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Surgery EOR > Gallbladder disorders + Anal disorders > Flashcards

Gallbladder disorders + Anal disorders Flashcards

1
Q

what is obstructed in cholecystitis

A

cystic duct

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2
Q

sx cholecystitis

A

RUQ pain (> 6 hours)
fever

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3
Q

dx cholecystitis

A

US first
then HIDA scan / cholescintigraphy

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4
Q

tx cholecystitis

A

IV fluids first
then abx (Cef + Metro)
then cholecystectomy (definitive)

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5
Q

RF cholecystitis

A

Obesity
female
advancing age
pregnancy

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6
Q

RF for acalculous cholecystitis

A

critically ill

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7
Q

cause of acalculous cholecystitis

A

no stones - stasis and ischemia of bile

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8
Q

will pts a acalculous cholecystitis be jaundiced

A

yes

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9
Q

where does infection from ascending cholangitis ascend from

A

duodenum - e coli

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10
Q

what is ascending cholangitis

A

infection/inflammation in common bile duct

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11
Q

MC cause ascending cholangitis

A

choledocholithiasis

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12
Q

sx cholangitis

A

charcots triad - fever, RUQ pain, jaundice
Reynold’s pentad - hypotension/shock + AMS

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13
Q

dx cholangitis

A

US first
then ERCP (diagnostic and therapeutic)

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14
Q

labs for cholangitis

A

leukocytosis
increased alk phos
increased GGT
increased bilirubin > 2
ALT and AST can be elevated too

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15
Q

labs for choledocholithiasis

A

same for cholangitis

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16
Q

dx choledocholithiasis

A

US first
then ERCP (diagnostic and therapeutic)

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17
Q

will pts w choledocholithiasis be jaundiced

A

yes

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18
Q

what gallbladder diseases will need abx

A

cholecystitis (including acalculous)
cholangitis

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19
Q

what is an anal fissure

A

linear tear/crack in the anal mucosa distal to the dentate line; MC posterior midline

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20
Q

what other disease is anal fissure closely associated with

A

Crohn

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21
Q

sx anal fissure

A

painful defection; pain may last for minutes to hours; better before next BM

“passing glass” “passing a knife”

hematochezia

22
Q

dx anal fissure

A

clinical
anoscopy for hematochezia

23
Q

tx anal fissure

A

fiber, warm sitz bath
topical nifedipine, nitroglycerin, hydrocortisone, or diltiazem

botox injection - risk of fecal incontinence
lateral internal sphincterotomy - risk of fecal incontinence

24
Q

acute vs chronic anal fissure

A

acute < 8 weeks
chronic > 8 weeks

25
Q

anorectal/perianal abscesses arise from

A

anal crypt glands

26
Q

MC organism involved in anorectal/perianal abscess

A

staph aureus

27
Q

where are anorectal/perianal abscesses MC located

A

posterior rectal wall

28
Q

sx anorectal/perianal abscess

A

severe, constant rectal pain worse with sitting, defecating, coughing

fluctuant = abscess

29
Q

tx anorectal/perianal abscess

A

I & D then abx (augmentin or Cef + Metro)

30
Q

what is an anal fistula

A

abnormal communication btwn anus and perirectal skin

31
Q

what is anal fistula MC due to

A

drainage from abscess

32
Q

Parks classifications for anal fistula

A

type 1 - Intersphincteric
type 2 - Transphincteric
type 3 - suprasphincteric
type 4 - extrasphincteric

33
Q

which parks classification for anal fistula is MC

A

type 1

34
Q

describe type 1 anal fistula

A

Intersphincteric - only through internal sphincter; due to perianal abscess

35
Q

describe type 2 anal fistula

A

Transsphincteric - through internal and external sphincter; from ischiorectal abscess

36
Q

describe type 3 anal fistula

A

Suprasphincteric - through internal sphincter and the extends superiorly btwn sphincters; from supralevator abscess

37
Q

describe type 4 anal fistula

A

Extrasphincteric - begins at rectum (not the anus, unlike the other three types) and extends down through the levator ani muscle

38
Q

what type of anal fistula is not included in the parks classification

A

superficial fistula; this is submucosal and does not involve sphincters

39
Q

tx anal fistula

A

fistulotomy – open it and get rid of fistula by secondary intention

partial sphincterectomy - more likely to cause fecal incontinence

40
Q

what are hemorrhoids

A

engorgement of venous plexus

41
Q

what type of cells are internal hemorrhoids covered by

A

columnar cells

42
Q

what type of cells are external hemorrhoids covered by

A

squamous cells

43
Q

where do internal hemorrhoids originate from

A

superior hemorrhoid vein

44
Q

where do external hemorrhoids originate from

A

inferior hemorrhoid vein

45
Q

internal and external hemorrhoids in relation to dentate line

A

internal - proximal to (above)
external - distal to (below)

46
Q

difference in sx internal vs external hemorrhoids

A

internal - bleed, no pain
external - pain, no bleed

47
Q

if there is bleeding from the rectum, what test do you have to do

A

anoscopy

48
Q

tx hemorrhoids

A

fiber supplementation, fuids
topical hydrocortisone or topical lidocaine
internal - rubber band ligation, sclerotherapy, etc
external - hemorrhoidectomy

49
Q

grading for internal hemorrhoids

A

grade 1 - no protrusion
grade 2 - protrusion but spontaneously reduce
grade 3 - protrusion but manually reduce
grade 4 - protrusion and no reduction; risk strangulation

50
Q
A

Surgery EOR (7 decks)

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