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Surgical Recall > Emma Holliday for Surgery: Part IV > Flashcards

Emma Holliday for Surgery: Part IV Flashcards

1
Q

Zenker’s Diverticulum pres and tx

A

Bad breath and snacks in the AM

Tx with surgery

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2
Q

Is Zenker’s a true diverticulum? Why?

A

False. Only has mucosa. True would be full thickness

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3
Q

Someone has dysphagia to liquids and solids? What do we do

A

Achalasia. Tx w/ CCB, nitrates, botox, or heller myotomy

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4
Q

Two things we associate with achalasia

A

Assoc w/ Chagas dz and esophageal cancer.

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5
Q

Dysphagia that is worse with hot or cold liquids or with chest pain that feels like an MI with NO regurg

A

Diffuse esophageal spasm. Treat with CCB or nitrates

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6
Q

Epigastric pain worse after
eating or when laying down
cough, wheeze, hoarse.

A

GERD.

Most sensitive test is 24-hr pH monitoring.

Do endoscopy if “danger signs” present.

Tx w/ behav mod 1st, then antacids, H2 block, PPI.

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7
Q

GERD Indications for surgery?

A

bleeding, stricture, Barrett’s, incompetent LES, max dose PPI w/ still sxs, or no want meds.

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8
Q

When to suspect Boerhaave’s or Esophageal Rupture

A

If hematemesis (blood occurs after vomiting, w/ subQ emphysema). Can see pleural effusion w/ ↑amylase

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9
Q

Pt presents with hematemesis. Next?

A

CXR, gastrograffin esophagram. NO endoscopy

Tx? surgical repair if full thickness

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10
Q

Gastric Varices pres

A

If gross hematemesis unprovoked in a cirrhotic w/ pHTN.

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11
Q

Pt with hematemesis and hypovolemic shock

A

do ABCs, NG lavage, medical tx w/ octreotide or SS. Balloon tamponade only if you need to stablize for transport

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12
Q

Tx of choice for bad varices?

A

Endoscopic sclerotherapy or banding

*Don’t prophylactically band asymptomatic varices. Give BB.

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13
Q

If progressive dysphagia/wgt loss.

A

Esophageal carcinoma

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14
Q

Esophageal carcinoma, two types and how we know which is which

A

Squamous cell in smoker/drinkers in the middle 1/3.

Adeno in ppl with long standing GERD in the distal 1/3.

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15
Q

Best 1st test if you think esophageal cancer?

A

barium swallow, then endoscopy w/ bx, then staging CT.

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16
Q

Acid reflux pain after eating, when laying down

A

Hital hernia

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17
Q

Type 1 vs 2 hiatal hernia

A

Type 1: Sliding. GE jxn herniates into thorax. Worse for GERD. Tx sxs.

Type 2: Paraesophageal. Abd pain, obstruction, strangulation Tx with surgery

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18
Q

Gastric ulcer pres

A

Mid epigastric pain worse with eating. H.Pylori and NSAIDs and steroids big hitters on this.

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19
Q

Workup for potential gastric ulcer:

A

Double-contrast barium swallow-punched out lesion w/ reg margins.

EGD w/ bx can tell H. pylori, malign, benign.

Surgery if lesion persists after 12wks of treatment.

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20
Q

Most common gastric cancer

A

Adeno. Especially in Japan

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21
Q

Krukenberg tumor

A

Ovarian tumor often met from the stomach

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22
Q

Virchow’s nodes

A

L supraclavicular fossa, met from gastric

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23
Q

Lymphoma with gastric cancer

A

2/2 HIV

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24
Q

Blummer’s shelf mets

A

From gastric, feel on DRE

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25
Q

Sister Mary Joseph node

A

Umbilical node indicating mets

26
Q

MALT-Lymphoma caused by

A

H Pylori

27
Q

What is Mentrier’s Disease

A

protein losing enteropathy, enlarged rugae.

28
Q

Gastric varices caused by:

A

Splenic vein thrombosis

29
Q

Dieulafoy’s:

A

massive hematemesis

mucosal artery erodes into stomach. It’ll poke it’s ugly head in and out, you’ll see a patient with repeated history of negative endos but has hematemesis randomly

30
Q

If the mid epigastric pain improves with eating, what do we think?

A

Duodenal ulcer

31
Q

How do we diagnose duodenal ulcers?

A

blood, stool or breath test for H. pylori but endoscopy w/ biopsy (CLO test) is best b/c it can also exclude cancer.

32
Q

Tx for duodenal ulcers

A

PPI, clarithromycin & amoxicillin for 2wks. Breath or stool test can be test of cure.

33
Q

Cause of duodenal ulcer

A

95% 2/2 H. Pylori

34
Q

If you have that mid epigastric pain and are assuming duodenal ulcers but they don’t resolve, what could it be?

A

ZE syndrome.

Do a Secretin Stim Test (find inapprop high gastrin)

Treat with Surgical resection of pancreatic/duodenal tumor

35
Q

A patient has bilious vomiting and post-prandial pain. Recently lost 200lbs on “Biggest Loser”.

A

SMA Syndrome

3rdpart of duodenum compressed by AA and SMA

Treat by restoring weight/nutrition. Can do Roux-en-Y

36
Q

Most common causes of pancreatitis?

A

Gallstones and EtOH

37
Q

How do we diagnose pancreatitis?

A

Increase amylase and lipase, CT is best imagine technique

38
Q

Treatment of pancreatitis

A

NG suction, NPO, IV rehydration and observation

39
Q

Bad prognostic factors for pancreatitis (9)

A 
old
WBC over 16K
Glc over 200
LDH over 350
AST over 250
drop in HCT
decr calcium
acidosis
hypox
40
Q

Complications (4) for pancreatitis

A

pseudocyst (no cells!), hemorrhage, abscess, ARDs

41
Q

Steatorrhea

A

Think chronic pancreatitis

42
Q

How can chronic pancreatitis lead to gastric varices?

A

Can cause a splenic vein thrombosis leading to gastric varices

43
Q

Adenocarcinoma in he head of the pancreas presents how

A

Courvoisier’s sign: Large non-tender GB, itching, jaundice

44
Q

Trousseau’s sign

A

Migratory thrombophlebitis linked to pancreatic cancer

45
Q

Diagnosing pancreatic cancer

A

EUS and FNA bx

46
Q

When do we treat pancreatic cancer with a Whipple?

A

thrombophlebitisoutside abdomen, no extension into SMA or portal vein, no liver mets, no peritoineal mets.

47
Q

How does an insulinoma present?

A

sxs (sweat, tremors, hunger, seizures) + BGL

48
Q

Presentation of glucagonoma

A

Hyperglycemia, diarrhea, weight-loss

49
Q

Characteristic rash of glucagonoma?

A

necrolytic migratory erythema

50
Q

Presentation of a somatistatinoma

A

Commonly malignant. see malabsorption, steatorrhea, ectfrom exocrine pancreas malfxn

51
Q

Presentation of a VIPoma

A

Watery diarrhea, hypokalemia, dehydration, flushing.

Looks very similar to a carcinoid tumor

52
Q

Treat VIPoma?

A

Octreotide

53
Q

Presentation of Acute cholecystitis

A
  • RUQ pain to the back
  • N/V
  • Fever
  • Worse with fatty foods
54
Q

Best diagnosis and tx for acute cholecystitis

A

U/S and treat with cholecystectomy. If unstable, do a percutaneous cholecystostomy

55
Q

Choledocolithiasis presentation

A
  • RUQ pain
  • High bili
  • Alk Phos
56
Q

Dx/Tx for choledoco

A

U/S will show CBD stone

Treat with Chole +/- ERCP to remove stone

57
Q

Pres for ascending cholangitis

A
  • RUQ pain
  • Fever
  • Jaundice
  • Low BP
  • AMS
58
Q

Tx for ascending cholangitis

A

Fluids and broad spectrum Abx.ERCP and stone removal

59
Q

Type 1 vs Type 5 choledochal cysts

A

1: Fusiform dilation of the CBD, treat with excision
5: Caroli’s Disease. Cysts in the intrahepatic ducts. Need a liver transplant

60
Q

Cholangiocarcinoma is super rare. What puts someone at risk?

A

Primary sclerosing cholangitis (UC), liver flukes and thorothrast exposure.

Tx w/ surgery +/-radiation.

Surgical Recall (15 decks)

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