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Surgery EOR (billie) > extra stuff that wasnt on the blue print but apparently will be on the test > Flashcards

extra stuff that wasnt on the blue print but apparently will be on the test Flashcards

1
Q

what is Zollinger ellison syndrome

A

a gastrin secreting pancreatic tumor

causes increased gastric acid leading to PUD

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2
Q

what is the presentation of zollinger ellison syndrome

A
  • PUD s/s (burning/gnawing pain made better by food)
  • diarrhea
  • hxof multiple PUD’s that do not resolve with h pylori treatment or H2s
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3
Q

50% of zollinger ellison cases occur with what other disease

A

MEN 1
(3Ps: pancreatic, pituitary and parathyroid tumor disorder)

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4
Q

what is the diagnostic for zollinger ellison syndrome

A
  • serum gastrin level (extremely high)
  • secretin test (will inhibit gastrin in normal, but will stimulate gastrin in ZES
  • abdominal CT (shows pancreatic tumor)
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5
Q

what is the tx for zollinger ellison syndrome

A
  1. PPI (omeprazole) OR octreotide
  2. surgical rmoval of tumor. chemo if mets.
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6
Q

what causes umbilical hernias

A

increased intra-abdominal pressure from:
* obesity
* ascites
* long-term abdominal distention.

pregnancy is huge risk factor

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7
Q

what is encapsulated in an umbilical hernia

A

fat or omentum BUT bowel can become incarcerated within it.

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8
Q

what is the treatment for umbilical hernias

A
  • if easily reducible -> elective surgery repair
  • if bowel incarceration -> immediate surgery
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9
Q

what characterizes esophageal stricture

A
  • aperistalsis
  • lower esophageal sphincter dysfunction
  • progressive dysphagia
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10
Q

what causes esophageal stricture

A
  • GERD
  • erosive esophagitis
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11
Q

what is the clinical presentation of esophageal stricture

A
  • heartburn
  • progressive dysphagia (to solids)
  • odynophagia
  • food impaction
  • chest pain
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12
Q

what diagnostics are used in suspected esophageal stricture

A
  • initial = barium swallow
  • confrimation = EGD
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13
Q

what would you see on EGD of esophageal stricture

A
  • edema
  • cellular infiltrates
  • basal cell hyperplasia
  • increased type III collagen deposition
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14
Q

what is the treatment for esophageal stricture

A

mechanical esophageal dilation followed by PPIs

steroid injections if refractory

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15
Q

what is achalasia and what causes it

A

failure of the lower esophageal sphincter to relax secondary to progressive degeneration of ganglion cells in the myenteric plexus in the esophageal wall

aka just distal narrowing of esophagus

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16
Q

what is the presentation of achalasia

A
  • gradual difficulty in swallowing solids AND liquids
  • discomfort/fullness when eating
  • regurgitation of food
  • weight loss
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17
Q

how do you differentiate the presentation of esophageal stricture and achalasia

A

achalasia has trouble with liquids AND solids. stricture is only solids.

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18
Q

what is the diagnostic study of choice for achalasia

A
  • initial = barium swallow (birds beak)
  • confirmation = esophageal manometry
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19
Q

what is the treatment for achalasia

A
  • pneumatic dilation (MC)
  • laparoscopic heller myotomy
20
Q

what is zenkers diverticulum

A

A sac-like outpouching of the mucosa and submucosa through Killian’s triangle

21
Q

what is the cause of zenkers diverticulum

A

loss of elasticity of the upper esophageal sphincter

22
Q

almost all patients with zenkers diverticulum have what associated issues

A
  • hiatal hernia
  • reflux
23
Q

what are the s/s of zenkers diverticulum

A
  • dysphagia and regurg over years
  • halitosis
  • nocturnal choking
24
Q

how do you diagnose zenkers diverticulum

A

barium swallow

25
Q

what is the treatment for zenkers diverticulum

A

upper esophageal myotomy

26
Q

what is pernicious anemia

A

lack of intrinsic factor (secreted by stomach cells) leading to B12 deficiency and megaloblastic anemia

27
Q

what are the s/s of pernicious anemia

A

classic triad of weakness, sore tongue (glossitis), and paresthesias

28
Q

what is the MC cause of hematochezia in pateints <50. what about >60

A
  • <50 = hemorroids
  • > 60 = diverticulOSIS
29
Q

what is the MC gastric cancer

A

adenocarcinoma

30
Q

what is the presentation of gastric cancer

A
  • abdominal pain
  • unintentional weight loss
  • reduced appetite
  • melena, nausea, vomiting
31
Q

what physical exam findings may suggest metastasis of gastric cancer

A
  • virchow node (left supraclavicular node)
  • irish node (left axillary node)
  • sister mary joseph node (periumilical)
  • acanthosis nigricans
32
Q

confrimatory test for gastric cancer

A

upper endoscopy with biopsy

endoscopy will show irregular ulcers with THICK margins

33
Q

tx for gastric cancer

A

subtotal or total gastrectomy with extended lymph node dissection

34
Q

what causes esophageal varices

A

portal hypertension

caused by liver cirrhosis 2/2 alcohol or viruses

35
Q

what is teh diagnostic tool of choice for esophageal varices

A

EGD

36
Q

what is the treatment for prevention of esophageal variceal hemorrhage

A

beta blockers.

37
Q

what medications are used to stop acute bleeds from esophageal varices

A

vasopressin and nitroglycerin

38
Q

what would a barium enema show in sigmoid volvulus

A

gradual tapering of the sigmoid colon (birdbeak sign)

achalasia also has birdbeak sign

39
Q

what is the treatment of sigmoid volvulus

A

emergent surgical management and decompression

40
Q

what are the 4 grades of hepatic encephalopathy

A
41
Q

what is the treatment for hepatic encephalopathy

A

Grade 1 and 2 = discharge
Grade 3 and 4 = ICU for lactulose +/-rifamixin

42
Q

what is the tumor marker associated with hepatic carcinoma

A

elevated alpha-fetoprotein

43
Q

what tumor marker is assocaited with pancreatic cancer

A

CA19-9

44
Q

how do you differentiate inguinal vs femoral hernias

A

inguinal hernias are above the inguinal ligament

femoral hernias are below the inguinal ligament

45
Q

what is the treatment of a pancreatic pseudocyst

A

observation as long as there are minimal symptoms

if not minimal then can drain via surgery

46
Q

what would a endoscopy show in a patient with zollinger ellison syndrome

A
  • prominent gastric folds
  • multiple solitary ulcers, prominent in the duodenum
47
Q

If a patient has a carcinoid tumor, what will a 24 hour urine show

A

increased levels of 5-hydroxyendoeletic acid.

Surgery EOR (billie) (24 decks)

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