General Flashcards
Management of acute cholangitis
- Fluids
- Abx
- ERCP
Most common causes of acute cholangitis
- Gallstones
- Malignancy
- Inflammatory strictures
Significant bleeding can occur during a distal pancreatectomy due to injuries to tributaries of the
Splenic vein
Treatment of choice for gastric trichobezoars
Gastrotomy with bezoar extraction (laparoscopic or open)
Ureteral injuries with < 50% transection can be repaired with
Stent and drainage, regardless of location.
Management for ureteral injuries > 50% transection distal to the iliac vessels (distal third)
Reimplantation into the bladder
Psoas hitch procedure or Boari flap
Management for ureteral injuries > 50% proximal to the iliac vessels (middle third)
Debridement, spatulation of ureteral ends, and primary anastomosis
Most common cause of primary adrenal insufficiency
Autoimmune atrophy of adrenals
Most commonly injured nerves during laparoscopic inguinal hernia repairs
Genitofemoral and lateral femoral cutaneous nerves.
Femoral nerve palsy (leg weakness with knee buckling / inability to extend the knee) is a known complication of
Ilioinguinal nerve blocks
- between external and internal oblique muscles at ~1-2 cm medial / inferior to ASIS.
Techniques to improve difficult colonoscopy
- Limiting air insufflation.
- Changing patient positioning.
- Withdraw scope to reduce looping.
- Apply counter abdominal pressure
- Use pediatric colonoscope
Nicotinic acetylcholine receptor agonist used in paralysis in intubation
Succinylcholine
Spinal cord injuries can lead to severe hyperkalemia from succinylcholine due to
Upregulation of acetylcholine receptors.
(others include severe burns and neuromuscular disorders)
Mutations in SMAD4, BMPR1A that leads to numerous polyps in colon/rectum, gastric polyps, and AVMs
Juvenile polyposis (autosomal dominant)
Mutation in STK11/LKB1 that leads to small intestine colon and gastric polyps, increase risk of malignancy, pigmentation of lips / buccal membranes, hamartomas.
Puetz-Jeghers syndrome
Mutation in APC that lead to thousands of colonic / duodenal adenomas, desmoid tumors, osteomas, fibromas, lipomas, and thyroid/adrenal tumors
Gardner syndrome
Mutation in APC, DNA mismatch repair that leads to colonic adenomas, medulloblastoma, and gliobastloma multiforme
Turcot syndrome
Mutation in hMLH1/hMSH2 that leads to sebaceous adenoma/adenocarcinomas, BCC, CRC, and GU malignancies
Muir-Torre syndrome
PRSS1 gene mutation (autosomal dominant) is most commonly associated with
Hereditary pancreatitis (no specific treatment)
Patients with hereditary pancreatitis can develop chronic pancreatitis and should be advised about what risk factor for pancreatic adenocarcinoma?
Smoking cessation
Stretch marks (striae atrophicae) are caused by
Disruption of dermis, collagen fibers, and atrophy of epidermis.
Most common cause of acute liver failure in the United States
Acetaminophen overdose.
- 2nd most common is idiopathic liver failure
First line diagnostic tool for nonocclusive mesenteric ischemia in critically ill patients
CT angiogram
- no contrast enhancement of bowel wall
- pneumatosis intestinalis
- portal venous gas
- distended bowel
What is needed to ensure a complete resection of a colonic polyp during cold snare polypectomy?
Margin of healthy tissue
- 6 o’clock positioning of polyp and downward pressure.
EGD findings that indicate re-bleeding risk in peptic ulcer disease (from high to low)
- Active pulsatile bleeding
- Active oozing
- Visible vessel in ulcer
- Adherent clot to base
- Ulcer with black spot
- Visible clean ulcer
What is an organ space wound infection?
< 30 days without implant or < 1 year after surgery with an implants.
- deep organ spaces that have been manipulated.
What is the most common complication of hepatic trauma?
Bile leak.
Abd pain, distension, feeding intolerance, elevated LFTs.
What are the two states in which patients can have falsely lowered anion gap measurements in metabolic acidosis?
Hypoalbuminemia
Hyperkalemia
What are characteristics of third-degree frostbite?
Full thickness injury, hemorrhagic blisters, nonviable skin can form black eschar. Takes 1-3 months to heal.
Management of hypothermia
Remove all jewelry
Rapid rewarming of tissue in heated water (98.6 F - 102.2 F)
Needle aspiration for blisters that are NOT hemorrhagic
Heavy smokers are at risk for develop peripheral artery disease where?
Superficial femoral artery
Intra-aortic balloon pump is indicated for
- Cardiogenic shock following MI
- Mitral regurgitation with HD instability w or w/o MI
- VSD following MI
Most common complication after a Whipple procedure
Delayed gastric emptying.
Leak / abscess should be ruled out prior to initiating Reglan / erythromycin.
Popcorn-like calcifications on CXR or chest CT are
Pulmonary hamartoma
Management of hypercalcemia
Normal saline and loop diuretics
- LR and potassium sparing diuretics are contraindicated
How does ASA affect platelet aggregation and clotting?
Irreversible inhibition of PGE synthesis in platelets by acetylating COX. Leads to permanent dysfunction of platelets.
