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ABS > General Abdomen > Flashcards

General Abdomen Flashcards

1
Q

Predominant cause of chylous ascites in Western world

A

malignancy (esp lymphoma), cirrhosis

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2
Q

MCC chylous ascites in developing world

A

infectious such as tuberculosis and filariasis

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3
Q

Chylous ascites: triglyceride count

A

Usually >200 mg/dL

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4
Q

greatest risk for recurrent ulcer bleeding

A

visible vessel

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5
Q

most common location of bleeding ulcers

A

posterior duodenal bulb

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6
Q

Tx of biliary cystadenoma

A

surgical enucleation or resection (anatomic not required)

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7
Q

Tx of PCLD type 1

A

limited number of large cysts

aspiration/sclerosis or unroofing

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8
Q

tx of type 2 PCLD

A

moderate sized cysts with intervening normal parenchyma

surgical unroofing or resection

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9
Q

tx of type 3 PCLD

A

diffuse involvement of moderate and small cysts without much normal parenchyma
typically requires transplant after failure of medical mgmt

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10
Q

hydatid cysts associated with what parasite

A

echinococcus granulosis

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11
Q

thick walled, calcified cysts with daughter cells in periphery

A

hydatid cysts

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12
Q

tx of hydatid disease

A

PAIR or open surgical pericystectomy + anti helminthic drugs (albendazole or mebendazole) for 2 weeks preoperatively
PAIR = puncture, aspiration, injection of sclerosing agents and reaspiration of contents

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13
Q

tx of amebic abscess

A

Flagyl (Due to entamoeba histolytica)

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14
Q

narrowing of aortomesenteric angle to <25

A

SMA syndrome

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15
Q

normal aortomesenteric angle

A

38-65 degrees

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16
Q

annular pancreas is a result of

A

tethering of ventral pancreatic bud to duodenum (failure of CLOCKWISE rotation)

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17
Q

tx of annular pancreas in children

A

duodenal bypass

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18
Q

annular pancreas a/w

A

down syndrome

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19
Q

duodenal atresia cause

A

complete failure of recanalization of duodenum after 7th wee kof gestation

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20
Q

prenatal ultrasound in duodenal atresia

A

polyhdramnios

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21
Q

“double bubble” sign

A

duodenal atresia

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22
Q

diagnose duodenal atresia - waht next?

A

place NG or OG, clinically stabilize and then perform duodenoduodenostomy or duodenojejunostomy

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23
Q

spillage of what kind of hepatic cyst can lead to anaphylaxis

A

echinococcal/hydatid

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24
Q

what should you do if echinococcal cyst with jaundice, increased LFTs or cholangitis?

A

pre op ERCP to check for communication with biliary system

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25
Q

what type of diagnostic testing can be done for echinococcal disease

A

casoni skin test, serology

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26
Q

what kind of infection a/w variceal bleeding

A

schistosomiasis

also will see maculopapular rash, increased eosinophils

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27
Q

tx of schistosomiasis

A

praziquantel, contrtol of variceal bleeding if present

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28
Q

1 organism in poyogenic abscess

A

E.coli

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29
Q

what type of diagnostic testing can be used when diagnosing amebic hepatic abscess (E. histolytica)

A

indirect hemagglutination
ELISA
indirect IF
latex agglutination

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30
Q

when should eprcutanoeus drainage be performed for amebic abscess

A 
>10 cm diameter
subcapsular
pre rupture status
superinfected
resistance to medical tx
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31
Q

indications for surgery in pancreatic cysts

A

worrisome cytology
dilated pancreatic duct in presence of solid component in cyst
Some guidelines include jaundice as well

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32
Q

pancreatic cyst size > ___ cm is worrisome per guidelines and warrants additional workupo

A

3 cm

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33
Q

cross-linked mesh

A

biologic

increases durability, tensile strength, and resistance to bacterial contamination

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34
Q

to be defined as biliary dyskinesia must have episodes of duration lasting at least how long?

A

30 min

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35
Q

what type of pain is needed to be defined as biliary dyskinesia

A

crescendo pain not relieved by BM, postural change or antacids

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36
Q

2 most significant facrors for hernia recurrence

A

hernia width

contamination

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37
Q

contrast when suspecting appendicitis

A

IV only

enteral does not increase accuracy of diagnosis

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38
Q

frequency of port site recurrence in gallbladder cancer

A

10%

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39
Q

McVay/Cooper repair approximates what to what

A

transversus abdominis aponeurosis (Conjoint) to Cooper’s ligament

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40
Q

when performing Mcvay repair for possible strangulated femoral hernia what should you be sure to do

A

incise thigh fascia below inguinal ligament to displace the fat tissue surrounding femoral hernia sac and check contents

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41
Q

usually femoral hernia is found where in relation to inferior epigastrics

A

medial

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42
Q

splenic vein - above or below artery

A

below

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43
Q

splenic vein originates within what ligament

A

splenorenal

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44
Q

where does splenic vein unite with SMV

A

posterior to neck of pancreas/splenic mesenteric confluence (forms hepatic portal vein)

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45
Q

median 5 year survival after resection of invasive IPMN

A

43%

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46
Q

branch duct IPMN <1 cm mgmt (no concerning CA sx)

A

cross sectional imaging annually

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47
Q

branch duct IPMN 1-3 cm mgmt (no concerning CA sx)

A

repeat cross sectional imaging in 6 months then annually if no change

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48
Q

branch duct IPMN >3 cm mgmt (no concerning CA sx)

A

resection to negative margins

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49
Q

5 year survival after resection of non invasive IPMN

A

77%

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50
Q

How often do IPMN recur

A

8% (Doesnt matter if invasive or not)

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51
Q

double duct sign

A

simultaneous dilation of cbd and pancreatic ducts

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52
Q

2 MC causes of double duct sign

A

CA of head of pancreas and ampullary tumors

could also be impacted gallstone in distal duct with assoc edema

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53
Q

Puestow procedure

A

main pancreatic duct is dilated greater than 8 mm and consists of performing a longitudinal pancreaticojejunostomy.

creation of retrocolic Roux limb, opening of duct from head to tail, 1 or 2 layer side to side pancreaticojejun

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54
Q

Frey procedure

A

A Frey’s procedure is indicated in patients with chronic pancreatitis who have the majority of their disease within the head of the pancreas and involves resecting peripancreatic ductal tissue in the head of the pancreas and performing a longitudinal pancreaticojejunostomy.

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55
Q

Beger procedure

A

local resection of pancreatic head with duodenal preservation ** creation of retrocolic Roux limb, end to end pancreaticojejunostomy with pancreaticojejunostomy to pancreatic head remnant

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56
Q

Key to Beger procedure

A

preservation of posterior branch of GDA to maintain viability of duodenum and distal CBD

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57
Q

Diff between Beger and Frey

A

Frey procedure does NOT transect the pancreatic neck vs Beger does

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58
Q

What is the conjoint tendon

A

transversus abdominis + internal oblique

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59
Q

where do the epigastric vessels run in lap hernia repair

A

lateral umbilical fold

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60
Q

what does the medial umbilical fold contain

A

remnant of umbilical aa

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61
Q

what does the median umbilical fold contain

A

remantn of the urachus

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62
Q

MCC pyogenic liver abscess

A

cholangitis 2/2 gram negative aerobes

E. Coli, klebsiella pneumonia and proteus spp

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63
Q

hepatic abscess following liver txp should raise concern for

A

presence of hepatic artery thrombosis

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64
Q

need for frozen section on desmoid?

A

yes to ensure complete excision otherwise recurrence up to 80%

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65
Q

overall recurrence rate for appendicitis tx with antibiotics

A

5-38%

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66
Q

bile duct excision and hepaticojejunostomy is tx for which types of choledochal cysts

A

type I and IV

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67
Q

early washout during delayed or late phase on multi phase CT scan may indicate 1 of 2 things

A

hepatic adenoma or HCC

68
Q

modality of choice for pancreatic cysts

A

MRCP

69
Q

describe peritoneum

A

bidirectional semipermeable membrane made of simple squamous epithelium

70
Q

parietal peritoneum covers

A

abdominal wall, portions of pelvis and diaphragm

71
Q

visceral; peritoneum blood supply

A

splanchnic vessels

72
Q

parietal peritoneum blood supply

A

branches of intercostal, subcostal, lumbar and ilaic vessels

73
Q

visceral vs parietal peritoneum nerve supply

A

visceral - few nerves (localization is poor)

parietal - travels with somatosensory spine nerves, localized pain

74
Q

Retroperitoneal organs

A 
SAD PUCKER
Suprarenal (Adrenal) glands
Aorta/IVC
Duodenum (2nd, 3rd)
Pancreas
Ureters
Colon (asc., desc.)
Kidneys
Esophagus
Rectum
75
Q

gold standard to hypertrophy anticipated future liver remnant

A

portal vein embolization

76
Q

Tx for somatostatinoma

A

Usually in head, enucleation is not adequate resection for pts with somatostatinoma given high likelihood of malignancy. Have to do Whipple

77
Q

best test to dx chronic mesenteric iscehemia

A

CTA

78
Q

abx combo for pyogenic liver abscess

A

ampicillin + aminoglycoside + flagyl

79
Q

percutaneous drainage for pyogenic liver abscess contra indications

A 
abdominal patholgoy
coagulopathy
inaccessibility
massive ascites
small, multiloculated, or multiple abscesses
80
Q

fibropolycystic liver disease aka

A

choledochal cyst

81
Q

2 genetic conditions that increase risk for cholangioCA

A

Lynch syndrome

biliary papillomatosis

82
Q

liver flukes a/w

A

cholangioCA of intrahepatic bile ducts

83
Q

migration of adult Ascaris worms into biliary tree

A 
biliary colic or strictures
acalculkous chole
ascending cholangitis
liver abscesses
recurrent pyogenic cholangitis (stone formation around dead A. lumbricoides in the bile duct)
pancreatitis
84
Q

two things seen on PBS of post splenectomy pt

A

howell-jolly bodies

siderocytes

85
Q

one of key issues with lap ventral hernia repair

A

fascia often not closed primarily

86
Q

characteristics of chylous ascites

A

elevated TGs
leukocytosis with lymphocytic predominance
negative fluid cultures

87
Q

sensitivity of ERCP to diagnose pancreatic CA

A

approaches 90%

88
Q

sensitivity of CT for dx of pancreatic CA

A

85%

89
Q

bismuth classification: tumor involves common hepatic duct DISTAL to bifurcation

A

class I

90
Q

bismuth classification: tumor involves confluence of right and left hepatic ducts and extends to RIGHT hepatic duct

A

class IIIa

91
Q

bismuth classification: tumor involves confluence of right and left hepatic ducts, extends to LEFT hepatic duct

A

class IIIb

92
Q

bismuth classification: tumor involves confluence of right and left hepatic ducts and extends to both right and left hepatic ducts

A

class IV

93
Q

klatskin tumor

A

upper duct (or hilar) cholangiocarcinoma

94
Q

MC organism a/w SBP

A

aerobic gram negative rods (over 50% are E. coli species)

Top 3:
E coli
Klebsiella pneumo
Pneumococci

95
Q

in utero that majority of pancreas drained by ?

A

dorsal duct, opens up into MINOR papilla

96
Q

in adults, 70% of pancreas is drained by

A

ventral duct, opens up into major papilla

97
Q

in pancreas divisum, major drainage of pancreas is done by the

A

dorsal duct which opens up into MINOR papilla

98
Q

atezolizumab moa

A

commonly used in unresectable HCC

monoclonal Ab of IgG1 isotype against protein programmed cell death-ligand 1 (PD-L1)

99
Q

MOA of sorafenib

A

multikinase inhibitor with activity against VEGF

100
Q

most reliable dx tool for budd chiari

A

duplex US of liver and vasculature

101
Q

any injury to CBD with ductal tissue loss or when >50% of duct involved, tx of choice

A

roux en y choledochoj (distal CBD) or hepaticoj (proximal CBD)

102
Q

second line therapy for ITP

A

rituximab or thrombopoietin receptor agonist ssuch as romiplostim or eltrombopag

103
Q

rituximab MOA

A

monoclonal Ab that targets CD20 on B cells

104
Q

what pathologic process involving spleen poorly delineated on B mode US

A

infarction

can use US contrast (sulfur hexafluoride lipid-type A microspheres)

105
Q

comared with surgical resection alone, surgical resection and adjuvant XRT in tx of GB cancer is a/w

A

slightly longer survival

106
Q

c peptide levels in insulinoma

A

c-peptide (marker for insulin secretion) levels are elevated

107
Q

pts with glucagonoma increased risk for

A

DVT

108
Q

Dx of glucagonoma can be confirmed with glucagon level > than

A

500 pg/mL

109
Q

glucagonoma - location

A

head and tail of pancreas, tend to be large with mets at time of dx

110
Q

tx of choice glucagonoma

A

surgical removal with debulking

111
Q

MCC atraumatic splenci rupture

A

malignant hematologic disorders

112
Q

repeat cscope in pts with <20 hyperplastic polyps <10 mm

A

10 years

113
Q

individuals with 1-2 adenomas <10 mm should undergo next surveillance cscope at

A

7-10 years

114
Q

individuals with 3-4 adenomas <10 mm, surveillance cscope at

A

3-5 years

115
Q

indiduals with 5-10 adenomas should undergo surveillance in

A

3 years

116
Q

individuals with adenoma > or = 10 mm should undergo surveillance in

A

3 years

117
Q

individualks with adenoma with villous component or high grade dysplasia should undergo surveillance in

A

3 years

118
Q

pts with >10 adenomas should undergo surveillance in

A

1 year with cosndieratio for genetic testing

119
Q

in case of piecemeal resection of adenoma > or = 20 mm

A

cscope in 6 months, then 1 year later, then 3 years after second exam

120
Q

individuals with 1-2 sessile serrated polyps

A

5-10 years

121
Q

indviduals with 3-4 sessile serrated polyps <10 mm should undergo cscope in

A

3-5 years

122
Q

individuals with hyperplastic polyp > or = 10 mm surveillance in

A

3-5 years

123
Q

individuals with 5-10 SSPs should undergo surveillance in

A

3 years

124
Q

individuals with SSP > or = 10 mm should undergo surveillance in

A

3 years

125
Q

individuals with SSP with dysplasia or traditional serrated adenoma surveillance in

A

3 years

126
Q

risk of OPSI highest when spleen removed for

A

malignancy

127
Q

mesh placement with lowest recurrence rates for ventral hernia

A

sublay

128
Q

location for mesh implantation in TAR (posterior component separation)

A

sublay in retromuscular position

129
Q

which procedure does acellular dermal matrix mesh demonstrate lower recurrence rates and fewer infectious complications than artificial mesh

A

VHR with concomitant ECF repair (or in general, presence of heavy contamination)

130
Q

describe polydioxanone suture

A

slowly absorbable (6-9 months)

131
Q

describe polyglactin suture

A

rapidly absorbable (2-3 months)

132
Q

adjuvant chemotherapy in pancreatic adenoCA

A

survival benefit and decreases recurrence
gemcitabine or FU + folinic acid
Gemcitabine favored because of lower toxicity

133
Q

Adjuvant chemoXRT in pancreatic adenoCA indications

A

residual microscopic disease

node positive disease

134
Q

after ruling out malignancy and parasitic infection, next step in splenic cyst?

A

perc aspiration

135
Q

local recurrence in retroperitoneal sarcoma

A

up to 35-60% of pts after 10 years

136
Q

which fascial closure techniques minimize incidence of incisional hernia after elective midline laparotomy

A

onlay polypropylene mesh reinforcement

137
Q

RFA in HCC

A

small <3 cm HCC

138
Q

MC complication after RFA for HCC

A

hemorrhage

can combine with chemoembolization to avoid hemorrhagic complications

139
Q

when does retroperitoneal sarcoma get adjuvant chemo?

A

mets

typically anthracyclin based

140
Q

what improves overall survival in retroperitoneal sarcoma

A

grossly negative margins

141
Q

pancreatic tumor that stains positive for beta catenin

A

solid pseudopapillary neoplasm

142
Q

most precise single predictor of operative mortality at 30 days in pts with liver cirrhosis

A

MELD

143
Q

indication for CBD resection in gallbladder CA

A

cystic duct margin +

144
Q

1 RF for splenic a aneurysm

A

atherosclerosis

145
Q

mesh placement with lowest recurrence

A

sublay

146
Q

Class A child pugh class score

A

5-6

147
Q

Class B child pugh class score

A

7-9

148
Q

MC chemo agent used in HIPEC

A

Mitomycin

149
Q

MC chemo agent used in HIPEC

A

fMitomycin

150
Q

Expected mean survival for pt with stage IV colorectal CA + peritoneal carcinomatosis

A

6 mos

151
Q

In order to facilitate HIPEC, debulking of any lesions bigger than what size?

A

> 2 mm

152
Q

Chemotherapy in HIPEC is most effective at what temp

A

41 degrees celsius

153
Q

Howell Jolly Bodies

A

Nuclear remnant
Asplenic patients

154
Q

Heinz bodies

A

denatured hemoglobin
Seen in asplenic patients, thalassemias, and G6PD deficiency

155
Q

Pappenheimer bodies

A

Iron granules found in RBCs in pts with sideroblastic anemia

156
Q

Acanthocytes

A

Spur cells

157
Q

Schistocytes

A

Microangiopathic hemolysis as in TTP or DIC

158
Q

2nd most common location of accessory spleen

A

Tail of pancreas

159
Q

3rd MC location of accessory spleen

A

Greater omentum

160
Q

Ranson criteria at admission

A

On admission: Age > 55 years WBC count > 16,000/mm^3 Blood glucose level > 200 mg/dL LDH > 350 IU/L AST > 250 U/L

161
Q

Ranson criteria at 48 hrs

A

Hematocrit decrease > 10% from admission BUN increase > 5 mg/dL from admission Serum calcium < 2 mmol/L Partial pressure of oxygen < 60 mmHg Base deficit > 4 mmol/L Fluid sequestration > 6 L

162
Q

ranson score >3 pts

A

severe

163
Q

Indications for resection of pancreatic cystic neoplasm

A

Main pancreatic duct dilation >10 mm
Cystic lesion >3 cm in size
Presence of mural nodules of >5 mm
Atypical cytology
Associated solid components with the cyst

164
Q

surgical correction of annular pancreas in neonate

A

Annular pancreas is a congenital anomaly that causes a ring of pancreatic tissue to envelop the second portion of the duodenum. In over 2/3 of cases, patients are asymptomatic, but when they are, it presents as duodenal obstruction. This anomaly can be associated with Down Syndrome and other intestinal atresias. The procedure of choice in neonates is a duodenoduodenostomy

165
Q

surgical correction of annular pancreas in adult

A

duodenojejunostomy or gastrojejunostomy is preferred.

ABS (23 decks)

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