Chapter 4 - General Surgery (Part 3) Flashcards
Presentation, work-up, Rx of primary hyperaldosteronism?
Hypokalemia in a hypertensive (usually female) patient not on diuretics
Modest hypernatremia
Metabolic alkalosis
High aldosterone
Low renin
Appropriate response to postural changes (more aldosterone when upright than when lying down) suggests hyperplasia (treated medically) vs. lack of response (inappropriate) is diagnostic of adenoma
Localize with adrenal CT scan, remove surgically to cure
Presentation of pheochromocytoma?
Thin, hyperactive women who have attacks of pounding headache, perspiration, palpitations, pallor associated with extremely high blood pressure
Dx and Rx pheochromocytoma?
24-hour urinary determination of VMA (may give false positives), metanephrines (more specific), or urinary free urinary catecholamines
CT scan of adrenals or radionuclide studies if looking for extra-adrenal sites; tumors are usually large
Rx with surgery with careful pre-Rx with alpha-blockers
Presentation of coarctation of the aorta?
May be recognized at any age, but patients are typically young, have HTN in the arms with normal pressure (or low pressure, or no clinical pulses) in the lower extremities
Dx and Rx coarctation of the aorta?
CXR - scalloping of the ribs (erosion from large collateral intercostals)
Spiral CT scan enhanced with IV dye (CT angio) usually diagnostic
Surgical correction is curative
Presentation of renovascular hypertension?
Young women with fibromuscular dysplasia or old men with arteriosclerotic occlusive disease
HTN resistant to usual medications
Faint bruit over flank or upper abdomen suggests diagnosis
Work-up and Rx of renovascular hypertension?
Multifactorial, but Duplex scanning of the renal vessels and CT angio have prominent roles
Therapy is imperative in the young women, usually balloon dilatation and stenting, more controversial in older men with short life expectancy from other manifestations of arteriosclerosis
“-tomy”
To cut
“-ectomy”
Take out or resect
“-ostomy”
To make an opening
-If the name of a single organ precedes the suffix, the opening is to the outside
If the names of two organs precede the suffix, the opening is between them (anastomosis)
“-plasty”
To change the shape of
“-pexy”
To fit in place
“-rrhaphy”
Suture or sew together
“-scopic”
Minimally invasive with camera
