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General Surgery EOR > GastroIntestinal/Nutritional > Flashcards

GastroIntestinal/Nutritional Flashcards

1
Q

Biliary Colic,
Acute Cholecystitis,
Acute Cholecystitis, Acute Cholangitis,
Acute Hepatitis,

A

Causes of RUQ abdominal pain

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2
Q

Splenomegaly, Splenic infarct,
Splenic abscess,
splenic rupture

A

Causes of LUQ abdominal pain

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3
Q

Acute myocardial infarction, acute pancreatitis, chronic pancreatitis, peptic ulcer disease, GERD

A

Causes of epigastric abdominal pain

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4
Q

Appendicitis, diverticulitis, nephrolithiasis, pyelonephritis, cystitis,

A

Causes of lower abdominal pain

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5
Q

Patient will present as → a 49-year-old female with a 2-day history of right-upper-quadrant, colicky abdominal pain, as well as nausea and vomiting. Examination shows significant pain with palpation in the right upper quadrant. Laboratory findings include an elevated WBC count, alkaline phosphatase, and bilirubin level.

A

Acute/Chronic Cholecystitis

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6
Q

What is the most specific test for acute cholecystitis?

A

HIDA

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7
Q

PE findings include: RUQ pain, guarding, and +Murphy’s sign

A

Cholecystitis

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8
Q

Precipitated by fatty meals. Class pt = Fertile+ Fat+ Forty

A

Cholecystitis

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9
Q

Ultrasound = 1st line imagine procedure
Radionuclide scanning (HIDA) = Gold Standard

A

DX for cholecystitis

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10
Q

What is the procedure of choice for uncomplicated acute and chronic cholecystitis?

A

Lap Chole

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11
Q

What are the complications of acute cholecystitis?

A

Abscess perforation, choledocholithiasis, cholecystenteric fistula formation, gallstone ileus,

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12
Q

Labs usually associated with acute cholecystitis?

A

Increase WBC. May have slight elevation in alk phos, LFTs, amylase

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13
Q

Burning pain or discomfort in the upper chest and midchest, possibly involving the neck and throat, usually occurs after eating or at night and may worsen when lying down

A

heartburn and dyspepsia

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14
Q

Standard workup for this prior to surgical procedure includes:
Endoscopy with biopsy (gold standard)
Manometry
24 hour ambulatory pH probe testing
barium esophagography

A

Heartburn and dyspepsia

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15
Q

lifestyle modifications and acid suppression therapy is standard treatment for the classic presentation

A

Heartburn and dyspepsia

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16
Q

histamine H2 receptor antagonist -> PPI for mild or intermittent sx

A

tx for heartburn and dyspepsia

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17
Q

Triple therapy PPI+ clarithromycin + amoxicillin +/- metronidazole

A

tx for H. pylori infection

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18
Q

fundoplication if failed medical management or complications

A

surgical tx for heartburn/ dyspepsia

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19
Q

Patient will present as → a 37-year-old male complaining of rapid onset of severe mid-epigastric pain with radiation to the back after eating a large meal. The pain lessens when the patient leans forward or lies in the fetal position. Physical exam shows a low-grade fever, epigastric tenderness, diminished bowel sounds, and bruising of the flanks.

A

Acute/chronic pancreatitis

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20
Q

superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus

A

Cullen’s sign

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21
Q

bruising of the flanks, the part of the body between the last rib and the top of the hip

A

Grey Turner’s sign

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22
Q

The classic triad = pancreatic calcification, steatorrhea, and diabetes mellitus

A

Chronic pancreatitis

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23
Q

Abdominal CT is the diagnostic test of choice
Sentinel loops on X-Ray
(look for diminished bowel sounds as part of the exam question)
ERCP is the most sensitive

A

Dx for acute and chronic pancreatits

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24
Q

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

A

pancreatic pseudocyst (complication of acute pancreatitis)

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25
Q

Prochlorperazine 5 to 10 mg IV or
Droperidol 0.625 mg IV

A

rescue antiemetics for PONV

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26
Q

If the patient is hungry and can eat, you should seriously question the diagnosis of what surgical condition?

A

appendicitis

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27
Q

patients with acute hematemesis is indicative of what?

A

Upper GI bleed

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28
Q

Symptoms that suggest the bleeding is severe include orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities.

A

hematemesis

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29
Q

IV access or transfusion for pts that remain hemodynamically unstable

A

tx for hematemesis

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30
Q

Patient will present as → a 14-year-old boy with nausea, vomiting, constipation, and periumbilical pain that has settled in the lower right quadrant. The patient’s mom gave him a piece of toast and some water about 5 hours ago but he vomited 30 minutes after eating. On physical exam, he has tenderness and guarding in the lower right quadrant, pain upon flexion and internal rotation of right lower extremity, RLQ pain with right hip extension, and RLQ pain with palpation of the LLQ. Blood tests reveal leukocytosis with a shift to the left.

A

Appendicitis

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31
Q

1st sx is crampy or “colicky” pain around the navel. Usually a marked reduction in or total absence of appetite

A

appendicitis

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32
Q

Patient will present as → a 65-year-old female with diffuse abdominal pain and vomiting. She has not had a bowel movement in three days. PE reveals high-pitched, hyperactive bowel sounds, tympany to percussion, no rebound tenderness, and a temperature of 100.4 F. Abdominal radiograph reveals distended loops of bowel with a step ladder pattern of differential air-fluid levels.

A

Small bowel obstruction

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33
Q

Intussusception is the most common cause of this in children.

A

Smal bowel obstruction

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34
Q

decompression with a NGT. Surg if mechanic obstruction is suspected

A

small bowel obstruction

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35
Q

Where is the most common location of a large bowel obstruction?

A

Sigmoid colon

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36
Q

What finding on abdominal x-ray should make you think of bowel obstruction?

A

Air fluid levels

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37
Q

Patient will present as → a young mother who brings her 12-month-old daughter to your office reporting that she has had recurrent “belly aches” for the past two weeks. The child experiences sudden, colicky abdominal pain that recurs every 15 to 20 min, often with vomiting. These episodes are interspersed with periods of no complaints. The mother also reports that she has seen her squatting with her knees to her chest, which seems to relieve her of her symptoms. She describes her stool as bloody with mucus, almost as though it were a currant jelly. On physical examination, you note abdominal distention and tenderness along with a sausage-shaped abdominal mass in the RUQ.

A

Intussuception

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38
Q

what type of stool is pathognomonic for intussusception?

A

currant jelly stool

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39
Q

An abdominal x-ray will reveal a “Crescent sign” or a “Bull’s eye/target sign/coiled spring lesion” representing layers of the intestine within the abdomen.

A

Intussusception

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40
Q

Ultrasound shows “target sign”

A

Intussusception

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41
Q

Air or barium enema may be curative for children; if not, surgery is needed.

Adults generally require surgery

A

tx for Intussusception

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42
Q

What is the gold standard for confirming the dx of intussusception in children?

A

Barium enema (both diagnostic and therapeutic)

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43
Q

what is the diagnostic test of choice for esophageal webs?

A

barium swallow

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44
Q

esophageal webs + dysphagia + iron deficiency anemia

A

Plummer-Vinson syndrome

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45
Q

Patient will present as → a 62-year-old man with a history of alcoholism complains of difficulty swallowing solids that has progressed to difficulty swallowing liquids. He has smoked 1-2 packs of cigarettes per day for the past 38 years. In addition he reports occasional bouts of hematemesis and hoarseness, along with progressive weight loss and weakness.

A

esophageal cancer

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46
Q

smoking and alcohol consumption is associated with which kind of esophageal cancer?

A

Squamous cell CA (most common world wide)

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47
Q

Barrett’s esophagus is associated with which kind of esophageal cancer?

A

Adenocarcinoma (most common in the US)

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48
Q

What is the dx test of choice for esophageal cancers?

A

Upper endoscopy with biopsy. (CT scans for staging)

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49
Q

tx for esophageal cancer?

A

esophageal resection. (endoscopic screening recommended for pts with Barrett’s Q3-5 years)

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50
Q

Adenocarcinoma of the esophagus most likely occurs in which part of the esophagus?

A

Lower third

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51
Q

Patient will present as → a 43-year-old woman who comes to the emergency department with a 12-hour history of right upper quadrant (RUQ) abdominal pain. The pain is severe now but waxes and wanes and is associated with nausea and some episodes of vomiting. The pain sometimes radiates through to the back. She feels warm but has not checked her temperature. There is no diarrhea. Her last bowel movement was 1 day ago and was normal. The patient has no similar history in the past. On examination, the patient is an obese young woman in some discomfort. Her vital signs reveal a temperature of 100 ° F and pulse of 102 beats/ minute. Her blood pressure is 130/70 mmHg, and her respirations are 18 breaths/minute. There is no scleral icterus. The chest is clear, and the cardiovascular examination is normal. Abdominal examination reveals marked upper abdominal tenderness with guarding, especially in the RUQ. On palpation of the RUQ of the abdomen when the patient is asked to take a deep breath, there is a marked increase in pain. The bowel sounds are present but seem slightly sluggish. The patient has no drug allergies and is not taking any medications at present.

A

Cholelithiasis and choledocholithiasis

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52
Q

gallstones in the gallbladder (no inflammation)

A

cholelithiasis

53
Q

cystic duct obstruction by gallstones

A

cholecystitis

54
Q

gallstones in the biliary tree – associated with ductal dilation and biliary colic or jaundice. Stones in the common bile duct

A

Choledocholithiasis

55
Q

biliary tract infection secondary to obstruction by gallstones

A

Cholangitis

56
Q

What age should adults be screened for colorectal cancer according to USPSTF?

A

45 to 75

57
Q

This presents as painless rectal bleeding and a change in bowel habits

A

colorectal carcinoma

58
Q

A barium enema with classically show this for colorectal carcinoma

A

“apple core” lesion

59
Q

definitive diagnosis for colorectal carcinoma

A

colonoscopy and biopsy

60
Q

What are the colonoscopy guidelines for screening with increased risk factors such as adenomatous polyps or colon cancer in a 1st degree relative?

A

age 40 or 10 years younger for earliest diagnosis in the family

61
Q

Whats the recommended age for screening if you have a hx of Crohn’s disease of UC?

A

Any age

62
Q

Patient will present as → a 68 year old man who presents to the ED with unintentional weight loss and bloody stool. He reports that he experiences abdominal pain/fullness on occasions for the past 20 years. On PE, he is guaiac positive. There is a supraclavicular lymphadenopathy noted along with Sister Mary Joseph’s node. Labs show low hemoglobin levels.

A

gastric cancer

63
Q

How do you dx gastric cancer?

A

EGD and biopsy

64
Q

What will CBC show for gastric cancer?

A

microcytic/hypochromic anemia

65
Q

How do you treat gastric cancer?

A

surgical removal of the stomach. Gastrectomy is only curative tx.

66
Q

What are risk factors for gastric cancer?

A

fm hx of gastric cancer, gastric ulcers, H. Pylori, pernicious anemia (vitamin B12 anemia)

67
Q

Patient will present as → a 6-week-old first-born baby boy with projectile vomiting after feedings over the last 24 hours. Mom says that he enjoys feeding, and even after he vomits, he appears eager and hungry. On physical exam, you palpate an olive-shaped mass in the epigastric region at the lateral edge right upper quadrant. Labs show blood pH 7.47 and potassium of 3.2 mmol/L. On a barium upper GI series report, the radiologist states a “string sign” is present.

A

pyloric stenosis

68
Q

what is most likely dx if Infants feed well for first 2-3 weeks of life then presents with nonbilious vomiting after most or every feeding

A

pyloric stenosis

69
Q

A string sign on barium swallow should make you think of what diagnosis?

A

pyloric stenosis

70
Q

what is the tx for pyloric stenosis?

A

pyloromyotomy (ramstedt procedure)

71
Q

what is the most common cause of massive lower GI bleeding?

A

diverticulitis

72
Q

This disease presents as painless rectal bleeding, particularly in an elderly patient.

A

Diverticulosis

73
Q

What will a CT scan show for diverticular disease?

A

Fat stranding and bowel wall thickening

74
Q

What is the outpatient tx for colonic diverticulitis?

A

pain control and a liquid diet. If ABX needed, can use cipro and metronidazole

75
Q

What is a complication of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)

A

cholangitis

76
Q

the presenting sx associated with ascending cholangitis include

A

fever, right upper quadrant pain, and jaundice (Charcot’s triad)

77
Q

Reynolds pentad includes what? and what is it a sx of?

A

Hypotension

Confusion

Right upper quadrant pain

Jaundice

Fever

78
Q

What is a good initial test for ascending cholangitis and what will it show?

A

US. biliary dilation or stones

79
Q

In patients with Charcot’s triad and abnormal liver tests, proceed directly to which test to confirm the diagnosis and provide biliary drainage?

A

ERCP

80
Q

Patient will present as → a 52-year-old female with a history of cirrhosis secondary to long-standing alcohol abuse visits your office to discuss a 15-pound weight loss over the last 6 months. She reports early satiety, jaundice and vague abdominal discomfort. Her ascites, generally stable and small, has worsened in the last 3 weeks.

A

hepatic carcinoma

81
Q

What tumor marker may be used for liver cancer?

A

alpha-fetoprotein

82
Q

What type of tumor is an aggressive tumor that often occurs in the setting of chronic liver dz and cirrhosis

A

hepatocellular carcinoma

83
Q

What are some sx of pancreatic carcinoma?

A

weight loss, epigastric and pain, clay-colored stools.

84
Q

What tumor marker can be used to follow pancreatic cancer?

A

CA 19-9

85
Q

What is Courvoisier’s sign?

A

nontender, palpable gallbladder (may indicate pancreatic neoplasm)

86
Q

What is the treatment for pancreatic carcinoma?

A

Whipple procedure

87
Q

Patient will present as → a 68-year-old smoker with a 25 lb weight loss over the last three months that is associated with a burning pain deep in the epigastrium after eating, diarrhea, and jaundice. Physical exam reveals a palpable non-tender gallbladder and clay-colored stool. Labs show total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150.

A

pancreatic carcinoma

88
Q

What are the types of hiatal hernias?

A

Sliding hiatal hernia - type 1 (accounts for > 90 percent)

Paraesophageal hiatal hernia - type 2 (accounts for <5 percent)

89
Q

What is the surgery for type 1 hiatal hernia?

A

Nissen fundoplication

90
Q

A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?

A

Crohn’s disease

91
Q

Which inflammatory bowel disease is limited to the mucosa and submucosa?

A

Ulcerative colitis

92
Q

What are some radiographic findings of Crohn’s disease?

A

String sign of the terminal ileum

93
Q

What are some radiographic findings of Ulcerative colitis?

A

Tubular (lead pipe) appearance

94
Q

This presents with bloody puss-filled diarrhea, rectal/LQ pain, fever, urgency

A

Ulcerative colitis

95
Q

This presents with and pain, weight loss, non-bloody diarrhea, oral mucosal aphthous ulcers.

A

Crohn’s disease

96
Q

Where does Crohn’s disease most commonly present?

A

terminal ileum

97
Q

What will an antibody test show for Crohn’s disease?

A

+Anti-Saccharomyces cerevisiae antibodies (ASCA)

98
Q

What will an antibody test show for Ulcerative Colitis

A

Antineutrophil cytoplasmic antibodies (p-ANCA)

99
Q

A patient on sulfasalazine (anti inflammatory) for an inflammatory bowel disease should be supplemented with what vitamin?

A

Folate

100
Q

Is surgery curative for Crohn’s or ulcerative colitis?

A

UC

101
Q

What is the maintenance medication for IBD?

A

Sulfasalazine

102
Q

serum bilirubin of > 2.5 mg/dl is a sign of what?

A

Jaundice

103
Q

What are the 4 cardinal signs of strangulated bowel?

A

fever, tachycardia, leukocytosis, localized and pain

104
Q

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

A

Small bowel obstruction

105
Q

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

A

large bowel obstruction

106
Q

What is the most common cause of large bowel obstruction?

A

colorectal cancer

107
Q

What is a classic radiographic finding of SBO?

A

dilated loops of small intestine, air fluid levels, bowel stacking

108
Q

What is a “coffee bean sign” indicative of

A

volvulus (loop of intestine twists around itself causing a bowel obstruction

109
Q

Patient will present as → a 45-year-old man with severe rectal pain when he defecates, lasts for several hours and subsides until the next bowel movement. He has been constipated for the past 6 months and when he does have a bowel movement the stool is covered with bright red blood. A sentinel pile (thickened mucosa) is noted on physical exam.

A

Anal fissure

110
Q

Patient will present as → a 47-year-old man with severe rectal pain when he defecates. He has a fever of 102.2 F (39 C). On exam there is perianal swelling, redness and tenderness. A palpable mass is felt at the anal verge.

A

rectal abscess

111
Q

Patient will present with → perianal drainage, perirectal abscess, recurrent perirectal abscess, “diaper rash,” itching

A

rectal fistula

112
Q

What is a risk factor for an increased incidence of duodenal and gastric ulcers, as well as a decrease in rate of healing?

A

cigarette smoking

113
Q

food classically causes pain for this type of ulcer

A

gastric ulcer

114
Q

food classically decreases pain for this type of ulcer

A

duodenal ulcer

115
Q

duodenal and gastric ulcers are most commonly caused by what?

A

H. pylori infections

116
Q

What is the most accurate dx test for PUD?

A

Upper endoscopy

117
Q

tx for H. Pylori

A

PPI + Amoxicillin 1g PO BID + Metronidazole or Clarithromycin 500 mg PO BID

118
Q

What is more painful, internal or external hemorrhoids?

A

external hemorrhoids

119
Q

What causes more bleeding, internal or external hemorrhoids?

A

internal hemorrhoids

120
Q

This involves protrusion of the stomach through the diaphragm via the esophageal hiatus. It can cause symptoms of GERD; acid reduction may suffice, although a surgical repair can be used for more serious cases.

A

Hiatal (diaphragmatic) hernia

121
Q

This type of hernia occurs when there is weakening in the anterior abdominal wall and may be either incisional or umbilical

A

Ventral hernia

122
Q

This hernia is associated with vertical incisions, especially with obesity

A

Incisional hernia

123
Q

This hernia is very common, generally is congenital, and appears at birth. Many resolve on their own and rarely require intervention. Refer to surgery if hernia persists >2 years of life.

A

umbilical hernia

124
Q

This hernia goes through a 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.

A

Indirect inguinal hernia (most common)

125
Q

this hernia goes though a passageof intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum

A

Direct inguinal hernia

126
Q

Patient will present as → 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.

A

toxic megacolon

127
Q

a complication of inflammatory bowel disease, such as ulcerative colitis and, more rarely, Crohn’s disease, and of some infections of the colon, including Clostridium difficile infections, which have led to pseudomembranous colitis.

A

Toxic Megacolon

128
Q

plain-film radiography will show colonic dilation > 6 cm

A

toxic megacolon

129
Q

At least three of the following for a dx: Fever (>101.50F),
Heart rate > 120/min,
Neutrophilic leukocytosis (>10.5 x 109/L)
and Anemia.

A

toxic megacolon

General Surgery EOR (10 decks)

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