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General Surgery EOR > Gastrointestinal and Nutritional > Flashcards

Gastrointestinal and Nutritional Flashcards

1
Q

What are the causes of epigastric pain?

A

PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss

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2
Q

What are the causes of RUQ pain?

A

cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (especially during pregnancy), thoracic causes (e.g, pleurisy/pneumonia), PE, pericarditis, MI (especially inferior MI)

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3
Q

What are the causes of LUQ pain?

A

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease

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4
Q

What are the causes of LLQ pain?

A

diverticulitis, sigmoid volvulus, perforated colon, colon cancer, urinary tract infection, small bowel obstruction, inflammatory bowel disease, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes, appendicitis (rare)

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5
Q

What are the causes of RLQ pain?

A

appendicitis! and same as LLQ; also mesenteric lymphadenitis, cecal diverticulitis, Meckel’s diverticulum, intussusception

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6
Q

What is the presentation of acute/chronic cholecystitis?

A

45-year old woman with RUQ pain for 12 hours, fever, and leukocytosis

  • 5 Fs: female, fat, forty, fertile, fair
  • (+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
  • RUQ pain after a high-fat meal
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7
Q

How is acute/chronic cholecystitis dx?

A
  • ultrasound if the preferred initial imaging
  • gallbladder wall > 3 mm, pericholecystic fluid, gallstone
  • HIDA is the best test (gold standard)
  • porcelain gallbladder = chronic cholecystitis
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8
Q

What is the tx for acute/chronic cholecystitis?

A

cholecystectomy

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9
Q

What is acute pancreatitis?

A

epigastric abdominal pain with radiation to the back and elevated lipase

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10
Q

What is the etiology of acute pancreatitis?

A

cholelithiasis or alcohol abuse

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11
Q

How is acute pancreatitis dx?

A
  • clinical + elevated lipase and amylase

- CT required to differentiate from necrotic pancreatitis

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12
Q

What are the signs of acute pancreatitis?

A

grey turner’s sign (flank bruising) and Cullen’s sign (bruising near umbilicus)

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13
Q

What is ransoms criteria for poor prognosis of acute pancreatitis?

A 
at admit:
-age > 55
-leukocyte >16,000
-glucose >200
-LDH >350
-AST >250
at 48 hours:
-arterial PO2 <60
-HCO3 <20
-calcium < 8.0
-BUN increased by 1.8+ 
-hematocrit decrease by 10%
-fluid sequestration > 6 L
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14
Q

What is the tx for acute pancreatitis?

A

IV fluids (best), analgesics, bowel rest

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15
Q

What are the complications of acute pancreatitis?

A

pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)

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16
Q

What is chronic pancreatitis?

A

the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus
-alcohol abuse

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17
Q

What is the tx of chronic pancreatitis?

A

no alcohol, low-fat diet

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18
Q

What are the characteristics of anal fissure?

A
  • small split or tear in the anal mucosa
  • there may be blood on the outside of the stool or on the toilet tissue following a bowel movement
  • anal fissures are extremely common in your infants but may occur at age
  • studies suggest 80% of infants will have had an anal fissure by age one
  • most fissures heal on their own
  • vertical fissures = most common
  • horizontal fissures = Crohn’s dz, HIV
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19
Q

What is the tx of anal fissures?

A

stool softeners, bulk, petroleum jelly

-these measures generally heal more than 90% of anal fissures

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20
Q

What is anorectal abscess?

A
  • infection of an anal fissure, STDs, and blocked anal glands are common causes of anorectal abscesses
  • deep rectal abscesses may be caused by intestinal disorders such as Crohn’s disease or diverticulitis
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21
Q

What is the tx for anorectal abscess?

A

I&D, warm sitz baths, pain medication and antibiotics

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22
Q

What is an anorectal fistula?

A

open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded

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23
Q

What are the characteristics of appendicitis?

A

the first symptom is crampy or “colicky” pain around the navel (periumbilical)

  • there is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low-grade fever
  • as the inflammation increases, the abdominal pain tends to move downward - begins in epigastrium - umbilicus - RLQ
  • right lower quadrant = “McBurney’s point”
  • this “rebound tenderness” suggests inflammation has spread to the peritoneum
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24
Q

What are the signs of appendicitis?

A
  • Rovsing - RLQ pain with palpation of LLQ
  • Obturator sign - RLQ pain with internal rotation of the hip
  • Psoas sign - RLQ pain with hip extension
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25
Q

How is an appendicitis dx?

A
  • imaging if atypical presentation - apply ultrasound or abdominal CT scan
  • CBC - neutrophilic supports the diagnosis
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26
Q

What is the tx for appendicitis?

A

surgical appendectomy

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27
Q

What are the guidelines for bariatric surgery?

A
  • BMI > 40 (basically 100 pounds above ideal body weight) or
  • BMI > 35 with a medical problem related to morbid obesity
  • individuals must have failed other non-surgical weight loss programs
  • they must be psychologically stable and able to follow post-op instructions
  • obesity is not caused by a medical disease such as endocrine disorders
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28
Q

How is BMI measured?

A

body weight in kg divided by height in meters squared

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29
Q

What are the characteristics of bowel obstruction?

A

colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery

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30
Q

What are the characteristics of large bowel obstruction?

A

gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, obstipation, less vomiting (feculent), more common in the elderly

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31
Q

What should you look for in bowel obstruction?

A
  • look for vomiting of partially digested food, severe abdominal dissensions and high pitch hyperactive bowel sounds progressing to silent bowel sounds
  • KUB shows dilated loops of bowel with air-fiuid levels with little or no gas in the colon
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32
Q

What is the treatment of bowel obstruction?

A

bowel rest, NG tube placement, surgery as directed by underlying cause

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33
Q

What is cholangitis?

A

RUQ pain, jaundice, and fever
-a complications of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)

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34
Q

What is Charcot’s triad?

A

RUQ tenderness, jaundice, fever

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35
Q

What is Reynold’s pentad?

A

Charcot’s triad + altered mental status and hypotension

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36
Q

What is the dx and tx for cholangitis?

A

ERCP is the optimal procedure both for diagnosis and for treatment

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37
Q

What is cholelithiasis and choledocholithiasis?

A

a precursor to cholecystitis, cholesterol stones account for >85% of gallstones in the Western world

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38
Q

What is colorectal carcinoma?

A

painless rectal bleeding and a change in bowel habits in patients 50-80 years of age

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39
Q

What are the characteristics of colorectal carcinoma?

A
  • apple core lesion on barium enema, adenoma most common type
  • Tumor Marker: CEA
  • more likely to be malignant: sessile, >1 cm, villous
  • less likely to be malignant: pedunuclated, < 1 cm, tubular
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40
Q

What is the tx of colorectal carcinoma?

A

resection and adjuvant chemotherapy

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41
Q

How is constipation defined?

A

as less than 2 bowel movements per week

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42
Q

What is obstipation?

A

a severe form of constipation, where a person cannot pass stool or gas

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43
Q

What are the signs and symptoms of a small bowel obstruction?

A

colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery

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44
Q

What are the signs and symptoms of a large bowel obstruction?

A

gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, obstipation, less vomiting (feculent), more common in the elderly

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45
Q

What is an illeus?

A
  • hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction
  • illeus that persists for more than 3 d following surgery is termed postoperative dynamic ileum or paralytic ileus
  • signs: absent bowel sounds
  • CT scan with gastrografin - must exclude mechanical obstruction
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46
Q

What is gastroparesis?

A
  • a condition that affects the stomach muscles and prevents proper stomach emptying
  • MCC: diabetes
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47
Q

What is pseudomembranous colitis?

A
  • inflammation of the colon caused by the bacteria clostridium difficile
  • occurs secondary to treatment with antibiotics with broad-spectrum antibiotics - pencilling, cephalosporins, and FQ
  • mild watery foul-smelling diarrhea (>3 but < 20 stools/day)
  • IV metronidazole OR PO vancomycin (this is the only use for oral vancomycin)
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48
Q

What is diverticular disease?

A

LLQ pain, tenderness, abdominal distention, fever, and leukocytosis in older patients

  • inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine
  • the presence of the pouches themselves is called diverticulosis
  • when they become inflamed, the condition is known as diverticulitis
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49
Q

What are the characteristics of diverticular disease?

A
  • left-sided Appy
  • most common location: sigmoid colon
  • fevers/chills/nausea/vomiting/left-sided abdominal pain
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50
Q

How is diverticular disease dx?

A

abdominal/pelvic CT scan revealing fat stranding and bowel wall thickening
-the most common cause of massive lower gastrointestinal bleedings

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51
Q

What is the tx of diverticular disease?

A

ciprofloxacin or augmentin/+ metronidazole (flagyl)

  • recurrent attacks or presence of perforation, fistula, or abscess requires surgical removal of the involved portion of the colon
  • treat by increasing the bulk in the diet with high-fiber foods and bulk additives such as Metamucil
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52
Q

What is esophageal cancer?

A

progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
-squamous cell m/c worldwide and adenocarcinoma common in the US

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53
Q

What is adenocarcinoma of the esophagus?

A

a complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus

54
Q

What is squamous cell of the esophagus?

A
  • associated with smoking and alcohol use
  • affects proximal (upper) 2/3rds of the esophagus
  • progressive dysphagia, weight loss, hoarseness
  • diagnostic studies: endoscopy + biopsy
  • treatment: resection
55
Q

What is an esophageal strictures?

A

solid food dysphagia in a patient with a history of GERD

  • GERD and scleroderma
  • ingestion of corrosive substances
  • viral or bacterial infections
56
Q

What are the symptoms of esophageal strictures?

A

difficulty and painful swallowing, weight loss, regurgitation of food

57
Q

What is esophageal achalasia?

A

primary esophageal motility disorder characterized by the absence of lower esophageal peristalsis
-difficulty swallowing caused by a failure of the LES to relax and poor peristaltic waves, production a motor disorder signified by initial complaints of dysphagia for solids and liquids

58
Q

How is esophageal strictures dx?

A

barium swallow shows there is acute tapering at the lower esophageal sphincter and narrowing at the gastroesophageal junction, producing a “bird’s beak” or “rat’s tail” appearance - distal 2/3 most common
-esophageal manometry is the best test to diagnosis shows the absence of esophageal peristalsis

59
Q

What is the tx for esophageal strictures?

A

EGD dilation of the esophagus or myotome is the preferred treatment

60
Q

What is an esophageal web?

A

thin membranes in the mid-upper esophagus

-may be congenital or acquired

61
Q

What is plummer-vinson?

A

esophageal webs + dysphagia + iron deficiency anemia

62
Q

What is a schatzki ring?

A

a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring)
-if the lumen of this ring becomes too small, symptoms occur

63
Q

What is gastric cancer?

A

presents with weight loss, abdominal fullness/pain, anemia, early satiety, melena, anorexia, guaiac positive stool

  • adenocarcinoma
  • the incidence is extremely high in Japan, Chile and iceland
64
Q

What are the risk factors for gastric cancer?

A
  • a family history of gastric cancer
  • gastric ulcers
  • Helicobacter pylori
  • pernicious anemia
65
Q

What are the sx of gastric cancer?

A
  • a loss of appetite
  • difficulty swallowing, particularly difficulty that increases over time
  • vague abdominal fullness
  • nausea and vomiting weight loss
  • abdominal fullness prematurely after meals
66
Q

How is gastric cancer dx?

A

EGD (esophagogastroduodenoscopy) and biopsy showing gastric cancer

  • a CBC showing microcytic/hypochromic anemia
  • postive guaiac
67
Q

What is the tx for gastric cancer?

A

radiation therapy and chemotherapy can be beneficial but the prognosis is poor

68
Q

What is heartburn and dyspepsia?

A

dyspepsia and abdominal pain are common indications of gastritis

69
Q

What are the causes of heartburn and dyspepsia?

A
  • autoimmune or hypersensitivity reaction (e.g pernicious anemia)
  • infection - H. pylori (most common)
  • inflammation of the stomach lining (NSAIDs and alcohol)
70
Q

What are the characteristics of autoimmune or hypersensitivity reaction?

A
  • location: body of the fundus

- pernicious anemia + schilling test + decrease intrinsic factor and parietal cell antibodies

71
Q

What are the characteristics of infection - H. pylori?

A
  • location: antrum and body
  • studies: urea breath test or fecal antigen
  • treatment: PPI (ie. omeprazole) + clarithromycin + amoxicillin +/- metronidazole
72
Q

What are the characteristics of the inflammation of the stomach lining?

A
  • NSAIDs: cause gastric injury by diminishing oral prostaglandin production in the stomach and duodenum
  • alcohol: a leading cause of gastritis
73
Q

What is the etiology of peptic ulcer disease?

A

H. pylori (most common), NSAID use, Zollinger-Ellison syndrome (refractory PUD) - gastrin-secreting tumor

  • duodenal ulcer - pain improved with food
  • gastric ulcer - pain worsen with food
74
Q

How is peptic ulcer disease dx?

A

endoscopy with biopsy is the gold standard for diagnosis

75
Q

What is the tx for peptic ulcer disease?

A
  • H. pylori infection: triple therapy PPI (omeprazole) + clarithromycin + amoxicillin +/- metronidazole
  • NSAIDs use: discontinue use
  • Zollinger-Ellison syndrome: PPI and resect the tumor
76
Q

What are the signs and symptoms of peptic ulcer disease?

A

hematemesis, abdominal discomfort, dull pain

77
Q

What are the signs and symptoms of esophageal varices?

A

hematemesis, bleeding, difficulty swallowing

78
Q

What are the signs and symptoms of alcohol abuse?

A

physical dependence, craving, vomiting

79
Q

What are the signs and symptoms of Mallory-Weiss syndrome?

A

a tear in the lining of the stomach just above the esophagus caused by violent retching or vomiting

80
Q

What are the signs and symptoms of coagulation disorders?

A

characterized by a decreased ability to form a clot

81
Q

What are the signs and symptoms of esophageal cancer?

A

progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis

82
Q

What are the signs and symptoms of Gastrointestinal System Neoplasms?

A

abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool

83
Q

What is an hemorrhoid?

A

very common especially during pregnancy and after childbirth

  • constipation, prolonged sitting during bowel movements
  • bright red blood in the stool
  • anal itching
84
Q

What is the tx for a hemorrhoid?

A

stool softness, corticosteroid, sitz baths

-internal hemorrhoids = rubber band ligation

85
Q

What is hepatic carcinoma?

A

abdominal pain, weight loss, right upper quadrant mass

86
Q

What is the etiology of hepatic carcinoma?

A

cirrhosis, hepatitis B, hepatitis C, hepatitis D, aflatoxin from aspergillus
-tumor marker: increase alpha-fetoprotein and abnormal liver imaging

87
Q

What is the tx for hepatic carcinoma?

A

resection, transplant - poor prognosis

88
Q

What is an indirect inguinal hernia?

A

(most common): passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum
-often congenital and will present before age one

89
Q

What is a direct inguinal hernia?

A

passage of intestine through the external inguinal ring at Hesselbach’s triangle, rarely enters the scrotum

90
Q

What is a ventral hernia?

A

often from previous abdominal surgery, obesity

-abdominal mass noted at the site of previous incision

91
Q

What is an umbilical hernia?

A

very common, generally is congenital and appears at birth

  • many umbilical hernias resolved on their own and rarely require intervention
  • refer to surgery if an umbilical hernia persists >2 years of life
92
Q

What is a strangulated hernia?

A

hernia becomes strangulated when the blood supply of its contents is seriously impaired

93
Q

What is an obstructed hernia?

A

this is an irreducible hernia containing intestine that is obstructed from without or within, but there is no interference to the blood supply to the bowel

94
Q

What is an incarcerated hernia?

A

hernia so occluded that it cannot be returned by manipulation, it may or may not become strangulated

95
Q

What is a hiatal hernia?

A

diaphragmatic: involves protrusion of the stomach through the diaphragm via the esophageal hiatus
- it can cause symptoms of GERD

96
Q

What is the tx for a hiatal hernia?

A

acid reduction may suffice, although surgical repair can be used for more serious cases

97
Q

What is Crohn’s disease?

A

any part of the GI tract from the mouth to the anus

98
Q

What are the characteristics of Crohn’s disease?

A
  • “skip areas” with transmural (full-thickness)
  • young adults (20-40) 2 to 3 times more common in jews
  • Pathology: antibodies against intestinal epithelia cells
  • appearance leading to the typical “cobblestone”
99
Q

What are the sxs of Crohn’s disease?

A

cramping, tenderness, flatulence, N/V/D, F/C, mild bleeding or may be massive, diarrhea (4 to 6 times/day), RLQ pain, steatorrhea, marked weight loss

  • obstruction, fistulas, abscesses, and perforation
  • malabsorption of B12, megaloblastic anemia
100
Q

How is Crohn’s dx?

A

barium “string sign” (segments of stricture separated by normal bowel) BX

101
Q

What is the tx for Crohn’s?

A

maintenance meds: sulfasalazine (azulfidine)

  • mesalamine
  • prednisone during flare-up
  • restrict fiber in the diet
102
Q

What is ulcerative colitis?

A
  • acute inflammation of the large bowel rectosigmoid area
  • increase risk of colorectal CA
  • pathology: cause is unknown, antibodies that cross-react with intestinal epithelial cells and certain serotypes of E. coli, food allergy to proteins
  • mucosal surface shows superficial ulcerations area is greatly thickened and rigid “lead pipe”
  • backwash iritis can be seen in UC versus ileitis which is seen in Crohn’s
103
Q

What are the sxs of ulcerative colitis?

A

bloody diarrhea containing pus and mucus

  • n/v, abdominal pain, spastic rectum, anus
  • anemia (Fe++ deficiency)
  • coagulation defects dur to Vit K deficiency
  • erythema nodosum, uveitis, toxic megacolon
104
Q

How is ulcerative colitis dx?

A

sigmoidoscopy and bx

105
Q

How is the tx for ulcerative colitis?

A

maintenance meds: sulfasalazine

  • mesalamine, NSAIDs
  • prednisone during flare-ups
  • antispasmodics only used for patients with frequent and troublesome diarrhea may precipitate toxic megacolon
106
Q

What is the serum bilirubin for jaundice?

A

> 2.5 mg/dl

107
Q

What are the causes of postoperative jaundice?

A
  • prehepatic
  • hepatic
  • posthepatic
108
Q

What are the causes of prehapatic jaundice?

A

hemolysis (prosthetic valve), resolving hematoma, transfusion reaction, post cardiopulmonary bypass, blood transfusions (decreased RBC compliance leading to cell rupture)

109
Q

What are the causes for hepatic jaundice?

A

drugs, hypotension, hypoxia, sepsis, hepatitis, “sympathetic” hepatic inflammation from adjacent right lower lobe infarction of the lung or pneumonia, preexisting cirrhosis, right-sided heart failure, hepatic abscess, pyelphlebitis (thrombosis of portal vein), Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnons syndrome, fatty infiltrate from TPN

110
Q

What are the causes for posthepatic jaundice?

A

choledocholithiasis, stricture, cholangitis, cholecystitis, biliary-duct injury, pancreatitis, sclerosing cholangitis, tumors (e.g cholangiocarcinoma, pancreatic cancer, gallbladder, metastases), biliary stasis (e.g ceftriazone)

111
Q

What is melena?

A

black tarry stool - upper GI bleed

112
Q

What are the causes of melena?

A

gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome

113
Q

What is hematochezia?

A

bright red blood per rectum (BRBPR) - lower GI bleed

114
Q

What are the causes of hematochezia?

A

hemorrhoids, anal fissure, polyps, proctitis, rectal ulcers, and colorectal cancer
-diverticulosis is generally an incidental finding, since diverticular bleeding is usually of greater volume

115
Q

What is postoperative nausea and vomiting?

A

an unpleasant complication affecting 30 percent of children and adults after anesthesia
-vomiting or retching can result in wound dehiscence, esophageal rupture, aspiration, dehydration, increased intracranial pressure, and pneumothorax

116
Q

What is the cause of nausea?

A

can have causes that aren’t due to underlying disease

  • examples include motion such as a car and plane, taking pill on an empty stomach, eating too much or too little, or drinking too much alcohol
  • gastroenteritis
  • common cold
  • migraine headache
  • food poisoning
  • influenza virus
  • pyloric stenosis
  • peptic ulcer disease
  • hiatal hernia
117
Q

What is pancreatic carcinoma?

A

an elderly man with large nontender palpable gallbladder (Courvoisier’s sign)
-painless jaundice is pathognomonic

118
Q

What are the characteristics of pancreatic carcinoma?

A
  • the 4th leading cause of death form cancer in the U.S.
  • the disease is slightly more common in men than in women and risk increases with age
  • the cause is unknown, but the incidence is greater in smokers
  • almost one-third of cases of pancreatic carcinoma can be attributed to cigarette smoking and ETOH abuse
  • most commonly ductal adenocarcinoma located at the pancreatic head
119
Q

What is the presentation of pancreatic carcinoma?

A
  • weight loss/epigastric pain, clay-colored stools
  • jaundice + palpable non-tender gallbladder (Courvoisier’s sign)
  • virchow’s node (or signal node) is a lymph node in the left suprclavicular fossa (the area above the left clavicle) that is associated with pancreatic cancer
120
Q

How is pancreatic carcinoma dx?

A
  • ERCP
  • abdominal CT scan: 75% show tumor at the head of the pancreas, 25% at the tail
  • pancreatic bx
  • abdominal MRI
  • elevated serum bilirubin
  • abnormal liver function tests
  • CA 19-9 is present in about 80% of patients who have pancreatic cancer
121
Q

What is the tx of pancreatic carcinoma?

A
  • at the time of diagnosis, only about 20% of pancreatic tumors can be removed by the standard procedure is called a pancreaticoduodenectomy (Whipple procedure)
  • when the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended
122
Q

What is pancreatic pseudocyst?

A

pancreatitis and a palpable epigastric mass

  • cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas
  • classically occur 2-3 weeks after acute pancreatitis
  • presents with abdominal pain and a palpable epigastric mass
  • CT scan is the study of choice
123
Q

What is the tx for pancreatic pseudocyst?

A

if pseudocyst persists for 4-6 weeks or continues to enlarge

  • surgical decompression (pancreaticogastrostomy)
  • percutaneous drainage
  • can become infected and lead to peritonitis
124
Q

What is peptic ulcer disease?

A

duodenal ulcer (food classically relieves pain think duodenum = decease with food)

  • ct scan is the study of choice
  • gastric ulcer (food classically causes pain)
125
Q

What is pyloric stenosis?

A

an infant with projectile vomiting

  • palpable epigastric olive-shaped mass (is pathognomonic for the disorder)
  • on ultrasound, you will see a “double-track”
  • barium studies will reveal a “string sign” or “shoulder sign”
126
Q

What is the treatment for pyloric stenosis?

A

by pyloromyotomy - known as Ramstedt procedure

127
Q

What is small bowel carcinoma?

A

the most common presenting symptom of small bowel tumor is abdominal pain-typically intermittent and cramps in nature

128
Q

What are the characteristics of small bowel carcinoma?

A
  • adenocarcinomas represent from 25 to 40 percent of small bowel cancers - highest in the duodenum
  • Crohn’s disease predisposes to adenocarcinoma within the involved area of the small intestine
129
Q

How is small bowel carcinoma dx?

A

radiographic (computed tomography [CT] scan, small bowel series, enteroclysis ) or endoscopic (wireless capsule endoscopy, push enteroscopy, double-balloon endoscopy)

130
Q

What is the tx for small bowel carcinoma?

A

surgery - localized adenocarcinomas of the small bowel are best managed with wide segmental surgical reaction
-adjuvant chemotherapy to patients with lymph node-positive

131
Q

What is toxic megacolon?

A

a 24-year old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray

  • toxic patient: sepsis, febrile, abdominal pain
  • megacolon: acutely and massively distended colon
  • can occur with IBD (UC>Crohn’s)
132
Q

What is the tx for toxic megacolon?

A

decompression of the colon is required

-In some cases, colostomy or even complete clonic resection may be required

General Surgery EOR (10 decks)

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