Endo Surgery Flashcards by CABS Cabanela

indications for hyperpth surgery

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

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preoperative imaging prior to hyperparathyroid surgery

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

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structures that can be missed in parathyroid uts

posterior area in tracheo-esophaeal groove

anterior mediastinum due to sternal bone

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surgical approaches for hyperpth

bilateral cervical exploration

minimally invasive parathyroid surgery for adenomas

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indications for surgery in parathyroid cancer

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

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surgery for parathyroid cancer

wide excision with thyroid lobectomy (ipsilateral)

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surgical approaches for thyroid

subtotal thyroidectomy
lobectomy: benign
total thyroidectomy: malignancy
laparoscopic thyroidectomy
robot assisted thyroidectomy

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diagnostic procedures for adrenals

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

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indications for surgery for incidentaloma

hormonally active or >6 cm or malignant

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treatment for hyperaldosteronism

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

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treatment for acth independent cushings

unilateral adrenalectomy

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treatment for acth dependent cushings

excision of primary tumor through tss

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treatment for failed surgery of cushings

bilateral adrenalectomy

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treatment for pheochromocytoma

laparoscopic adrenalectomy

+ chemo if malignant

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curative treatment for insulinoma

surgery via enucleation

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test of choice to confirm insulinoma

72hr fasting test

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other surgeries for insulinoma

distal pancreatectomy
whipple’s procedure

splenectomy when tumor encroaches on most distal portion of pancreas

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what is removed in whipple’s procedure

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

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what is zollinger ellison syndrome

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

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peptic ulcerations are commonly found in the ___

proximal duodenum

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treatment for gastrinoma

PPI
enucleation of pancreatic head
distal pancreatectomy = body and tail

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clinical presentation of glucagonoma

necrolytic migratory erythema

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treatment for glucagonoma

unresectable :(

total parenteral nutrition and ocreotide for palliation

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clinical features of vip tumor

elevated vip + secretory diarrhea

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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%