Gen Surg Flashcards
Gen surg start in competencies document 1 pg 60. before that is CV, Vascular, ENT, ENDO, Urology then Gen surg.
okay
Blunt trauma, abdominal
you get solid organ injury leading to either retroperitoneal bleeding or intra-abdominal bleeding. stabilize ABCs, mx of injury, SAMPLE hx. Phx : RBS, 2ndary survey. Ix: everything, esp crossmatch, PTT, INR, SK, ABGs, Tox screen, unrianalysis and image area needed ( FAST, DTL, peritoneal lavage for fluid, CT for specific ogan injury). mgmt: 2 large bore IVs, bolus 1 L colloid then do blood, maintenance 125ccs, + abx, analgesia, nausea control, NG, foley
penetrating trauma
when penetrating blow occurs and hits a hollow organ ( GI or liver), so now we worry about sepsis. same as blunt trauma where need ABCs, RBCs, Sample, 2ndary survey. IXs everything + imaging. Mgmt 2 large bore, bolus 1 L colloid followe by blood product, NG, Foley, ABX, nausea analgesia
anorectal fissure, abscess, vs fistula
fissure- BRBPR, extreme pain. tx fiber/ sphincterotomy
abscess-leukocytosis, I+D, Abx
fistulae- feel opening ) bidigital rectal exam), several surgeries
hemmroids, internal and external
external hemmroids- prolapsed submucosa veins due to increased pelvic/ abdominal pressures ( portal HTN, pregnancy, constipation) = painful = do anoscope and tx with rubber band ligation, coagulation, or hemorrhoidectomy.
interal= venous prolapse above dentate line ( painless) that have a 4-stage classification. pregnant pt complains pain following bowel mvmts, hematochezia ( fresh blood on stool),
appendiceal abscess
along with appendicities, you get an abscess ( collection of pus), so on U/S you see hypoechoic fluid in the RLQ. You can get CT for more detail, or if larger than 4cm, I+D + appendectomy. If under 4cm, some ppl try to just penetrate with abx first, then appy.
appendicitis
hx: N/V fever, diffuse pain (vague=visceral) localizing to RLQ ( parietal = point tenderness). Px: mcburneys, Rosvings ( palpation to left causes pain on right side), psoas sign ( retrocecal appendix), or obturator sign ( pelvic appendix). ix: CBC ( see high WBCs), BHCG( r/opreg), UA, CXR/ AXR to check perforation, CT optimal. Tx: surgery+ Abx+ fluid resuscitation ( stability lytes before going to OR!). Do colonoscopy in elderly to r/o neoplasm
biliary colic aka choledocholithiasis
defn; stone in common bile duct
hx: forty y.o. fat, female has pain after fatty meals in RUQ/ right shoulder ( referred from gallbladder) + jaundice ( bile duct is blocked) Px: elevated bilirubin ( direct) Ix/ Tx: ERCP, followed by possible lap cholesystectomy
CHOLECYSTITIS tehehe all in caps
gallstones obstruct the cystic duct ( duct leading otu of gallbladder), so gall gets inflamed. Hx RUQ pain in forty, fat, female. Px: murphys sign ( pain + inspiratory arrest). Ix: LFTs, ALP, GGT, CBC shows WBCs up, U/S shows thick gallbladder wall. HIDA scan is the most sensitive. tx: NPO, Iv fluids, analgesia, ABX, + cholecystectomy
cholangitis
once gallstones obstruct cystic duct, the biliary duct system can also get infected/inflamed = called cholecystitis. Hx: charcots triad: fever, jaundice, pain RUQ. Pentad = hypotention and mental status changes. px: charcots triad ix: Bili increased, ALP, LFTs, Leukocytosis ix: U/S or ERCP. mgmt : NPO, IV fluids, ABXXX + chole once sx resolve
CRC - colorectal carcinoma
an old man with a high fat, low fiber diet/ IBD/smoking, comes in with rectal bleeding. Depending on Right or left, may have symptoms of obstruction. Px: sns of anemia, fatigue, wt loss, ix: CBC (anemia), CEA, FOBT +ve. Imaging: barium enema will show “apple core”, colonscopy. Tx + staging: CT chest, abdo, pelvis, resect ( colectomy + anastamosis)
prognosis
stage 1: 90% stage 2: 70% stage3: 50% stage 4: 10% - 90% of recurrences occur within 3 years
DDX of someone with colon problems
polyps( neoplastic or non neo), lipoma, leiomyoma, volvulus, malrotation, diverticulosis, angiodysplasia, carcnoid tumor
polyps - what do you need to know?
they can be neoplastic ( juvenile polyps, Puetz-Jegher syndrome) or non-neo ( hyperplastic polyp, mucosal polyp, pseudopolyp, submucosal polyps). Can be sessile ( flat) or pedunculated. start screening at 50 yrs of age with colonoscopy, if adenomatous polyp then can be malignant (villour type), so need coagulation, ligation, or surgical operation if cnanot be removed endoscopically.
diverticular disease : diverticulosis
diverticulosis = outpouching of the colon due to low fibre diet, diverticulitis = its gets infected and gives painless bleeding. Rule of 2’s for diverticular disease. hx: LLQ pain, tendernessw/o fever/ WBCs. Ix: CBC, Lytes, Bun, Cr, AXR, scope. tx: resect involved region.
duodenal ulcer
hx: gnawing epigastric pain, relieved by food or antacids, worse in the middle of the night ( when stomach is empty), due to increased acid productionN/V. Px: ix: EGD, H pylori breath test, endoscopy/ Biopsy. Tx: Decrease risk factors( steroids, NSAIDS, smoking), increase mucous ) misoprostol), reduce acid ( PPI), kill hpylori ( PPI + clarithro+ amox). surgery if refractory to med mgmt.
