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Step 2 CK: Surgery > Gastrointestinal & Nutrition > Flashcards

Gastrointestinal & Nutrition Flashcards

1
Q

Treatment:

Acute variceal bleeding

A

establish vascular access with two large bore intravenous needles OR a central line

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2
Q

Treatment:

Acute gastrointestinal perforation

A

emergent laparotomy

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3
Q

How is the treatment of acute gastrointestinal perforation altered when patient is on warfarin?

A

Fresh frozen plasma must be infused pre-operatively to achieve rapid reversal of anti-coagulation.

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4
Q

Why should patients with blunt abdominal trauma be evaluated by focused assessment with sonography for trauma (FAST)?

A

You perform the FAST exam to evaluate for intraperitoneal hemorrhage.

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5
Q

How does a positive FAST scan change the management of a patient with blunt abdominal trauma?

A

A positive FAST abdominal scan requires emergent exploratory laparotomy.

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6
Q

Clinical Manifestation:

acute-onset mid-abdominal pain out of proportion to physical exam

A

This is most likely acute mesenteric ischemia.

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7
Q

What is the most common cause of acute mesenteric ischemia?

A

The most common cause of acute mesenteric ischemia is an embolus from the heart.

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8
Q

How does the diagnosis change when a patient with acute mesenteric ischemia develops (1) peritoneal signs and (2) begins to pass bloody stool?

A

This patient has progressed to bowel infarction.

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9
Q

What complication is common in older patients after vascular surgery?

A

Ischemic colitis is very common in older patients after vascular surgery, typically due to extensive underlying atherosclerosis.

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10
Q

Diagnosis:

CT findings in a patient with ischemic colitis

A

thickening of the bowel wall

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11
Q

Diagnosis:

Colonoscopy findings in a patient with ischemic colitis

A
  1. cyanotic mucosa

2. hemorrhagic ulcerations

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12
Q

What are the qualifying criteria (3) for surgery in patients with intestinal obstruction?

A
  1. clinical or hemodynamic instability
  2. failure to improve after initial conservative measures (i.e bowel rest, IV rehydration, nasogastric tube)
  3. development of symptoms/signs of strangulation (i.e. fever and tachycardia)
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13
Q

Clinical Manifestation:

early psoas abscess

A

subacute presentation of psoas abscess:

  1. fever
  2. lower abdominal or flank pain that radiates to the groin
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14
Q

Describe the “psoas sign” often detected upon clinical examination of a patient with a psoas abscess.

A

abdominal pain with hip extension

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15
Q

What imaging modality is required to diagnose a psoas abscess?

A

CT scan is necessary for official diagnosis.

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16
Q

Treatment:

Psoas abscess

A
  1. Drainage

2. Antibiotics

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17
Q

Clinical Manifestation:

  1. acute pain
  2. swelling of the midline sacrococcygeal skin and subcutaneous tissues
A

Pilonidal disease

These patients often present with acute infection of a dermal sinus tract over the coccyx.

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18
Q

Treatment:

Umbilical hernia in an infant

A

Umbilical hernias are generally reducible and close spontaneously before the age of 5. Surgery is not required initially.

  • Umbilical hernias are especially common in African-American infants.
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19
Q

Clinical Manifestation:

  1. acute abdominal pain out of proportion to examination findings
  2. metabolic acidosis
  3. atrial fibrilation
A

Bowel ischemia

Patient may also have peripheral vascular disease (PVD) or other known risk factors of thromboembolic disease in addition to abdominal pain and metabolic acidosis. Atrial fibrillation is a common finding because cardiac embolus is the most common cause of acute mesenteric ischemia.

20
Q

What is the most common etiology for a complete small-bowel obstruction?

A

Post-operative adhesions

21
Q

Clinical Manifestation:

  1. nausea
  2. vomiting
  3. abdominal bloating
  4. XRay indicating: dilated loops of bowel
A

small bowel obstruction

22
Q

Treatment:

Complicated diverticulitis with abscess formation

A

CT-guided percutaneous drainage. Surgery is recommended if percutaneous drainage fails.

23
Q

Clinical Manifestation:

Acute cholecystitis

A
  1. RUQ pain
  2. Fever
  3. Leukocytosis

Patients may or may not have leukocytosis.

24
Q

Diagnosis:

  1. RUQ pain x 7 days
  2. fever x 7 days
  3. Leukocytosis
A

Perforated appendicitis with abscess formation.

Symptoms of appendicitis >5 days puts patients at risk for perforation and abscess formation.

25
Q

Treatment:

Clinically stable patient with appendicitis

A
  1. IV hydration
  2. Antibiotics
  3. Bowel rest
  4. Interval appendectomy (4-6 weeks later)
26
Q

Treatment:

Sphincter of oddi dysfunction

A

ERCP with sphincterotomy

27
Q

Damage to this organ is often missed immediately following blunt trauma to the upper abdomen.

A

Pancreas

28
Q

What complications might occur if pancreatic injury is missed on CT scan following blunt trauma to the upper abdomen?

A
  1. retroperitoneal abscess

2. pseudocyst

29
Q

Clinical Manifestation:

  1. nausea
  2. diarrhea
  3. abdominal cramps
  4. palpitations
  5. diaphoresis
A

Dumping syndrome

30
Q

What is a common complication postgastrectomy?

A

Dumping syndrome (

Indicated by GI symptoms (nausea, diarrhea, abdominal cramps) & vasomotor symptoms (palpitations, diaphoresis)

31
Q

Treatment:

Dumping syndrome

A

dietary modification

Symptoms will diminish over time.

32
Q

What solid organs are most commonly injured after blunt abdominal trauma?

A
  1. Liver

2. Spleen

33
Q

What is emphysematous cholecystitis?

A

infection of the gall bladder wall with a gas-forming bacteria

34
Q

What type of patient is most likely to get emphysematous cholecystitis?

A

Immunosupressed patients (i.e. diabetics)

35
Q

Treatment:

Emphysematous cholecystitis

A

Emergent cholecystectomy

36
Q

Clinical Manifestation:

  1. Constant, insidious, gnawing epigastric pain that is worse at night
  2. Anorexia with weight loss
  3. Jaundice
A

Pancreatic cancer

Jaundice is due to extrahepatic biliary obstruction.

37
Q

How can you clinically differentiate a peptic duodenal ulcer from pancreatic cancer?

A

Peptic duodenal ulcers are generally associated with epigastric abdominal paint that is periodic and relieved by meals.

38
Q

When should you suspect gallstone pancreatitis in a patient with epigastric pain radiating to the back?

A

Suspect gallstone pancreatitis when there is:

  1. evidence of pancreatitis (epigastric pain radiating to the back)
  2. elevated alanine aminotransferase (ALT) >150 U/L
39
Q

Treatment:

Gallstone pancreatitis in a medically stable patient

A

early cholecystectomy

40
Q

Diagnosis:

  1. early satiety
  2. nausea
  3. nonbilious vomiting
  4. weight loss

in a patient with a history of recent acid ingestion

A

Pyloric stricture –> gastric outlet obstruction

41
Q

Diagnosis:

  1. jaundice
  2. hypotension
  3. extensive blood loss into tissues
  4. massive blood replacement

following prolonged surgery

A

postoperative cholestasis

42
Q

Diagnosis:

Imaging in acalculous cholecystitis

A
  1. gallbladder wall thickening
  2. gallbladder wall distension
  3. pericholecystic fluid
43
Q

Treatment:

Acalculous cholecystitis

A
  1. antibiotics
  2. percutaneous cholecystostomy (stoma in gallbladder)
  3. cholecystectomy when medical condition stabilizes

Acalculous cholecystitis is most common in critically ill patients and is often difficult to assess due to underlying illness.

44
Q

Diagnosis:

  1. absent bowel sounds
  2. gaseous distention of both the small and large bowels
A

Paralytic (adynamic) ileus

45
Q

When might paralytic (adynamic) ileus occur?

A
  1. after abdominal surgery

2. in cases of retroperitoneal hemorrhage associated with vertebral fracture

46
Q

Treatment:

Isolated duodenal hematoma

A
  1. Nasogastric suction
  2. Parenteral nutrition

Duodenal hematomas most commonly occur in children following blunt abdominal trauma.

47
Q

Treatment:

  1. Migratory abdominal pain (periumbilical –> RLQ)
  2. Nausea/Vomiting
  3. Fever
  4. Leukocytosis
  5. McBurney point tenderness
  6. Rovsing’s sign
A

Emergent Appendectomy

This patient is not clinically stable and can not be managed with interval appendectomy.

Step 2 CK: Surgery (4 decks)

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