Gen Sx Flashcards
Cx of GERD
damage that might have been done to the lower esophagus (peptic esophagitis) and the possible development of Barrett’s esophagus
When to do Sx for GERD
• Appropriate in long-standing symptomatic disease that cannot be controlled by medical
means (using laparoscopic Nissen fundoplication)
• Necessary when complications have developed (ulceration, stenosis) (using laparoscopic
Nissen fundoplication)
• Imperative if there are severe dysplastic changes (resection is needed)
where solids are swallowed with less difficulty than liquids.
Achalasia
_______ is typically done first to evaluate for an obstructing lesion
Barium swallow
Xray of achalasia
X-rays show megaesophagus.
Tx of achalasia
balloon dilatation done by endoscopy, however recurrence is high and many patients ultimately require an esophagomyotomy (Heller).
Cancer of the esophagus shows the classic progression of dysphagia starting with ________
meat, then other solids, then soft foods, eventually liquids, and finally (in several months) saliva
________ is seen in people with long-standing gastroesophageal reflux
Adenocarcinoma
_________ also results from prolonged, forceful vomiting but leads to esophageal perforation
Boerhaave’s syndrome
______is a mucosal laceration typically at the junction of the esophagus and stomach
Mallory-Weiss tear
_______ of the esophagus is by far the most common reason for esophageal perforation
Instrumental perforation
Tx of gastric lymphoma
treatment is chemotherapy.
Surgery is only indicated if perforation is feared as the tumor melts away.
Low-grade lymphomatoid transformation (MALTOMA) can
be reversed by _______
eradication of H. pylori
_________ is more common in the elderly.
Symptoms include: • Anorexia • Weight loss • Vague epigastric distress or early satiety • Occasional hematemesis
Gastric adenocarcinoma
SSx of SBO
Early on, high-pitched bowel sounds coincide with the colicky pain (after a few days there is silence
patient develops fever, leukocytosis, constant pain, signs of peritoneal irritation, and ultimately full-blown peritonitis and sepsis
Strangulated obstruction
________ is seen in patients with a small bowel carcinoid tumor with liver metastases.
It includes diarrhea, flushing of the face, wheezing, and right-sided heart valvular damage
(look for prominent jugular venous pulse
Carcinoid syndrome
How to get 5 IAA in pts with suspected carcinoid
Whenever syndromes produce episodic attacks or spells, the offending agent will be at
high concentrations in the blood only at the time of the attack. A blood sample taken afterward
will be normal. Thus, a 24-hour urinary collection is more likely to provide the diagnosis.)
___________ typically presents with anemia (hypochromic, iron deficiency) in the right age group (age 50–70). Stools will be 4+ for occult blood.
Colonoscopy and biopsies are diagnostic; surgery (right hemicolectomy) is treatment of choice
Cancer of the right colon
_________ typically presents with bloody bowel movements and obstruction.
Blood coats the outside of the stool, there may be constipation, stools may have narrow caliber.
Cancer of the left colon
Dx of left colon CA
Flexible proctosigmoidoscopic exam (45 or 60 cm) and biopsies
Colonic polyps may be premalignant. In descending order of probability for malignant degeneration are:
familial polyposis (and variants such as Gardner’s), f amilial multiple inflammatory polyps, villous adenoma, and adenomatous polyp
Polyps that are not premalignant include
juvenile, Peutz-Jeghers, isolated inflammatory, and hyperplastic.
UC surgery indications
present >20 years
severe interference with nutritional status,
multiple hospitalizations,
need for high-dose steroids or immunosuppressants,
or development of toxic megacolon