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Year 3 > COMBANK Surg COMAT > Flashcards

COMBANK Surg COMAT Flashcards

1
Q

surg tx for intestinal malrotation

A

Ladd’s procedure

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2
Q

What is done in Ladd’s procedure?

A

disrupts the bands of Ladd (which are a fibrous extension of the peritoneum that anchor the cecum to the abd wall) allowing the surgeon to mobilize R colon and cecum to reduce intestinal malrotation

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3
Q

Nissen fundoplication

A
  • uses the fundus of the stomach to posteriorly plicate, or encircle, the distal end of the esophagus 360 degrees creating a narrowed lower esophageal sphincter, especially during peristalsis of the stomach.
  • Narrowing of the esophageal hiatus is also done with suture thereby reducing the risk of a sliding hernia
  • tx for refractory GERD and/or hiatal hernia
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4
Q

Whipple’s procedure

A
  • pancreaticoduodenectomy
  • two stages of surgery which involve an antrectomy, cholecystectomy, choledochectomy, and duodenectomy as well as the removal of the head of the pancreas as well as regional lymph nodes
  • jejunum is attached to the pancreas for digestive enzymes, the distal stomach for passage of food, and to the hepatic duct for bile passage
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5
Q

Ramstedt pyloromyotomy

A
  • longitudinal incision along the pylorus of an infant with hypertrophic pyloric stenosis
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6
Q

Sigmoidopexy

A

correction of sigmoid volvulus (malrotation) by open, laparoscopic, or a tube passed through the rectum and followed by fixation of the sigmoid colon to the abdominal wall to prevent recurrence.

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7
Q

test of choice when SBO is suspected

A

abdominal series
- includes: an upright chest radiograph to look for pneumoperitoneum, an upright abdomen to see air-fluid levels, and a supine abdomen which best shows bowel dilation

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8
Q

Classic findings of a SBO on radiography

A

ladder-like dilated loops of bowel with air fluid levels

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9
Q

most common cause of SBO in US

A

Postoperative adhesions

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10
Q

all causes of SBO

A 
postop adhesions
hernias
fecaliths
neoplasm
volvulus
gallstone ileus
intussusceptions
SMA syndrome
abscess
diverticulitis
annular pancreas
bowel wall hematoma
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11
Q

most common cause of SBO in children and in non-industrialized nations

A

hernias

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12
Q

surgical indications in SBO

A

complete SBO, strangulated bowel, or bowel perforation

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13
Q

why are lactated ringers good in trauma/shock setting

A

lactate is converted to bicarbonate in the body and can buffer the hypovolemia-induced metabolic acidosis

  • note: nml saline is also an equivalently good answer
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14
Q

when is hypertonic saline indicated

A

only in those with severe hyponatremia (< 115 mEq/L) with neurologic manifestations such as a coma or seizure

  • ex 3% NS
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15
Q

what IV fluid can’t be given as a bolus

A

anything with dextrose b/c can cause hyperglycemia

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16
Q

Progression of persistently hypotensive trauma pt

A
  • Lactated Ringers bolus
  • up to 2-3 L of crystalloid infusion
  • then colloid
  • can consider giving blood transfusion of packed RBCs at time of 2nd fluid bolus
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17
Q

What are Crystalloids?

A

fluids that have an electrolyte composition similar to plasma such as Ringer’s lactate or normal saline

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18
Q

What are colloids?

A

blood products, albumin, as well as synthetic colloids such as hetastarch and hespan

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19
Q

Why do colloids work when crystalloids dont?

A

colloids have greater ability to stay intravascularly than do crystalloid solutions

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20
Q

most common cause of spontaneous bloody nipple discharge

A

solitary intraductal papilloma in one of the large subareolar ducts under the nipple

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21
Q

Richter’s hernia

A

when only the antimesenteric wall of a hollow abdominal organ becomes incarcerated in an inguinal hernia
— can see bowel ischemia without bowel obstruction (dangerous and difficult to dx)

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22
Q

Amyand hernia

A
  • aka appendiceal hernia
  • inguinal hernia containing the vermiform appendix
  • can have s/sx of appendicitis
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23
Q

sliding inguinal hernia

A

hernia containing a hollow retroperitoneal organ, most commonly the bladder or colon

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24
Q

Littre’s hernia

A

hernia that contains a Meckel’s diverticulum

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25
Q

pantaloon hernia

A

inguinal hernia that contains elements of both a direct and an indirect inguinal hernia

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26
Q

acute hemorrhagic gastropathy

A

development of hemorrhagic gastric lesions shortly after exposure to toxic substances that contribute to ischemia or erosions in the stomach:
– NSAIDs, alcohol, cocaine, iron pills, and chemotherapy

  • note: bleeding may be delayed up to one week
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27
Q

Mallory-Weiss syndrome

A

characterized by upper gastrointestinal bleed secondary to shear stress causing mucosal tears in GE junction…. due to an increase in abdominal pressure including vomiting and hiatal hernia

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28
Q

hemochromatosis complications

A
  • mainly result from cirrhosis including portal HTN, esophageal varices
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29
Q

infectious causes of esophagitis

A

ommonly seen in immunocompromised hosts (HIV patients) include candida, cytomegalovirus, and herpes simplex virus

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30
Q

hallmark of esophageal candidiasis

A

odynophagia (painful swallowing) with or without oral thrush

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31
Q

treatment of active peptic ulcers associated with NSAID use

A

proton pump inhibitor (PPI) therapy and cessation of nonsteroidal anti-inflammatory drugs (NSAID)

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32
Q

Atypical ductal hyperplasia (ADH)

A

characterized by a proliferation of uniform epithelial cells with monomorphic round nuclei filling part, but not all, of the involved duct

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33
Q

Atypical ductal hyperplasia (ADH) tx

A
  • usually dx by core needle biopsy

- tx with excisional biopsy of the lesion and continued mammographic screening

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34
Q

Achalasia

A

failure of the lower esophageal sphincter to relax and aperistalsis

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35
Q

causes of fever postoperatively

A

5 W’s: wind-atelectasis, water-urinary tract infection, wound-wound infection, walking-deep venous thrombosis (DVT), and wonder drugs-drug fever

note: medications can be anytime. Other causes have specific timeline

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36
Q

most common cause of fever postop 24-48h

A

atelectasis

— get CXR

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37
Q

most common cause of fever postop day 3

A

UTI

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38
Q

most common cause of fever postop day 5

A

wound infection

really anytime but usually after day 5

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39
Q

most common cause of fever postop day 7-10

A

DVT/PE

can be as early as day 5

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40
Q

Malignant hyperthermia syndrome (MH)

A

inherited, pharmacogenetic disorder of skeletal muscle that results in a hypermetabolic state post anesthesia administration

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41
Q

what agents trigger malignant hyperthermia?

A

all potent inhalation agents and succinylcholine

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42
Q

pathophys of malignant hyperthermia

A
  • AD
  • most frequently associated with a mutation in the ryanodine receptor gene (RYR1). RYR1 mutations result in increased sensitivity of skeletal muscle calcium channels to agonists, leading to uncontrolled calcium release into the muscle sarcoplasm. Intracellular hypercalcemia in skeletal muscle activates metabolic pathways leading to ATP depletion, acidosis, membrane destruction and cell death
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43
Q

tx of malignant hyperthermia

A

discontinuing medication, cooling, hyperventilation, and dantrolene administration
— often given procainamide too to avoid v-fib

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44
Q

common etiology in elderly patient of weakness, weight loss, and microcytic anemia with a positive stool guaiac test

A

colorectal cancer

— must consider before other dx

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45
Q

best test to screen for and diagnose colorectal cancer

A

colonoscopy

– can do tissue biopsy

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46
Q

charcot’s triad

A

RUQ pain
jaundice
fever

= cholangitis

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47
Q

Reynolds pentad

A

charcot’s triad (RUQ pain, jaundice, fever)
hypotension
AMS

48
Q

tx of Chron’s disease

A
  1. For acute/remission: 5-ASA meds (Ex/ sulfasalazine, mesalamine)
    +/- abx (cipro, metro)
  2. For acute: corticosteroids
  3. For remission/refractory: immunomodulators (6-MP, AZAthioprine, infliximab)
49
Q

most common cause of GERD

A

decreased lower esophageal sphincter tone

50
Q

test of choice in evaluation of GERD

A

only needed if refractory or with dysphagia:

upper endoscopy with biopsy

51
Q

deficiency of ___ in hemophilia A

A

factor VIII

52
Q

lab value identifying Hemophilia A

A

prolonged PTT
normal PT
normal bleeding time
normal platelet count

53
Q

Tx for hemophilia A

A

cryoprecipitate

— rich in factor VIII and fibrinogen

54
Q

tx of Hempohilia B

A

factor IX products

55
Q

key identifier between partial and full thickness wounds

A

pain

painless = full thickness

56
Q

superficial partial burn characteristics

A
  • involves upper dermal layers
  • often causes fluid filled blisters several hours later
  • underlying tissue is moist, pink, painful
  • blanches upon palpation
57
Q

deep partial burn characteristics

A
  • extend into reticular dermis
  • blisters, painful, blanch (or not blanch)
  • pink and white mottled appearance of underlying wound (compromised blood flow)
58
Q

epidermal burn characteristics

A
  • erythematous (dilation of underlying dermal vasculature)
  • painful
  • no blisters
59
Q

fourth degree burn characteristics

A
  • deep
  • potentially life-threatening
  • extend into underlying tissues (fascia, muscle, bone)
60
Q

full thickness burn characteristics

A
  • range in color (white -> black)
  • leathery with eschar
  • do not blanche
  • insensate
61
Q

vitamin deficiency in Crohn’s

A

zinc

vit B12

62
Q

s/sx of zinc depletion

A

dermatitis (acrodermatitis enteropathica, alopecia, eczema)
hypogonadism
growth retardation
taste abnormalities

63
Q

acute hemolytic transfusion reaction (AHTR) pathophys

A

rapid destruction of donor RBCs by preformed antibodies

64
Q

cause of acute hemolytic transfusion reaction (AHTR)

A

ABO incompatibility

65
Q

acute hemolytic transfusion reaction (AHTR) s/sx

A 
fever, chills
shock
hemolysis
DIC (oozing blood, hemoglobinuria)
renal failure (acute tubular necrosis)
66
Q

focal nodular hyperplasia on CT scan

A

hypervascular mass containing arteriovenous connections
in liver
(usually asymptomatic)

67
Q

hepatic adenoma on CT scan

A

NO AV connections

68
Q

appearance of gastric ulcers

A

discrete mucosal lesions with a punched-out smooth ulcer base, often filled with whitish fibrinoid exudate

69
Q

appearance of duodenal ulcers

A
  • sharply demarcated edges
  • exposed underlying submucosa
  • clean and smooth ulcer base (but acute ulcers and those with recent hemorrhage can demonstrate eschar or adherent exudate)
70
Q

ulcers and food

A
  • shortly after meals with gastric ulcer and 2-3 hours afterward with duodenal ulcer.
  • Food or antacids relieve the pain of duodenal ulcers but provide minimal relief of gastric ulcer pain.
71
Q

Dieulafoy’s lesion

A

single large tortuous arteriole in the submucosa which does not undergo normal branching or a branch with caliber of 1–5 mm (more than 10 times the normal diameter of mucosal capillaries)
- causes erosion and bleeds

72
Q

when should you not use permanent prosthetics

A
  • ex mesh

in setting of fecal contamination

73
Q

Oral tongue cancer

A
  • Squamous cell carcinoma is the most common

- most commonly presents as an ulcerated exophytic lesion on the posterior and lateral aspect.

74
Q

difference between pilonidal disease and hidradenitis suppurativa (aka acne inversa)

A
  • chronicity of HS/AI compared to pilonidal disease with a strong history of chronic disease and recurrence of disease.
  • HS/AI is seen in family history and can be seen in axillae, groin, breast, thigh of family members
  • Both can involve gluteal cleft, are painful with abscess and sinus tracts, and are follicular occlusion
75
Q

tx of gastric adenocarcinoma

A

depends on location and spread of tumor:

  • antrum -> subtotal gastrectomy
  • middle or upper -> total gastrectomy
76
Q

Clean contaminated wounds

A

sterile wounds that require opening of a non-sterile hollow viscus organ without significant spillage of infectious contents

77
Q

Contaminated wounds

A

accidental wounds that involve violation of sterile fields or gross spillage of infectious content into a previously sterile field.

78
Q

Gross contaminated wounds

A

traumatic wounds that have a significant delay in attaining treatment, oftentimes including areas of necrosis or frank purulence.

79
Q

tx of Tension pneumothorax

A

should initially be needle decompressed followed by tube thoracostomy

80
Q

how to estimate burn size

A

In adults (rule of 9s):

  • the anterior and posterior trunk each account for 18% ,
  • each lower extremity is 18%,
  • each upper extremity is 9%,
  • and the head is 9%.

Superficial or first-degree burns should not be included when calculating the percent TBSA

81
Q

Schatzki ring

A
  • aka esophageal ring
  • a mucosal thickening causing stricture usually at the squamocolumnar junction of the lower esophagus
  • tx = dilation
82
Q

tx fro Zenker’s diverticulum

A

cricopharyngeal myotomy (b/c is outpouching of the cricopharyngeal m.)

83
Q

Billroth’s operation

A

partial gastrectomy where the pylorus is removed and the proximal stomach anastomosed to the duodenum

84
Q

Heller myotomy

A

esophagomyotomy

- cutting the esophageal sphincter muscle, performed laparoscopically

85
Q

Blind loop syndrome

A

can result after a chronic obstruction to a portion of the intestines causing bacterial overgrowth due to stasis within the obstructed limb

  • note: bacteria bind vit B12 and can cause megaloblastic anemia and peripheral neuropathy. (can also see vit A def)
86
Q

electrolyte effect of succinylcholine

A

can cause hyperkalemia in predisposed pt (burn and spinal cord injury)

87
Q

Spigelian hernias

A

arise from a defect in Spigel’s fascia, the aponeurotic layer between the rectus abdominis and external oblique muscle along the linea semilunaris.
- usually present without a bulge

88
Q

test to dx achalasia

A

esophageal motility study (manometry) (showing aperistalsis, increased resting pressure of LES, failure of relaxation of LES in response to swallowing)

  • Note: if unsure, then get barium esophagram
89
Q

surgery for achalasia

A

Heller myotomy with partial fundoplication

  • Note: pneumatic dilation is also first line tx
90
Q

abs for colorectal surgery

A

general:
- second gen cephalosporins (cefotetan and cefoxitin) if single drug
- – (b/c need to cover g- and anaerobes)
- ampicillin/sulbactam
- cefazolin + metro
- clindamycin + fluorquinolone or aztreonam

if bowel perf: broader spectrum abx

91
Q

paraphimosis

A

retracted foreskin develops a fixed constriction proximal to the glans

92
Q

Phimosis

A

inability to retract the foreskin proximally to the glans penis

93
Q

Balanoposthitis

A

inflammation secondary to an infection of the glans penis and the surrounding foreskin

94
Q

manifestations of Peutz-Jeghers syndrome

A

pigmented mucocutaneous macules (often around mouth) and
multiple hamartomatous gastrointestinal polyps
—> at risk for intussusception

95
Q

common GI complication in Peutz-Jeghers syndrome

A

nearly half will have an intussusception due to hamartomatous polyps of GI tract

96
Q

orchiopexy

A

permanent fixation of testicle to scrotum

  • do this bilaterally after a testicular torsion within 6hrs of event
97
Q

tx of LCIS

A

tamoxifen therapy if ER+

LCIS is not cancerous or pre-malignant so no surgery needed. Just indicates increased risk of breast CA in general

98
Q

when to drain a post-op seroma

A

should not be performed unless the seroma is symptomatic or lasts for longer than 6-8 weeks due to the risk of mesh infection

99
Q

when are glycogen stores depleted

A

after 24-48h of starvation

100
Q

what to do with large polyp found on colonoscopy

A

remove by saliine injection & cautery snare if possible. If not (ex/ >2-3cm) then surg consult.

101
Q

bezoar

A
  • mass trapped in the gastrointestinal system

- most often in stomach

102
Q

abx for MRSA resistant infections

A

Linezolid

activity against MRSA, streptococci, almost all g+, some anaerobic… and as effective as Vanco

103
Q

treatment of appendiceal carcinoid

A
  • greater than 1.5 cm is a right hemicolectomy
  • less than 1.5 cm then an appendectomy
  • Octreotide for carcinoid syndrome
104
Q

sx of compartment syndrome

A

5 P’s: pain, paresthesias, pallor, paralysis, and pulselessness.

105
Q

What to remove when surgery for appendiceal cystic lesion.

A
  • can either be a cystadenoma or a cystadenocarcinoma.
  • – Cystadenomas can be treated with an appendectomy alone, but are often difficult to diagnose grossly.
  • – A right hemicolectomy is indicated if suspicious for cystadenocarcinoma.
  • These cysts should not be biopsied to avoid rupture which can cause pseudomyxoma peritonei.
106
Q

layer of the intestinal wall is most important in maintaining tensile strength

A

The submucosal layer

    • has a high content of collagen fibers and is where the tensile strength of the bowel lies
    • Tensile strength is mainly determined by collagen cross linking.
107
Q

Inflammatory breast cancer vs infectious mastitis

A

Failure of oral antibiotics and lack of an abscess help distinguish inflammatory cancer from mastitis.

108
Q

Immediate treatment of central retinal artery occlusion

A

ocular massage
– Repeated pressure for 10-15 seconds on the orbit improves retinal blood flow and may allow the embolus to move downstream to restore blood flow to some of the retina

109
Q

window for tPA

A

4-6hrs from sx onset

110
Q

treatment for toxic megacolon

A

subtotal abdominal colectomy with end ileostomy.

111
Q

abx C diff is resistant to

A

clindamycin
cephalosporins
fluoroquinolones

112
Q

Things that cause a right shift of the hemoglobin-oxygen dissociation curve

A

(decrease in affinity of Hb for O2)

acidosis, high altitude, increase in pCO2, increase in temperature, and increase in metabolic needs.

113
Q

apple core abd XR

A

colon carcinoma

114
Q

Kidney/coffee bean sign abd XR

A

sigmoid volvulus

or closed loop SBO

115
Q

Rigler sign

A

presence of both inner and outer walls of the bowel on abd XR

= pneumoperitoneum

116
Q

Billroth II procedure

A

gastrojejunostomy

  • for PUD or gastric adenocarcinoma
117
Q

Billroth I procedure

A

gastroduodenostomy

  • for PUD or gastric adenocarcinoma

Year 3 (15 decks)

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