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05 Endo > Endo Surgery > Flashcards

Endo Surgery Flashcards

1
Q

indications for hyperpth surgery

A

serum ca levels >12 mg/dl
elevated urinary ca >400 mg/24 hrs
decreased bone density >2 sd
elevated alp

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2
Q

preoperative imaging prior to hyperparathyroid surgery

A 
uts
sestamibi scintigraphy (technetium 99)
ct scan (for mediastinal adenomas)
mri
angiography
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3
Q

structures that can be missed in parathyroid uts

A

posterior area in tracheo-esophaeal groove

anterior mediastinum due to sternal bone

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4
Q

surgical approaches for hyperpth

A

bilateral cervical exploration

minimally invasive parathyroid surgery for adenomas

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5
Q

indications for surgery in parathyroid cancer

A

ca >14 mg/dl
vocal cord paralysis
local recurrence after resection

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6
Q

surgery for parathyroid cancer

A

wide excision with thyroid lobectomy (ipsilateral)

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7
Q

surgical approaches for thyroid

A 
subtotal thyroidectomy
lobectomy: benign
total thyroidectomy: malignancy
laparoscopic thyroidectomy
robot assisted thyroidectomy
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8
Q

diagnostic procedures for adrenals

A

uts
ct scan: procedure of choice, aldosteronomas
mri: pheochromocytomas
isotope scan, angiography and percutaneous biopsy

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9
Q

indications for surgery for incidentaloma

A

hormonally active or >6 cm or malignant

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10
Q

treatment for hyperaldosteronism

A

aldosterone producing adrenocortical adenoma: unilateral adrenalectomy
idiopathic hyperaldosteronism: spironolactone or unilateral adrenalectomy

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11
Q

treatment for acth independent cushings

A

unilateral adrenalectomy

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12
Q

treatment for acth dependent cushings

A

excision of primary tumor through tss

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13
Q

treatment for failed surgery of cushings

A

bilateral adrenalectomy

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14
Q

treatment for pheochromocytoma

A

laparoscopic adrenalectomy

+ chemo if malignant

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15
Q

curative treatment for insulinoma

A

surgery via enucleation

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16
Q

test of choice to confirm insulinoma

A

72hr fasting test

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17
Q

other surgeries for insulinoma

A

distal pancreatectomy
whipple’s procedure

splenectomy when tumor encroaches on most distal portion of pancreas

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18
Q

what is removed in whipple’s procedure

A

head of the pancreas, distal stomach, duodenum, gallbladder, common hepatic duct

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19
Q

what is zollinger ellison syndrome

A

noted jejunal peptic ulcer disease in association with gastric hypersecretion and islet cell tumors of the pancreas

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20
Q

peptic ulcerations are commonly found in the ___

A

proximal duodenum

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21
Q

treatment for gastrinoma

A

PPI
enucleation of pancreatic head
distal pancreatectomy = body and tail

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22
Q

clinical presentation of glucagonoma

A

necrolytic migratory erythema

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23
Q

treatment for glucagonoma

A

unresectable :(

total parenteral nutrition and ocreotide for palliation

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24
Q

clinical features of vip tumor

A

elevated vip + secretory diarrhea

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25
Q

treatment for vip tumor

A

ocreotide or surgery

26
Q

clinical features of somastatinoma

A

steatorrhea
cholelithiasis
t2dm
hypochlorhydria

27
Q

treatment for somstatinoma

A

surgical resection

28
Q

classic syndrome of carcinoid disease

A

diarrhea, flushing, localized or generalized pain, valvular heart disease

29
Q

usual location of argentaffin cell tumors

A

appendix and small intestines

30
Q

diagnosis for carcinoid disease

A

5-hiaa in 24hr urine sample

somatostatin receptor scintigraphy

31
Q

medical treatment for carcinoid disease

A

ocreotide and interferon alpha

32
Q

chemotherapy for carcinoid disease

A

reserved for malignant/advanced tumors but still poor efficacy

33
Q

primary treatment for carcinoid disease

A

surgery

resection even with metastasis to ln can be curative

34
Q

appendix surgery for carcinoid disease

A

< 2cm: appendectomy

> 2cm: cecectomy or right hemicolectomy

35
Q

colorectal surgery for carcinoid disease

A

<1 cm: local excision

>1 cm: formal cancer resection, abdominoperineal resection

36
Q

surgery for gastric tumors in carcinoid disease

A

<2 cm: endoscopic removal

>2 cm: partial or total gastrectomy with nodal excision

37
Q

surgery for duodenal cancers in carcinoid disease

A

<1 cm: endoscopic

>1 cm: open, whipple’s procedure

38
Q

other procedures for carcinoid disease

A

lung and bronchial resection
partial hepatectomy and liver transplant
valvular heart replacement

39
Q

definition of men 1

A

occurence of neoplasms in at least 2 endo tissues (parathyroid, endocrine pancreas, pituitary, thyroid, adrenals)

hyperparathyroidism and gastrinoma* or insulinoma

40
Q

treatment for men 1

A

total parathyroidectomy with intramuscular autotranspalntation or subtotal 3 1/2 gland removal

pancreaticoduodenal resesction if >2 cm for net

41
Q

t/f insulinomas are better because they are benign, while gastrinomas are usually malignant

A

true

42
Q

prinipal feature of both types of men2

A

medullary thyroid carcinoma

43
Q

clinical features of men2a

A

pheochromocytoma and hyperparathyroidism

44
Q

clinical features of men2b

A 
neuromata, prognathism
skeletal abnormalities
marfanoid habitus
ganglioneuromas in gi forming megacolon
NO HYPERPARATHYROIDISM
45
Q

men2 treatment

A
  • total thyroidectomy with central neck node dissection for mtc
  • ca/pentagastrin stimulation test
  • bilateral adrenalectomy for pheochromocytoma
  • subtotal or total parathyroidectomy
46
Q

indications for bariatric surgery

A

> 40 bmi with failed adequate exercise and diet program

obese patients with related conditions (hpn, dm, osa)

47
Q

classifications of bariatric surgery

A

malabsorptive and restrictive (page 6)

48
Q

malabsorptive types of bariatric surgeries

A 
biliopancreatic diversion (stomach resection, duodenum and jejunum bypass)
jejunoileal bypass
endoluminal sleeve (incision free)
49
Q

restrictive types of bariatric surgeries

A 
vertical band gastroplasty (staple)
gastric banding (gastric pouch + narrow outlet, safest)
sleeve gastrectomy (stomach reduction, irreversible)
intragastric balloon
50
Q

side effects of biliopancreatic diversion

A

malabsorption and malnutrition

53 kg weight loss in 3 years

51
Q

side effects of jejunoileal bypass

A

no longer performed due to bacterial enteritis & arthritis-dermatitis syndrome

52
Q

effects of endoluminal sleeve

A

30% weight loss in 6 months

can be a precursor to another bariatric procedure
safe to use in t2dm

53
Q

effects of sleeve gastrectomy

A

30-50% weight loss in 6-12 mos

dumping syndrome is less likely to occur due to pyloric preservation

54
Q

effects of intragastric balloon

A

reduction of 5-9 in bmi within 6 mos

can be left for 6 mos and be precuursor for another bariatric surgery

55
Q

combined malabsorptive and restrictive type of bariatric surgery

A

roux-en-y gastric bypass - divides proximal stomach and connects to distal limb of small bowel

56
Q

effects of roux en y surgery

A

greater and faster weight loss

dumping syndrome can help patient avoid high calorie sweets

57
Q

side effects of roux en y

A

decreased absorption of iron, ca, and minerals = anemia and osteoporosis

58
Q

nutritional supplementation post-bariatric surgery

A

page 7

59
Q

complications after bariatric surgery

A
  • gallstone formation = prophylactic cholecystectomy
  • gastric dumping syndrome
  • site leakages
  • incisional hernnia and operative-site infections
60
Q

excess weight loss for different bariatric procedures

A

agb: 46.2%
roux en y: 59.5%
biliopancreatic diversion: 63.3%

05 Endo (16 decks)

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