Chapter 4: General Surgery

Question 1

What is a typical case of gastroesophageal reflux look like?

Answer 1

An overweight individual complains of burning retrosternal pain and “heartburn” that is brought on by bending over, wearing tight clothing, or lying flat in bed at night.

Question 2

When vague symptoms present with GERD how do you diagnose it?

Answer 2

pH monitoring

Question 3

What is GERD relieved by?

Answer 3

Ingestion of antacids or over the counter H2 blockers

Question 4

What is the concern if there is longstanding GERD?

Answer 4

The damage that might have been done to the lower esophagus (peptic esophagitis) and the possible development of Barrett’s esophagus.

Question 5

If GERD a is long standing what tests should be done?

Answer 5

Endoscopy and biopsies are the indicated tests

Question 6

When is surgery for GERD appropriate?

Answer 6

• In longstanding symptomatic disease that cannot be controlled by medical means (Nissen fundoplication)
• it is necessary in anyone who developed complications (ulceration, stenosis) ( Nissen fundoplication)
• it’s imperative if there are sever days plastic changes (radioablation and Nissen fundoplication)

Question 7

How can you tell you have esophageal motility problems?

Answer 7

1. Crushing pain with swallowing in uncoordinated massive contraction.
2. Where solids are swallowed with less difficulty than liquids

Question 8

What tests are done when esophageal motility problems are thought? Which one is diagnostic?

Answer 8

1. Barium swallow

2. Manometry studies (diagnostic)

Question 9

Achalasia presents in what manner?

Answer 9

1. Women
2. Dysphasia that is worse for liquids
3. Sitting up straight makes it feel better
4. regurgitation of undigested foods

Question 10

What does an X-ray show in achalasia?

Answer 10

Megaesophagus

Question 11

What is the diagnostic test for achalasia?

Answer 11

Manometry

Question 12

What is the treatment for achalasia?

Answer 12

Balloon dilation by endoscopy.

Question 13

What is the classic progression of symptoms for someone with cancer of the esophagus?

Answer 13

1. Dysphasia with meat
2. Then other solids
3. Then soft foods
4. Eventually liquids
5. Saliva

Significant weight loss is always seen

Question 14

Who normally gets squamous cell carcinoma of the esophagus?

Answer 14

Men with a history of smoking and drinking. Blacks have a high incidence.

Question 15

When is adenocarcinoma of the esophagus seen?

Answer 15

Longstanding GERD.

Question 16

How is cancer of the esophagus diagnosed?

Answer 16

Endoscopy and biopsies BUT barium swallow must precede the endoscopy to prevent inadvertent perforation.

Question 17

What assesses operability in someone with cancer of the esophagus?

Answer 17

CT scan, most cases only get palliative care rather than curative surgery.

Question 18

When do Mallory-Weiss tears occur?

Answer 18

After prolonged forceful vomiting leading to esophageal perforation. Bright red blood comes up.

Question 19

How is a Mallory Weiss tear diagnosed?

Answer 19

Endoscopy and it allows photocoagulation (laser)

Question 20

How does boerhaave syndrome occur?

Answer 20

Starts with prolonged, forceful vomiting leading to esophageal perforation.

Question 21

How does boerhaave syndrome present?

Answer 21

Continuous, severe, wrenching epigastric and low sternal pain of sudden onset, soon followed by fever, leukocytosis, and a very sick looking patient.

Question 22

What is the diagnostic test for boerhaave syndrome?

Answer 22

Contrast swallow

(Gastrografin first if barium is negative) and emergency surgery repair should follow.

Question 23

What is the most common cause of esophageal perforation?

Answer 23

Instrumental perforation of the esophagus.

Question 24

How does instrumental perforation of the esophagus present?

Answer 24

All symptoms of perforation after endoscopy and then there may be emphysema in the lower neck (virtually diagnostic in this setting)

Question 25

How does gastric adenocarcinoma present?

Answer 25

1. Elderly
2. Anorexia
3. Weight loss
4. Vague epigastric distress
5. Early satiety
6. Occasionally hematemesis

Question 26

What is diagnostic for gastric adenocarcinoma?

Answer 26

Endoscopy and biopsies

CT helps assess operability

Question 27

What is the best therapy for gastric adenocarcinoma?

Answer 27

Surgery

Question 28

Gastric lymphoma vs gastric adenocarcinoma.

Answer 28

• almost as common as gastric adenocarcinoma.
• Presentation and diagnosis are similar
• but treatment is based on chemotherapy or radiation not surgery.

Question 29

When is surgery done in a gastric lymphoma?

Answer 29

If perforation is feared as the tumor melts away.

Question 30

How can a MALTOMA be reversed?

Answer 30

By eradicating H. pylori.

Question 31

Typically when do mechanical intestinal obstructions occur?

Answer 31

Caused by adhesions in those who have had prior laparotomy.

Question 32

How does a mechanical intestinal obstruction present?

Answer 32

1. Colicky abdominal pain
2. Protracting vomiting
3. Progressive abdominal distinction (if it’s a low obstruction)
4. No passage of gas or feces

Question 33

How does a mechanical intestinal obstruction sound early on?

Answer 33

High-pitched bowel sounds coincide with the colicky pain (after a few days there’s silence)

Question 34

What does an X-ray show when there is mechanical intestinal obstruction?

Answer 34

Shows distended loops of small bowel, with air-fluid levels.

Question 35

How does treatment of a mechanical intestinal obstruction begin?

Answer 35

1. NPO
2. NG suction
3. IV fluids
4. Hoping for spontaneous resolution
5. Watching for early signs of strangulation

Question 36

When does surgery become an option for someone with an intestinal obstruction?

Answer 36

If conservative management is unsuccessful, within 24 hours in cases of complete obstruction or within a few days in cases of partial obstruction.