EOR Deck Flashcards
what type of hernia is commonly present at birth?
umbilical
surgery consult if persists > 2 years of age
direct vs indirect relationship to inferior epigastric artery
MD don’t LIe
direct hernia - medial to IEA
indirect hernia - lateral to IEA
INdirect goes IN the deep inguinal ring & superficial ring but Direct Doesn’t
complications of hernias
Incarcerated - can’t be reduced but still receives blood supply
Strangulated - blood supply is cut off (medical emergency)
elevation in which is more sensitive for pancreatitis
lipase (3x ULN)
stays elevated longer compared to amylase which tends to be transient (48-72 hours)
what is likely seen on CMP in pancreatitis?
hypocalcemia
** calcium soaks around pancrease (akak from hypercalcemia) diminish tot
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Truama
Steroids
Mumps/Malignancy
Autoiummune
Scorpion sting
Hyperlipidema
Hypercalcemia
ERCP !!!
Drugs (sulfa, protease inhibitors, HCTZ, GLP-1s)
ranson criteria for severe pancreatitis
used to predict severity of acute pancreatitis (3+ criteria means severe)
MC site of anal fissure
posterior midline
guidelines for bariatric surgery
BMI > 40 (100 lb over ideal body weight)
BMI > 35 w/ medical problem sequelae of obesity
Failed other surgical programs → must be psychologically stable & able to follow post-op instructions
Obesity NOT EXPLAINED by medical organic cause (i.e. endocrine)
most likely acid-base disturbance to develop postoperatively from SBO
metabolic alkalosis (hypochloremic, hypokalemic)
2/2 to volume contraction + gastric fluid loss
MC location for diverticula
sigmoid colon (2/2 to increased intraluminal pressure)
Painless rectal bleeding
diverticulosis
dx imaging of choice for diverticulitis
CT w/ Contrast
will see fat stranding and bowel thickening
TX of choice for diverticulitis
augmentin /bactrim
OR
cipro + metronidazole
indicator of unresectable gastric cancer
- encasement of the hepatic artery
- vascular involvement of aorta, hepatic artery or proximal splenic artery
- distant metastasis
when do you usually experience pain from duodenal ulcers?
2-5 hours after meals
risk factor for pancreatic cancer
tobacco use
where do internal hemorrhoids arise from?
superior hemorrhoidal cushion
what are external hemorrhoids assoc with anatomically?
inferior hemorrhoidal plexus
where do internal & external hemorrhoids drain into?
internal pudendal veins
anatomy assoc with perirectal abscess?
perianal dermis
how many episodes a week of GERD is considered severe & requires immediate PPI use
> 2-3x week
grade I hepatic encephalopathy
disordered sleep, depression, irritability, mild cognitive fx
grade II hepatic encephalopathy
lethargy, confusion, personality changes, disordiention, asterisxis
grade III hepatic encephalopathy
somnolence, confusion, inability to follow commands, disorientation
grades IV of hepatic encephalopathy
coma
classic radiographic finding seen in perforated diverticulitis
free air outside of the bowel in the abdomen
primary choledocolithiasis is assoc with with type of stones
pigment stones
these stones originate in the common bile duct
MC in pt with biliary stasis (think CF)
secondary choledocolithiasis is assoc with what type of stones?
cholesesterol
stones origiante in the gallbladder and are then passed into the common bile duct
herniation through the femoral canal BELOW the inguinal ligament
femoral hernia
inguinal hernias are located where in relation to the inguinal ligament
SUPERIOR (above)
what incision site has the highest incidence of developing an incisional herna?
midline incisions
** painLESS bump at site of previous surgery scar
what complication is associated with a sliding hiatal hernia
schatzki ring
what condition desribes a thin linea alba & frequently coincides w/ an umbilical hernia
rectus abdominis diastasis
treatment of choice for complicated diverticulitis w/ pericolonic abscess > 4 cm
percutaneous drainage
labs that support hemolysis as etiology of jaundice ??
decreased haptoglobin, HCT
increased LDH, retic & fragmented RBCs on smear
MC type of pancreatic cancer
ductal adenocarcinoma (at pancreatic head)
Courvoisier’s sign
palpable non-tender gallbladder (think pancreatic cancer)
(+) CA 19-9
pancreatic cancer
gold standard imaging for PUD
endoscopy
PUD alarm sx
- 50
- dyspepsia
- hx of GU
- anorexia
- wt loss
- anemia
- dysphagia
what test is required if GU is found on UGI series
endoscopy (for biopsy - want to r/o malignancy)
gold standard test for H.Pylori
endoscopy w/ biopsy + rapid urease test
purpose of H/pylori antibodies
confirms infx but NOT eradication
H. pylori tx
Clarithromycin + amoxicillin + PPI
Side effect of PPI therapy
B12 deficiency
tx for refractory PUD
parietal cell vagotomy
findings on US for pyloric stenosis
double track
findings on barium study for pyloric stenosis
string sign
labs for pyloric stenosis
hypochloremic hypokalemic metabolic alkalosis (contraction alkalosis)
colon & small bowel tumor marker
CEA
labs in toxic megacolon
Elevated CRP & Anemia
initial TOC for cholelithiasis
RUQ transabdominal US
what medication should be abministered to a hemodynamically stable pt prior to colonoscopy ?
polyethylene glycol (clean out laxative)
Fasting serum gastrin levels > 10 x ULN
think gastrinoma (ZES)
results of secretin stimulation test for ZES
BIG elevation of gastrin
disorder assoc with ZES
MEN 1 (autosomal dominant)
use of CA19-9 for pancreatic cancer
good from monitoring but not SCREENING
what age do you start screening for colorectal cancer?
USPSTF says 50 (45 is grade B recommendation)
how do you reduce sigmoid volvulus?
sigmoidoscpy
3-6-9 rule
bowel is considered dilated when dilation is > 3 cm, 6 cm and 9 cm for the small bowel, large bowel, cecum, respectively
which virus is assoc. with increased risk of gastric cancer
EBV
MC benign cause of LBO
volvulus
** MCC overall is colon cancer
MC site of large bowel obstruction
at or below the transverse colon
when is meckel diverticulum most likely dx?
boys age 10 or younger
Meckle diverticulum: rules of 2s
2 y/o
2 feet from iliocecal valce
2 in long
2% population
2 epithelila types (gastric, intestinal or pancreatic)
howship-romberg sign
assoc. w/ obturator hernia
pain extends down the medial aspect of the thigh w/ movement of the knee
thigh pain + sx of small bowel obstruction in older woman
think obturator hernia
what three surgical emergencies are pregnant patients w/ RLQ pain at increased risk for ?
ovarian torsion
ectopic pregnancy
appendicitis
```
~~~
tx of recurring c diff
fidaxomicin 200 mg PO Q 12 hours
abx assoc with C diff
clindamycin
cephalosporins
FQs
medication used for prophylaxis of esophageal varicies?
propanolol
what cancer is associated with GERD
columnar metaplasia of the suqmous epithelium (esophageal cancer)
barretts esophagus –> adenocarcinoma
marker for hepatocellular carcinoma
AFP
ranson criteria (at admission)
age > 55
WBC > 16000
Glucose > 200
LDh > 350
AST > 250
Localized bowel wall thickening and increased soft tissue density in pericolonic fat are demonstrated on an abdominal CT scan.
diverticulitis
what type of adenomatous polyps has greatest risk for malignancy?
villious
MC location for colorectal carcinoma
sigmoid
two main types of esophageal cancer
SCC (arises in proximal 2/3 of esophagus)
adenocarcinoma (distal 1/3 of esophagus)
TOC for pt with cholelithiasis
elective cholecystectomy
tx for cholangitis
abx (pip-tazo) + biliary drainage (ERCP)
tx of esophageal spasm
ccb
complication of chron disease
anal fistulas, perirectal abscess
right-sided colorectal cancer symptoms
IDA
Anemia
Melena
Fatigue
left-sided colorectal tumors
Cramping
Hematochezia
Stool Narrowing
Tenesmus
WL
MC sites of volvulus
sigmoid -1
cecal - 2
first line tx for achalasia
pneumatic balloon dilation
what is elevated in intrahepatic cholestasis?
increased alk phos
** think blockge (e.g. tumor)
sx of conjugated hyperbili
dark urine
pale stools
gold standard test for dx cholecystitis
HIDA
when does screening begin for FAP?
10 y/o
what are the watershed areas of the colon?
splenic fixture
rectosigmoid junction
s/sx of gastric cancer in proximal stomach
dysphagia
PE on ekg
deep S in lead I
Q wave in lead III
inverted T wave in lead III
S1Q3T3
parkland formula
4 mL x wt (kg) x total BSA
give 50% first 8 hours, remainder over 16 hours
best initial test for progressive dysphagia
upper endoscopy
MOA of Phenoxybenzamine
Alpha blocker
indications for formula fluid resuscitation in burns
Children w/ > 10% TBSA
adults > 15% TBSA
use parkland fomula
MC tumor to metastasize to brain
melanoma
hormonal therapy in receptor positive BC
ER positive: tamoxifen
ER positive & post-menopausal: aromatase inhibitors
HER2 positive: monoclonal ab
MC type of breast cancer
infiltrating ductal carcinoma
breast cancer screening
biannual 40-74 y/o
most sensitive finding on biopsy for breast cancer
spiculated soft tissue mass
imaging for women w/ breast concerns by age
< 30: US
30-39: US & focused or bilateral mammo
40+: bilateral mammo + US
CKD Staging
Stage 1 - normal GFR (>/= 90) + either persistent albuminuria or known structural/hereditary renal disease
Stage 2 - mild GFR 60 to 89 mL
Stage 3 - moderate GFR 30-59
Stage 4: severe GFR 15- 29
Stage 5: kidney failure GFR < 15
gold standard imaging for nephrolithiasis
NON CON CT AP
tx of POUR
decompression of bladder by catherterization (in-and-out catheterization OR indwelling foley)
** indwelling cath poses risk for UTI
meds tht cause urinary retention
anticholinergies
antidepressants
opioids
benzos
CC antagonists
NSAIDs
perferred form of Dialysis cath for long-term therapy?
Upper Extremity AVF
** created by anastaomsis between brachial/radial aa AND cephalic vv
** can consider graft if HD < 2 yr duration
Dialysis access steal syndrome
hand pain, diminished sensation/motor fx, cyanosis of digits & diminished/absent pulses after UE fistual placement
older pt, painLESS hematuria & tobacco use
BLADDER CANCER
what zone of prostate does cancer usually arise?
peripheral
** for PSA >4 & rapidly rising –> refer to urology
what zone of prostate does BPH arise?
transitional zone
coag disorder commonly assoc with wilms tumor?
VW disease
TRIAD assoc. with Renal Cell Carcinoma
abdominal mass
flank pain
hematuria
paraesophageal vs sliding hiatial hernia
A “sliding hernia” - stomach & lower part of the esophagus slide up through the diaphragm
“paraesophageal hernia” - stomach pushes through the diaphragm alongside the esophagus (bulges out next to it, rather than sliding up through the opening)
barretts esophagus dysplasia
squamous –> columnar epithelium
pre-operative abx for appendicitis
single dose 2nd gen cephalosporin
cefoxitin, cafezolin, cefotetan
abx for non-operative appendicitis
Levofloxacin
Metronidazole
characteristic of tremor form hyperthyroidism
high frequency & low amplitude
medication indicated in mgmt of PAD
Aspirin
Most Common Causes of Postoperative Fever
Wind (Atelectasis)
Water (UTI)
Walking (DVT)
Wound (Infection)
Wonder Drug (Fever)
*
risk factors for PONV
- N/V Prior to Surgery
- Female Sex
- hx of PONV
- Non-Smoker
- Increasing Age
- Hx of Chemo N/V
- General Anesthesia
- Long Duration of Surgery
- Opioid Administration
Best Imaging Modality for Acute Aterial Emboli
CTA of Pelvis w/ Runoff
MCC of Significant Lower GI Bleeding
Diverticulosis
Think: Elderly, Smoker, Painless Hematochezia
what is required pre-op for pt w/ hx of MI and > 40 y/o
EKG
pressure to dx compartment syndrome
> 30 mmHG
normal: 0-8 mmHg
hypocalcemia on ekg
prolonged QT
tx hypercalcemia
IV normal saline & furosimide
when should you d/c aspirin before surgery?
stop 7 days before & resume 7 days after
when should pt be prompted to stop smoking before surgery?
at least 8 weeks prior
do you continue methodone tx on day of surgery?
yes, continue use including day of surgery to avoid WD
time line of post-operative fever
wind (atelectasis/pneumonia): < 1 day
water (uti/dehydration): 2-3 days
walk (DVT/PE): 3-7 days
wound (infx/hematoma): 5-7 days
wonder drugs (allergy): anytime
Virchow Triad
Circulatory Stasis
Endothelial Injury
Hypercoaguable State
what general surgery has a high cardiac risk?
Open Cholecystectomy
how do you prevent postoperative pulmonary (sp. atelectasis) complications?
incentive spirometry
pre-operative DVT prophylaxis
intermittent pneumatic compression + LMWH
1st line tx for community acquired MRSA suspicious lesions
(non beta-lactam abx)
clinda
trimethoprim-sulfamethoxazole
tetracyclines
central venous catheter infection rates
subclavian: lowest risk
IJ: double risk compared to subclavian
Femoral: highest risk infx
how to stabilize cardiac membrane in hyperK
calcium gluconate or calcium chloride
assoc w/ reduced mortality in pt w/ STEMI
aspirin & a P2Y12 receptor blocker (ticagrelor/prasugrel)
Westermark Sign on CXR
s/x of PE
(aka a vascular cutoff sign)
what protein marker can be used to assess short-term changes in nutritional status?
pre-albumin (if low, pt may require enteral or parenteral nutrition)
what happens to albumin after surgery
decreases d/t stress
most appropriate IV fluid for preop pt who is NPO
LF (bc its considered balanced crystalloid - will match body’s natural electrolyte balance w/o making significant changes)
when should hemodyalysis pt be dialyzed prior to elective surgery?
1 day before
how to prevent pulmonary complications in asthmatics requiring intubation prior to surgery ?
Administer rapid-acting beta-agonist or nebulized tx 30 min prior to surgery
goodpasture syndrome
glomerulonephritis + pulmonary sx
red cell casts + hemoptysis suggests vasculitis or goodpasture syndrome
what type of pneumothorax occurs in conjunction with menstrual periods?
catemenial pneumothorax
where should tip of the IVC filter be placed?
inflow of the renal veins
lung cancer assoc w. smoking that can NOT be tx w/ surgery
small cell lung CA
gold standard test for dx lung cancer
Final needle transthoracic aspiration
MCC post-op pneumonia
pseudomonas
tx w/ pip-tazo, cefepime, levo, meropenem
hereditary spherocytosis: hypoplastic crisis
follows acute viral illness, profound anemia, HA, nausea, pancytopenia, hypoactive marrow, pigmented gallstones
labs in DIC
high: PT / PTT, INR, Fibrin Degredation Products
low: Platelets, Fibrinogen
tx of DIC
- administer antifibrinolytic (e.g.TXA)
- heparin
- glucocorticoids
minimum platelet count for surgical clearance
most major surgies: 50,000/micoL
low risk endoscopic procedures: 20,000/microL
neuro/ocular surgery: 100,000/microL
sequale of bariatric surgery
pernicious anemia
** removal of gastric parietal cells in the stomach –> decreased secret
Where is Vitamin B12 Absorbed?
Terminal Ileum
labs in pernicious anemia
ELEVATED MMA & Homocystine
labsin folate deficiency (anemia)
only ELEVATED homocystine
mcc of compartment syndrome?
Tibial fx
tibialis anterior mc compartment
mgmt of SAH
- keep systolic BP< 160
commonly achieved w IV labetalol/nicardapine
**Nimodipine (dhp-ccb) given to every SAH pt w/ anuerysm w/ 4 days of sx onset x 21 days –> prevents vasospasm !!!
scoring tool for determining the risk of stroke
ABCD2
age, blood pressure, clinical fx, duration of sx, DM
characteristic of TIA d/t carotid artery stenosis
monocular vision loss
CT findings in chronic vs acute subdural hematoma
Acute: concave crescent shaped hyperdensity
Chronic: concave crescent shaped hypodensity
mgmt of subdural hematoma
- burr holes - drains blood
- occasionally want to reverse anticoagulation therapy to help w clot drainage (esp. in chronic)
wernicke encephalopathy triad
confusion
ataxia
opthalmoplegia
sequele of wernicke encephalopathy
Korsakoff syndrome –> anterograde/retrograde anesia & confabulation
MRI finding in wernicke encephalopathy
abnormality w/n mamillary bodies
tx of wernicke encephalopathy
thiamine infusion (however, give glucose first)
CEA prophylaxis
low dose aspirin prior to procedure
MCC of secondary hyperparathyroidism
CKD
MC Type of thyroid cancer
papillary (80%)
papillary = popular
what will you see on a cancerous thyroid nodule in uptake scan?
cold –> does not take up iodine from RAI scan
** will require a FNA w/ biopsy
indications for parathyroidectomy
- serum ca > 1 mg/dL above ULR
- T-score below or at -2.5
- vertebral fx
- CrC < 60 mL/min
- 24 hour urinary ca > 400 mg/day
- kidney stones
- calcium in renal parenchyma
- age < 50 y/o
best test for hypothyroidism
TSH
MEN 1
pituitary adenoma
parathyroid tumor
pancreatic tumor
best test for hyperthyroidism
T4
men IIA
parathyroid adenoma
pheocromocytoma
medullary thyroid carcinoma
men IIB
medullary thyroid carcinoma
multiple mucosal neuromas
marfanoid habitus
pheochromocytoma
what type of cell does medullary thyroid cancer arise from?
parafollicular cells
hypothyroidism effects on BP?
diastolic htn
2/2 increase PVR
hashimoto ab
antithyroid peroxidase
antithyroglobulin
thyroid cancer assoc w/ iodine deficiency
follicular
what size thyroid nodule should be biopsied
> 1 cm
monitoring for AAA
> 5.5 cm or grown 0.5 cm in 6 mo –> immediate surgery w/ q6 mo US
5.0-5.4: US/ CT Q6 mo
4.0-4.9: US/CT Q12 mo
3.0-3.9: US/CT Q3 years
gold standard for AAA dx
angiography
dysphagia, regurgitation of food, halitosis
Zenkers Diverticulum
barium swallow followed by EGD to r/o malignancy
PAD dx on ABI
ABI < 0.9
mainstay tx for caludication in PAD
cliostazole –> platelet inhibitor
** CI in pt w/ heart failure
tx of AAA > 5.5 cm
emergent endovascular stent-graph placement
USPSTF screening for AAA
men 65-75 who have every smoked
tx of cardiac tamponade
pericardiocentesis
beck triad
hypotension
JVD
muffled heart sounds
pulsus paradoxus
> 10 mmhg drop in systolic BP w/ inspiration
tx of recurrent pericardial effusion?
pericardial window is preferred over pericardiocentesis
BP goal in aortic dissection
systolic 100-120 achieved w/ labetalol or esmolol
** esmolol for pt with severe asthma or bradycardia
what type of aortic dissection always requires surgical intervention
standford type A (this is a surgical emergency)
indications for surgery w/ standford type B dissection
- major vascular occlusion
- EOD
- aortic rupture
- hypertension refractory to medication
tx of acute limb ischemia
revascularization
(4 hours of occlusion increases risk of compartment syndrome)
next best test for working up murmur
TTE
most accurate test for working up new murmur
TEE
anticoagulation used for pt w kidney disease
unfractionated heparin
ABI index that indicated chronic limb-threatening ischemia
< 0.4
use of what medications is CI in. aortic dissection?
thrombolytics
late finding of acute arterial occlusion indicating ischemia
paresthesia - loss of motor fx
common site of arterial embolus
commonf emoral artery
ecg changes in prinzmental angina
TRANSIENT ST elevation
medication CI in isolated PAD?
BB –> will worsen claudication
specific indicator of inc risk of postop cardiopulmonary
inability to climb two flights of stairs or walk four blocks
indication for surgery of peptic ulcer disease
ulcer > 3
** WL is MC post surgical complication d/t limiting food intake bc of early satiety
RF for esophageal stricture
- GERD
- radiation to head & neck
- eosinophilic esophagitis
** barium swallow usually NOT helpful in dx –> get endoscopy
PUD tx
duodenal ulcers: PPI for 4-8 wks
gastric ulcers: 8-12 wks
** can use celecoxib for pain control (selective cox2i)
branchial cleft cyst
located LATERAL aspect of the neck
thyroglossial duct cyst
located MIDLINE of neck (close to hyoid bone)
** MC after URI
long, nonbranching anomalous arterial branch origiinating from the SMA that transveres the mesentary toward RLQ on contrast angiography
Meckle Diverticulum
hypoglycemia in perioperative setting
serum glucose < 70
[severe if < 40]
tx for preoperative glucose > 180 mg/dL
IV insulin + 5% dextrose solution
perioperative glycemic target = 110-180 mg/dL
hwo to tx alert pt with hypoglycemia post-op
15 g carbohydrates (aka 4 glucose tabs)
tx for hypoglycemia w/ AMS
glucagon IM 1 mg
shifting dullness
Ascities
highest surgical risk for DVT
ortho procedures (e.g. total joint)
truama
low risk DVT prophy
CVD, compression socks & venous foot pumps until ambulating
mod-high DVT prophylaxis
LMWH
[they require fractionated heparin instead]
CI in renal disease
leser-trelat sign
appearance of many SKs assoc. with hepatocellular carcinoma
what predisposing disease for hepatocellular carcinoma gives pt highest risk of developing the maliganancy?
hep C
new onset htn in pregnancy ddx
gestational htn, preE or Hydronephrosis
tx of hydronephrosis in afebrile, nonauric pt
percutaneous ANTEGRADE stent
percutaneous nephrostomy
tx of hydronephrosis in septic pt
retrograde ureteral stenting
MC type bladder cancer
urothelial (transitional cell) carcinoma
tx of varicose veins 2/2 to saphenous vein reflux that is refractory to conservative mgmt
radiofrequency ablation
reticular veins at the medial malleolus are a sx of?
saphenous vein insufficiency
what type of groin hernia is most likely to strangulate?
femoral hernia
PTT measures what?
intrinsic pathway (XIII, IX, X, XI, XII, thrombin & prothrombin)
PT measures what?
XII
tx of VWF
desmopressin
tx of recurrent diverticulitis
surgical bowel resection
colorectal cancer incidience by location
rectosigmoid > ascending > descending
L side : tends to obstruct
R side: tends to bleed
hyperkalemic emergency
> 6.5 mEq/L
ddx of etiology: renal failure, DKA, rhabdo, TLS, meds
cardiac assoc with HF
ventricular arrythmias 2/2 to filling defects & poor contractility
** typically require ICD esp if EF is 35% or less
preferred anticoagulation in pt with malignancy presenting with PE
LMWH (SQ) x 6 months
preferred dx test for esophageal stricture
endoscopy
serum albumin
used to assess nutritional status
level < 3.5 = malnutrition –> assoc. with poor wound healing, inc risk infx & inc length of hospital stay
CI to carotid artery endarterectomy
- prior ipsilateral endarterectomy
- significant cardiovascular or pulmonary comorbidities that inc anesthesia risk.
(if they don’t qualify - carotid artery stenting)
indication for carotid endarterectomy
asymptomatic & stenosis > 80%
tx of acute arterial occlusion
revascularization w/ open thrombectomy or embolectomy
post operative urinary retention volume
> 100 mL
reciprocal ST depression in anterior leads (V1-V6)
posterior wall MI
circumflex artery occulsion
indiciation for surgical intervention of hemothorax
output of > 1500 cc blood on chest tube insertion or > 200mL/hr over 3 hours
** requires surgical exploration to id source fo bleeding
counseling for ESRD
-sodium intake < 2g/day
-potassium intake < 1500 mg/day
- avoid excessive oral fluid intake
- low-protein diet
third degree burns
full thickness burn involving epidermis, dermis & SQ tissue
fourth degree burns
extend to fascia, muscle, tendon or bone
w/u for small-volume hematochezia
pt < 45: anoscopy or sigmoidoscopy
pt > 45 (regardless of BL): colonscopy
preferred fluids for post-op hypovolemia
NS (0.9%) [ esp in cases of alkalosis or volume loss]
** hypertonic saline used if pt has lowe serum concentration or open abd
tx of NSAID associated PUD
omeprazole x 8 weeks w/ f/u endoscopy
serum lactate > 4 mmmol/L
lactic acidosis
in what order does intestinal motility usually return following surgery?
small intestine –> stomach –> colon
soft tissue gas (subQ emphysema) detected on US or CT
necrotizing fasciitis
Autonomic dysreflexia
2/2 spinak cord injury @ T6 or above that leads to unchecked sympathetic tone
requires removal of noxious stimuli below level of injury (MC bladder)
Tx w/ nifedipine or nitroglycerin
empiric therapy for perianal abscess
amox-clav or cipro + metronidazole
preferred surgical tx for cecal volvulus
hemodynamically stable: ileocecectomy
unstable: cecopexy +/- cecostomy tube
finding on plain film abdmoinal XR for cecal volvulus
coffee bean or comma appearance sign
volvulus on barium enema
bird beak sign
sigmoid vs cecal volvulus
cecal is mc d/t congenital abnormal connection thus is MC in younger pt
in which artery does occlusion cause claudication in upper 2/3 calf?
superficial femoral artery
MCC Erythema Multiforme (EM)
HSV
** other causes sulfa drugs, oral hypoglycemics, anticonvulsants, PCNs,
precipitating factor for intraparenchymal hemorrhage
physical activity
RF: HTN, amyloid angiopathy,, vascular malformation
focal white hyperdense lesion w/n brain parenchyma on non-con CT
intraparenchymal hemorrhage
Atelectasis
loss of lung colume d/t collapse of lung tissues
** pt typically presents w. increased work of breathing & hypoxia
characteristics of benign peptic ulcer
smooth, regular, rounded edges w/ flat, smooth ulcer base often filled w/ exudate
lung cancer screening
50-80 w/ 20+ pack year history of smoking AND currently smoke OR quit within last 15 years → Annual Low dose CT
Screening can be D/C once someone has quit smoking for 15 years
What are the three criteria for diagnosis of chronic kidney disease?
- decreased fx for 3+ months
- GFR < 60
- strucutral/functional kidney abnormalities
Importance of LATERAL anal fissures
significant for secondary anal fissures —> likely caused by chron’s, granulomatous disease, malignancy, communicable disease
when is it appropriate to test for cure in H.Pylori patients?
4 weeks after completion of therapy
sludge vs gallstones on US
sludge : echogenic withOUT shadowing
gallstones: echogenic WITH shadowing
Toxic Megacolon Tx
- complete bowel rest
- NG tube
- PPI for stress gastritis prophylaxis
- IV glucocorticoids if underlying IBD
- surgical subtotal colectomy w/ end ileostomy (refractory pt)
** higher consideration for surgery in pt w/ IBD on second line tx
