Endo Surgery Flashcards
indications for hyperpth surgery
serum ca levels >12 mg/dl
elevated urinary ca >400 mg/24 hrs
decreased bone density >2 sd
elevated alp
preoperative imaging prior to hyperparathyroid surgery
uts sestamibi scintigraphy (technetium 99) ct scan (for mediastinal adenomas) mri angiography
structures that can be missed in parathyroid uts
posterior area in tracheo-esophaeal groove
anterior mediastinum due to sternal bone
surgical approaches for hyperpth
bilateral cervical exploration
minimally invasive parathyroid surgery for adenomas
indications for surgery in parathyroid cancer
ca >14 mg/dl
vocal cord paralysis
local recurrence after resection
surgery for parathyroid cancer
wide excision with thyroid lobectomy (ipsilateral)
surgical approaches for thyroid
subtotal thyroidectomy lobectomy: benign total thyroidectomy: malignancy laparoscopic thyroidectomy robot assisted thyroidectomy
diagnostic procedures for adrenals
uts
ct scan: procedure of choice, aldosteronomas
mri: pheochromocytomas
isotope scan, angiography and percutaneous biopsy
indications for surgery for incidentaloma
hormonally active or >6 cm or malignant
treatment for hyperaldosteronism
aldosterone producing adrenocortical adenoma: unilateral adrenalectomy
idiopathic hyperaldosteronism: spironolactone or unilateral adrenalectomy
treatment for acth independent cushings
unilateral adrenalectomy
treatment for acth dependent cushings
excision of primary tumor through tss
treatment for failed surgery of cushings
bilateral adrenalectomy
treatment for pheochromocytoma
laparoscopic adrenalectomy
+ chemo if malignant
curative treatment for insulinoma
surgery via enucleation
test of choice to confirm insulinoma
72hr fasting test
other surgeries for insulinoma
distal pancreatectomy
whipple’s procedure
splenectomy when tumor encroaches on most distal portion of pancreas
what is removed in whipple’s procedure
head of the pancreas, distal stomach, duodenum, gallbladder, common hepatic duct
what is zollinger ellison syndrome
noted jejunal peptic ulcer disease in association with gastric hypersecretion and islet cell tumors of the pancreas
peptic ulcerations are commonly found in the ___
proximal duodenum
treatment for gastrinoma
PPI
enucleation of pancreatic head
distal pancreatectomy = body and tail
clinical presentation of glucagonoma
necrolytic migratory erythema
treatment for glucagonoma
unresectable :(
total parenteral nutrition and ocreotide for palliation
clinical features of vip tumor
elevated vip + secretory diarrhea
treatment for vip tumor
ocreotide or surgery
clinical features of somastatinoma
steatorrhea
cholelithiasis
t2dm
hypochlorhydria
treatment for somstatinoma
surgical resection
classic syndrome of carcinoid disease
diarrhea, flushing, localized or generalized pain, valvular heart disease
usual location of argentaffin cell tumors
appendix and small intestines
diagnosis for carcinoid disease
5-hiaa in 24hr urine sample
somatostatin receptor scintigraphy
medical treatment for carcinoid disease
ocreotide and interferon alpha
chemotherapy for carcinoid disease
reserved for malignant/advanced tumors but still poor efficacy
primary treatment for carcinoid disease
surgery
resection even with metastasis to ln can be curative
appendix surgery for carcinoid disease
< 2cm: appendectomy
> 2cm: cecectomy or right hemicolectomy
colorectal surgery for carcinoid disease
<1 cm: local excision
>1 cm: formal cancer resection, abdominoperineal resection
surgery for gastric tumors in carcinoid disease
<2 cm: endoscopic removal
>2 cm: partial or total gastrectomy with nodal excision
surgery for duodenal cancers in carcinoid disease
<1 cm: endoscopic
>1 cm: open, whipple’s procedure
other procedures for carcinoid disease
lung and bronchial resection
partial hepatectomy and liver transplant
valvular heart replacement
definition of men 1
occurence of neoplasms in at least 2 endo tissues (parathyroid, endocrine pancreas, pituitary, thyroid, adrenals)
hyperparathyroidism and gastrinoma* or insulinoma
treatment for men 1
total parathyroidectomy with intramuscular autotranspalntation or subtotal 3 1/2 gland removal
pancreaticoduodenal resesction if >2 cm for net
t/f insulinomas are better because they are benign, while gastrinomas are usually malignant
true
prinipal feature of both types of men2
medullary thyroid carcinoma
clinical features of men2a
pheochromocytoma and hyperparathyroidism
clinical features of men2b
neuromata, prognathism skeletal abnormalities marfanoid habitus ganglioneuromas in gi forming megacolon NO HYPERPARATHYROIDISM
men2 treatment
- total thyroidectomy with central neck node dissection for mtc
- ca/pentagastrin stimulation test
- bilateral adrenalectomy for pheochromocytoma
- subtotal or total parathyroidectomy
indications for bariatric surgery
> 40 bmi with failed adequate exercise and diet program
obese patients with related conditions (hpn, dm, osa)
classifications of bariatric surgery
malabsorptive and restrictive (page 6)
malabsorptive types of bariatric surgeries
biliopancreatic diversion (stomach resection, duodenum and jejunum bypass) jejunoileal bypass endoluminal sleeve (incision free)
restrictive types of bariatric surgeries
vertical band gastroplasty (staple) gastric banding (gastric pouch + narrow outlet, safest) sleeve gastrectomy (stomach reduction, irreversible) intragastric balloon
side effects of biliopancreatic diversion
malabsorption and malnutrition
53 kg weight loss in 3 years
side effects of jejunoileal bypass
no longer performed due to bacterial enteritis & arthritis-dermatitis syndrome
effects of endoluminal sleeve
30% weight loss in 6 months
can be a precursor to another bariatric procedure
safe to use in t2dm
effects of sleeve gastrectomy
30-50% weight loss in 6-12 mos
dumping syndrome is less likely to occur due to pyloric preservation
effects of intragastric balloon
reduction of 5-9 in bmi within 6 mos
can be left for 6 mos and be precuursor for another bariatric surgery
combined malabsorptive and restrictive type of bariatric surgery
roux-en-y gastric bypass - divides proximal stomach and connects to distal limb of small bowel
effects of roux en y surgery
greater and faster weight loss
dumping syndrome can help patient avoid high calorie sweets
side effects of roux en y
decreased absorption of iron, ca, and minerals = anemia and osteoporosis
nutritional supplementation post-bariatric surgery
page 7
complications after bariatric surgery
- gallstone formation = prophylactic cholecystectomy
- gastric dumping syndrome
- site leakages
- incisional hernnia and operative-site infections
excess weight loss for different bariatric procedures
agb: 46.2%
roux en y: 59.5%
biliopancreatic diversion: 63.3%
