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CB Surgery > Gen Surg > Flashcards

Gen Surg Flashcards

1
Q

A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, abdominal radiograph reveals free air under the diaphragm. Management?

A

Emergent laparotomy to repair a perforated viscus

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2
Q

What is the most likely cause of acute lower GI bleeding in patients > 40 years of age?

A

Diverticulosis

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3
Q

What is the diagnostic modality used when ultrasonography is equivocal for cholecystitis?

A

HIDA (hepatobiliary imilodiacetic acid) scan

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4
Q

What are the risk factors for cholelithiasis?

A

Fat, female, fertile, forty, flatulent

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5
Q

Inspiratory arrest during palpation of the RUQ?

A

Murphy’s sign, acute cholecystitis

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6
Q

What is the most common cause of small-bowel obstruction in patients with no history of abdominal surgery?

A

Hernia

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7
Q

What is the most common cause of small-bowel obstruction in patients with history of abdominal surgery?

A

Adhesions

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8
Q

A 30 year old man with ulcerative colitis + fatigue, jaundice and pruritus?

A

Primary sclerosing cholangitis

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9
Q

What type of hernia has the highest risk of incarceration - indirect, direct, or femoral?

A

Femoral

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10
Q

What causes severe abdominal pain out of proportion to the exam?

A

Mesenteric ischemia

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11
Q

How do you confirm diagnosis of ileus?

A

Abdominal x-ray (or CT)

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12
Q

50 year old man with hx of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. What is the management?

A

Confirm dx of acute pancreatitis: increased amylase and lipase
Make pt NPO, IV fluids, O2, analgesia, and time

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13
Q

Colon cancer region based on symptoms:

Anemia from chronic disease, occult blood loss, vague abdominal pain

A

Right sided: rare to have obstruction

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14
Q

Colon cancer region based on symptoms:

Obstructive symptoms, change in bowel movements

A

Left sided: “apple-core lesion

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15
Q

What presents with palpable, contender gallbladder?

A

Courvoisier sign (suggests pancreatic cancer)

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16
Q

Barium swallow shows corkscrew-shaped esophagus in what disorder?

A

Diffuse Distal Esophageal Spasm

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17
Q

What is the definitive test to diagnose distal esophageal spasm?

A

Esophageal manometry

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18
Q

The musculature of the upper 1/3 of the esophagus is ____ muscle, whereas that of the lower 2/3 is ____ muscle.

A

Skeletal

Smooth

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19
Q

What is achalasia?

A

A motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis in the distal 2/3 of the esophagus.

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20
Q

What condition shows esophageal dilation with a “bird’s beak” tapering of the distal esophagus on barium swallow?

A

Achalasia

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21
Q

What condition has a cervical out pouching through the cricopharynxgeus muscle and is a posterior, false diverticulum?

A

Zenker diverticulum

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22
Q

Why does esophageal cancer metastasize early?

A

Esophagus lack a serosa

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23
Q

What type of cancer occurs in the upper and middle thirds of the esophagus?

A

SCC

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24
Q

What type of cancer occurs in the lower third of the esophagus?

A

Adenocarcinoma

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25
Q

What condition shows an irregular Z line (squamocolumnar junction between the esophagus and stomach) due to columnar metaplasia of the lower esophagus on upper endoscopy?

A

Barrett esophagus

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26
Q

What causes Type A chronic gastritis?

A

Type A (10%): occurs in the fundus and is due to antibodies to parietal cells; causes pernicious anemia

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27
Q

What causes Type B chronic gastritis?

A

Type B (90%): occurs in the antrum and may be caused by NSAIDs or H pylori

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28
Q

What is the triple therapy for H pylori infection?

A

Amoxicillin
Clarithromycin
Omeprazole

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29
Q

What is a Krukenberg tumor?

A

A gastric adenocarcinoma txt metastasizes to the ovary.

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30
Q

What gastric tumor presents in patients with chronic H pylori infection?

A

MALT lymphoma

note: it is the only malignancy that can be cured with antibiotics - triple therapy

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31
Q

What cancer presents with Virchow’s node?

A

Gastric

32
Q

Pain from what ulcer increases after a meal?

A

Gastric pain is GREATER after a meal

Duodenal pain DECREASES after meal

33
Q

What rare condition is characterized by gastrin-producing rumours in the duodenum and/or pancreas, that leads to over secretion of gastrin?

A

Zollinger-Ellison Syndrome

34
Q

How do patients with Zollinger-Ellison syndrome present?

A

Hypercalcemia (associated with MEN1)
Epigastric pain (peptic ulcer)
Diarrhea (due to mucosal damage and pancreatic enzyme inactivation leading to malabsorption)

35
Q

What is the difference between a partial and complete SBO?

A

Partial: passing flatus, no stool
Complete: no flatus, no stool

36
Q

What is Pellagra?

A

A deficiency of B3 (niacin), secondary to recurrent carcinoid tumor

37
Q

What is the classic presentation of Pellagra? (4 Ds)

A

Diarrhea
Dementia
Dermatitis
Death

38
Q

How is gallstone ileum a form of SBO?

A

It occurs when a stone lodges at the ileoceal valve

39
Q

How does ileus present on x-ray?

A

Air is present throughout the small and large bowel.

40
Q

Should you do a sigmoidoscopy in the early stages of diverticulitis?

A

No - should be avoided because of the increase risk of perforation

41
Q

What is ogilvie syndrome?

A

Pseudo-obstruction

42
Q

What does iron deficiency anemia in elderly indicate until proven otherwise?

A

Colorectal cancer

43
Q

What are the risk factors for colon cancer?

A
  1. Increased age, peak 70-80
  2. Hereditary polyposis syndromes (FAP, HNPCC)
    • Fam Hx (esp first degree relatives <60)
  4. IBD (U/C > Crohns)
  5. Adenomatous polyps (villous > tubular; sessile > pedunculated)
  6. High fat, low fiber diet
44
Q

How do you differentiate upper from lower GI bleeding?

A

Ligament of Treitz (anatomic boundary between the duodenum and jejunum)

45
Q

What is Hasselbach triangle?

A

Area bounded by inguinal ligament, inferior epigastric artery, and rectus abdomens (relevant in inguinal hernias)

46
Q

What is the difference in location between direct and indirect hernias regarding the inferior epigastric vessels?

A

Direct hersais lie Me”D”ial
Indirect hernias lie “L”ateral

to inferior epigastric vessels

47
Q

“Lead Pipe” colon on barium enema

A

Ulcerative Colitis

48
Q

Is there an increased risk in colon cancer for U/C or Crohn’s?

A

U/C

total proctocolectomy can be curative/ recommended for prevention

49
Q

What disease are perianal issues, tags, fistulas associated with?

A

Crohn Disease

50
Q

The rectum is alway involved in which IBD?

A

U/C

51
Q

What medical treatment is used in IBD?

A

5-ASA; corticosteroids for flare ups; immunomodulators (azathioprine) and biologics (infliximab)

52
Q

Most gallstones are precipitates of ___.

A

Cholesterol (therefore radiopaque)

53
Q

Define cholelithiasis

A

Stones in gallbladder

54
Q

Define cholecystitis

A

Inflammation of the gallbladder, typically due to stone occluding cystic duct

55
Q

Define choledocolithiasis

A

Stone in CBD

56
Q

Define cholangitis

A

Infection of the CBD, usually due to stone in CBD

57
Q

Define gallstone ileus

A

Mechanical obstruction resulting from the passage of a large (>2.5 cm) stone into the bowel through a cholecystoduodenal fistula (obstruction often at ileocecal valve)

58
Q

Is it common for HCV to become chronic ?

A

Yes

70-80% of patients will develop chronic hepatitis

59
Q

Primary sclerosing cholangitis is strongly associated with what IBD?

A

Ulcerative colitis

60
Q

MRCP/ERCP that shows multiple bile duct strictures and dilatations, “beading”, is indicative of what disease?

A

Primary Sclerosing Cholangitis

61
Q 
Lab findings:
increased alk phos
increased bill
\+ antimitochondrial antibody
increased cholesterol
A

Primary Biliary Cirrhosis

62
Q 
Clinical Presentation:
RUQ tenderness
Abdominal distention 
Jaundice
Easy Bruising
Cogaulopathy

With risk factors: high alc intake, chronic hep B

A

Hepatocellular carcinoma

63
Q

How does an insulinoma present?

A

Hypoglycaemia satisfying Whipple Triad:

1) documented hypoglycaemia on a venipuncture
2) with associated symptoms including sweating, palpitations, anxiety, tremor, headache, confusion
3) resolution of symptoms with correction of hypoglycaemia

64
Q

What is the definitive test for insulinoma?

A

72-hour fasting test

65
Q

What is a Vipoma?

A

Results from VIP-producing tumor, highly malignant

From non B-islet cells of pancreas

66
Q

What is the most common pancreatic cancer?

A

Ductal adenocarcinoma in the head of the pancreas

67
Q

What are the risk factors for pancreatic cancer?

A

1) Smoking
2) Chronic pancreatitis
3) 1st degree relative with pancreatic cancer

68
Q

What is Courvoisier sign?

A

Palpable, nontender gallbladder

69
Q

What type of organisms are post-splenectomy patients susceptible to?

A

Encapsulated organisms

70
Q

What vaccines should be administered post-splenectomy?

A

1) Streptococcus pneumonia: Pneumovax 23
2) Haemophilus influenzae type B: HibTITER
3) Neisseria meningitides
Age 16-55: Meningococcal (groups A, C, Y, W-135) polysaccharide diphtheria toxoid
conjugate vaccine (Menactra)
Age >55: Meningococcal polysaccharide vaccine (Menomune-A/C/Y/W-135)

71
Q

What are the findings on u/s in acute cholecystitis?

A

1) Gallstones
2) Gallbladder wall thickening (5mm or greater)
3) Pericholecystic fluid
4) Positive sonographic Murphy’s sign

72
Q

What is a HIDA scan?

A

A nuclear imaging procedure that utilizes a radioactive tracer, technetium-99m, to evaluate GB fxn

73
Q

In general, is X-ray utilized for workup of biliary disease?

A

No (only 20% of gallstones will contain sufficient calcium to be seen on x-ray)

74
Q

What is the average age of patients presenting with ischemic colitis?

A

70

75
Q

What nerve give voluntary anal sphincter control?

A

inferior rectal nerve

CB Surgery (5 decks)

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