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Clin Med II - Exam 3 > Beloy - GI Surgery > Flashcards

Beloy - GI Surgery Flashcards

1
Q

where do we make gas

A

upper ⅓ of abdomen

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2
Q

white stool =

A

pancreatitis

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3
Q

what does irregular bleeding/easy bruising make you think

A

liver d.o

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4
Q

general GI pre op work up includes

A

EKG

CXR

UA

pregnancy test

CBC, CMP, INR/PTT

radiology

bowel prep

surgical consent

type screen vs cross match

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5
Q

why isn’t BMP helpful in GI surgical pre op work up

A

no liver

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6
Q

when is crossmatching used for GI pre op surgery

A

when lots of blood loss is expected

more thoroughly tested and “reserving” blood for pt

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7
Q

ulcer is considered non-healing after

A

more than 12 weeks of medical therapy

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8
Q

__ have significantly reduced surgical intervention for gastric and duodenal ulcers

A

antacids

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9
Q

zollinger-ellison syndrome is caused by

A

hypersecretion of gastrin

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10
Q

nausea w.o heartburn can be a symptom of

A

ulcers

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11
Q

2 types of gastric cancers

A

adenocarcinoma

GIST (gastrointestinal stromal tumors)

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12
Q

90% of gastric tumors are

A

gastric adenocarcinoma

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13
Q

rf for gastric adenocarcinoma

A

h. pylori

smoking

pernicious anemia

genetic

obesity

prior gastrectomy

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14
Q

4 common stomach procedures

A

ex lap w. gram patch

antrectomy

rou-en Y gastric bypass vs lap adjustable binding vs gastric sleeve

gastrectomy

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15
Q

gastrin stimulates __ production

and is found in the __

A

gastric acid

antrum

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16
Q

types of gastric bypass

A

restrictive

malabsorptive

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17
Q

restrictive bypass makes the stomach

A

smaller

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18
Q

malabsorptive bypass removes the ability of the stomach to

A

absorb food

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19
Q

roux-en Y gastric bypass also elliminates the __ of the stomach,

where some __ are produced

A

fundus

hormones for hunger

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20
Q

in lap surgery, we insufflate the abdomen w. __

because __

A

CO2

less easily absorbed → won’t cross into blood

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21
Q

watch for __ on insufflation bc you are reducing blood flow to the heart

A

hypotn

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22
Q

what is this showing

A

lap band surgery

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23
Q

what is this showing

A

gastric sleeve

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24
Q

what is this showing

A

gastric bypass

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25
Q

gastric bypass surgery is indicated for (2)

A

BMI > 40

BMI >35 w. weight related health problem

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26
Q

post gastric bypass concerns

A

dumping syndrome:

post prandial tachycardia

sweating

abd pain

diffuse diarrhea

dumping syndrome

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27
Q

besides dumping syndrome, what is another complication of gastric bypass

A

gastroparesis

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28
Q

tx for gastroparesis

A

NPO

IV fluids

+/- TPN

pro motility agents

NG vs dobhoff

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29
Q

what are 2 promotility agents

A

reglan

erythromycin

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30
Q

PEG (percutaneous endoscopic gastrostomy) tube is inserted

A

into the stomach wall

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31
Q

there are __ sections of the liver,

and each has its own __

A

8

blood supply

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32
Q

what does a liver work up involve

A

exam

hepatic US/CT scan

bilirubin

CMP, coags, NH3

CBC (heme-8)

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33
Q

child-pugh classification is used to

A

assess/predict mortality during surgery/prognosis

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34
Q

hepatic US shows __

while a CT is a __ image

A

flow

static

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35
Q

what is a 3D CT used to assess

A

vascular inflow/outflow of biliary drainage

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36
Q

when do we start to care about elevated bilirubin

A

when it’s more than twice the normal value

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37
Q

4 types of liver tumors

A

metastatic/primary

hepatic adenoma

hepatocellular carcinoma

intrahepatic cholangiocarcinoma

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38
Q

what is a hepatic hemangioma

A

benign vascular malformation → not cancer

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39
Q

tx for hepatic hemantiomata

A

watch and wait

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40
Q

major rf for hepatic hemangioma

A

woman taking OCP

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41
Q

mc primary liver ca

A

HCC

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42
Q

portal vein embolization is commonly done __

in order to

A

several weeks prior to liver resection

redirect flow

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43
Q

MELD score assesses

A

severity of liver and kidney dz

prioritizes pt’s for transplantation

44
Q

jackson-pratt drain is commonly used

A

post liver resection

45
Q

if stones are visualized on US, you need to order

A

ERCP

46
Q

ERCP is more invasive than MRCP, but can be used as

A

dx and tx for stones

47
Q

what happens if you cut the common bile duct during cholecystectomy

A

patient will die

48
Q

in a cholecystectomy, you cut the

A

cystic duct

49
Q

what is a complication of ERCP

A

pancreatitis

50
Q

ascending cholangitis is mc caused by

A

gram negative bacilli

e.coli

klebsiella

enterobacter

51
Q

what is charcot triad and what does it make you think

A

jaundice, abd pain, fever

cholangitis

52
Q

percutaneous transhepatic colangiography is used to

A

drain the gallbladder in unstable pt until they are stable enough for surgery

53
Q

in US, 80% of gallstones contain

A

cholesterol

54
Q

porcelain gallbladder is __

and is considered __ until proven otherwise

A

calcification of the gallbladder

cancer

55
Q

if you see a pt w. n/v, abd pain, and pale/white stools, what tests do you order

A

lipase

amylase

US or CT

pancreatitis

56
Q

when would you order MRCP over ERCP

A

ERCP not available

ex middle of the night, no doc available

57
Q

what is protocol for pancreas CT

A

drink water so you can differentiate stomach from pancreas

58
Q

dx test for pancreatitis

A

ERCP

CT

59
Q

pt’s w. intraductal mucinous neoplasms need

A

bx and US q 6 months for monitoring of pancreatic adenocarcinoma

60
Q

pancreatic pseudocysts are a collection of

A

amylase and lipase

61
Q

pancreaticoduodenectomy is also called

A

Whipple

62
Q

whipple can increase 5 year survival rate of pancreatic adenocarcinoma by

A

20%

63
Q

post op care for whipple/pancretectomy

A

several JP drains

NG tube

64
Q

post op complications of whipple/pancretectomy

A

DM

ileus/constipation

gastroparesis

65
Q

spleen work up includes

A

CMP

CBC

complete immunization hx

PE

CT vs US

+/- FAST if ER setting

66
Q

3 conditions that increase size of spleen

A

ITP

hereditary spherocytosis

blood cancers

67
Q

100% of pt’s w. splenic artery aneurysm vs splenic infarction get

A

splenectomy

68
Q

what do you think when you see splenic cyst/abscess

A

IVDU

69
Q

is spleen fxn preserved after splenic artery embolization

A

yes!

70
Q

what must pt be given before d.c after splenectomy

A

immunizations must be UTD

71
Q

after splenectomy, you are concerned about what organisms

A

encapsulated →

pneumococcal

H.flu

meningococcal

72
Q

what tx might be given to pt w. reactive thrombocytosis and leukocytosis post splenectomy

A

ASA

73
Q

SI work up

A

CMP

CBC

KUB vs abdo erect and lateral decubitus views

PE

CT vs US

+/- FAST if in ED

74
Q

mc cause of lower GI bleeding in peds

A

meckel’s diverticula

75
Q

small bowel perforations usually involve

A

resection → bc they are hard to repair

76
Q

non op tx for intusussception

A

air enema

NG tube

hydration

77
Q

major post op complication of small bowel resection

A

adhesions!

78
Q

constipation tx from least to most effective

A

senna

colace

miralax

go-lightly suppository

enema

de-impaction

79
Q

you know a pt does not have ileus if they are

A

passing gas

80
Q

imaging to dx ileus

A

KUB

OR

abd, supine, and erect imaging

81
Q

what is this showing

A

rim enhancement → infxn

82
Q

mc surgical emergency of the abdomen

A

appendicitis

83
Q

what do you think when you see, cramping, periumbilical pain that migrates to teh RLQ; +/- fever

A

appendicitis

84
Q

what will CT show for appendicitis

A

thick wall > 2 mm

increased size > 7 mm

plegmon or abscess

free fluid

85
Q

what % of appendicitis pt’s need appendectomy

A

30%

→ abx becoming more favorable

86
Q

when is surgery indicated for appendectomy

A

if appendicolith is noted on CT

87
Q

what is an appendicolith

A

poop stone

88
Q

work up for large intestine

A

CMP

CBC

KUB or abd, erect, lateral decubitus views

PE → including DRE

CT vs US

FAST if in ED

89
Q

mc sx of colon ca (3)

A

BRBPR → bright red blood per rectum

anemia

change in stool character

90
Q

ogilvie’s syndrome is also called

A

colonic pseudo-obstruction

91
Q

cecum > __ is diagnostic for ogilvie’s syndrome

A

10 cm

92
Q

ogilvie’s syndrome is caused by

A

dysregulation w.in ANS

93
Q

tx for ogilvie’s syndrome (3)

A

decompression - NGT or colonoscopy

neostigmine

surgical resection

94
Q

engorgement of normal fibrovascular cushions

A

hemorrhoids

95
Q

what should be first line of tx for hemorrhoids

A

always try OTC meds first!

96
Q

4 OTC meds for hemorrhoids

A

witch hazel

phenylephrine supp

hydrocortisone cream

sitz baths

97
Q

henorrhoidectomy is always indicated for

A

incarcerated or gangrenous hemorrhoids

98
Q

sx of external hemorrhoids

A

painful

bright red blood

99
Q

epigastric abd hernia is located

A

above umbilicus → upper abd at midline

100
Q

direct inguinal abd hernia is located

A

near opening of inguinal canal

101
Q

indirect inguinal hernia is located

A

at opening of inguinal canal

i for indirect

102
Q

what is a FAST exam

A

Focused Assessment with Sonoraphy in Trauma

emergent US to look at:

pericardial

perihepatic

perisplenic

pelvic

+/- pleural

103
Q

if all else fails, __ is used in GI traumas

A

abdominal packing

104
Q

GI eval includes

A

complete H&P

105
Q

abd surgery can have many complications, so when in doubt __

A

make pt NPO

106
Q

in GI eval, have low threshold to order

A

imaging if indicated

Clin Med II - Exam 3 (14 decks)

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