Beloy - GI Surgery Flashcards by Alice Richards

where do we make gas

upper ⅓ of abdomen

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white stool =

pancreatitis

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what does irregular bleeding/easy bruising make you think

liver d.o

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general GI pre op work up includes

EKG

CXR

pregnancy test

CBC, CMP, INR/PTT

radiology

bowel prep

surgical consent

type screen vs cross match

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

no liver

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when is crossmatching used for GI pre op surgery

when lots of blood loss is expected

more thoroughly tested and “reserving” blood for pt

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ulcer is considered non-healing after

more than 12 weeks of medical therapy

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__ have significantly reduced surgical intervention for gastric and duodenal ulcers

antacids

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zollinger-ellison syndrome is caused by

hypersecretion of gastrin

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nausea w.o heartburn can be a symptom of

ulcers

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2 types of gastric cancers

adenocarcinoma

GIST (gastrointestinal stromal tumors)

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90% of gastric tumors are

gastric adenocarcinoma

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rf for gastric adenocarcinoma

h. pylori

smoking

pernicious anemia

genetic

obesity

prior gastrectomy

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4 common stomach procedures

ex lap w. gram patch

antrectomy

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

gastrectomy

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gastrin stimulates __ production

and is found in the __

gastric acid

antrum

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types of gastric bypass

restrictive

malabsorptive

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restrictive bypass makes the stomach

smaller

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malabsorptive bypass removes the ability of the stomach to

absorb food

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

where some __ are produced

fundus

hormones for hunger

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in lap surgery, we insufflate the abdomen w. __

because __

CO2

less easily absorbed → won’t cross into blood

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

hypotn

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what is this showing

lap band surgery

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what is this showing

gastric sleeve

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what is this showing

gastric bypass

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gastric bypass surgery is indicated for (2)

BMI \> 40 BMI \>35 w. weight related health problem

post gastric bypass concerns

**dumping syndrome:** post prandial tachycardia sweating abd pain diffuse diarrhea dumping syndrome

besides dumping syndrome, what is another complication of gastric bypass

gastroparesis

tx for gastroparesis

NPO IV fluids +/- TPN pro motility agents NG vs dobhoff

what are 2 promotility agents

reglan erythromycin

PEG (percutaneous endoscopic gastrostomy) tube is inserted

into the stomach wall

there are __ sections of the liver, and each has its own \_\_

8 blood supply

what does a liver work up involve

exam hepatic US/CT scan bilirubin CMP, coags, NH3 CBC (heme-8)

child-pugh classification is used to

assess/predict mortality during surgery/prognosis

hepatic US shows \_\_ while a CT is a __ image

flow static

what is a 3D CT used to assess

vascular inflow/outflow of biliary drainage

when do we start to care about elevated bilirubin

when it's more than twice the normal value

4 types of liver tumors

metastatic/primary hepatic adenoma hepatocellular carcinoma intrahepatic cholangiocarcinoma

what is a hepatic hemangioma

benign vascular malformation → ***not cancer***

tx for hepatic hemantiomata

watch and wait

major rf for hepatic hemangioma

woman taking OCP

mc primary liver ca

HCC

portal vein embolization is commonly done \_\_ in order to

several weeks prior to liver resection redirect flow

MELD score assesses

severity of liver and kidney dz prioritizes pt's for transplantation

jackson-pratt drain is commonly used

post liver resection

if stones are visualized on US, you need to order

ERCP

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

dx and tx for stones

what happens if you cut the common bile duct during cholecystectomy

patient will die

in a cholecystectomy, you cut the

cystic duct

what is a complication of ERCP

pancreatitis

ascending cholangitis is mc caused by

**gram negative bacilli** e.coli klebsiella enterobacter

what is charcot triad and what does it make you think

jaundice, abd pain, fever cholangitis

percutaneous transhepatic colangiography is used to

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

in US, 80% of gallstones contain

cholesterol

porcelain gallbladder is \_\_ and is considered __ until proven otherwise

calcification of the gallbladder cancer

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

lipase amylase US or CT ***pancreatitis***

when would you order MRCP over ERCP

ERCP not available ex middle of the night, no doc available

what is protocol for pancreas CT

drink water so you can differentiate stomach from pancreas

dx test for pancreatitis

ERCP CT

pt's w. intraductal mucinous neoplasms need

bx and US q 6 months for monitoring of pancreatic adenocarcinoma

pancreatic pseudocysts are a collection of

amylase and lipase

pancreaticoduodenectomy is also called

Whipple

whipple can increase 5 year survival rate of pancreatic adenocarcinoma by

20%

post op care for whipple/pancretectomy

several JP drains NG tube

post op complications of whipple/pancretectomy

DM ileus/constipation gastroparesis

spleen work up includes

CMP CBC complete immunization hx PE CT vs US +/- FAST if ER setting

3 conditions that increase size of spleen

ITP hereditary spherocytosis blood cancers

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

splenectomy

what do you think when you see splenic cyst/abscess

IVDU

is spleen fxn preserved after splenic artery embolization

yes!

what must pt be given before d.c after splenectomy

immunizations must be UTD

after splenectomy, you are concerned about what organisms

encapsulated → pneumococcal H.flu meningococcal

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

ASA

SI work up

CMP CBC KUB vs abdo erect and lateral decubitus views PE CT vs US +/- FAST if in ED

mc cause of lower GI bleeding in peds

meckel's diverticula

small bowel perforations usually involve

resection → *bc they are hard to repair*

non op tx for intusussception

air enema NG tube hydration

major post op complication of small bowel resection

adhesions!

constipation tx from least to most effective

senna colace miralax go-lightly suppository enema de-impaction

you know a pt does not have ileus if they are

passing gas

imaging to dx ileus

KUB OR abd, supine, and erect imaging

what is this showing

rim enhancement → infxn

mc surgical emergency of the abdomen

appendicitis

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

appendicitis

what will CT show for appendicitis

thick wall \> 2 mm increased size \> 7 mm plegmon or abscess free fluid

what % of appendicitis pt's need appendectomy

30% → *abx becoming more favorable*

when is surgery indicated for appendectomy

if appendicolith is noted on CT

what is an appendicolith

poop stone

work up for large intestine

CMP CBC KUB or abd, erect, lateral decubitus views PE → **including DRE** CT vs US FAST if in ED

mc sx of colon ca (3)

BRBPR → bright red blood per rectum anemia change in stool character

ogilvie's syndrome is also called

colonic pseudo-obstruction

cecum \> __ is diagnostic for ogilvie's syndrome

10 cm

ogilvie's syndrome is caused by

dysregulation w.in ANS

tx for ogilvie's syndrome (3)

decompression - NGT or colonoscopy neostigmine surgical resection

engorgement of normal fibrovascular cushions

hemorrhoids

what should be first line of tx for hemorrhoids

always try OTC meds first!

4 OTC meds for hemorrhoids

witch hazel phenylephrine supp hydrocortisone cream sitz baths

henorrhoidectomy is always indicated for

incarcerated or gangrenous hemorrhoids

sx of external hemorrhoids

painful bright red blood

epigastric abd hernia is located

above umbilicus → upper abd at midline

direct inguinal abd hernia is located

near opening of inguinal canal

indirect inguinal hernia is located

at opening of inguinal canal ## Footnote ***i for indirect***

what is a FAST exam

**Focused Assessment with Sonoraphy in Trauma** emergent US to look at: pericardial perihepatic perisplenic pelvic +/- pleural

if all else fails, __ is used in GI traumas

abdominal packing

GI eval includes

complete H&P

abd surgery can have many complications, so when in doubt \_\_

make pt NPO

in GI eval, have low threshold to order

imaging if indicated