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

Emma Holliday for Surgery: Part VI Flashcards

1
Q

If we see an inflammatory bowel issue involving the terminal ileum, think:

A

Crohn’s Disease.

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2
Q

Crohn’s disease most closely mimics

A

Appendicitis

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3
Q

We see this lab finding most readily with Crohn’s patients

A

Fe deficiency anemia

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4
Q

Inflammatory bowel disease continuously involving the rectum =

A

UC

RARELY get some ileal backwash, but never any higher than that

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5
Q

UC causes an increased risk for:

A

Primary Sclerosing Cholangitis

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6
Q

PSC leads to increased chance of

A

Cholangial CA

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7
Q

Crohn’s is likely to cause a ______. Tx with _____.

A

Fistula. Give Metronidazole

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8
Q

Granulomas on bx =

A

Crohn’s

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9
Q

Tramnsmural inflammation

A

Crohn’s

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10
Q

Cure for UC

A

Colectomy

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11
Q

Smokers have a lower risk of developing _____ and a higher risk for ______.

A

UC. Smokers have a higher risk for Crohn’s

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12
Q

Highest risk of Colon CA seen in _____ patients

A

UC. Another reason to get a colectomy!

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13
Q

UC is associated with this lab finding

A

p-ANCA

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14
Q

How do we treat IBD

A

ASA, sulfasalazine to maintain remission. Corticosteroids to induce remission. For Crohn’s, give Metro for ANY ulcers or abscess to prevent fistula. Give Azathrioprine for Crohn’s, and 6MP with methotrexate for severe symptomatic disease

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15
Q

Are the diverticula seen in diverticulitis false or true diverticulae?

A

False, believe it or not.

Only outpocketings of the mucosa

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16
Q

Cause of diverticulae

A

2/2 low fiber diet in areas of weakness where blood vessels penetrate and leads to bleeding

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17
Q

What makes diverticulitis?

A

Diverticulum becomes obstructed and forms abscess/perforates

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18
Q

Sx’s of diverticulitis

A

LLQ pain, constipation, diarrhea

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19
Q

Imaging for diverticulitis

A

Look for free air, CT is best to evaluate for abscess. NO BARIUM ENEMA

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20
Q

Tx for diverticulitis

A

NPO, NG suction, IVF, broad spectrum abx, and pain management

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21
Q

Do we do a colonoscopy for diverticulitis?

A

Yes, 4-6 weeks later

22
Q

When is surgery indicated for diverticulitis?

A

Multiple episodes, age over 50.

Elective better than emergency so we can do a primary anastamosis!

23
Q

Risk factors for colorectal cancer

A

Genetics

UC

24
Q

Genetic risk factors for colorectal CA

A 
AFP
Lynch
HNPCC
Gardners
Cowdens
25
Q

GI symptoms of Colorectal cancer based on location

A

Right sided = bleeding
Left sided = obstruction
Rectal Cancer = Pain/fullness, bleeding, obstruction

26
Q

Workup for colorectal cancer

A

DRE, transrectal US (depth of invasion), COLONOSCOPY

CEA to measure recurrance, CT for staging

27
Q

Treatment for colon cancer

A

Remove affected segment and chemo if node +

28
Q

Treatment for rectal cancer

A

Upper/Middle 1/3 = Resect area

Lower 1/3 = APR = Remove sphincter and give permanent colostomy

29
Q

Do we screen for AAA?

A

Yes.

Men 65-75 who have EVER smoked. Do abdominal U/S

30
Q

Symptoms of AAA

A

Pulsatile abdominal mass

31
Q

Treatment for AAA

A

Conservatively if less than 5cm and asymptomatic. Monitor every 3-12 months.

Surgery if greater than 5 cm or after observing you notice it growing 4mm per year

32
Q

Symptoms of ruptured AAA

A

Severe sudden abdominal flank or back pain, shock, tender pulsatile mass

50% will die before getting to hospital

33
Q

1 cause of death post-op from AAA

A

MI

34
Q

Other post-op complications and symptoms from AAA

A

Bloody diarrhea = ischemic colitis

Weakness, decreased pain with preserved vribration and position - ASA syndrome

1-2 years later with brisk bleeding GI - Aortoenteric fistula

35
Q

When do I suspect an acute mesenteric ischemia?

A

Acute Abd pain in a pt with A-Fib, subtherapeutic on warfarin, or pt s/p high dose vasoconstrictors (shock, bypass)

36
Q

What do I do if suspecting mesenteric ischemia?

A

Angiography of SMA/IMA

Tx with embolectomy. If thrombus or aortomesenteric, do a bypass.

37
Q

What defines a chronic mesenteric ischemia?

A

Slow progressing stenosis of 2.5 vessels (Celiac, SMA, or IMA)

38
Q

Sxs of chronic mesenteric ischemia

A

Severe mid-epigastric pain after eating, food fear and weight loss. “Pain out of proportion to exam”

39
Q

How do we diagnose chronic mesenteric ischemia

A

Duplex or angiography

40
Q

How do we treat chronic mesenteric ischemia

A

Aortomesenteric bypass or transaortic mesenteric endarterectomy

41
Q

5 P’s of arterial occlsuion

A 
Pain
Pallor
Pulseless
Paresthesia
Paralysis
42
Q

Treatment for arterial occlusion

A

–Tx w/ immediate heparin + prepare for surgery.
–Surgery (embolectomy or bypass) done w/in 6hrs to avoid loss.
–Thrombolytics may be possible if: no surg in last 2wks, hemorrhagic stroke.

43
Q

Complications of repairing occlusion

A

–Complications = compartment syndrome during reperfusion period –> do fasciotomy watch for myoglobinuria.

44
Q

What is claudication?

A

Pain in the butt, calf, thigh upon exertion, improved with rest

45
Q

What is the best test for claudication

A

Ankle-Brachial index. More than 1 is normal.

  • Claudication and ulcers: 0.4-0.8, use medical management
  • Limb ischemia - 0.2-0.4, surgery is indicated
  • Gangrene Less than 0.2 may require amputation
46
Q

How do we diagnose a DVT?

A

Duplex U/S and check for PE

47
Q

How do we treat a DVT

A

Heparin, then overlap with Warfarin for 5 days, then continue warfarin for 3-6 months

48
Q

Complications of DVT

A

Post-phlebotic syndrome = chronic valvular incompetence, cyanosis and edema

49
Q

PE indications

A

Random signs = right heart strain on EKG, sinus tach, decr vascular markings on CXR, wedge infarct, ABG w/ low CO2 and O2.

50
Q

Treatment for PE

A

If suspected, give heparin 1st! Then work up w/ V/Q scan, then spiral CT. Pulmonary angiography is gold standard.

Tx w/ heparin warfarin overlap. Use thrombolyticsif severe but NOT if s/p surgery or hemorrhagic stroke. Surgical thrombectomy if life threatening.

51
Q

When do we use an IVC filter for PE

A

IVC filter if contraindications to chronic coagulation.

Surgical Recall (15 decks)

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