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General Surgery 1 > Dr.ahmet Cihangir > Flashcards

Dr.ahmet Cihangir Flashcards

1
Q

Types of Wound Closure

A

• -Primary closure (Repair/Suture)​ • -Secondary closure (Spontaneous)​ • -Tertiary closure (Delayed primary)​

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2
Q

Stages of Wound Healing

A

1-Hemostasis
2-inflammation
3-Fibroplasia(proliferation)
4-maturation (remodeling, reconstruction)

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3
Q

What are the features of hemostasis stage of wound healing?

A

Injury  Bleeding  Vasoconstriction  Platelet form the first plug  Coagulation factors  Fibrin

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4
Q

Whats the fibrin’s job in hemostasis?

A

Fibrin functions both as hemostatic and as a network for inflammatory cells to come to the injury sites.

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5
Q

What are the platelets’s job in hemostasis stage?

A

Platelets are also responsible for the production of cytokines that regulate wound healing.

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6
Q

What are platelets alpha granules contain of?

A

Platelet alpha granules contain PDGF, TGF-β, IGF-1, fibronectin, fibrinogen, thrombospondin, and
vWF.

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7
Q

How leukocytes and fibroblasts attract to the wound ?

A

thrombin-activated platelets released PDGF,TGF-B ,IGF-1 , TGF-alpha that attract them.

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8
Q

How many days does the inflammation stage of wounds healing take?

A

2-4 days

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9
Q

What are the Signs of inflammation ?

A

Rubor (flushing), dolor(pain), calor(fever), tumor(swelling)

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10
Q

What is job of the mast cells in wound healing ?

A

Mast cells release substances such as histamine and serotonin that increase vascular permeability.

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11
Q

what are the PMN leukocytes do in the inflammation stage of wound healing ?

A

PMN leukocytes are the first to arrive at the wound area … They dominate for 24-48 hours… They digest the tissue residues in the wound area.

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12
Q

What are the second inflammatory cells that come to wound and what do they do?

A

macrophages ,They reach significant amounts
between 48-96 hours after injury and remain at the wound site until healing is complete.macrophages also secrete some
mitogenic substances that stimulate fibroblastic proliferation.

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13
Q

What is the T lymphocytes’ job in inflammation?

A

T lymphocytes peak around 1 week after injury. T lymphocytes bridge the transition from inflammation
to proliferation.

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14
Q

When Fibroplasia happened in wound healing?

A

Between 4-12 days…

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15
Q

What is The primary function of fibroblasts ?

A

collagen synthesis

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16
Q

When is the lag phase ?

A

The time between the injury and the onset of collagen in the healing wound is
called the lag phase (Transformation of undifferentiated mesenchymal cells into
highly specialized fibroblasts). This period lasts 3-5 days.

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17
Q

When the collagen synthesis begins to decrease?

A

After about 3-4 weeks

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18
Q

What happened in Maturation stage of healing?

A

-collagen synthesis begins to decrease.
-This is the period when collagen maturation begins.(not synthetesis)
-This is the period when serine proteases and matrix metalloproteases (MMPs) are most active.
-Inflammatory cells are reduced.
-Angiogenesis decreases and fibroplasia ends.

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19
Q

……….&……….build the early matrix scaffold

A

Fibronectin and Type III collagen

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20
Q

What is the final matrix

A

Type I collagen

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21
Q

What is fibitillin and where does it secrete from?

A

Fibrillin secreted from fibroblasts is essential for the formation of elastic fibers found in connective
tissue.

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22
Q

Scar maturation and remodeling continues for ……. months following injury.

A

6-12

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23
Q

The mechanical strength of the scar can never reach the mechanical strength of the uninjured tissue.

A
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24
Q

What is Epithelialization

A

It is the closure of the defect by migration and proliferation of keratinocytes in injuries
that are not full-thickness in the skin or mucosa.

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25
Q

When does epithelialization begin and end?

A

Epithelialization begins within 1 day and is completed
within 48 hours in primary closure wounds

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26
Q

Which elements support epithelialization

A

EGF, TGF-beta, basic fibroblast growth factor (bFGF), PDGF and IGF-1 support epithelization.

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27
Q

………… It is the mechanism that plays a role in the repair of full-thickness skin injuries or tubular
organs such as the common bile duct and esophagus

A

Contraction

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28
Q

Wound contraction is provided by ………….. rich in actin filaments, a contractile protein.

A

myofibroblasts

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29
Q

Factors Affecting Wound Healing

A
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30
Q

When do chronic wounds happen

A

If it doesn’t get better in 3 months

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31
Q

What is Marjolin ulcer?

A

Malignant transformation of the wound may be observed.we call it Marjolin ulcer

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32
Q

Know the differences btw keloid and hypertrophic scar

A
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33
Q

Gastrointestinal Wound Healing
Happens where

A

predominantly in the submucosa with the serosa.
(heal without scarring )

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34
Q

what are disease of the colon motility

A

diverticular disease
colon volvulus
rectal prolapsus
irritable bowel syndrome
constipation

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35
Q

diverticular disease

A

an abnormal sac or pouch protruding from the wall of a hollow organ

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36
Q

true diverticulum

A

composed of all layers of the intestinal wall at sites of penetration of the muscular wall by arterioles

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37
Q

what are the complications of diverticular disease

A

diverticulitis, bleeding,abscess,fistulas,narrowed colon

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38
Q

what are the symptoms of diveticular disease

A

abd pain, cramping, nausea/vomiting , fever

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39
Q

what are the Hinchey classification of diverticular disease

A

stage 1: pericolic and mesenteric abscess
stage 2:pelvic abscess
stage 3: Generalized purulent peritonitis
stage 4: fecal peritonitis

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40
Q

uncomplicated diverticulitis

A

peridiverticular inflammation

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41
Q

complicated diverticulitis

A

inflammation + free intraperitoneal perforation, abscess , fistula formation , obstruction

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42
Q

which laboratory tests we can use for diverticular disease

A

blood tests, ultrasonography , water-soluble contrast enema ,CT, MRI

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43
Q

what is the treatment of diverticular disease ?

A

1.medical 2.surgery

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44
Q

what is the treatment of uncomplicated diverticulitis ?

A

it can be treated with oral antibiotic covering anaerobic and aerobic microorganisms.
clear liquid diet
no hospitalisation

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45
Q

what is the treatment of complicated diverticulitis ?

A

1.abscess (pain , fever , leucocytosis)
USG or CT guided drainage with antibiotics
2.fistula ( pneumaturia, fecaluria , recurring urinary tract infection 0
surgery
3. obstruction ( should be distinguished from cancer )
surgery

46
Q

what is the prevention from diverticular disease ?

A

diets high fiber are recommended to increase stool bulk and prevent constipation which reduces pressure in the colon.

47
Q

what is the definition of colon Volvulus ?

A

the condition in which the bowel becomes twisted on its mesenteric axis that results in partial or complete obstruction of the bowel.
any portion of the colon can torse if that segment has long and floppy mesentery.

48
Q

where we can see the most cases of colon volvulus ?

A

sigmoid volvulus

49
Q

what are the associated factors of colon volvulus ?

A

chronic constipation(low fiber diet)
aging (70-80 yrs )
previous abd surgery
laxative abuse

50
Q

what are the symptoms of colon volvulus ?

A

abd pain
distention
vomiting

51
Q

what laboratory test we use for colon volvulus ?

A

abd x-ray
barium enema (birds beak sign)
CT ( COFFE BEAN)

52
Q

what are the treatments of colon volvulus ?

A

1.endoscopic detorsion and rectal tube insertion
elective colon resection
2. patients with signs and symptoms of sepsis ,fever ,leucocytosis , and peritonitis should taken to surgery

53
Q

what is rectal prolapse ?

A

protrusion of the full thickness of the rectal wall through the anus

54
Q

what is mucosal prolapse ?

A

protrusion of only the rectal mucosa from the anus.

55
Q

what is the ethiology of rectal prolapse ?

A

*women aged 50 or older are 6 times as likely as men have rectal prolapse
*chronic constipation with straining
*multiparous women

55
Q

what is the clinic of rectal prolapse ?

A

-rectum protruded through anal canal
-fecal or gas incontinence
-soiling or leakage
-poor quality of life

56
Q

what is lab test for rectal prolapse?

A

None!!!!

57
Q

what is the treatment of rectal prolapse ?

A

1.perineal operation
2.abd operation

58
Q

what are the perineal operations for rectal prolapse ?

A
  1. anal encirclement(thiersch)
    2.perineal proctectomy (altimeter )
59
Q

what are the abd operations of rectal prolapse ?

A

1.rectopexy with suture or mesh (rip stein, wells )
2.resection and rectopexy(

60
Q

what are the complications of surgery of anal prolapse ?

A

-recurrence
-constipation
-sacral venous bleeding
-pelvic nerve damage

61
Q

which medical treatment we can use for rectal prolapse ?

A

stool softeners ->decrease bowel movement

62
Q

what is rectocele ?

A

abnormal sac-like projection of the anterior portion of the lower rectum through vagina.

63
Q

what is the etiology of rectocele ?

A

rectal pressure are higher than those in vagina , therefore pressure tends to push the rectum anteriorly.

64
Q

what is the clinic of rectocele

A

*major symptom is stool trapping
*women commonly describe requiring vaginal digital pressure to reduce the bulge

65
Q

what is the diagnosis of rectocele ?

A

-DRE(lithotomy position )
-defecography

66
Q

WHAT are the treatment of rectocele?

A

-smaller than 2cm -> no need for surgery
-surgical treatment with transanal or transvaginal approach

67
Q

what is irritable bowel syndrome ?

A

a functional gastrointestinal disorder characterized by abd pain and altered bowel habits in the absence of specific and organic pathology

68
Q

what is the clinic of irritable bowel syndrome ?

A

-altered bowel habits
-abd pain
-abd bloating

69
Q

Are gastric tumors mostly malignant or benign?

A

Malignant
-adenocarcinoma 95%
-lymphoma 4%
-GIST(leiomyosarcoma)

70
Q

What can reduce the risk of gastric cancer?

A

Aspirin, Diet (fresh fruits and vegetables), Vitamin C

71
Q

What can increase the risk of gastric cancer?

A

.Hypoacidity (85% of all gastric cancers)
• H. Pylori
• Atrophic gastritis (95% of all gastric cancers)
• Adenomatous polyp (especially > 2cm)
• Genetics
• Pernicious anemia
• A blood group
• Environmental factors
• Nitrites and Smoked fish(3,4 benzopyrene)
• Aflatoxin
• Duodenal ulcer surgery
• Residual stomach after resection (especially Billroth II operation)
• Presence of gastric ulcer
• Presence of intestinal metaplasia
• Epstein Barr Virus (EBV)

72
Q

What are the premalignant conditions for gastric cancer?

A

• Atrophic gastritis (highest risk)
• Hyperplastic polyp (lowest risk) and Adenomatous polyp
• Intestinal metaplasia
• Gastric ulcer
• Menetrier’s disease(Hypertrophic Gastritis)
• Ectopic pancreas (most often in the antrum

73
Q

Early stage gastric cancer

A

-It is defined as adenocarcinoma confined to the mucosa and submucosa of the stomach, regardless of lymph node(LN) involvement. (While LN is 5% in tumors involving only the mucosa (T1a), 20% LN is involved in
submucosal involvement (T1b). )
-It is most common in the corpus.
-Small intramucosal lesions can be treated with EMR.(no surgery)

74
Q

Classification of Early gastric cancer:

A

-Ty pe 1 ->Exophytic (Protruded) – antrum
-Type 2 -> Superficial – antrum
a. Elevated
b. Flat
c. Depressed (MOST COMMON) – corpus
-Type 3 ->Excavated - corpus

75
Q

**Lauren classification system for gastric cancer **

A
76
Q

What is Ino perability Criteria in Gastric Cancer

A

• Krukenberg Tumor: Implantation in the Ovary • Blummer’s Shelf: Implantation into the Rectouterine fascia
• Sister Joseph Nodule: Umbilicus met.
• Virchow’s nodule: Left supraclavicular LN metastasis
• Irish nodule: Left axilla LN met
• Peritonitis carcinomatosis
• M1

77
Q

What is the clinic of gastric cancer?

A

Anorexia and weight loss are the most common symptoms(%95).

78
Q

What is the diagnosis of gastric cancer?

A

Endoscopy + Bx is the gold standard

79
Q

What is the treatment of gastric cancer?

A

-Surgery
(More than 15 lymph nodes need to be
resected for an adequate staging.)
-Neoadjuvant treatment of gastric adenocarcinoma is being evaluated especially in cases with clinical T3 or N1 disease.
• According to the Japanese treatment guidelines for gastric cancer, EMR is the standard of care for differentiated mucosal gastric cancers that are less than 2 cm in size and have almost no risk of lymph node metastasis and no signs of ulceration.

80
Q

Where is the most common site of primary GI lymphoma?

A

Stomach >small intestine

81
Q

Gastric lymphoma mostly originates from which cells?

A

B cell origin

82
Q

Low-grade MALT lymphoma probably arises from the background of ……………….associated with ……

A

Chronic gastritis,H.pylori

83
Q

Which cancer of gastric is treated with antibiotics not surgery?

A

Low-grade MALT lymphoma

84
Q

2/3 if all GISTs occur in the………….

A

Stomach

85
Q

GISTs are ………… growing (fast/slow)…………….(mucosa/submucosal)

A

Slow,submucosal

86
Q

GISTs originate from which cells?

A

Interstitial cells of cajal

87
Q

C-kit (CD117) 95%, CD34 60-70% and smooth muscle actin 30-40% (most GISTs do not show actin and desmin positivity) are
positive in GISTs.

A
88
Q

In GISTs what are positive?

A

C-kit (CD117) 95%, CD34 60-70% and smooth muscle actin 30-40% (most GISTs do not show actin and desmin positivity) are positive in GISTs.

89
Q

The prognosis in GISTs depends on …………,……….,…………

A

depends more on the size of the tumor, the number of mitoses, and metastases which typically occur hematogenously.

90
Q

Are the GISTs mostly solitary or multiple?

A

Solitary

91
Q

**lesion larger than 1 cm may behave as malignant and may recur. **

A
92
Q

Which tumors should be removed?

A

Symptomatic tumors and tumors larger than 1 cm should be removed.

93
Q

R ISK OF AGGRESSIVE BEHAVIOR IN GIST

A

-very low risk (size <2 cm )(mitoses <5)
-low risk (size 2-5cm)(mitoses <5)
-medium risk(size <5cm)(mitoses 6-10)or(size 5-10cm)(mitoses >5)
-high risk (size>10cm)(her hangi mitotik index)or (her hangi boyut)(mitoses >10)

94
Q

What are the gastric carcinoid originates from?

A

enterochromaffin-like (ECL) cells

95
Q

Plasma chromogranin A level is elevated in patients with gastric carcinoids. CT
scan and octreotide scan can be useful in staging. • Gastric carcinoids should be resected.

A
96
Q

What are the clinical manifestations of MENETRIER’S DISEASE (HYPERTROPHIC GASTRITIS) ?

A

Clinical manifestations include pain, anemia, and hypoproteinemia.

97
Q

Definition of MENETRIER’S DISEASE (HYPERTROPHIC GASTRITIS)

A

-It is a rare inflammatory disease of the gastric epithelium. TNF-α is responsible for the
pathogenesis. (The disease is thought to be of autoimmune origin.)
-• It is characterized by very large gastric folds in the proximal stomach(It mostly involves the corpus and fundus).
-Common in men.
-Definitive diagnosis is made by biopsy with loss of oxyntic gland and detection of foveolar hyperplasia.
-Symptomatic treatment ‘Cetuximab’ is applied. (if no response or sometimes protein
loss is very rapid and excessive àtotal gastrectomy performed)

98
Q

What are the arteries of thyroid?

A

-sup thyroid arteries-> external carotid arteries
-the inf thyroid arteries-> thyrocervical trunk-> subclavian artery
-A.thyroidea ima -> directly from aorta

99
Q

The most common lymphatic metastasis in thyroid malignancies are where?

A

central neck triangle

100
Q

In thyroid malignancies the least lymphatic metastases

A

metastases to the submaxillary node

101
Q

How is the innervation of thyroid?

A

• It is innervated by sympathetic nerves from the cervical ganglia and parasympathetic
nerves from the vagus (N. laryngeus superior and inferior).

102
Q

• If the N. laryngeus superior is damaged what gonna happen for the patient?

A

the patient has impaired voice modulation
(horse voice) and difficulty swallowing liquid foods.

103
Q

horse voice) and difficulty swallowing liquid foods. • N.L. Recurrence (inferior) injury causes …………

A

vocal cord paralysis

104
Q

• The most specific test for determining thyroid function is …….

A

TSH

105
Q

T3 has a half-life of …….day, while T4 has about ……. days.

A

1,7

106
Q

Wolff-Chaikoff effect.

A

The presence of excess iodide first leads to an increase in organification and then its suppression, which
is called the Wolff-Chaikoff effect.

107
Q

What is happening in Refetoff syndrome?

A

In patients with end-organ resistance to T4 (Refetoff syndrome), T4 levels are elevated, but TSH levels
are usually normal.

108
Q

What is the most useful test in early hyperthyroidism

A

Free T3 measurements

109
Q

How we can monitor patients with differentiated thyroid cancer for recurrence?

A

Use of thyroglobulin (TG)

General Surgery 1 (2 decks)

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