Ileus or abdominal pain
Catecholamine requirement
Episode of hypotension
Gradual rise in serum transaminase level

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21
Q

usual suspect for NOMI

A

Sick CV patient

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22
Q

First thing to do if patient presents with Mesenteric ischemia concerns

A

hep ggt

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23
Q

4 pos prognosticators for spontaneous fistula closure

A

free distal flow, 2cm tract length, <1cm bowel involv, healthy surrounding bowel

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24
Q

at what duration does surgical intervention need to be discussed for fistula

A

8 weeks, but generally optimize until 6 months

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25
Q

MC overall cause of ECF

A

iatrogenic

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26
Q

3 imaging studies for ECF

A

fistulogram
CT PO
CT rectal(distal obstruction or hollwo viscus rectal connection suspected)

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27
Q

3 output grades for ECF

A

<200, 200-500, >500

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28
Q

agents to begin to decrease fistula out put

what helps in crohns

A

h2 or ppi; octreotide

infliximab

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29
Q

What metric do we look at for ECF considering PO vs TPN

A

fistula daily output, needs to be under 500cc/d

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30
Q

What are the basic principles of fistula management in the subacute setting

A

wound care(pouches?), PO v tpn, electrolyte/fluid resus

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31
Q

what artery supplies meckels

2 meckels tissue types

A

vitelline

gastric and panc

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32
Q

meckels scan?

A

technitium 99 binds to gastric mucosa

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33
Q

3 meckels concerning features, how does this guide us

A

fibrous bands, >2cm, palpable abnormalitiy

resect or not

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34
Q

segmental meckels removal in bleeding cases if these characteristics are present

A

2cm neck, narrow lumen, palp abnorm, unhealthy appearing tissues

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35
Q

when to consider removal of incidental meckels

why

A

age younger than 50 years, male sex, diverticulum length >2 cm, and ectopic tissue or palpable abnormalities.

Ca risk vs resection complication risk

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36
Q

what can be used for diarrhea with radiation enteriitis

A

Cholestyramine is commonly used to bind bile acid that is not absorbed in the ileum due to radiation damage of the small bowel, making the bile acid insoluble and osmotically inactive.

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37
Q

MC benign sb tumor

MC location

A

adenomas, Brunner gland, villous adenomas

ileum

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38
Q

carcinoid tumor now known as….

cell type

location in GI tract in descending order of prevalence

A

net

enterochromafin like

appendix>small int> colon> stomach> rectum

39
Q

Mc site of SB adenoca

A

duo and prox j

40
Q

where is malignant SB lymphoma found and why?

A

ileum, all the peyers patchers

41
Q

2 worrisome sb adenomas and their backgrounds

A

villous - 50% mal risk

familial in duo – FAP

42
Q

hamartomas in SB are associated with …

A

PJS — melanin defects

43
Q

adenoca of SB accounts for __% of mal sb tumors

assoc with …

MC site

A

50

crohns in young age

ileum

44
Q

SB lymphoma make up __% of sb malig

risk factors

MC intestinal neoplasm in this population

A

25

celiac and aids

younger than 10

45
Q

2 mc presentations of small bowel adenomas

A

obstruction and bleeding

46
Q

ct findings indicative of SB NET

A

A diagnosis of a NET of the small intestine can be confidently made based on the classic appearance of a solid mass with spiculated borders that is associated with linear strands within the mesenteric fat and kinking of the bowel on abdominal CT scan.

47
Q

what imaging modality can help with identifying SB NETs

Tx for lymphoma?

A

dotatate

resection if symptomatic!! then systemic

48
Q

SB adenoca mets to liver, tx?

A

Folfox

49
Q

SB NET with carcinoid syndrome tx?

A

octreotide

50
Q

how can duodenal adenomas be conservatively managed depending on location and anatomy

A

endoscopy

51
Q

3 genes for colon cancer

What are the MMR genes?

A

KRAS
APC
TP53

MLH1, MSH2/6, PMS2

52
Q

CPG island mutations for colon ca due to …..

A

loss of BRAF and MLH1

53
Q

age of screening for colon ca

A

45

54
Q

is a high MMR or low MMR assoc with poor colon ca prog

A

low

55
Q

6 genetic syndromes for colon ca

A

FAP, HNPCC, JPS, PJS, li fraumeni, cowden

56
Q

who is high risk for colon cancer

when to screen

A

1st degree fam hx of adv adenoma or colon ca

40 or 10 y prior to dg

57
Q

screening time and finding:

5-10
5
3 then 5
8 y after onset

A

2ad 1cm
2 serr 1cm
3-10ad >1cm HGD
IBD

58
Q

T staging for adenoca of colon

A
59
Q

Stage 2 colon cancer T N M

who gets adjuvant?

A

T2-4 n0

High risk:
LVI
poorly diff
T4
<12LN
onstruction
Pos margins

60
Q

S3 colon ca adjuvant reg and duration

A

6 months FOLFOX or CAPOX

61
Q

5y survival for all colonc ca stages

A

90
75
50
5

62
Q

surveillance schedule for all stages of colon ca

A

1 - 1y colonoscopy
2/3/4 - hnp and cea 6m x2 year, then 6m x 5

CT CAP 12m x 5
Colon 1 3 5

63
Q

HNPCC inh pattern
gene type
7 cancers

A

AD
MMR
colon, endom, ovary, stomach, biliary, sb, urothelial

64
Q

Op choice for HNPCC

A

segment or total — no diff in survivial

65
Q

who needs lynch screening

A

3 relatives, 2 gens, 1 crc prior to 50

66
Q

2 weird HNPCC skin things

A

sebacious adenoma and keratocanthomas

67
Q

all screening for FAP

A
68
Q

3 weird specific FAP pathologies non cancer

A

desmoids, jaw osteoma, epidermal cysts

69
Q

who has hamartomatous disease, colon cancer syndromes

A

PJS, JPS

70
Q

Op choice for FAP

A

total with end v pouch

dont leave rectum

71
Q

risk of colon ca with FAP by 45yo

A

90%

72
Q

2 dietary risk factors for diverticulosis

A

red meat and low fiber

73
Q

what type of diverticula is a colonic diverticula

mech?

A

false, weak point where arteriole inserts into muscle

74
Q

6 at risk populations for diverticular disease

A

obese, poor activity, nsaids, opiates, steroids, smoking

75
Q

ideal number of attacks before colectomy for diverticulitis

A

4

76
Q

Percent of patients with recurrent diverticular disease after first attack

A

20-40

77
Q

Layers involved in acute ischemic colitis

A

mucosa and sm

78
Q

dg test of choice for ischemic colitis

A

colonoscopy unprepped

79
Q

one big long term sequelae of ischemic colitis

A

strictures

80
Q

describe avms and their role in LGIB

A

With age, low-grade obstruction of submucosal veins from chronic colonic contraction can lead to arteriovenous communication and dilation in the form of angiodysplasias.
As the veins become tortuous and precapillary valves become incompetent, the resulting arteriovenous malformations (AVMs) may cause slow blood loss that frequently presents as melena or subacute anemia. AVMs represent 5% to 10% of lower GI bleeds.

81
Q

The most common causes of lower GI bleeding

A

The most common causes of lower GI bleeding are diverticulosis (30%-65%), ischemic colitis (5%-20%), hemorrhoids (5%-20%), polyp/neoplasm (2%-15%), and angioectasias (5%-10%).

82
Q

LGIB accounts for __% of all GIB

A

20

83
Q

first step in evaluating for UGIB

Neg pred value?

A

NGT

only 645%

84
Q

Initial dg test for LGIB

A

prepped colonoscopy within 24h and for reccurrence

85
Q

Thoracic duct anatomy

A
86
Q

where does the thoracic duct originate

A

L2 at cirstena chyli

87
Q

pathophys of chylothorax

A

Chylothorax can cause significant systemic protein loss, which lowers oncotic pressure and can result in high-volume pleural effusions.

88
Q

MCC of non trauma chylo

A

malig

89
Q

TG level to dg chylo

what if it is indeterminate? what is the indet value?

A

110

50-110, chylomicron by lipoprotein elctrophereses

90
Q

duration of cons mng for chylo?

poor surgical candidate next step

A

5-7d

embol

91
Q

what cause for chylo has highest fail rate for intervention?

what extra step is taken?

A

malign

pleurodesis

92
Q

what dietary change is made for chylo leak

A

medium chain

avoid long chain

93
Q
A

Written Boards - Final (21 decks)

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