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

Emma Holliday for Surgery: Part V Flashcards

1
Q

What hepatitis do we suspect with AST being 2x the ALT?

A

Alcoholic hepatitis that is rversible

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2
Q

If ALT > AST and very high (in the 1000s) and our patient shows signs of hepatitis what do we suspect?

A

Viral hepatitis

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3
Q

If AST and ALT are high s/p hemorrhage, surgery or sepsis, what do we suspect?

A

Shock to the liver due to hypovolemia

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4
Q

TIPS relieves portal HTN, but…

A

Worsens your hepatic encephalopathy.

Tx with lactulose to help rid the body of ammonia

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5
Q

Risk factors for hepatocellular carcinoma?

A

Chronic Hep B carrier > hep C. Cirrhosis for any reason also an indicator, as is carbon tetrachloride or aflatoxin exposure

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6
Q

How do we diagnose hepatocellular carcinoma?

A

High AFP in 70% of folks. Also can use a CT or MRI

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7
Q

How can we treat hepatocellular carcinoma?

A

Can surgically remove solitary mass, use rads or cryoablation for pallation of multiple ones.

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8
Q

We have a female who is on an OCP. We palpate an abdominal mass or maybe she has a spontaneous rupture leading to hemorrhagic shock.

What do we suspect?

A

Hepatic adenoma

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9
Q

If we suspect a hepatic adenoma, how do we diagnose it?

A

U/S or MRI

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10
Q

How do we treat hepatic adenoma?

A

Discontinue OCPs. Resect if large or pregnancy is desired.

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11
Q

This is the 2nd most common benign liver tumor, women more likely to get than men, but it is less likely to rupture:

A

Focal nodular hyperplasia

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12
Q

How do we treat focal nodular hyperplasia?

A

No tx is needed

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13
Q

Most common bugs to cause bacterial abscess in the liver:

A

E.coli
Bacterioides
Enterococcus

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14
Q

How do we treat a bacterial abscess?

A

Surgical drainage and IV antibiotics

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15
Q

RUQ pain + profuse sweating + rigors + palpable liver =

A

Entamoeba histolytica

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16
Q

How do we treat entamoeba histolytica?

A

Metronidazole.

DO NOT DRAIN IT

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17
Q

Patient from Mexico presents with RUQ pain and large liver cysts found on U/S =

A

Echinococcus

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18
Q

How is Echinococcus transmitted?

A

Hydatic cyst parasite from dog feces

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19
Q

Lab findings for echinococcus

A

Eosinophilia

+ Casoni skin test

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20
Q

How do we treat echinococcus?

A

Albendazole and surgery to remove the entire cyst. Rupture can lead to anaphylaxis

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21
Q

After a splenectomy we worry about a lot of things.

What do we do if someone gets thrombocytosis > 1 million post op?

A

Give aspirin

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22
Q

What prophylactic preparation will we give our patients prior to splenectomy or when their spleen is for whatever reason toast?

A 
Prophylactic PCN
Vaccines:
 - S. Pneumo
 - H. Flu
 - N Meningitidis
23
Q

When do we consider ITP on our differential?

A
  • Isolated event of thrombocytopenia
  • Bleeding gums, petechiae, nosebleeds
  • Decreased platelet count
  • Increased megakaryocytes in bone marrow
  • Spleen NOT enlarged
24
Q

How do we treat ITP

A

Steroids first. If relapse, splenectomy.

25
Q

How will hereditary spherocytosis present?

A

See sxs of hemolytic anemia like jaundice and (4 labs) ( increased indirect bili, LDH, decreased haptoglobin, elevated retic count)

26
Q

Smear of spherocytosis

A
  • Spherocytes

- Positive osmotic fragility test

27
Q

Pt’s with hereditary spherocytosis are prone to:

A

Gallstones

28
Q

Tx for hereditary spherocytosis

A

Splenectomy

29
Q

When do we consider traumatic spleen rupture?

A

Lower left rib fracture and intra abdominal hemorrhage. Can have Kehr’s sign (irritates left diaphragm)

30
Q

Classic presentation of appendicitis:

A

Umbilical pain that travels to RLQ with N/V

31
Q

If the appendix perforates or you suspect abscess formation, what do you do?

A

Drain, give abx to cover E.Coli and bacteroides, and do interval appendectomy

32
Q

Number one site of a carcinoid tumor:

A

Appendix

33
Q

Carcinoid tumor symptoms?

A

Diarrhea and wheezing

34
Q

When do carcinoid tumors occur?

A

When mets to the liver due to first pass metabolism

35
Q

3 D’s of carcinoid tumor

A

Diarrhea
Dementia
Dermatitis

36
Q

What surgery options do we have for a carcinoid tumor

A

Hemicolectomy

Appendectomy

37
Q

When do we do a hemicolectomy on a carcinoid tumor?

A

If > 2 cm, @ base of the appendix, or with positive nodes

38
Q

When do we do an appendectomy on a carcinoid?

A

If it is anything other than hemicolectomy qualifiers (If > 2 cm, @ base of the appendix, or with positive nodes)

39
Q

5 biggest suspect conditions that make us worried about SBO

A 
Hernia
Prior GI surgeries leading to adhesions
Cancer
Intussusception
IBD
40
Q

Sx’s associated with SBO

A

Pain, constipation, obstipation, vomiting

41
Q

First step in diagnosing SBO

A

Upright CXR to look for free air. CT can show point of obstruction

42
Q

Treatment for SBO

A

IVF, NG tube.

Only do surgery if there are peritoneal signs, increased WBC, and/or no improvement within 48 hours

43
Q

Two locations we can get a volvulus

A

Cecal or sigmoid

44
Q

Treatment for volvulus

A

Decompression from below if not strangulated. Otherwise, need surgical removal and colostomy

45
Q

Post-op Ileus common due to these two scenarios:

A

HypoK (replete them) and opiates

46
Q

Dx findings for post-op ileus

A

Dilated loops of small bowel with air fluid level

47
Q

Treatment for post-op ileus

A

Surgery for perforation. Give lactulose and erythromycin

48
Q

What is Ogilvie’s syndrome?

A

See massive colonic distension. If > 10cm, need decompression with NG tube and Neostigmine (watch for bradycardia) or colonoscopic decompression

49
Q

Umbilical hernias adult vs kiddos

A

In kiddos they close spontaneously by age 2. In adults, we see them 2/2 obesity, ascites, or pregnancy

50
Q

Indirect hernia defined as

A

Through the inguinal ring LATERAL to the epigastric vessels in the spermatic cord. R more often than left, and usually 2/2 to congenital issues like a patent proc vaginalis

51
Q

Direct hernia defined as

A

Through hasselback’s triangle MEDIAL to epigastric vessels, more often through time and acquired weakness

52
Q

Femoral hernia most often seen in:

A

Women.

53
Q

Treatment for hernias?

A

Emergent surgical repair if incarcerated to avoid strangulation. Elective if reducible

Surgical Recall (15 decks)

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