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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
When does epithelialization begin and end?
Epithelialization begins within 1 day and is completed within 48 hours in primary closure wounds
26
Which elements support epithelialization
EGF, TGF-beta, basic fibroblast growth factor (bFGF), PDGF and IGF-1 support epithelization.
27
............ 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
Contraction
28
Wound contraction is provided by .............. rich in actin filaments, a contractile protein.
myofibroblasts
29
Factors Affecting Wound Healing
30
When do chronic wounds happen
If it doesn't get better in 3 months
31
What is Marjolin ulcer?
Malignant transformation of the wound may be observed.we call it Marjolin ulcer
32
Know the differences btw keloid and hypertrophic scar
33
Gastrointestinal Wound Healing Happens where
predominantly in the submucosa with the serosa. (heal without scarring )
34
what are disease of the colon motility
diverticular disease colon volvulus rectal prolapsus irritable bowel syndrome constipation
35
diverticular disease
an abnormal sac or pouch protruding from the wall of a hollow organ
36
true diverticulum
composed of all layers of the intestinal wall at sites of penetration of the muscular wall by arterioles
37
what are the complications of diverticular disease
diverticulitis, bleeding,abscess,fistulas,narrowed colon
38
what are the symptoms of diveticular disease
abd pain, cramping, nausea/vomiting , fever
39
what are the Hinchey classification of diverticular disease
stage 1: pericolic and mesenteric abscess stage 2:pelvic abscess stage 3: Generalized purulent peritonitis stage 4: fecal peritonitis
40
uncomplicated diverticulitis
peridiverticular inflammation
41
complicated diverticulitis
inflammation + free intraperitoneal perforation, abscess , fistula formation , obstruction
42
which laboratory tests we can use for diverticular disease
blood tests, ultrasonography , water-soluble contrast enema ,CT, MRI
43
what is the treatment of diverticular disease ?
1.medical 2.surgery
44
what is the treatment of uncomplicated diverticulitis ?
it can be treated with oral antibiotic covering anaerobic and aerobic microorganisms. clear liquid diet no hospitalisation
45
what is the treatment of complicated diverticulitis ?
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
what is the prevention from diverticular disease ?
diets high fiber are recommended to increase stool bulk and prevent constipation which reduces pressure in the colon.
47
what is the definition of colon Volvulus ?
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
where we can see the most cases of colon volvulus ?
sigmoid volvulus
49
what are the associated factors of colon volvulus ?
chronic constipation(low fiber diet) aging (70-80 yrs ) previous abd surgery laxative abuse
50
what are the symptoms of colon volvulus ?
abd pain distention vomiting
51
what laboratory test we use for colon volvulus ?
abd x-ray barium enema (birds beak sign) CT ( COFFE BEAN)
52
what are the treatments of colon volvulus ?
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
what is rectal prolapse ?
protrusion of the full thickness of the rectal wall through the anus
54
what is mucosal prolapse ?
protrusion of only the rectal mucosa from the anus.
55
what is the ethiology of rectal prolapse ?
*women aged 50 or older are 6 times as likely as men have rectal prolapse *chronic constipation with straining *multiparous women
55
what is the clinic of rectal prolapse ?
-rectum protruded through anal canal -fecal or gas incontinence -soiling or leakage -poor quality of life
56
what is lab test for rectal prolapse?
None!!!!
57
what is the treatment of rectal prolapse ?
1.perineal operation 2.abd operation
58
what are the perineal operations for rectal prolapse ?
1. anal encirclement(thiersch) 2.perineal proctectomy (altimeter )
59
what are the abd operations of rectal prolapse ?
1.rectopexy with suture or mesh (rip stein, wells ) 2.resection and rectopexy(
60
what are the complications of surgery of anal prolapse ?
-recurrence -constipation -sacral venous bleeding -pelvic nerve damage
61
which medical treatment we can use for rectal prolapse ?
stool softeners ->decrease bowel movement
62
what is rectocele ?
abnormal sac-like projection of the anterior portion of the lower rectum through vagina.
63
what is the etiology of rectocele ?
rectal pressure are higher than those in vagina , therefore pressure tends to push the rectum anteriorly.
64
what is the clinic of rectocele
*major symptom is stool trapping *women commonly describe requiring vaginal digital pressure to reduce the bulge
65
what is the diagnosis of rectocele ?
-DRE(lithotomy position ) -defecography
66
WHAT are the treatment of rectocele?
-smaller than 2cm -> no need for surgery -surgical treatment with transanal or transvaginal approach
67
what is irritable bowel syndrome ?
a functional gastrointestinal disorder characterized by abd pain and altered bowel habits in the absence of specific and organic pathology
68
what is the clinic of irritable bowel syndrome ?
-altered bowel habits -abd pain -abd bloating
69
Are gastric tumors mostly malignant or benign?
Malignant -adenocarcinoma 95% -lymphoma 4% -GIST(leiomyosarcoma)
70
What can reduce the risk of gastric cancer?
Aspirin, Diet (fresh fruits and vegetables), Vitamin C
71
What can increase the risk of gastric cancer?
.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
What are the premalignant conditions for gastric cancer?
• 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
Early stage gastric cancer
-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
Classification of Early gastric cancer:
-Ty pe 1 ->Exophytic (Protruded) – antrum -Type 2 -> Superficial – antrum a. Elevated b. Flat c. Depressed (MOST COMMON) – corpus -Type 3 ->Excavated - corpus
75
**Lauren classification system for gastric cancer **
76
What is Ino perability Criteria in Gastric Cancer
• 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
What is the clinic of gastric cancer?
Anorexia and weight loss are the most common symptoms(%95).
78
What is the diagnosis of gastric cancer?
Endoscopy + Bx is the gold standard
79
What is the treatment of gastric cancer?
-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
Where is the most common site of primary GI lymphoma?
Stomach >small intestine
81
Gastric lymphoma mostly originates from which cells?
B cell origin
82
Low-grade MALT lymphoma probably arises from the background of ...................associated with ......
Chronic gastritis,H.pylori
83
Which cancer of gastric is treated with antibiotics not surgery?
Low-grade MALT lymphoma
84
2/3 if all GISTs occur in the.............
Stomach
85
GISTs are ............ growing (fast/slow)................(mucosa/submucosal)
Slow,submucosal
86
GISTs originate from which cells?
Interstitial cells of cajal
87
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.
88
In GISTs what are positive?
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
The prognosis in GISTs depends on ............,..........,............
depends more on the size of the tumor, the number of mitoses, and metastases which typically occur hematogenously.
90
Are the GISTs mostly solitary or multiple?
Solitary
91
**lesion larger than 1 cm may behave as malignant and may recur. **
92
Which tumors should be removed?
Symptomatic tumors and tumors larger than 1 cm should be removed.
93
R ISK OF AGGRESSIVE BEHAVIOR IN GIST
-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
What are the gastric carcinoid originates from?
enterochromaffin-like (ECL) cells
95
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.
96
What are the clinical manifestations of MENETRIER'S DISEASE (HYPERTROPHIC GASTRITIS) ?
Clinical manifestations include pain, anemia, and hypoproteinemia.
97
Definition of MENETRIER'S DISEASE (HYPERTROPHIC GASTRITIS)
-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
What are the arteries of thyroid?
-sup thyroid arteries-> external carotid arteries -the inf thyroid arteries-> thyrocervical trunk-> subclavian artery -A.thyroidea ima -> directly from aorta
99
The most common lymphatic metastasis in thyroid malignancies are where?
central neck triangle
100
In thyroid malignancies the least lymphatic metastases
metastases to the submaxillary node
101
How is the innervation of thyroid?
• It is innervated by sympathetic nerves from the cervical ganglia and parasympathetic nerves from the vagus (N. laryngeus superior and inferior).
102
• If the N. laryngeus superior is damaged what gonna happen for the patient?
the patient has impaired voice modulation (horse voice) and difficulty swallowing liquid foods.
103
horse voice) and difficulty swallowing liquid foods. • N.L. Recurrence (inferior) injury causes ............
vocal cord paralysis
104
• The most specific test for determining thyroid function is .......
TSH
105
T3 has a half-life of .......day, while T4 has about ....... days.
1,7
106
Wolff-Chaikoff effect.
The presence of excess iodide first leads to an increase in organification and then its suppression, which is called the Wolff-Chaikoff effect.
107
What is happening in Refetoff syndrome?
In patients with end-organ resistance to T4 (Refetoff syndrome), T4 levels are elevated, but TSH levels are usually normal.
108
What is the most useful test in early hyperthyroidism
Free T3 measurements
109
How we can monitor patients with differentiated thyroid cancer for recurrence?
Use of thyroglobulin (TG)

General Surgery 1 (2 decks)

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